Diagnóstico ecocardiográfico de una hernia de hiato. Reporte de un caso / Echocardiographic diagnosis of a Hiatus Hernia: A case report

The diagnosis of a hiatus hernia (HH) is typically confirmed with an upper gastrointestinal barium X-ray, gastroscopy or upper-intestinal endoscopy. In several cases, HH has been diagnosed with an echocardiogram. We here describe a case of an HH visible on an echocardiogram in a male patient with chest pain.

Estudio comparativo de precisión diagnóstica preoperatoria y la confirmación laparoscópica de hernia hiatal / Comparative study of preoperative diagnostic precision and laparoscopic confirmation of hiatal hernia

Resumen Introducción: La hernia hiatal (HH) de tipo I por deslizamiento es el tipo más frecuente, siendo difícil de definir objetivamente, por lo que el principal foco de controversia es su diagnóstico. El objetivo del presente trabajo es reportar los resultados respecto de la precisión diagnóstica del estudio preoperatorio y confirmarlo con el diagnóstico laparoscópico de este tipo de HH. Materiales y Método: Estudio prospectivo descriptivo de serie que incluyen pacientes con síntomas típicos de enfermedad por reflujo gastroesofágico, los cuales se sometieron a estudio con esófago-gastro-duodenoscopía, estudio manométrico y radiológico de esófago, estómago y duodeno con bario. Se incluyen sólo los pacientes en los cuales la endoscopía revela la existencia de HH por deslizamiento ≪ 5 cm. Estos pacientes se sometieron a tratamiento quirúrgico confirmándose o no la existencia de HH al momento de la exploración laparoscópica. Resultados: El valor predictivo positivo y sensibilidad para manometría fue de un 51,2% y 70%, para la radiología 91,7% y 80,5% y para endoscopia 80,3% y 70,7% respectivamente. Conclusión: Para el diagnóstico confiable de HH antes del tratamiento, las tres investigaciones mencionadas deben ser obligatorias antes de la cirugía.

Introduction: Being type I hiatal hernia (HH) the most frequent, is difficult to define objectively and therefore, the main focus of controversy is the diagnosis. The aim of this paper is to report the results regarding the diagnostic accuracy of the preoperative study and to confirm it with the laparoscopic diagnosis of hiatal hernia. Materials and Method: This descriptive and prospective study includes patients with typical symptoms of gastroesophageal reflux disease who underwent esophageal-gastro-duodenoscopy, manometry and radiological study of esophagus with barium swallow. Only patients in whom endoscopy reveals the existence of HH by sliding ≪ 5 cm are included. These patients underwent surgical treatment confirming or not the existence of HH at the time of laparoscopic exploration. Results: The positive pre- dictive value and sensibility for manometry was 51.2% and 70%, for radiology 91.7% and 80.5%, and for endoscopy 85.3% and 70.7% respectively. Conclusion: For the reliable diagnosis of HH before treatment, the three mentioned investigations must be mandatory before the surgery.

Doença ulcerosa péptica: realmente é possível identificá-la por meio das características da dor epigástrica? / Peptic ulcer disease: is it really possible to identify it through the characteristics of epigastric pain?

OBJETIVO: Determinar se características da dor epigástrica são capazes de identificar pacientes com doença ulcerosa péptica. MÉTODOS: Estudo caso-controle, com coleta de dados de setembro de 2014 a junho de 2016. Foram incluídos pacientes com mais de 18 anos com dispepsia que realizaram endoscopia digestiva alta ambulatorialmente. Os pacientes foram abordados antes de realizar a endoscopia digestiva alta, verificando, em suas guias, a presença de dispepsia, tendo sido convidados a responder um questionário, e, posteriormente, o prontuário de cada entrevistado foi avaliado para verificação do diagnóstico, sendo, então, divididos entre o Grupo Doença Ulcerosa Péptica (casos), com 32 pacientes, e o Grupo Controle, com 44 pacientes com dispepsia atribuída a outras causas. RESULTADOS: Dos pacientes com dispepsia não ulcerosa, 52,27% caracterizaram a dor como em queimação, sendo 47,72% moderada e que piorava com alimentação. Dentre os demais sintomas, 45,45% relataram náuseas e 25% desconforto pós-prandial, com 52,27% relatando histórico familiar negativo de doença ulcerosa péptica. Em contrapartida, dos pacientes com doença ulcerosa péptica, 53,12% referiram dor em queimação e de moderada intensidade, e 50% relataram piora com alimentação. Dentre os demais sintomas, prevaleceram também náuseas (53,12%) e desconforto pós-prandial (40,62%). A maioria (81,25%) relatou histórico familiar de doença ulcerosa péptica. Observou-se diferença estatística em dor noturna, predominando na doença ulcerosa péptica (p=0,0225) e dor em cólica na dispepsia não ulcerosa (p=0,0308), assim como na ausência de histórico familiar entre os pacientes com dispepsia não ulcerosa (p=0,0195). CONCLUSÃO: A dispepsia relacionada à doença ulcerosa péptica relaciona-se, principalmente, à piora noturna, sendo que a intensidade da dor, a relação com alimentação e os sintomas associados não auxiliaram na diferenciação da dispepsia não ulcerosa, diferentemente do que a literatura tradicionalmente informa. (AU)

To determine whether it is possible to identify Peptic Ulcer Disease through the characteristics of epigastric pain. METHODS: This is a case-control study with data collected between September 2014 and June 2016 including patients over 18 years of age with dyspepsia who underwent upper gastrointestinal endoscopy as outpatients. The patients were approached before the upper gastrointestinal endoscopy when their test requisition form indicated the presence of dyspepsia. The subjects were invited to answer a questionnaire and, afterwards, the records of all interviewees were evaluated to check for the diagnosis. Then, they were divided into a peptic ulcer disease group (cases), with 32 patients, and a control group, with 44 patients with dyspepsia from other causes. RESULTS: Among non-ulcer dyspepsia patients, 52.27% described the pain as a "burning pain", with 47.72% reporting it as moderate and aggravated by food intake. As for other symptoms, 45.45% of subjects reported nausea, and 25% reported postprandial discomfort; 52.27% had no family history of peptic ulcer disease. In contrast, 53.12% of peptic ulcer disease patients reported "burning" and moderate pain, and 50% said the pain was aggravated by eating. As for the other symptoms, nausea (53.12%) and postprandial discomfort (40.62%) prevailed; most of the patients (81.25%) had family history of peptic ulcer disease. There was a statistical difference in night pain, which was more prevalent in peptic ulcer disease (p=0.0225), and colicky pain, which was more frequent in nonulcer dyspepsia (p=0.0308), as well as absence of family history in non-ulcer dyspepsia patients (p=0.0195). CONCLUSION: Dyspepsia caused by peptic ulcer disease is mainly related to night worsening, and pain intensity, the relationship with food intake, and associated symptoms did not help differentiate nonulcer dyspepsia, differently from what the medical literature traditionally suggests. (AU)

Hernia paraesofágica mixta con mal rotación de estómago / Mixed paraesophageal hernia with bad gastric rotation

Las hernias hiatales, son defectos anatómicos en el hiato diafragmático. Las de tipo "paraesofágicas" son frecuentes, se sabe que atentan contra la vida de una manera potencial, ya que presentan un alto riesgo de complicación de vólvulo y encarcelación lo que incrementa con la edad. Objetivo: establecer una ruta diagnóstica para mejorar el abordaje clínico de esta patología. Caso Clínico: niño de 4 años, con historia de dolor abdominal de 3 meses de evolución en región mesogástrica, que se acompaña de palidez hiporexia y estreñimiento. Laboratorio: hemoglobina 4.3g/dl, hematocrito 13.9%, diagnóstico de anemia, diagnóstico por endoscopía: hernia hiatal tipo III (mixta), mal rotación de estómago. Se trató con funduplicatura Nissen y posteriormente con dilataciones esofágicas. Conclusión: La hernia hiatal es la anormalidad más frecuente del tracto digestivo alto, las de tipo paraesofágico son infrecuentes y debe ser incluida como diagnóstico diferencial en niños con repetidos episodios de infección respiratoria o vómitos a repetición. El estudio diagnóstico de elección es el esofagograma con medio de contraste.

Hernia paraesofágica con vólvulo gástrico / Paraesophageal hernia with gastric volvulus

La hernia hiatal tipo IV es la más rara. Se puede reparar por vía abdominal o torácica y por la cirugía laparoscópica mínimo invasiva. Paciente de 67 años de edad, de sexo femenino, que presentaba desde hace más menos 5 meses cuadros de vómitos postprandiales inmediatos con repercusión en el estado nutricional, llega con deshidratación ligera al servicio de urgencias, se realiza panendoscopia digestiva superior de urgencia diagnosticándose una hernia paraesofágica con el estómago intratorácico, se complementó el estudio con una serie esófago-gastroduodenal corroborando el diagnóstico de vólvulo gástrico órgano-axial. Se discute el caso en colectivo y se decide su corrección quirúrgica por vía laparoscópica con evolución satisfactoria(AU)

The hiatal hernia type IV is the weirdest. It can be treated abdominal or thooracic via using lowest invasive laparoscopic surgery. 67 years old patient, famela, who was suffring from postprandial vomiting, affecting her nutritional condition.Patient gets to emergency suffering from light dehydration. An upper digestive panendoscopy is done.Diagnosis: Paraesophageal hernia in intrathoracic stomach the medical examinationwas complemented with a esophagus - gastorduodenal study, assuring the gastric volvulus axial- organ diagnosis. The case is analyzed by medical team and patient was treather surgically through laparoscopic surgery. Patient improved satisfactorily(AU)

Does Sedation Affect Examination of Esophagogastric Junction during Upper Endoscopy?

PURPOSE: During sedated esophagogastroduodenoscopy (EGD), patients may not be able to perform inspiration, which is necessary to examine the esophagogastric junction. Therefore sedation may affect diagnosis of gastroesophageal reflux-related findings. The aim of our study was to investigate the effect of sedation on diagnosis of gastroesophageal reflux-related findings during EGD. MATERIALS AND METHODS: This retrospective study evaluated 28914 patients older than 20 years who underwent EGD at our institution between January 2011 and December 2011. Ultimately, 1546 patients indicated for EGD for health check-up and symptom evaluation were included. RESULTS: There were 18546 patients who had diagnostic EGD: 10471 patients (56%) by non-sedated EGD and 8075 patients (43%) by sedated EGD. After statistical adjustment for age, sex, and body mass index, minimal change esophagitis, and hiatal hernia were significantly less frequently observed in the sedated EGD group [odds ratio (OR), 0.651; 95% confidence interval (CI), 0.586 to 0.722 and OR, 0.699; 95% CI, 0.564 to 0.866]. Nevertheless, there was no significant difference in other findings at the gastroesophageal junction, such as reflux esophagitis with Los Angeles classification A, B, C, and D or Barrett's esophagus, between the two groups. Similarly, there were no differences in early gastric cancer, advanced gastric cancer, and gastric ulcer occurrence. CONCLUSION: Sedation can impede the detection of minimal change esophagitis and hiatal hernia, but does not influence detection of reflux esophagitis of definite severity and Barrett's esophagus.

Dolor precordial como forma de presentación de la hernia hiatal paraesofágica / Presentation of Paraesophageal hiatal hernia. A case report

Fundamento: la hernia hiatal es una afección del tracto digestivo, dentro de ella la variedad paraesofágica es infrecuente. Objetivo: ofrecer una panorámica clínica y quirúrgica de la hernia hiatal paraesofagica y realizar diagnóstico diferencial con patologías cardiovasculares por las complicaciones graves que trae consigo esta enfermedad. Presentación de caso: paciente de la sexta década de la vida acudió a consulta de gastroenterología por presentar dolor precordial, epigastralgia cuando ingería alimentos en grandes cantidades, saciedad precoz, disfagia a los líquidos en ocasiones, regurgitaciones ácidas, salida de alimentos por las fosas nasales y pérdida de peso progresiva. Se le realizó estudio contrastado de esófago, estómago y duodeno donde se diagnosticó hernia hiatal paraesofágica, fue intervenido por vía laparoscópica; se le realizó reducción de la hernia, cirugía de los pilares y funduplicatura de Nissen-Rossell ,con evolución satisfactoria. Conclusiones: ante el dolor precordial es necesario detenerse en la semiología del mismo y diferenciar el cardiovascular del no cardiovascular pues en la hernia hiatal paraesofágica sus complicaciones tienen una alta morbimortalidad.

Background: hiatal hernia is a condition of the digestive tract; within it the paraesophageal variety is uncommon. Objective: to offer a clinical and surgical review of this kind of paraesophageal hiatal hernia and perform a differential diagnosis with cardiovascular pathologies due to the severe complications this disease may bring about. A case presentation : a 60 years- old patient came to the gastroenterology consultation presenting precordial and epigasttric pain when eating great amount of food, precocious satiety, frequent dysphagia due to liquids consumption, acid regurgitation, food exit through the nasal cavity and loss of weight. A contrasted study of esophagus, stomach and duodenum was done and it was diagnosed paraesophageal hiatal hernia, he underwent laparoscopic surgery where hernia reduction, pilars surgery and Nissen funduplication were performed and the prognosis was good. Conclusions: before presenting precordial pain, it is necessary to take into account its semiology and differenciate cardiovascular from non-cardiovascular pain as in paraesophageal hiatal hernia its complications have a high morbi-mortality.

Hernia omental a través de hiato esofÔgico que imita tumor lipomatoso mediastinal / [Omental hernia through esophageal hiatus simulates mediastinal lipomatous tumor].

Omental hernia through the esophageal hiatus is extemely infrequent. Paraesophageal hiatal hernia with omentum in the herniary sac mimics a mediastinal lipomatous tumor and differential diagnosis should be made. This diagnosis requires experience and knowledge of the differences between these two pathologies. In the following study we describe the case of an omental hernia and the characteristics that make it different from other pathologies.

Barium swallow study in routine clinical practice: a prospective study in patients with chronic cough / Estudo radiografico com ingestao de bario na rotina clinica: um estudo prospectivo em pacientes com tosse cronica

OBJECTIVE: To assess the routine use of barium swallow study in patients with chronic cough. METHODS: Between October of 2011 and March of 2012, 95 consecutive patients submitted to chest X-ray due to chronic cough (duration > 8 weeks) were included in the study. For study purposes, additional images were obtained immediately after the oral administration of 5 mL of a 5% barium sulfate suspension. Two radiologists systematically evaluated all of the images in order to identify any pathological changes. Fisher's exact test and the chi-square test for categorical data were used in the comparisons. RESULTS: The images taken immediately after barium swallow revealed significant pathological conditions that were potentially related to chronic cough in 12 (12.6%) of the 95 patients. These conditions, which included diaphragmatic hiatal hernia, esophageal neoplasm, achalasia, esophageal diverticulum, and abnormal esophageal dilatation, were not detected on the images taken without contrast. After appropriate treatment, the symptoms disappeared in 11 (91.6%) of the patients, whereas the treatment was ineffective in 1 (8.4%). We observed no complications related to barium swallow, such as contrast aspiration. CONCLUSIONS: Barium swallow improved the detection of significant radiographic findings related to chronic cough in 11.5% of patients. These initial findings suggest that the routine use of barium swallow can significantly increase the sensitivity of chest X-rays in the detection of chronic cough-related etiologies. .

OBJETIVO: Investigar o uso rotineiro do estudo radiográfico com ingestão de bário em pacientes com tosse crônica. MÉTODOS: Entre outubro de 2011 e março de 2012, 95 pacientes consecutivos submetidos a radiografia de tórax devido a tosse crônica (duração > 8 semanas) foram incluídos no estudo. Como propósito do estudo, radiografias de tórax adicionais foram obtidas imediatamente após a administração oral de 5 mL de uma suspensão de sulfato de bário a 5%. Dois radiologistas avaliaram todas as imagens de forma sistemática para identificar alterações patológicas. O teste exato de Fisher e o teste do qui-quadrado para dados categóricos foram utilizados nas comparações. RESULTADOS: As imagens obtidas imediatamente após a ingestão de bário revelaram patologias significativas potencialmente relacionadas a tosse crônica em 12 (12,6%) dos 95 pacientes. Essas patologias, incluindo hérnia diafragmática, neoplasia de esôfago, acalasia, divertículo esofágico e dilatação anormal do esôfago, não foram detectadas nas imagens obtidas sem a administração do contraste. Após o tratamento adequado, os sintomas desapareceram em 11 pacientes (91,6%), enquanto o tratamento foi ineficaz em 1 (8,4%). Não foram observadas complicações relacionadas à ingestão de bário, como aspiração. CONCLUSÕES: A ingestão de bário melhorou a detecção de achados radiológicos significantes relacionados a tosse crônica em 11,5% dos pacientes. Esses resultados iniciais sugerem que a utilização rotineira da ingestão de bário aumenta significantemente a sensibilidade de radiografias de tórax na detecção de etiologias relacionadas a tosse crônica. .

Hernia hiatal paraesofágica: a propósito de un caso / Paraesophageal hiatal hernia: a case report

Se presenta un caso de aparición poco frecuente, atendido en la consulta de Gastroenterología del Hospital Provincial Dr Antonio Luaces Iraola de Ciego de Ávila. Se trata de una paciente femenina, de 67 años de edad, que acude a consulta con dolor en epigastrio que aumenta con la ingestión de alimentos, pirosis postpandrial, vómitos frecuentes y ocasionalmente falta de aire, el examen físico fue totalmente negativo. Se realizaron estudios pertinentes y se arribó al diagnóstico de Hernia Hiatal Paraesofágica. Se realizó cirugía por vía abdominal se logró la reparación del hiato esofágico y se realizó funduplicatura gástrica.

A case of little frequent sappearance is presented, taken care of Gastroenterology service from Provincial Hospital Dr Antonio Luaces Iraola in Ciego de Avila. A feminine patient, of 67 years of age, that goes to consultation with epigastrium pain that increase with food ingestion, postprandrial pyrosis, frequent vomiting and occasionally lack of air, the physical examination was negative. Pertinent studies were carried out and it was arrived at the diagnosis of Paraesophageal Hiatal Hernia. Abdominal Surgery achieving the repair of the esophageal hiatus and gastric fundoplication were carried out.

La hernia hiatal y su relación con el reflujo gastroesofágico / Hiatus hernia and its relations with gastro-esophageal reflux

La hernia hiatal (HH) es una condición relativamente frecuente en la población adulta. Su relación con el enfermedad por refl ujo gastroesofágico (ERGE) no está clara. El objetivo de este estudio fue contribuir a defi nir esta asociación. Con éste propósito, realizamos un análisis prospectivo de 335 personas (entre 15-92 años, edad promedio 50,6, 55,49% del sexo femenino). Nuestro estudio consistió en una revisión de las historias clínicas y esofagogastroduodenoscopia (EGD) para determinar presencia de hernia hiatal y de manifestaciones endoscópicas de esofagitis de refl ujo (ER) para determinar si existe o no una relación entre HH y ERGE. Una HH fue encontrada en 104 casos (31,04%), 78 (75%) fueron evidenciadas en pacientes con síntomas de refl ujo gastroesofágico (RGE) y 26 825%) en sujetos asintomáticos para RGE (p= 0.0001). Sin embargo, cuando el hallazgo de HH fue evaluado en pacientes sintomáticos para ERGE 37,50% (72/208 casos) y en aquello sin síntomas 20,47% (26/127 casos), no se encontró diferencia estadística significativa (p >0.05). 40 sujetos (11,94%) de la cantidad total de individuos analizados tuvieron alteraciones endoscópicas de RGE (90%), 36 de ellos con síntomas de RGE (90%) y 4 (10%) asintomáticos para esta condición (diferencia estadísticamente significativa P< 0.0001). La asociación entre HH y hallazgos endoscópicos de RE fue evidenciada en 20 de 40 casos (50%). De ellos, 19 tenían síntomas de RGE (95%). Sólo 1 (5%) fue asintomático de RGE. Hallazgos a la EGD de RE sin HH se encontraron en los otros 20, 17 de ellos (85%) sintomáticos para ERGE y 15% asintomáticos. En ambos subgrupos una diferencia estadísticamente significativa (P < 0-001) fue encontrada entre pacientes con síntomas de RGE y aquellos sin síntomas, reforzando la relación existente entre HH, hallazgos endoscópicos de RE y síntomas de ERGE. HH sin hallazgos endoscópicos de ER fue reportada en 84 individuos, 60 de ellos con síntomas de ERGE (71,42%)...

Hiatus Hernia (HH) is a relatively frequent condition in adult population. Its relation with the gastro-esophageal refl ux disease (GERD) is not clear. The purpose of this study was contributing to the definition of this association. With this aim a prospective analysis was performed on 335 people (ranging and age of 15-92, average age of 50.6, 55.49% women). The study was based on reviewing the clinical records and esophagogastroduodenoscopies (EGD) for determining the presence of hiatus hernia and endoscopic manifestations of refl ux esophagitis (RE) as well in order to define if whether a relationship between HH and GERD does exist or does not. One HH was found in out of 104 cases (31.04%), 78 (75%) were evidences in patients with gastro-esophageal refl ux symptoms (GER), and 26 (25%) in GER-asymptomatic subjects (p= 0.0001). However, when assessing the HH finding in GERD-symptomatic patients - 37.50% (72/208 cases) - and in those without symptoms - 20.47% (26/127 cases) - no significant statistical difference was found - (p >0.05). 40 subjects (11.94%) out of the total amount of the analyzed subjects showed endoscopic GER disturbances - (90%). 36 out of them showed GER symptoms (90%) and 4 (10%) were asymptomatic for this condition (statistically significant difference: P< 0.0001). The association between HH and the ER endoscopic findings was evidenced in 20 out of the 40 cases (50%). From them, 19 showed GER symptoms (95%). Only 1 (5%) was GER-asymptomatic. ER’s GED findings without HH were locate in other 20 subjects, where 17 (85%) were GERD-symptomatic and 15% was asymptomatic. A statistically significant difference (P < 0-001) was found in both subgroups among patients with GER symptoms and those without symptoms, thus strengthening the relation existing among HH, the endoscopic findings, and GERD symptoms. HH without RE endoscopic findings was reported in 84 people, 60 of them with GERD symptoms (71.42%) and 24 without symptoms (28.57%)...

Comportamiento de patologías diagnosticadas por endoscopia digestiva superior: centro de diagnóstico integral Yagua, 2007 / Behavior of the pathologies diagnosed by upper digestive endoscopy at the integral diagnostic center Yagua, 2007

Se realizó un estudio observacional, descriptivo, de carácter retrospectivo, con el objetivo de conocer el comportamiento de las patologías diagnosticadas por endoscopia digestiva superior en un grupo de pacientes atendidos en el Centro de Diagnóstico Integral Yagua, del municipio Guacara, Estado Carabobo, en el período comprendido entre julio a diciembre de 2007. Utilizamos como universo 1542 pacientes de los cuales 464 representaron nuestra muestra simple aleatoria, predominando los pacientes de 45 a 59 años de edad, siendo la mayoría del sexo femenino. El promedio de edad de los casos fue de 46.2 años. La gastritis fue la patología de mayor diagnóstico endoscópico presente en algo más de la tercera parte de los pacientes, correspondiéndose principalmente con el sexo femenino. El estrés mantenido afectaba a más de la mitad de los pacientes estudiados, así como el tabaquismo y el consumo de alcohol fueron otros factores exógenos asociados de alta ocurrencia. El estudio endoscópico fue indicado principalmente bajo la impresión diagnóstica de dolor abdominal, síndrome ulceroso y esofagitis, encontrándose como hallazgo endoscópico fundamental en estos casos la gastritis, la úlcera péptica y la hernia hiatal respectivamente.

We made an observational, descriptive, retrospective study with the objective of knowing the behavior of the pathologies diagnosed by upper digestive endoscopy in a group of patients attended at the Integral Diagnostic Center Yagua, municipality of Guacara, Carabobo State, in the period from July to December 2007. Our universe were 1 542 patients, 464 of which were our simple randomized sample prevailing the 45 to 59 years-old patients, most of them women. The media age in these cases was 46.2 years. Gastritis was the pathology most frequently diagnosed by endoscopy, present in more than a third of the patients, mainly of the female sex. The maintained stress affected more than a half of the studied patients, and smoking and alcoholism were other exogenous factors associated to the high occurrence. The endoscopic study was indicated mainly under the diagnostic impression of abdominal pain, ulcerous syndrome and esophagitis, having as main endoscopic findings in these cases, gastritis, peptic ulcer and hiatal hernia respectively.

Hernia hiatal gigante: reporte de un caso / Giant hiatal hernia: a case report

La hernia de hiato es una situación patológica que se da cuando parte del estómago se introduce hacia el tórax. El esófago entra en el abdomen desde el tórax a través de un agujero o hiato que se encuentra en el diafragma. El estómago protruye a través de este hiato debilitado y produce ardores (pirosis) y dolor torácico. La persistencia en el tiempo de esta hernia, puede provocar una metaplasia de la mucosa esofágica dando al lugar al esófago de Barret el cual puede malignizar produciéndose cáncer de esófago. (1) La hernia de hiato es relativamente frecuente, afectando hasta un 20 por ciento de la población. Del total de pacientes con el trastorno, cerca del 10 por ciento son asintomáticos, dependiendo del grado de protrución estomacal y de que tanto esté afectado el esfinter esofágico inferior (EEI). Un 40 por ciento de las hernias de hiato son hernias deslizantes, en las que el EEI protruye conjuntamente con una porción del estómago y solo un 5 por ciento son paraesofágicas, en la que solo una porción del estómago se hace intratorácica mientras tanto que el EEI permanece intraabdominal. Los síntomas más comunes de una hernia de hiato incluyen pirosis, dolor torácico, disfagia, palpitaciones y ocasionalmente regurgitación o reflujo gastroesofágico. El diagnóstico de una hernia hiatal comienza con el éxamen físico por razón de la sintomatología. Los estudios radiográficos y la endoscopia digestiva demuestran la hernia hiatal y ayudan a descartar otras causas de molestias digestivas altas. (2) Se recomienda un procedimiento quirúrgico conocida como fundoplicación de Nissen, (3) Cuando los síntomas causados por una hernia de hiato son tan severas que pueden resultar en lesiones al esófago o incluso cáncer del esófago. (6) Se trata de lactante mayor de seis meses de edad quien es natural de la localidad y procedente de Cordero, quien inicia enfermedad actual el día de hoy en la madrugada según refiere la madre, caracterizado por vómitos en número incontables.

Congenital right intra-thoracic hiatal hernia

Congenital right sided intra-thoracic hiatal hernia is an uncommon clinical entity consisting of herniation of a viscous through congenitally abnormal esophageal hiatus into an intra-thoracic location. Is to present the diagnostic challenge and the surgical management of eight cases of this uncommon congenital anomaly admitted during asix years period [2000 - 2005] to the medical city teaching complex in Baghdad. Iraq and to compare the study with other international studies. Eight patients were studied retrospectively in details as regard the age, sex, clinical manifestations, radiological findings. Details of the operative findings and the surgical outcome. All the patients had right sided intra-thoracic abdominal organ herniation mostly the stomach, all the patients ahad large hiatus, the patients were managed successfully through laparatomy with uneventful postoperative course. This uncommon variety of the congenital hiatal hernia presented a diagnostic challenge to the pediatrician, pediatric surgeon and the thoracic surgeon .Laparatomy was the procedure of choice and adding an anti -reflux procedure is highly indicated

Incidental finding on coronary multislice CT angiography: frequency and diagnostic value

Multislice Coronary CT angiography [MSCTA] has emerged over the past few years as an important diagnostic tool in patients with low-intermediate likelihood of coronary artery disease [CAD] presenting with chest pain. MSCTA images also include parts of the lungs, abdomen, and mediastinum. Reading physicians are obliged to evaluate and report incidental [non cardiac] findings. The purpose of our study was to retrospectively assess the prevalence and clinical diagnostic impact of incidental [non cardiac] findings in low intermediate likelihood patients presenting with chest pain to a specialized imaging center. MSCTA was performed in 600 consecutive patients age of 55.8 +/- 10.0 years, with 3.0 +/- 1.5 risk factors, underwent retrospective ECG-gated examination of the coronary arteries using a 64-MSCT scanner [Aquilion, Toshiba Medical Systems, Tokyo, Japan]. In each examination findings were assessed and reported by a consensus between a cardiologist and a radiologist. Incidental finding is defined as a non cardiac finding not previously known; clinical significance was defined as that requiring further, diagnostic or interventional procedure. The 64 MSCT showed a great window for examining the coronaries allowing the diagnosis of a great variety of findings including calcium scoring, non-obstructive and obstructive plaques. The number, size and exerted degree of stenosis of plaques can be examined and outlined in more or less easy and rapid to perform procedure and acceptable by most patients. A wide multitude of incidental findings were seen in our study. Parts of the lungs [and sometimes the hole lungs] are examined during cardiac imaging. Most of the thoracic esophagus, thoracic aorta, diaphragm and a glance of the upper abdomen and breasts are seen during MSCTA of the heart. The visualized portion of the lungs and mediastinum showed multiple lesions. Lung subcentimeter nodules were seen in 10 cases. Five cases showed lung wedge shaped consolidation with associated pleural thickening. Significant mediastinal adenopathy [more than 1 cm in diameter] were seen in two cases. Lung neoplastic process that was proved to be pulmonary carcinoma was seen in 2 cases. Pulmonary embolism was encountered in almost tenth of our cases and actually was the cause of chest pain. Aortic lesions were seen in 12 patients; most of them were aneurysms and two cases were dissection and were incriminated as the major cause of chest pain in those patients. Hiatal hernia was a more or less common incidental finding seen in 40 cases. Hepatic and breast lesions were so few not seen in more than two cases each. Coronary artery MSCTA can reveal important non-cardiac findings and disease in extracardiac structures; these incidental findings are common, many of which would impact patient management. Cardiologist must be aware of the normal and abnormal findings and the best laid plan is to have an integrated cardiologist-radiologist team to ensure that important findings are not missed and unnecessary follow-up examinations are avoided

PHmetría y serie esofagogastroduodenal en niños con reflujo gastroesofágico / Comparison of esophageal pHmonitoring and barium esophagogram in the diagnosis of gastroesophageal reflux

Introducción. Objetivo: comparar la sensibilidad y la especificidad de la serie esofagogastroduodenal (SEGD) con la pHmetría intraesofágica por 24 horas en el diagnóstico de niños con reflujo gastroesofágico. Material y métodos. Diseño: retrospectivo, transversal, observacional y descriptivo. Ubicación: Servicio de Gastroenterología y Nutrición del Instituto Nacional de Pediatría, Secretaría de Salud, de enero de 1993 a diciembre de 1998. Se revisaron los estudios de 200 niños con diagnóstico clínico de reflujo gastroesofágico a los que se les realizó pHmetría por 24 horas con un Digitrapper Mk III (Synecties Medical System) con sondas semidesechables de monocristales de antimonio y los resultados de la misma se compararon con la SEGD. Con base a la clasificación de Boyle se establecieron 2 grupos: I con reflujo patológico y II sin reflujo patológico. Se utilizó la prueba exacta de Fisher para las variables categóricas y la prueba de Kruskal-Wallis con ji cuadrada con un grado de libertad para las variables continuas. En todas las contrastaciones se utilizaron pruebas de 2 colas con un alfa de 0.05.Resultados. Noventa y un pacientes (45 por ciento) integraron el grupo I (reflujo patológico) y 109 el grupo II (reflujo fisiológico). La sensibilidad de la SEGD fue de 49 por ciento, y su especificidad de 61 por ciento, con un valor predictivo positivo de 90 por ciento y valor predictivo negativo de 14 por ciento. Conclusión. De acuerdo con este estudio la SEGD no permite hacer el diagnóstico diferencial entre reflujo gastroesofágico patológico y fisiológico. Ambos estudios se complementan y pueden ser necesarios para el manejo en un mismo paciente, ya que la SEGD diagnostica malformaciones y alteraciones anatómicas del tracto gastrointestinal que dan un reflujo gastroesofágico secundario.