Ultrasonographic signs of sliding gastric hiatal hernia and their prospective evaluation

This study was conducted to identify sonographic findings that might be used in diagnosing sliding gastric hiatal hernia [SGHH] by using transabdominal ultrasound [TUS], to measure normal length and thickness of abdominal esophageal walls and to identify esophagogastric junction [OGJ]. A retrospective evaluation of 18 patients known to have sliding hiatal hernia and 12 normal controls was performed. A prospective study of 38 patients with symptoms suggesting hiatal herniation [epigastric or chest pain, heart burn and regurgitation] had been evaluated. In the controls, the OGJ could be visualized clearly in all cases and alimentary tract section [ATS] at the diaphragmatic hiatus ranged from 7.1 to 10.0 mm. The OGJ was not visualized in any of hernia patients whose alimentary tract diameters ranged from 16.0 to 21.0 mm. The use of US in the initial workup of patients with symptoms suggesting hiatus hernia may reduce the need for more invasive diagnostic procedures

Damage control system surgical and anaesthetic roles

This study was conducted on 16 cases in AL ZAHRAA University Hospital from March 1997 to March 1998. All cases were presented with multiple injuries, usually head injury, orthopedic as well as abdominal organs involvement are combined. The majority of cases due to close [blunt] trauma 10 cases [62.5%], the patients were seen in a state of shock and the effect of urgent packing was evaluated in this study. It was considered good in 9 cases. The early mortality [either on the theater table or before re-operation to remove pack] occurred in 4 cases, while late death after removal of pack and definitive repair occurred in 3 cases. This high mortality rate [7 cases] 44% were attributed to the extensive tissue injury as well as age and chronic diseases

Laparoscopy versus abdominal ultrasonography and diagnostic peritoneal lavage in abdominal trauma

The increasing incidence of severely injured patients with multiple organ injuries requires rapid and accurate diagnostic techniques. The accurate assessment of the injuries and the priority of treatment are factors that influence eventual outcome. Diagnostic peritoneal lavage and ultrasonography are the diagnostic modalities used in patients without obvious urgent indications for laparotomy after blunt trauma to the abdomen. From this study, U/S is non-invasive, rapid, available, without complication, but it inadequate investigation, in such patient, it also complemented by peritoneal lavage which considered as invasive but it rapid, cheep and accurate test in cases of abdominal trauma. So we conclude that, in patients with abdominal trauma, diagnostic peritoneal lavage and ultrasonography as well as laparoscopy are not competing procedures but are rather complementary in the evaluation of blunt abdominal trauma patients who are with or without indications for laparotomy. In our opinion, laparoscopy is more diagnostically accurate than lavage as well as ultrasonography. It is fast and safe examination which can be performed when its indicated. The number of unnecessary abdominal explorations in severely injured patients can be reduced to a negligible figures, thus decreasing morbidity, hospitalization time and costs