|
1
|
Abstract
RATIONALE Acute pancreatitis (AP) is one of the most common diseases of gastroenterological emergency with a highly variable clinical course and the incidence being on the rise in recent years. Posttraumatic diaphragmatic hernia is an uncommon disease and may manifest immediately or several years after the incident. Delayed presentation of traumatic diaphragmatic hernia associated with AP is relatively rare. PATIENT CONCERNS A 26-year-old male with history of left chest knife injury 10 years ago, had AP due to delayed traumatic diaphragmatic hernia 5 days after Dragon Boat Race. DIAGNOSES Thoracoabdominal computerized tomography detected left diaphragmatic hernia with pancreatic head displacement. Emergency surgery confirmed the diagnosis. INTERVENTIONS Emergency surgery to reduce and repair the hernia. OUTCOMES The patient was discharged from the hospital on the sixth postoperative day and no recurrence of pancreatitis during follow-up. LESSONS For patients without obvious etiology of AP, clinicians should be highly vigilant and inquire the history in detail. For patients with trauma, the relevant examination should be improved, and the pancreatitis caused by traumatic diaphragmatic hernia should be treated with emergency operation immediately.
Collapse
Affiliation(s)
| | - Chen Yu
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yin Zhu
- Department of Gastroenterology
| | | |
Collapse
|
|
2
|
Tolboom RC, Wijsman PJ, Broeders I, Draaisma WA. Laparoscopic Hiatal Hernia Repair in Patients with an Intrathoracic Pancreas: Case Series and a Review of Literature. Cureus 2020; 12:e7125. [PMID: 32257671 PMCID: PMC7105072 DOI: 10.7759/cureus.7125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Transhiatal herniation of the pancreas is rare with only 17 cases reported in 25 years. Presentation of pancreatic herniation is diverse. In the majority of cases, the pancreatic herniation is found incidentally on CT-scans made for evaluating complaints related to a large or giant hiatal hernia. We present a literature review and case series of three patients with symptomatic type IV hiatal hernia with incidental, asymptomatic pancreatic herniation. All cases were managed laparoscopically with robotic assistance.
Collapse
Affiliation(s)
- Robert C Tolboom
- Surgery, Meander Medical Center, Amersfoort, NLD.,Anesthesiology, Radboud University Medical Center (Radboudumc), Nijmegen, NLD.,Robotics and Mechatronics, University of Twente, Enschede, NLD
| | | | - Ivo Broeders
- Surgery, Meander Medical Center, Amersfoort, NLD
| | | |
Collapse
|
|
3
|
Transhiatal Herniation as the Cause of Acute Pancreatitis After Toupet Fundoplication. ACG Case Rep J 2019; 6:e00156. [PMID: 31737698 PMCID: PMC6791646 DOI: 10.14309/crj.0000000000000156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/10/2019] [Indexed: 01/12/2023] Open
Abstract
Hiatal translocation of the pancreas is rare because of its retroperitoneal location. Acute pancreatitis as a complication of hiatal hernia is uncommon. A 33-year-old man presented for 2 days of worsening epigastric abdominal pain and substernal chest pain. Laboratory studies were essentially unremarkable; however, computed tomography demonstrated a large right-sided hiatal hernia containing the entire stomach and the body of the pancreas, with peripancreatic edema consistent with pancreatitis. Most cases can be managed conservatively; however, elective surgical repair is suggested in severe cases or patients with low surgical risk.
Collapse
|
|
4
|
Komaei I, La Malfa G, Damiano C, Sarra F, Cassaro G, Barbera A, Bartolotta M, Currò G, Navarra G. Voluminous paraumbilical hernia containing the pancreas - An unusual cause of acute pancreatitis: A case report. Ann Med Surg (Lond) 2019; 45:6-10. [PMID: 31360452 PMCID: PMC6637250 DOI: 10.1016/j.amsu.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/25/2019] [Accepted: 07/07/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction The paraumbilical hernia sac often contains the omentum, the small bowel, and less commonly the colon. The herniation of the pancreas through a paraumbilical hernia is extremely rare and has been reported only by two cases in the literature; moreover, acute pancreatitis secondary to this condition is a particularly unusual event. Case report We present a very unusual case of a 67-year-old female patient with a voluminous paraumbilical hernia containing the pancreas, complicated by acute pancreatitis. Laboratory data revealed an elevation of the pancreatic enzymes. An intravenous contrast-enhanced computed tomography (CT) scan of the abdomen demonstrated a large hernia sac containing multiple viscera, including the pancreas. The patient underwent emergency laparotomy with a diagnosis of intestinal obstruction. Conclusion The clinicians should consider this rare condition in the differential diagnosis of patients presenting with large paraumbilical hernias associated with classical symptoms of acute pancreatitis, particularly in the absence of typical risk factors for pancreatitis. An intravenous contrast-enhanced abdominal CT scan should be performed immediately in these patients. We recommend the patients and the surgeons to consider prompt surgical repair for paraumbilical hernias to avoid further complications and the higher incidence of morbidity and mortality associated with emergency surgeries.
Collapse
Affiliation(s)
- Iman Komaei
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Giuseppe La Malfa
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Cristina Damiano
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Federica Sarra
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Gabriele Cassaro
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Adalberto Barbera
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Marcello Bartolotta
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Giuseppe Currò
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Giuseppe Navarra
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| |
Collapse
|
|
5
|
Mun YH, Park SY. Acute Pancreatitis after Additional Trauma in Chronic Traumatic Pancreatic Diaphragmatic Hernia. JOURNAL OF TRAUMA AND INJURY 2019. [DOI: 10.20408/jti.2019.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- You Ho Mun
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Sin Youl Park
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| |
Collapse
|
|
6
|
Kamal MU, Baiomi A, Erfani M, Patel H. Rare sequalae of hiatal hernia causing pancreatitis and hepatitis: A case report. World J Gastrointest Endosc 2019; 11:249-255. [PMID: 30918590 PMCID: PMC6425284 DOI: 10.4253/wjge.v11.i3.249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/23/2019] [Accepted: 03/11/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hiatal hernia (HH) contents commonly include stomach, transverse colon, small intestine, and spleen but herniation of the pancreas is an extremely rare phenomenon.
CASE SUMMARY 79-year-old female with multiple comorbidities presented to emergency department with complaints of weight loss for 6 mo and abdominal pain for one day. Physical examination revealed cachectic and dehydrated female and bowel sounds could be auscultated on the right side of chest. Computed tomography of the chest and abdomen revealed interval enlargement of a massive HH, containing stomach and much of the bowel as well as pancreas and distal extra-hepatic biliary duct, probably responsible for obstructive effect upon same. There was increased prominence of the pancreas consistent with pancreatitis. There was a large HH causing obstructive effect with dilated biliary system along gall bladder wall edema and pancreatitis. Patient clinical status improved with conservative treatment.
CONCLUSION HH presenting with acute pancreatitis is a serious diagnostic and therapeutic challenge. The initial management is conservative, even if the abdominal content has herniated to mediastinum. The incentive spirometry can be utilized in the conservative of the large HH. After stabilization of the patient, elective surgical intervention remains the mainstay of the management. Definitive treatment will vary from case to case depending on the acuity of situation and comorbidities.
Collapse
Affiliation(s)
- Muhammad Umar Kamal
- Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, United States
| | - Ahmed Baiomi
- Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, United States
- Division of Gastroenterology, Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, United States
| | - Mohamad Erfani
- Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, United States
- Division of Gastroenterology, Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, United States
| | - Harish Patel
- Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, United States
- Division of Gastroenterology, Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, United States
| |
Collapse
|
|
7
|
Transhiatal Herniation of the Pancreas: A Rare Cause of Acute Pancreatitis. ACG Case Rep J 2017; 4:e66. [PMID: 28516111 PMCID: PMC5425284 DOI: 10.14309/crj.2017.66] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 04/03/2017] [Indexed: 12/15/2022] Open
Abstract
Transhiatal herniation of the pancreas is rare. Acute pancreatitis secondary to this phenomenon is particularly unusual. A 102-year-old woman presented with 1 day of severe chest pain, vomiting, dyspnea, and diaphoresis. Serum lipase was elevated, and computed tomography angiogram of the chest and magnetic resonance cholangiopancreatography revealed a hiatal hernia containing the pancreas, with associated findings of pancreatitis. Pancreatitis in this setting may be due to repetitive trauma or ischemia from sliding, intermittent folding of the pancreatic duct, or pancreatic incarceration. Mild cases can be managed supportively, with surgery being reserved for severe cases or for younger patients with low surgical risk.
Collapse
|
|
8
|
Hiatus Hernia: A Rare Cause of Acute Pancreatitis. Case Rep Med 2016; 2016:2531925. [PMID: 27066077 PMCID: PMC4811074 DOI: 10.1155/2016/2531925] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/07/2016] [Indexed: 12/24/2022] Open
Abstract
Hiatal hernia (HH) is the herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm. A giant HH with pancreatic prolapse is very rare and its causing pancreatitis is an even more extraordinary condition. We describe a case of a 65-year-old man diagnosed with acute pancreatitis secondary to pancreatic herniation. In these cases, acute pancreatitis may be caused by the diaphragmatic crura impinging upon the pancreas and leading to repetitive trauma as it crosses the hernia; intermittent folding of the main pancreatic duct; ischemia associated with stretching at its vascular pedicle; or total pancreatic incarceration. Asymptomatic hernia may not require any treatment, while multiple studies have supported the recommendation of early elective repair as a safer route in symptomatic patients. In summary, though rare, pancreatic herniation should be considered as a cause of acute pancreatitis. A high index of suspicion for complications is warranted in cases like these.
Collapse
|
|
9
|
Dinc T, Kayilioglu SI, Coskun F. Late Onset Traumatic Diaphragmatic Herniation Leading to Intestinal Obstruction and Pancreatitis: Two Separate Cases. Case Rep Emerg Med 2015; 2015:549013. [PMID: 26380126 PMCID: PMC4561313 DOI: 10.1155/2015/549013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/16/2015] [Indexed: 11/18/2022] Open
Abstract
Although diaphragmatic injuries caused by blunt or penetrating trauma are rare entities, they are the most commonly misdiagnosed injuries in trauma patients and occur in approximately 3-7% of all abdominal or thoracic traumas. Acute pancreatitis secondary to late presenting diaphragmatic hernia is very rare. Here we present two separate cases: one with acute bowel obstruction and the other with acute pancreatitis secondary to late onset traumatic diaphragmatic hernia (three and twenty-eight years after chest trauma, resp.).
Collapse
Affiliation(s)
- Tolga Dinc
- Department of General Surgery, Ankara Numune Training and Research Hospital, Anafartalar Mah, Talatpasa Boulevard No. 5, Genel Cerrahi AD, 2. Kat B216, Altındağ, 06100 Ankara, Turkey
| | - Selami Ilgaz Kayilioglu
- Department of General Surgery, Ankara Numune Training and Research Hospital, Anafartalar Mah, Talatpasa Boulevard No. 5, Genel Cerrahi AD, 2. Kat B216, Altındağ, 06100 Ankara, Turkey
| | - Faruk Coskun
- Department of General Surgery, Ankara Numune Training and Research Hospital, Anafartalar Mah, Talatpasa Boulevard No. 5, Genel Cerrahi AD, 2. Kat B216, Altındağ, 06100 Ankara, Turkey
| |
Collapse
|
|
10
|
Bochdalek hernia and repetitive pancreatitis in a 33 year old woman. Int J Surg Case Rep 2014; 5:743-5. [PMID: 25222941 PMCID: PMC4189077 DOI: 10.1016/j.ijscr.2014.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/08/2014] [Accepted: 08/16/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Bochdalek hernia presentation in adulthood is rare. The presentation in newborns is the most common, manifesting with data from respiratory failure secondary to pulmonary hypoplasia, requiring urgent surgical intervention with high morbidity and mortality. PRESENTATION OF CASE We present the case of a 33 year old woman admitted in the emergency room with severe abdominal pain in the left upper quadrant and disnea. After physical examination and laboratory test we diagnose mild acute pancreatitis. The patient haven't colelitiasis by ulstrasound or any risk factor for pancreatitis. Initially she received medical treatment and was discharged after one week. After four weeks she presented the same symptoms in two different occasions, with severe and mild pancreatitis respectively. A computed tomography report a left posterolateral diafragmatic hernia. In spite of the rare association of pancreatitis and Bochdalek hernia, we realized it as the etiology until the second event and planned his surgery. We made a posterolateral torachotomy and diafragmatic plasty with a politetrafluoroetileno mesh and after a 6 months follow up she has coursed asymptomatic. DISCUSSION The high rate of complications in this type of hernia requires us to perform surgical treatment as the hernia is detected. In this case it is prudent medical treatment prior to surgical correction despite this being the origin of the pancreatitis, because the systemic inflammatory response added by the surgical act could result in a higher rate of complications if not performed at the appropriate time. There is no precise rule to determine the type of approach of choice in this type of hernia which thoracotomy or laparotomy may be used. CONCLUSION Bochdalek hernia is a rare find in adults who require treatment immediately after diagnosis because of the high risk of complications. When presented with data from pancreatitis is recommended to complete the medical treatment of pancreatitis before surgery to obtain the best results, unless it exist another abdominal complication.
Collapse
|
|
11
|
Boyce K, Campbell W, Taylor M. Acute pancreatitis secondary to an incarcerated paraoesophageal hernia: a rare cause for a common problem. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2014; 7:25-7. [PMID: 24653652 PMCID: PMC3956883 DOI: 10.4137/ccrep.s13079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 12/27/2022]
Abstract
This is a rare case report of acute pancreatitis secondary to a massive incarcerated paraoesophageal hernia. The pathogenesis resulted from obstruction of the distal pancreatic duct after displacement of the pancreatic head and body into the thorax as part of a Type IV paraoesophageal hernia. Although this condition is rare, the patient made steady progress following laparotomy and open repair of hernia. She made a good recovery after prompt therapy, therefore, this report can be a guide to the diagnosis and treatment of similar conditions.
Collapse
Affiliation(s)
- Kathryn Boyce
- Department of Hepatobiliary Surgery, Belfast Trust, Mater Hospital, Belfast, Northern Ireland
| | - William Campbell
- Department of Hepatobiliary Surgery, Belfast Trust, Mater Hospital, Belfast, Northern Ireland
| | - Mark Taylor
- Department of Hepatobiliary Surgery, Belfast Trust, Mater Hospital, Belfast, Northern Ireland
| |
Collapse
|
|
12
|
Tagaya N, Makino N, Saito K, Okuyama T, Kouketsu S, Sugamata Y, Oya M. Experience with laparoscopic treatment for paraesophageal hiatal hernia. Asian J Endosc Surg 2013; 6:266-70. [PMID: 23809870 DOI: 10.1111/ases.12049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/07/2013] [Accepted: 05/26/2013] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Paraesophageal hiatal hernia is often associated with a number of complications such as intestinal obstruction, gastric volvulus and acute pancreatitis, each of which can result in critical conditions requiring surgery. Herein, we report our surgical procedure for paraesophageal hiatal hernia. METHODS Since 2003, we have surgically treated hiatal hernia in 18 patients, including 2 men and 16 women, with a mean age of 73 years. Thirteen patients (72.2%) had a type-I hiatal hernia, two (11.1%) had type III and three (16.7%) had type IV. The operative procedure consisted of a crural repair and anti-reflux maneuver. RESULTS Laparoscopic procedures were completed in all patients. The mean operation time was 160.2 min for type I and 230.8 min for types III and IV. The mean postoperative hospital stay was 7.8 days, and there was no mortality. Three patients relapsed during the mean follow-up period of 74.9 months. Two of them were asymptomatic and one required laparoscopic reoperation. CONCLUSION Laparoscopic surgery for paraesophageal hiatal hernia is safe and effective with minimal morbidity and early recovery. However, it is important to determine the appropriate timing of surgery based on the severity of the hernia and the patient's general status and comorbidities.
Collapse
Affiliation(s)
- Nobumi Tagaya
- Department of Surgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | | | | | | | | | | | | |
Collapse
|
|
13
|
Jäger T, Neureiter D, Nawara C, Dinnewitzer A, Öfner D, Lamadé W. Intrathoracic major duodenal papilla with transhiatal herniation of the pancreas and duodenum: A case report and review of the literature. World J Gastrointest Surg 2013; 5:202-206. [PMID: 23805366 PMCID: PMC3692958 DOI: 10.4240/wjgs.v5.i6.202] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 04/09/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023] Open
Abstract
Transhiatal herniation of the pancreas is an extremely rare condition. In the published literature we found only eleven cases reported in the period of 1958 to 2011. A coincidental hiatal herniation of the duodenum is described in two cases only. To our knowledge, we report the first case with a hiatal herniation of the complete duodenum and proximal pancreas presenting an intrathoracic major duodenal papilla with consecutive intrahepatic and extrahepatic cholestasis. A 72-year-old Caucasian woman was admitted to our department with a hiatal hernia grade IV for further evaluation. According to our recommendation of surgical hernia repair soon after the diagnosis of a transhiatal herniation of the proximal pancreas and entire duodenum, we had to respect the declared intention of the patient for a conservative procedure. So we were forced to wait for surgical repair within an emergency situation complicated by a myocardial infarction and reduced general condition. We discuss the therapeutic decision making process and a complete literature review of this rare entity.
Collapse
|
|
14
|
Valente T, Rossi G, Lassandro F, Rea G, Muto M. Asymptomatic isolated partial hiatal herniation of the pancreas: MDCT evaluation and anatomical explanation: case report and review of literature. Clin Anat 2013; 26:1008-13. [PMID: 23553966 DOI: 10.1002/ca.22240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 02/17/2013] [Indexed: 12/15/2022]
Abstract
Isolated herniation of the pancreas through a gastroesophageal hiatus is an extremely rare condition, and only one case has been reported in the world literature. We describe a MDCT diagnosis of isolated partial hiatal hernia containing the body of a normal pancreas in an asymptomatic patient, give an anatomical explanation and review the corresponding literature.
Collapse
Affiliation(s)
- Tullio Valente
- Department of Radiology, Ospedali dei Colli, P.O. Monaldi, 80131, Naples, Italy
| | | | | | | | | |
Collapse
|
|
15
|
Patel R, More B, Sinha C, Rajimwale A, Ninan G. Gastric volvulus: A rare association with hyperamylasemia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013; 1:47-49. [DOI: 10.1016/j.epsc.2013.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
|
16
|
Jones HG, Kadhim A, Nutt M. Congenital diaphragmatic hernia: an unusual cause of obstructive jaundice. Ann R Coll Surg Engl 2012; 94:e8-9. [PMID: 22524906 PMCID: PMC3954212 DOI: 10.1308/003588412x13171221499180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2011] [Indexed: 11/22/2022] Open
Abstract
Congenital diaphragmatic hernias in adults are exceedingly rare. They have been reported to cause dyspnoea, gastric reflux and intestinal obstruction. We present the case of a young woman with obstructive jaundice secondary to a Bochdalek hernia of the right hemidiaphragm. We discuss the aetiologies, presentation, investigation and treatment of the disorder, and make recommendations on the management.
Collapse
Affiliation(s)
- H G Jones
- Department of Surgery, Royal Gwent Hospital, Newport, UK.
| | | | | |
Collapse
|
|
17
|
Abstract
INTRODUCTION Gastric volvulus is an important cause of nonbilious emesis that must be recognized early to ensure a good outcome. We reviewed 7 cases from our institution, Children's Healthcare of Atlanta (Egleston campus). In addition, we reviewed all gastric volvulus cases in children published to date in the English literature to draw general conclusions about the presentation and treatment of this unusual disease. METHODS An electronic literature search was performed to find all published cases of pediatric gastric volvulus. The care of all children from January 2002 to December 2007 who were treated for gastric volvulus was also reviewed. RESULTS There have been 581 cases of gastric volvulus in children published in English between 1929 and 2007. Of these, 252 were acute and 329 were chronic cases. The most common presentation of acute gastric volvulus is in a child <5 years old with nonbilious emesis, epigastric distention, and abdominal pain. Acute gastric volvulus is often associated with deformities of adjacent organs. Definitive diagnosis is made with upper gastrointestinal studies, and definitive therapy requires repair of associated defects and anterior fixation of the stomach to the abdominal wall. The most common presentation of chronic volvulus is in an infant <1 year old with emesis, epigastric distention, feeding difficulties, and growth failure. Treatment may be medical or surgical depending on the underlying etiology of the volvulus. CONCLUSIONS Acute gastric volvulus is a potentially life-threatening occurrence with a good outcome when treated in a timely fashion. Chronic volvulus may be more difficult to recognize. The common features of acute and chronic gastric volvulus described in this review should assist pediatric health care providers in promptly diagnosing and treating this disease.
Collapse
Affiliation(s)
- Randolph Kyle Cribbs
- Emory University, Division of Pediatric Surgery, 2015 Uppergate Dr NE, Atlanta, GA 30322, USA
| | | | | |
Collapse
|
|
18
|
Harrington DK, Curran FT, Morgan I, Yiu P. Congenital Bochdalek hernia presenting with acute pancreatitis in an adult. J Thorac Cardiovasc Surg 2008; 135:1396-7. [PMID: 18544398 DOI: 10.1016/j.jtcvs.2008.01.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 01/13/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Deborah K Harrington
- Department of Cardiothoracic Surgery, Newcross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom.
| | | | | | | |
Collapse
|
|
19
|
Delayed presentation of congenital diaphragmatic hernia manifesting as combined-type acute gastric volvulus: a case report and review of the literature. J Pediatr Surg 2008; 43:E35-9. [PMID: 18358272 DOI: 10.1016/j.jpedsurg.2007.11.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 11/09/2007] [Accepted: 11/09/2007] [Indexed: 11/20/2022]
Abstract
Acute gastric volvulus associated with congenital diaphragmatic hernia is an unusual surgical emergency. We describe a case of an 11-year-old girl who presented with a 4-day history of abdominal pain, nonproductive retching, cough, and shortness of breath. A chest radiograph revealed a large air-fluid level in left hemithorax and the presence of intestinal loops with marked mediastinal deviation. Nasogastric decompression was unsuccessful. Via a thoracoscopic approach, the large fluid-filled stomach was percutaneously decompressed but could not be reduced. Through a left subcostal incision, a left-sided diaphragmatic defect about 4 x 5 cm was encountered. A large portion of small intestines, ascending and transverse colon, strangulated but viable stomach, and a large spleen herniated through the defect. The contents were reduced, revealing a combined gastric volvulus. Once the diaphragmatic defect was repaired primarily, there was insufficient space in the abdominal cavity to contain all the viscera reduced form the chest. Therefore, we placed an AlloDerm patch on the fascia and closed with a wound V.A.C (Kinetic Concepts Inc, San Antonio, TX). Two weeks later, the wound was definitively closed; she recovered uneventfully and was discharged home 3 days later. To our knowledge, only 26 previous cases of acute gastric volvulus complicating a congenital diaphragmatic hernia in children have been reported in the literature. Our patient represents the 27th case and the first combined type acute gastric volvulus case.
Collapse
|
|
20
|
Tagaya N, Tachibana M, Kijima H, Kakihara Y, Hamada K, Sawada T, Kubota K. Laparoscopic treatment of paraesophageal hiatal hernia with incarceration of the pancreas and jejunum. Surg Laparosc Endosc Percutan Tech 2007; 17:313-6. [PMID: 17710057 DOI: 10.1097/sle.0b013e318059bf50] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We present a successful laparoscopic treatment of paraesophageal hiatal hernia with an incarceration of the pancreas and jejunum. The patient was a 75-year-old woman who had complaints of epigastric pain and dysphasia. A chest x-ray revealed a mediastinal air-fluid level. Chest computed tomography showed intestinal contents, body and tail of the pancreas, and the splenic artery within the mediastinum. At laparoscopy, jejunum was incarcerated into the mediastinal cavity through the internal hernia of transverse mesocolon. Body and tail of the pancreas and the splenic artery were also dislocated within the hernia sac. The operation time took 115 minutes. The patient tolerated a regular diet on the first postoperative day and was discharged uneventfully. There were no recurrence or abdominal symptoms during the 29-month follow-up period. In the case of asymptomatic paraesophageal hiatal hernia with incarcerating pancreas on diagnostic imagings, elective surgical treatment is required to prevent a critical outcome.
Collapse
Affiliation(s)
- Nobumi Tagaya
- Second Department of Surgery, Dokkyo University School of Medicine, Tochigi, Japan.
| | | | | | | | | | | | | |
Collapse
|
|
21
|
Bagłaj M, Dorobisz U. Late-presenting congenital diaphragmatic hernia in children: a literature review. Pediatr Radiol 2005; 35:478-88. [PMID: 15778858 DOI: 10.1007/s00247-004-1389-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Revised: 11/04/2004] [Accepted: 11/19/2004] [Indexed: 11/30/2022]
Abstract
This is a review of 122 articles published until December 2003 that describe 349 children with late-presenting postero-lateral congenital diaphragmatic hernia (CDH). Data regarding pre-operative diagnostic work-up were adequately reported in 177 patients with left CDH and in 41 with a right-sided defect. Chest radiography was the only diagnostic study in 92 (51.9%) children from the former group and in 17 (43.9%) from the latter group. In other patients, diagnostic work-up encompassed various combinations of two or more imaging modalities. Apart from chest radiography, contrast study of the upper gastrointestinal tract was the most frequently performed imaging modality. In 88 (25.2%) children, initial radiographic features of CDH were misinterpreted. Pneumothorax and pleural effusion were the most common initial findings. Analysis of the hernial content in this group of patients has shown that herniation of the stomach, spleen or omentum should be regarded as risk factors for misdiagnosis of left CDH, whereas for right CDH, the risk factor is the presence of liver in the chest. Late-presenting CDH may pose a significant diagnostic problem because of the great variability of radiographic appearance. Chest radiography following passage of a nasogastric tube and contrast studies of the gastrointestinal tract seem to be the most useful investigations for the diagnosis of left CDH. For patients with right CDH, owing to the high probability of liver herniation, a chest radiograph with liver scintigraphy or CT seems to be the best diagnostic option.
Collapse
Affiliation(s)
- Maciej Bagłaj
- Department of Pediatric Surgery, Wroclaw Medical University, M. Sklodowska 52, 50-367 Wroclaw, Poland.
| | | |
Collapse
|
|
22
|
Bagłaj M. Late-presenting congenital diaphragmatic hernia in children: a clinical spectrum. Pediatr Surg Int 2004; 20:658-69. [PMID: 15349741 DOI: 10.1007/s00383-004-1269-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2004] [Indexed: 10/26/2022]
Abstract
Articles dealing with late-presenting congenital diaphragmatic hernia (CDH) in children published until 2003 were collectively reviewed. The main purpose of the presented study was to gain insight into the clinical spectrum of this variant of CDH and to discuss its clinical and surgical aspects. In 125 articles, 362 patients were reported. Left posterolateral hernia was the dominant anatomical type, found in 79.4% of the children. Male-to-female distribution was nearly 2:1 in both right- and left-sided CDH. Associated anomalies were noted in 8.6% of children. Sixty-five percent of children with right CDH presented within the 1st year of life, whereas only 41.7% of patients with left CDH belonged to this age group. The children with right CDH presented with chronic symptoms in 57.4% of cases, while among those with left CDH, acute presentation prevailed, constituting 60.5% of this group. No strict correlation between age and clinical symptoms was noted, although the youngest patients tended to present with respiratory symptoms. Late-presenting diaphragmatic hernia is associated with a wide range of clinical symptoms occurring in various constellations. Dyspnea and vomiting were the most frequent symptoms found in patients with either chronic or acute manifestation. Preoperative mortality was 3.9% (14 children). In 45 children (12.4%), complications resulting from diaphragmatic hernia were noted, and in a further 11 children iatrogenic preoperative complications were noted. Among 152 children with reported CDH, true hernia with sac was found in 32.7%. Eight children (2.2%) died in the early postoperative period, while a further 13 patients (3.6%) had postoperative complications requiring surgical management. Recurrence of hernia was noted in seven children (1.9%). This collective review of basic epidemiological and clinical data from a large group of patients seems to support a hypothesis for a congenital nature of the diaphragmatic defect and an acquired nature of "herniation" of the viscera. The wide clinical spectrum of late-presenting CDH seems to be conditioned by two factors: timing of herniation and type of intraabdominal viscera displaced into the chest.
Collapse
Affiliation(s)
- Maciej Bagłaj
- Department of Pediatric Surgery, Wroclaw Medical University, M. Sklodowska 52, 50-367 Wroclaw, Poland.
| |
Collapse
|
|
23
|
Gremmels JM, Broome DR, Fisher KL. Pancreatic herniation through the gastroesophageal hiatus: magnetic resonance imaging, magnetic resonance cholangiopancreatography, and computed tomography evaluation. J Comput Assist Tomogr 2003; 27:616-8. [PMID: 12886153 DOI: 10.1097/00004728-200307000-00029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A rare case of pancreatic herniation through the gastroesophageal hiatus is presented, including magnetic resonance evaluation with magnetic resonance cholangiopancreatography and magnetic resonance angiography images unique to the published literature.
Collapse
Affiliation(s)
- Jeffrey M Gremmels
- Department of Radiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, USA
| | | | | |
Collapse
|
|
24
|
Abstract
Herniation of the pancreas into a diaphragmatic hiatal hernia is a rare condition reported in only three cases; all were symptomatic. We present a CT diagnosis of hiatal hernia containing the body and tail of a normal pancreas in an asymptomatic patient.
Collapse
Affiliation(s)
- Miriam Katz
- Deparment of Diagnostic Radiology, Rabin Medical Center, Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel.
| | | | | |
Collapse
|
|
25
|
Chevallier P, Peten E, Pellegrino C, Souci J, Motamedi JP, Padovani B. Hiatal hernia with pancreatic volvulus: a rare cause of acute pancreatitis. AJR Am J Roentgenol 2001; 177:373-4. [PMID: 11461866 DOI: 10.2214/ajr.177.2.1770373] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- P Chevallier
- Department of Radiology, Centre Hospitalier Régional et Universitaire de Nice, Hôpital Archet II, 151 route de Saint Antoine de Ginestière, BP 3079, 06202 Nice cedex 3, France
| | | | | | | | | | | |
Collapse
|
|
26
|
Beblawi IE, Caballero GA, Geenen JE. Acute pancreatitis complicating a huge ventral hernia: a case report. Gastrointest Endosc 2000; 51:216-7. [PMID: 10650273 DOI: 10.1016/s0016-5107(00)70423-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- I E Beblawi
- Pancreatic Biliary Section, St. Luke's Medical Center, Milwaukee, WI, USA
| | | | | |
Collapse
|
|
27
|
Abstract
Primary gastric volvulus in the neonatal period is extremely rare, with only 18 cases reported in the literature. The authors describe the case of a newborn with intrathoracic gastric volvulus and discuss its management.
Collapse
Affiliation(s)
- K H Mutabagani
- Department of Surgery, Columbus Children's Hospital, OH, USA
| | | | | |
Collapse
|
|
28
|
Beckmann KR, Nozicka CA. Congenital diaphragmatic hernia with gastric volvulus presenting as an acute tension gastrothorax. Am J Emerg Med 1999; 17:35-7. [PMID: 9928695 DOI: 10.1016/s0735-6757(99)90011-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This report describes a 3-month-old infant with acute severe respiratory distress in whom a diagnosis of congenital diaphragmatic hernia with tension gastrothorax and gastric volvulus was made. A review of the pathophysiology, clinical presentation, differential diagnosis, diagnostic evaluation, and treatment of congenital diaphragmatic hernia is presented.
Collapse
|
|
29
|
Milne LW, Hunter JJ, Anshus JS, Rosen P. Gastric volvulus: two cases and a review of the literature. J Emerg Med 1994; 12:299-306. [PMID: 8040585 DOI: 10.1016/0736-4679(94)90270-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report two cases of gastric volvulus. A discussion of the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of this rare entity is presented.
Collapse
Affiliation(s)
- L W Milne
- University of California, San Diego Medical Center, Department of Emergency Medicine 92103-8676
| | | | | | | |
Collapse
|