Resultados a largo plazo del tratamiento quirúrgico de Hernias Hiatales tipo III y IV con y sin refuerzo protésico

Introducción: El tratamiento de las Hernias Hiatales (HH) tipo III y IV es quirúrgico. Hay controversia sobre el refuerzo con malla. Nuestro objetivo fue comparar los resultados a largo plazo entre el uso o no de refuerzos protésicos. Materiales y Métodos: Cohorte prospectiva de 95 pacientes con HH tipo III y IV, entre los años 1997 y 2015 en el Hospital Clínico de la Universidad de Chile. Se evaluaron las características radiológicas, endoscópicas y funcionales pre y postoperatorias. Recidiva definida como recurrencia mayor a 3 cm. Análisis estadístico con chi2 y Test U-Mam-Whitney. P-value a 10 años) de HH tipo III y IV reparadas quirúrgicamente, no hay diferencias en la recidiva clínica con o sin el uso de mallas.

Introduction: The treatment of Hiatal Hernias (HH) type III and IV is surgical. There is controversy about reinforcement with mesh. Our objective was to compare the long-term results between the use or not of prosthetic reinforcements. Materials and Methods: Prospective cohort of 95 patients with HH type III and IV, between 1997 and 2015 at the Clinical Hospital of the University of Chile. Pre and postoperative radiological, endoscopic and functional characteristics were evaluated. Recurrence defined as a recurrence greater than 3 cm. Statistical analysis with chi2 and U-Mann-Whitney test. p-value 10 years) of surgically repaired type III and IV HH, there are no differences in clinical recurrence with or without the use of mesh.

Variability in presentation and management of gastric volvulus: report of 3 cases

Gastric volvulus is a pathology of acute or subacute presentation. Depending on the type, a gastric volvulus can present as an emergency if there is vascular compromise with necrosis and high risk of perforation and its surgical resolution is mandatory. Subacute gastric volvulus does not compromise the organ or organism urgently but is associated with high morbidity and should be resolved when the patient is in optimal conditions to offer definitive treatment. Depending on the torsion axis, it is classified as axial or mesenteroaxial organ, both merit reduction according to their presentation and the clinical context of the patient.

Vólvulo gástrico agudo: cuadro clínico infrecuente / Acute gastric volvulus: an uncommon presentation

RESUMEN El vólvulo gástrico agudo (VGA) es una entidad infrecuente, con elevada mortalidad de hasta 50%, y su diagnóstico se basa en un alto nivel de sospecha clínica. En el paciente estable se puede plantear manejo no operatorio, pero en el inestable se impone el tratamiento quirúrgico. Presentamos el caso de un paciente con VGA e inestabilidad hemodinámica, en el cual se realizó laparotomía y devolvulación gástrica, pero falleció en el posoperatorio inmediato por shock refractario.

ABSTRACT Acute gastric volvulus (AGV) is an uncommon condition with high mortality (up to 50%) and its diagnosis is based on high level of suspicion. Conservative management can be attempted in stable patients, but the surgical approach is indicated in unstable cases. We report the case of a patient with AGV and hemodynamic instability who underwent laparotomy with reduction of the volvulus but who died in the immediate postoperative period due to refractory shock.

Vólvulo gástrico en una paciente nonagenaria: intervención endoscópica y laparoscópica. Reporte de caso / Gastric volvulus in a nonagenarian patient: endoscopic and laparoscopic intervention. Case report

Resumen El vólvulo gástrico es una entidad rara que puede presentarse de manera aguda o crónica y se acompaña de síntomas inespecíficos. Es fundamental su rápida identificación, ya que tiene alta mortalidad y el tratamiento oportuno de esta patología determina el pronóstico del paciente. A continuación, presentamos el caso de una paciente femenina de 89 años, que consulta por cuadro clínico de dolor torácico atípico, con documentación en radiografía de tórax de vólvulo gástrico organoaxial, en quien se realiza inicialmente devolvulación endoscópica con éxito. Sin embargo, en las imágenes de control se evidencia recurrencia del vólvulo, por lo cual se realizó manejo quirúrgico con hiatoplastia y funduplicatura tipo Toupet, además de gastrostomía percutánea de fijación, procedimiento realizado sin complicaciones, con los que se logró la devolvulación completa sin recurrencia.

Abstract Gastric volvulus is a rare condition that can occur acutely or chronically and is accompanied by nonspecific symptoms. Its rapid identification is critical since it has high mortality rate and timely treatment determines the patient's prognosis. The following is the case of an 89-year-old female patient who presented with atypical chest pain, with organoaxial gastric volvulus on chest X-ray, in whom endoscopic devolvulation was initially performed successfully. However, control imaging scans revealed recurrence. Therefore, surgical management included hiatoplasty and Toupet fundoplication, as well as percutaneous fixation gastrostomy, a procedure that was completed without complications and resulted in complete devolvulation without recurrence.

An unusual presentation of acute gastric volvulus in the elderly patient: a case report and literature review

Gastric volvulus is nothing but the torsion of stomach in thoracic cavity by more than 1800 along its transverse or longitudinal axis. A very rare case occurring both in male and female. The term first described by Berti after doing an autopsy of a female, in 1886. We found a case of 65 years old male with history of dyspepsia since, 1 year with history of vomiting and pain abdomen since, 1 day. On evaluation, clinically gurgling sound heard on left side chest and with investigations like USG and CT whole abdomen, we came to know about mesentrico axial volvulus which is more common in children. Acute gastric volvulus cases have high mortality rate also requires emergency surgery. Gastric volvulus is very rare with variable and non-specific clinical presentations, hence high level of suspicion for radiologic diagnosis may require. 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. Timely diagnosis with proper treatment can potentially decreases morbidity and mortality of the patient.

Gastric volvulus or just a large stomach? a case report with literature review of gastric volvulus and gastrointestinal pathology in acromegaly

Gastric volvulus is a surgical emergency that requires prompt recognition and management. The acromegalic patient has a number of pathophysiological factors that predispose to gastric volvulus and slow gastrointestinal (GI) transit. Authors aimed to present a case of hiatus hernia and gastric volvulus in a patient with acromegaly and review the current literature on GI anomalies in this population. A 70-year-old female presented to our institute with epigastric pain and coffee-ground vomiting on the background of acromegaly secondary to pituitary adenoma (resected in 1997). She was found to have a gastric volvulus and hiatus hernia which was repaired laparoscopically. She was discharged home but re-presented six days later with abdominal distension and vomiting. Computed tomography (CT) scan of abdomen showed recurrent gastric volvulus with involvement of the transverse colon. She underwent a laparotomy but no evidence of gastric or colonic volvulus was seen intra-operatively. The CT findings were attributed to a large stomach and coiled redundant transverse colon which could be misinterpreted as volvulus on imaging. Gastroparesis and slow bowel transit were the likely aetiology of this second presentation. This is consistent with literature reporting slow bowel transit and dolichocolon in acromegalic patients. Gastric volvulus is a rare finding associated with acromegaly. Structural anomalies in the anatomy of the acromegalic patient can make CT diagnosis challenging. This case demonstrates the need for caution when interpreting imaging in this cohort, as well as the need for further research on GI pathology associated with acromegaly.

Examination characteristics and therapeutic approach on integrated traditional Chinese and western medicine for treatment of infants with gastric volvulus and gastroesophageal reflux-induced pneumonia / 中国中西医结合急救杂志

Objective To observe the influences on prognoses and airway acid and base levels while using anti-inflammatory and anti-reflux therapies combined with "Hezhong Fuzheng massage" for treatment of infants with gastric volvulus (GV) and gastroesophageal reflux (GER)-induced pneumonia in order to provide evidence for clinical diagnosis and treatment of such infant disease. Methods Sixty infants 1-6 months old admitted to the Department of Integrated Traditional Chinese and Western Medicine of Wuhan Children's Hospital from January 2013 to December 2015 were diagnosed as pneumonia combined with GV and GER by the chest radiograph and radiography of upper gastrointestinal tract (UGT) with iodine, and according to difference in diagnostic methods, they were divided into an observation 1 group (30 cases) and an observation 2 group (30 cases). In observation 1 group, 24-hour pH value in upper digestive tract especially the distal esophagus was dynamically monitored, while in observation 2 group, 24-hour multichannel intraluminal impedance (MII) combined with pH monitoring of esophagus was carried out. Furthermore, two control groups were set up, each 30 cases; after radiography of the UGT with iodine, the control 1 group was diagnosed as GV and GER without pneumonia and control 2 group was diagnosed as only simple GV. Treatment of infant pneumonia was carried out in accordance with the guidelines for the management of community-acquired pneumonia in children; the treatment of GV and GER included postural, dietary, prokinetic and Hezhong Fuzheng massage [acupoint selection and massage was undertaken in 5 steps: push from the palmar crease to Banmen (rectilinear pushing manipulation) 300 times, push abdominal Yin and Yang (finger-pushing massage) 200 times, palpate the abdomen (clockwise) 100 times, poking of Tianshu 100 times, poke alternately bilateral Zusanli 100 times. Once-daily massage, (15±2) minutes each time, for consecutive 7 days]. The results of pH monitoring of the distal esophagus in observation 1 group was recorded; All GER data concerning pH monitoring of observation 2 group and the results of esophagus multi-channel intra-luminal impedance combined with pH monitoring in control group were compared. After 7 days of continuous treatment, the clinical efficacy of pneumonia and GV, hospitalization time, prognosis and the changes of sputum pH before and after treatment in the two observation groups were compared. Results In two observation groups, the main type of 60 cases with GV was organoaxial volvulus, accounting for 91.67% (55 cases), and more than 60% patients exhibited sputum pH <7.0. The distal esophagus 24-hour pH dynamic monitoring in observation 1 group showed that there were 26 cases with acid reflux (86.67%), 4 cases with GER negative (13.33%), the proportion of pH < 4 in GER negative patients was significantly lower than that in moderate acid reflux patients [3.35% (0.77% - 8.08%) vs. 26.23% (15.19% - 42.87%), P < 0.05], the number of long reflux (> 5 minutes) in GER negative patients was significantly reduced than that in mild acid reflux patients [times: 2 (0-5) vs. 7 (2-15), P < 0.05], the longest time of reflux in GER negative patients was significantly shorter than that in either mild or moderate acid reflux patients [minutes: 5.9 (2.5-10.0) vs. 19.2 (5.9-51.0), 41.6 (16.9-121.0), both P < 0.05]. The 24-hour MII-pH monitoring of esophagus in observation 2 group showed that there were 30 cases with pathological reflux, mainly mild acid reflux accounting for 90%, in which the percentage of proximal reflux events was 46.07% in the total reflux events. The numbers of acid reflux and proximal reflux in the observation 2 group were significantly higher than those in the control 1 and 2 groups [1 305 (37.72%) vs. 795 (25.69%) and 136 (18.89%), 1 594 (46.07%) vs. 687 (22.20%) and 154 (21.39%), both P < 0.05]; there were no significant differences in total effective rate (100% vs. 100%, P > 0.05) and hospitalization time (days: 7.58±1.09 vs. 7.67±1.12, P > 0.05) between the two observation groups. Conclusions For the diagnosis of infant pneumonia combined with GV and GER, the first selection of chest radiograph and radiography of the UGT with iodine can identify the severity of pneumonia, whether it is complicated with GV and its classification, and whether GER exists at the same time. The estimation of 24-hour pH dynamic monitoring of the acid reflux in the upper digestive tract especially the distal esophagus is consistent with that of the 24-hour MII-PH monitoring of esophagus. Moreover, 24-hour MII-PH monitoring of esophagus can also identify non-acid reflux, resulting in the GER diagnosis more accurate. Since the proximal reflux ratio of infants with GV combined with GER and pneumonia is relatively high and easy to cause cough and aspiration. attention should be paid on early diagnosis and timely intervention to such patients. The sputum acidity test can reflect the airway acid-base level and its manipulation is simple, so by that the real time disease situation can be estimated, and aspiration of sputum also can help the treatment. The therapeutic schedule formulated by our group can elevate the therapeutic effect, improve the airway acid-base environment and benefit prognosis.

Clinical characteristics of children with pertussis syndrome and attention to the effect of gastroesophageal reflux caused by gastric volvulus on small infants with pertussis syndrome: an analysis of 807 cases / 中国中西医结合急救杂志

Objective To observe the clinical characteristics of infants with pertussis syndrome and the influence of gastroesophageal reflux (GER) on pertussis syndrome in small infants, and provide experience for improving curative effect. Methods ① The clinical data of 807 infants with pertussis syndrome treated at Wuhan Children's Hospital from January 2015 to June 2017 were retrospectively analyzed, in which their clinical characteristics including symptoms, signs and related physical and chemical examinations were summarized. ② Prospective randomized controlled trials were performed at the Children's Hospital of Wuhan from June 2017 to June 2018, there were 120 infants with ages < 6 months diagnosed as pertussis syndrome and simultaneously accompanied by gastric volvulus (GV) and GER, and they were randomly divided into a study group and a control group according to the date sequence of definite diagnosis, 60 cases in each group. The control group was given conventional medical treatment, while in the study group, additionally the infants received massage to restore gastric proper position and anti-reflux therapy. The clinical efficacies of two groups were observed. Results ① Retrospective analysis showed that clinically, pertussis syndrome commonly occurred in infants of ages < 6 months, accounting for 88.30% (713 cases); all cases had spastic cough, and 60.00% (484 cases) infants' coughing was severer at night. In laboratory examinations, 83.27% (672 cases) of the infants had elevated platelets (PLT), 25.03% (202 cases) had abnormal myocardial zymograms, and 70.38% (568 cases) had elevated white blood cells (WBC). In the pathogen examination, only were pathogens found in 34.8% infants, mainly single pathogen infection, accounting for 86.12%. Chest radiographs suggested 71.50% of infants with pneumonia, and 73.00% of infants with GER, among which 77.92% of infants were accompanied by GV. ② The prospective study showed that in the treatment of infants with pertussis syndrome accompanied by GV and GER, manual massage should be used timely to correct GV and simultaneously anti-reflux therapy should be given, in the aspects of time required to improve cough symptoms (days: 5.36±1.40 vs. 6.59±1.56, P < 0.01) and shortening of the hospital stay (days: 6.50±1.41 vs. 8.09±1.63, P < 0.01) in the study group were superior to those in the control group; the case of respiratory failure in the study group was lower than that in the control group [2 cases vs. 8 cases, P < 0.05]. Conclusions In pertussis syndrome, lymphocytes occupy the main proportion of WBC elevation that is an important differential criterion between pertussis syndrome and infantile pneumonia with gastric volvulus and gastroesophageal reflux. PLT elevation in pertussis syndrome suggests that attention should be paid to the elevation as that might be related to the disease prognosis. It is necessary to further investigate whether the positive pathogen discovered in the course of pertussis syndrome is a pathogenic one, and attention should also be paid to the medical examination of GV and GER in the small infants with pertussis syndrome, since early proper intervention to correct GV and GER can significantly improve their clinical efficacies.

Hernia diafragmática secundaria a trauma: presentación tardía / Complicated diaphragmatic hernia: late outcome of trauma

Resumen Introducción: La hernia diafragmática complicada de presentación tardía constituye una urgencia quirúrgica. Los objetivos del presente estudio son la descripción de las características del diagnóstico de las hernias diafragmáticas de presentación tardía, tratamiento, resultados y la identificación del punto de corte entre el inicio de los síntomas y el desarrollo de necrosis. Pacientes y Métodos: Estudio retrospectivo de una serie de casos constituida por todos los pacientes operados por hernia diafragmática complicada de presentación tardía entre los años 2006 y 2016. Se midieron variables categóricas y continuas que se presentan con estadística descriptiva. Se utilizaron curvas Receiver Operating Characteristics (ROC) a las 6 y 12 h desde el inicio de los síntomas, para determinar el punto de corte del tiempo de presentación clínica en pacientes sometidos a resección de algún órgano. Una vez establecido el punto de corte se calcularon la sensibilidad; especificidad; las razones de verosimilitud positiva y negativa; los valores predictivos positivo y negativo; y la prevalencia. Resultados: La presentación clínica, estudio, diagnóstico y tratamiento fue similar a lo descrito en la literatura quirúrgica. Se estableció el punto de corte a las 12 h con sensibilidad de 80% y especificidad de 83%. Conclusiones: El diagnóstico y tratamiento de estos pacientes debería ser llevado a cabo antes de las 6 h desde el inicio de los síntomas. Aun cuando el universo descrito es reducido, se sugiere que después de las 12 h desde el momento de la estrangulación, los órganos comprometidos se encontrarán necróticos requiriendo resección quirúrgica.

Introduction: Late presentation of traumatic diaphragmatic hernia constitutes a true surgical emergency. The purposes of this study were to describe the diagnostic characteristics, treatment and outcomes of late presentation diaphragmatic hernias and to identify a cutoff point from the onset of symptoms to necrosis development. Patients and Methods: A retrospective series of cases constituted by all patients subjected to emergency diaphragmatic hernia repair form 2006 to 2016 was studied. Categorical and continuous variables were measured and analyzed with descriptive statistics. Receiver Operating Characteristics (ROC) curves at 6 and 12 hours from the onset of symptoms were used to determine the cutoff point for organ resection. Once stablished the cutoff point, sensitivity, specificity, positive and negative predictive values and prevalence were calculated. Results: Clinical presentation, diagnostic study and surgical treatment were similar to what has been already described. The cutoff point was defined at 12 hours from the onset of symptoms with 80% sensitivity and 83% sensibility. Conclusions: The diagnosis and treatment of these cases should be carried on before the first 6 hours after the onset of symptoms. Even though the universe of this study was small, we may suggest that after 12 hours form the onset of symptoms, the implicated organs would be found necrotic requiring surgical resection.

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)

Vólvulo gástrico por hernia diafragmática crónica / Gastric volvulus due to chronic diaphragmatic hernia

Objetivo: Presentar un caso de vólvulo gástrico obstructivo. Caso clínico: Presentamos el caso de una paciente que inició con un episodio de obstrucción intestinal por una volvulación gástrica. El antecedente de otro episodio antiguo y la radiología de tórax alertaron de una posible hernia diafragmática crónica. La buena respuesta al tratamiento médico inicial permitió un estudio completo y una cirugía programada mediante abordaje laparoscópico.

Aim: To present a patient with gastric volvulus. Case report: A case of a female patient who started with an episode of intestinal obstruction due to gastric volvulus. The history of a former episode and chest radiology alerted us to a possible chronic diaphragmatic hernia. The patient's good response to initial medical treatment allowed a complete study and laparoscopic intervention.

Para-oesophageal and parahiatal hernias in an Asian acute care tertiary hospital: an underappreciated surgical condition

<p><b>INTRODUCTION</b>The prevalence of hiatal hernias and para-oesophageal hernias (PEHs) is lower in Asian populations than in Western populations. Progressive herniation can result in giant PEHs, which are associated with significant morbidity. This article presents the experience of an Asian acute care tertiary hospital in the management of giant PEH and parahiatal hernia.</p><p><b>METHODS</b>Surgical records dated between January 2003 and January 2013 from the Department of Surgery, Changi General Hospital, Singapore, were retrospectively reviewed.</p><p><b>RESULTS</b>Ten patients underwent surgical repair for giant PEH or parahiatal hernia during the study period. Open surgery was performed for four patients with giant PEH who presented emergently, while elective laparoscopic repair was performed for six patients with either giant PEH or parahiatal hernia (which were preoperatively diagnosed as PEH). Anterior 180° partial fundoplication was performed in eight patients, and mesh reinforcement was used in six patients. The electively repaired patients had minimal or no symptoms during presentation. Gastric volvulus was observed in five patients. There were no cases of mortality. The median follow-up duration was 16.3 months. There were no cases of mesh erosion, complaints of dysphagia or recurrence of PEH in all patients.</p><p><b>CONCLUSION</b>Giant PEH and parahiatal hernia are underdiagnosed in Asia. Most patients with giant PEH or parahiatal hernia are asymptomatic; they often present emergently or are incidentally diagnosed. Although surgical outcomes are favourable even with a delayed diagnosis, there should be greater emphasis on early diagnosis and elective repair of these hernias.</p>

Gastric Volvulus with Eventration of Diaphragm

Gastric volvulus with eventration of diaphragm is an uncommon occurrence. We report here case of a middle-aged woman who came with left-sided chest pain since 1 month, and occasional history of breathlessness in supine position. She was advised to have chest radiograph and ECG done. ECG was within normal limits. On chest radiograph, there was smooth, round, well-defined elevation of left hemidiaphragm with air fluid levels below it. Mediastinum was shifted towards right side. Based on that, barium meal was advised which showed contrast filling with alteration of axis of stomach. Organoaxial type of gastric volvulus is confirmed.

A prospective randomized controlled trial on effect of gastric volvulus early interference on incidence of pneumonia and prognosis of infants with cytomegalovirus infection cholestatic hepatopathy / 中国中西医结合急救杂志

Objective To study the effects of early application of integrated traditional Chinese medicine (TCM)and western medicine and massage on the incidence and severity of pneumonia and prognosis in the therapeutic course of infants with cytomegalovirus(CMV)infection infantile cholestatic hepatopathy(ICH)accompanied by gastric volvulus(GV). Methods A prospective randomized controlled trial was conducted. 120 infants 1-6 months old with CMV infection ICH and complicated with GV inpatients were divided into treatment group and control group (each,60 cases). The TCM Lidanheji(consisting of artemisiae capillaris 30 g,weeping forsythia 30 g,Chinese goldthread 5 g,prepared rhubarb 5 g,unpeeled root of herbaceous peony 30 g,cassia 5 g,fruit of citron or trifoliate orange 10 g,large-headed atractylodes 10 g,fruit of Chinese magnoliavine 10 g,pangolin scale 3 g and licorice root 5 g)for oral administration or enema and ganciclovir intravenous injection were given to both groups. In the control group,based on the above treatment,postural and diet therapy,prokinetics(domperidone)were given in cases with GV. The massage treatment was only applied for treatment of GV in treatment group. The pneumonia in both groups was treated in accord to the conventional diagnosis and treatment for infantile pneumonia,bronchiolitis,severe pneumonia and the guide and management of infantile community acquired pneumonia. The total number of cases with pneumonia and its severity occurring before and after treatment in the course of the disease,the clinical therapeutic effects of ICH, GV and infantile pneumonia,the clinical physical signs,biochemical indexes and the time of hospitalization were observed and compared between the two groups. Results Compared with control group,after treatment the curative rate and total effective rate of ICH,GV,infant pneumonia in treatment group were significantly higher〔the curative rate of ICH:83.05%(49/59)vs. 71.93%(41/57),total effective rate:96.61%(57/59)vs. 91.23%(52/57);the curative rate of GV:72.88%(43/59)vs. 51.79%(29/56),total effective rate:96.61%(57/59)vs. 78.57%(44/56);the curative rate of infant pneumonia:81.08%(30/37)vs. 67.44%(29/43),total effective rate:100%(37/37)vs. 100%(43/43),P<0.05 or P<0.01〕. In the treatment group,the total number of cases with pneumonia occurring in the therapeutic course and the incidence of severe pneumonia were significantly less than those in the control group〔the occurrence of pneumonia:12 cases vs. 21 cases,the incidence of severe pneumonia:16.67%(2/12) vs. 42.86%(9/21),P<0.05 or P<0.01〕. The enlargement of liver and spleen,the level of total bilirubin(TBil), direct bilirubin(DBil),total bile acids(TBA)and alanine aminotransferase(ALT)in two groups after treatment were significantly lower than those before treatment,the changes being more marked in treatment group(P<0.05 or P<0.01). The time of stay in hospital in treatment group was remarkably shortened(days:21.32±3.26 vs. 27.38±6.09, P<0.05). Conclusion Early interference with combined TCM and western medicine and massage for treatment of infants with CMV infection ICH accompanied by GV can significantly decrease the incidence of pneumonia and its severity occurring in the disease course,therefore this therapeutic method is beneficial to the treatment and prognosis of infants with CMV infection ICH.

Vólvulo Gástrico: A propósito de un caso / Gastric Volvulus: A Case Report

Vólvulo gástrico es la mal rotación del estómago en uno de sus ejes dentro de la cavidad abdominal pudiendo comprometer rápidamente la vida del paciente. El estómago anatómicamente es una víscera intraabdominal que está sujeta en varias de sus caras por ligamentos y estructuras que la mantienen relativamente fija en su posición, permitiéndole un rango de movimiento suficiente como para llevar a cabo su trabajo digestivo. Sin embargo, posee un eje natural sobre el cual tiende a pivotar cuando el movimiento es enérgico y amplio elevándose el riesgo de producirse una torsión en algunos de sus puntos no fijos. En otros casos desde el punto de vista patológico adquiriría también un eje transversal que le serviría a su vez de segundo eje de torsión, situación en especial frecuente en pacientes pediátricos. Si se diera el caso, puede producirse un vólvulo en los puntos previamente mencionados que como cualquier parte del tubo digestivo que sufre una compresión de su tejido someterá su vitalidad al peligro de isquemia y sufrimiento tisular, dando como presentación relacionada un cuadro de dolor moderado a severo y distensión abdominal que sumados a náuseas con o sin vómitos dan como resultado una signo sintomatología poco específica del Vólvulo Gástrico, razón por la cual su diagnóstico es difícil y necesaria su pronta resolución por los riesgos que conlleva; como es el caso del paciente describimos en éste caso.

Gastric volvulus is the wrong rotation of the stomach on one axis within the abdominal cavity can quickly compromise the patient's life. The stomach is anatomically an intra-abdominal organ that is subject to a number of its sides by ligaments and structures that remain relatively fixed in position, allowing a range of enough movement to carry out its digestive work. However, it has a natural axis around which tends to pivot when the movement is strong and broad and raises the risk of torsion can occur in some of its non-fixed points. In other cases the pathological point of view also acquires a transverse axis that would turn second torsion shaft, a situation particularly common in pediatric patients. If it were the case, a volvulus can occur in previously mentioned that as any part of the digestive tract that undergoes compression of the fabric shall submit its vitality to the danger of ischemia and tissue suffering, giving as related: pain points, severe abdominal distension, nausea with or without vomiting giving as a result unspecific diagnostic of gastric volvulus, which is why its diagnosis is difficult and necessary for their prompt resolution risks; as is the case of the patient we describe below.

Volvo gástrico associado a volvo cecal em paciente jovem / Gastric volvulus associated with cecal volvulus in a young patient

Relata-se o estudo de caso de uma mulher jovem com sintomas de obstrução intestinal alta, por volvo gástrico associado com volvo cecal causado por má rotação intestinal. Inicialmente, o volvo gástrico foi diagnosticado e pode ser desfeito durante endoscopia digestiva alta. No entanto, sintomas persistentes de obstrução intestinal conduziram ao diagnóstico de volvo cecal, que foi corrigido cirurgicamente, por laparotomia e cecopexia. A paciente teve remissão total dos sinais e sintomas e foi encaminhada para acompanhamento ambulatorial, e não tem apresentado alterações por longo período.

The authors report the case of a young woman with symptoms of high intestinal obstruction due to gastric volvulus associated with cecal volvulus caused by intestinal malrotation. Initially, the gastric volvulus was diagnosed and reversed during high digestive endoscopy. However, persistent intestinal obstruction symptoms led to diagnosis of cecal volvulus, which was corrected by laparotomy and cecopexy. The patient showed complete remission of clinical symptoms and was referred to outpatient follow-up, which has been uneventful so far.

Rare association of eventration of left hemidiaphragm with ipsilateral thyroid agenesis.

Eventration is a well-known congenital malformation of the diaphragm, usually asymptomatic and diagnosed incidentally on chest radiography. It is sometimes associated with a number of other congenital syndromes and anomalies. We report a rare case of eventration of left hemidiaphragm associated with gastric volvulus, ipsilateral thyroid agenesis and microphthalmia.

Sonographic Findings of Mesenteroaxial Gastric Volvulus in a Young Infant: A Case Report

We present a case of sonographically-diagnosed mesenteroaxial gastric volvulus in a neonate. Plain radiography revealed severe gaseous gastric distension. Ultrasonography (US) showed a displaced and compressed antrum and pylorus above the gastroesophageal junction. The provisional diagnosis was mesenteroaxial gastric volvulus. The patient underwent an emergency laparotomy and a mesenteroaxial gastric volvulus was found. This case shows that US can be useful for diagnosing mesenteroaxial gastric volvulus in neonates.

Hernia hiatal gigante con estómago intratorácico: reporte de un caso y revisión de la literatura / Giant hiatal hernia with intrathoracic stomach: a case report and literature review

Giant hiatal hernia (GHH) with intrathoracic stomach is a rare condition. It is a type 3 or mixed hernia (with sliding and paraesophageal component) with more than 30 percent of the stomach protruding into the chest cavity. These hernias are usually associated with gastric rotation, mostly with organoaxial twist. They have nonspecific clinical manifestations, which include vomiting, and chest or epigastric pain. Complications such as volvulus, perforation, or gastric obstruction constitute a medical emergency. In many cases, these hernias can be detected incidentally on a chest radiograph. Imaging studies, mainly multidetector CT and upper gastro-intestinal series represent vital tools for diagnosis and anatomical characterization of these lesions. The treatment of GHH requires an open or laparoscopic surgical approach. We report the case of a patient evaluated in our department who was diagnosed with giant hiatal hernia with intrathoracic stomach and organoaxial gastric rotation.

La hernia hiatal gigante (HHG) con estómago intratorácico es una enfermedad poco frecuente. Corresponde a una hernia tipo 3 o mixta (componente por deslizamiento y paraesofágico) que contiene más del 30 por ciento del estómago a nivel del tórax. Es común que estas hernias se asocien a rotación gástrica, preferentemente del tipo órgano-axial. Sus manifestaciones clínicas son inespecíficas e incluyen vómitos y dolor torácico o epigástrico. Pueden presentar complicaciones como vólvulo, perforación u obstrucción gástrica, constituyendo una emergencia médica. En muchos casos pueden ser detectadas en forma incidental en una radiografía de tórax. El estudio dirigido con imágenes, particularmente tomografía computada multidetector y estudio baritado esófago-estómago-duodeno, resultan fundamentales para el diagnóstico y caracterización de la anatomía de estas lesiones. El tratamiento es quirúrgico, sea por cirugía abierta o laparoscópica. Presentamos el caso de una paciente evaluada en nuestro servicio, en quien se realizó el diagnóstico de HHG con estómago intratorácico, con rotación gástrica órgano-axial.

Manejo endoscópico del vólvulo gástrico / Endoscopic treatment of gastric volvulus

El vólvulo gástrico es una enfermedad muy rara que puede ser aguda o crónica y estar asociada a otras patologías. Es muy importante su rápida identificación porque de su tratamiento oportuno va a depender el pronóstico del paciente. Usualmente el manejo es quirúrgico con la gastropexia abierta o laparoscopia; sin embargo, puede intentarse un manejo endoscópico el cual es más rápido, sencillo y genera una menor morbilidad para los pacientes.Presentamos en este artículo dos casos de vólvulo gástrico que fueron devolvulados de manera endoscópica; se describe detalladamente la técnica y se hace una revisión de la literatura de esta extraña enfermedad.

Gastric volvulus is a very rare disease which may be either acute or chronic, and which may be associated with other pathologies. Quick identification of gastric volvulus is very important because the prognosis of the patient depends on opportune treatment. Usually open gastropexy or laparoscopy is performed. Nevertheless, endoscopic treatment can be tried since it is faster and simpler and results in less morbidity.In this article we present two cases of endoscopic devolvulation of gastric volvulus. The technique is described in detail and we present a review of the literature regarding this strange disease.