1/6. Delayed traumatic diaphragmatic hernias presenting with strangulation.Traumatic diaphragmatic injuries commonly occur following blunt and penetrating trauma, and that may be missed during a first evaluation, resulting in chronic diaphragmatic hernia and/or strangulation. In this study, we present three cases of delayed traumatic diaphragmatic hernias presenting with strangulation. The type of trauma was blunt in two and penetrating in one patient. In all three cases, the diagnoses of diaphragmatic injuries were missed in acute and chronic settings. While two patients had transverse colonic strangulation, the other one had strangulated stomach and spleen. Transverse colon resection was performed in one patient. Two patients had postoperative complications, and no postoperative mortality was detected. patients complaining of upper abdominal pain and dyspnea with past history of thoracoabdominal trauma should be evaluated for a missed diaphragmatic injury. A high index of suspicion, physical examination of the chest, and x-ray film are helpful for diagnosis of delayed traumatic diaphragmatic hernias presenting with strangulation.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/6. Retrograde gastric intussusception after myotomy for achalasia.Retrograde gastroesophageal intussusception has been rarely reported in the literature. risk factors include poor fixation of the stomach due to either long or loose mesenteric attachments; high intraabdominal pressure due to retching, physical exertion, or ascites; and hiatal hernia, which can lead to the development of a large gastroesophageal opening. An attempt at endoscopic reduction is reasonable, but laparotomy and manual reduction is usually required. We report a case of retrograde gastroesophageal intussusception in a patient with long-standing achalasia and two previous Heller myotomies.- - - - - - - - - - ranking = 0.059522951917319keywords = physical (Clic here for more details about this article) |
3/6. Sudden onset of slow gastric emptying of food.Three healthy, young adults suddenly experienced the onset of slow gastric emptying. Their symptoms began in February, 1975 in association with a brief illness consistent with a viral gastroenteritis. They complained of early satiety, nausea, and vomiting when they ate solid food and they had lost 11-25 kg in body weight in 8-12 mo. On admission, their physical examinations and laboratory studies were within normal limits. Their stomachs emptied a barium mixture normally, and fiberoptic endoscopy did not detect any abnormalities. The slowed gastric emptying of food was documented with radioisotopic gastric emptying studies. The prolonged emptying rates of 2 patients were reduced 90% with metoclopramide. In association with metoclopramide therapy, the patients were able to eat more food, and they regained 8-10 kg of body weight in 4-6 mo. Their histories raise the possibility that their initial illness may have damaged the mechanisms which control the gastric emptying of food.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/6. Gastric actinomycosis.A case of actinomycosis of the stomach in a 61-year-old woman is reported. The patient presented to the hospital with a history of epigastric pain, fatigue, poor appetite, constipation and mild fever of 20 days' duration. On physical examination, a tender mass was felt at the epigastrium. Computed tomography (CT) showed a heterogeneously enhanced mass at the posterior wall of the stomach. Upper gastrointestinal series revealed a submucosal mass at the gastric antrum. A malignant tumor was suspected and surgery was recommended. A 5 x 4 x 2 cm mass was found at the posterior wall of the distal gastric antrum. A Billroth II subtotal gastrectomy was performed. Pathologic examination revealed suppuration and sulfur granules in the indurated mass. The patient was subsequently treated with intravenous penicillin-V for 12 days and then with oral penicillin-G for 4 months. She remained well at her last follow-up appointment. Although the initial radiologic findings were nonspecific, CT was of importance in delineating the location and evaluating the extent of the lesion.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/6. stomach rupture associated with physical struggle in a child.A 5-year-old girl with spontaneous rupture of the stomach was treated successfully with excision of the ischemic edges of the perforation with primary repair. In this case, vigorous resistance against medical measurement resulted in rupture of the stomach, which was already distended with a large amount of fluid and air. The child survived following immediate surgical intervention and intensive postoperative care.- - - - - - - - - - ranking = 0.23809180766927keywords = physical (Clic here for more details about this article) |
6/6. Gastric syphilis.A sexually transmitted disease is seldom considered in the differential diagnosis of patients with clinical gastritis. A patient with gastric syphilis is reported to alert emergency department physicians to this entity. history and physical findings of syphilis should be sought and rapid plasma reagin tests should be obtained in the patient with severe or refractory gastritis.- - - - - - - - - - ranking = 0.059522951917319keywords = physical (Clic here for more details about this article) |