Herniation Of Colon Research Articles

Early colonic transhiatal herniation and anastomotic leak after Ivor Lewis esophagectomy

Transhiatal herniation of the abdominal organs is a rare complication after esophagectomy. Surgical treatment is usually mandatory because of the high mortality associated with this condition. We present a case of colonic herniation that could contribute to failure of the esophagogastric anastomosis. Repair of both problems was performed through a right posterior thoracotomy.

Fecopneumothorax: A Rare Complication of Esophagectomy

Intrathoracic colon herniation after esophagectomy is rare. Furthermore, fecopneumothorax is an extremely infrequent clinical entity. We believe this is the first report in the literature of a patient with fecopneumothorax due to diverticular perforation of intrathoracically herniated transverse colon 2 months after transthoracic esophagectomy and cervical esophagogastric anastomosis. The relative literature addressing cause, clinical presentation, diagnosis, management, and prevention of this life-threatening complication of esophagectomy is reviewed.

Anterior Mediastinal Herniation of the Transverse Colon after an Omental Flap Transposition

Poststernotomy mediastinitis continues to be an infrequent but serious complication after cardiac surgery. We present a case of a 59-year-old man who developed a deep sternal wound infection after an emergency cardiac surgery. Omental transposition flap was used to cover the sternal defect. Several days later, the patient developed a transverse colon herniation into the anterior mediastinum that required emergency exploration and colon resection. The patient survived after a difficult hospital course. Indications, technical points, and possible complications of using omental flap transposition are discussed.

Transverse Colon Herniation Through the Foramen of Winslow Presenting With Unusual CT Findings

Bowel herniation through the foramen of Winslow is among the rarest of internal hernias, accounting for less than 0.8%. In its origin, a pivotal role is played by some anatomic variations, or anomalies such as the increased mobility of the right transverse colon, and maybe the exceedingly large bore of the foramen itself. The first case of hernia through the foramen of Winslow was reported by Blandin in 1834. Since then, no more that 200 new cases have been described. Diagnosis usually is established during surgery while treating a bowel obstruction. Only in an exceedingly small group of patients is diagnosis achieved preoperatively on the basis of radiological findings. We describe a preoperatively diagnosed case of transverse colon herniation through the foramen of Winslow, showing a portal vein narrowing and periportal lymphedema at computed tomography (CT). To the best of our knowledge, only a few cases of preoperative CT diagnosis of Winslow foramen hernia have been described in the past. None had the above-mentioned CT findings.

A case of symptomatic Morgagni’s hernia and a review of Morgagni’s hernia in Japan (263 reported cases)

An 81-year-old female patient was admitted to the emergency room of our hospital with complaints of respiratory distress, abdominal ache, nausea, and intermittent vomiting. A plain X-ray of the abdomen and chest revealed air-fluid levels on the abdomen and the right side of the chest. Laboratory tests showed severe acidemia with a blood base excess level of -24.9 mmol/L. Since the patient was considered to have acute intestinal obstruction due to transverse colon herniation into the thorax through a foramen of Morgagni, emergency surgery was performed. Operative findings revealed that the retrosternal diaphragm had a defect of 5 cm in diameter and 20 cm in length with the transverse colon herniated into the thorax. The diaphragm defect was sutured first, and partial resection of the transverse colon was performed. After the operation, the patient had no symptoms and no recurrence has been observed during the 1-year follow-up. There have been 263 reported cases of Morgagani hernia in Japan. The case of the Morgagni hernia is reported here with some bibliographical comments.

Laparoscopic reduction of acute intrathoracic herniation of colon, omentum and gastric volvulus

Intrathoracic gastric volvulus with herniation of colon and omentum in a paraesophageal hernia is a rare occurrence. It may present as an acute surgical emergency with life-threatening complications. The diagnosis is usually made by imaging studies and endoscopy. Definite treatment is surgery. We present the laparoscopic management of this case.

Isolated colonic hernia through the esophageal hiatus

We report on a 75-year-old woman with an isolated colonic hernia through the esophageal hernia. The patient had suffered from cough, palpitation and dyspnea. A chest X-ray showed a colon loop gas in the mediastinum. Simultaneous barium swallow and enema showed the herniation of the only transverse colon into the mediastinum and displacement of the distal esophagus by the migrated colon. The patient underwent an open-mesh cruroplasty and a Hill's posterior gastropexy. The postoperative clinical course was uneventful. The patient has cessation of the symptoms. To our knowledge, there are only five reports presenting patients with isolated colonic hernia through the esophageal hiatus, including our case.

Acute gastric volvulus: An unusual cause of gastric outlet obstruction

Gastric outlet obstruction initiated by acute gastric volvulus is rare but potentially fatal. An unusual case of intrathoracic acute gastric volvulus complicated by distal stomach and transverse colon herniation into retrocardial space is reported. Prompt clinical diagnosis was followed by emergency laparoscopic de‐rotation and gastropexy.

Herniation of the transverse colon after esophagectomy: is retrocardiac air a normal postoperative finding?

This study describes the radiographic and CT imaging features of colonic herniation complicating esophagogastrectomy in three patients, all of whom required surgery. After routine esophagogastrectomy with gastric pull-through for esophageal carcinoma, the intrathoracic gastric pull-through most often lies in a right paraspinal location. Once a left-sided gastric pull-through has been excluded, radiologists must be suspicious for left retrocardiac air lucency that possibly represents herniation of the nearby colon. Early diagnosis is important for the prevention of bowel strangulation, especially of the ischemia-susceptible splenic flexure.

Discussion

Transhiatal herniation of colon is uncommon after transhiatal esophagectomy. Two patients with this complication are presented. Presenting symptoms vary depending on the size and contents of the hernia. Patients may be asymptomatic. The diagnosis is suggested by plain chest radiography, and treatment, in symptomatic patients, is surgical reduction of the hernia via a laparotomy.

Transhiatal Herniation of Colon After Esophagectomy and Gastric Pull-up

Transhiatal herniation of colon is uncommon after transhiatal esophagectomy. Two patients with this complication are presented. Presenting symptoms vary depending on the size and contents of the hernia. Patients may be asymptomatic. The diagnosis is suggested by plain chest radiography, and treatment, in symptomatic patients, is surgical reduction of the hernia via a laparotomy.(Ann Thorac Surg 1997;63:554–6)

VOLVULUS OF THE STOMACH ASSOCIATED WITH COLON IN THE CHEST

SUMMARY Two cases of intrathoracic hernia of colon and stomach complicated by gastric volvulus are reported.

Delayed, traumatic intercosto-diaphragmatic hernia of colon

Stab wounds of the lower chest and upper abdomen can cause potentially lethal injuries depending upon the site and degree of penetration. Clinical examination and the chest X-ray can be deceptively normal in these cases’,“. Local wound exploration and peritoneal lavage have their limitations’,3. Isolated diaphragmatic injuries due to stab wounds of the left lower chest can remain asymptomatic and present as gastrointestinal obstruction4. To prevent complications, routine laparotomy in all penetrating wounds of the lower chest and upper abdomen has been recommended’,2. We report a case of a penetrating stab wound of the left lower chest which presented 20 years later with intercostodiaphragmatic hemiation of the splenit flexure of the colon. To the best of our knowledge, this report is the first of its kind.

Diaphragmatic herniation of the large bowel

We present 19 patients who were found to have colonic herniation into the chest via the oesophageal hiatus on barium enema. This was demonstrated by showing the position of the hernia and its intimate association with the oesophagus at barium swallow. In nearly all cases there was a co-existent partially volved hernia of the stomach. It is concluded that in adults, colonic herniation into the chest noted at routine barium enema can occur via the oesophageal hiatus and is invariably associated with herniation of the stomach which in many cases is partially volved. The patients are usually elderly and female and are unlikely to present subsequently as an emergency.

Large-bowel obstruction resulting from traumatic diaphragmatic hernia: imaging findings in four cases.

Large-bowel obstruction is most often due to primary carcinoma, diverticulitis, or volvulus. In populations of patients in which trauma is prevalent, however, an additional important consideration is traumatic diaphragmatic hernia. We describe the findings on plain radiographs and single-contrast enema in four adults who had vague complaints of abdominal pain days to months after an abdominal stab injury and large-bowel obstruction resulting from herniation of colon or omentum through the left hemidiaphragm. We retrospectively analyzed plain radiographs of the chest and abdomen that were obtained before confirmation of colonic obstruction by single-contrast enema, surgery, or both in four men. Herniation of colon or omentum through the left hemidiaphragm was confirmed at surgery in all four cases. Posteroanterior and lateral radiographs of the chest obtained as part of the initial evaluation showed, in all four cases, abnormalities of the left hemidiaphragmatic contour. These included elevation of the hemidiaphragm in one case, loss of definition of a portion of the hemidiaphragm due to adjacent confluent opacity in two cases, pleural effusion in two cases, and small cystic lucencies above the diaphragmatic contour in one case. Abdominal radiographs obtained at the same time as the initial chest radiograph showed normal findings in two cases and mild dilatation of gas-filled colon in the upper part of the abdomen in two cases. In three of the four patients, progressive dilatation of the colon to the level of the splenic flexure was seen on serial abdominal radiographs. Large-bowel obstruction was confirmed by single-contrast enema in three cases and surgery in four cases. Minimal dilatation of the large bowel in the fourth patient resolved the day after admission; however, progression to complete obstruction was shown by single-contrast enema the following day. Delayed herniation through a trauma-induced defect in the left hemidiaphragm can be an unsuspected cause of large-bowel obstruction. Abnormalities of the left hemidiaphragmatic contour on plain radiographs of the chest should suggest the diagnosis in patients who have abdominal pain, colonic dilatation, and a history of abdominal injury.

Hiatal herniation of the colon with digestive tract bleeding

A 71 year old woman with hiatal herniation was admitted to our hospital with anemia and melena. A barium enema revealed hiatal herniation of the transverse colon in conjunction with the stomach, which seemed to be strangulated by the esophageal hiatus. She underwent surgery, for which Hill's gastropexy method was employed and has had no signs of bleeding since. By presenting this case, we stress the importance of marking a careful differential diagnosis due to the variability in symptoms of digestive tract bleeding.

Isolated Herniation of the Colon Through the Esophageal Hiatus: Case Report

Colonic herniation through the esophageal hiatus is an unusual condition. Isolated herniation of the colon has not to our knowledge been reported. Computerized tomography is not required to exclude pericardial herniation. An illustrative case is reported.

Colon hernia through a hiatus in the broad ligament. Report of a case and review of the literature.

Colon hernia through a hiatus in the broad ligament. Report of a case and review of the literature.

Hernia through the Foramen of Winslow, Hernia Traversing the Lesser Sac and Allied Conditions

A review of the general features is given based on a study of 62 cases from the literature; a further case showing previously undescribed clinical and radiological features is reported. The cases are subdivided according to hernial contents and the X-ray appearances for each type are given. When, as is common, there is intestine in the sac, the stomach is displaced forwards and to the left by a circumscribed collection of gas which projects above the lesser curvature. Incarcerated small intestine shows as multiple fluid levels within the limits of the sac; if barium is given, bunched and dilated bowel is seen confined as if in a bag on the left side, and a loop may be seen crossing over the duodenum to enter the gas-filled area. Stretching and great dilatation of the duodenum is a very striking feature. In colonic hernia a single fluid level is seen in the plain film and the duodenum is not stretched. Oral barium studies are not advised in this type. The less common varieties are described and the differential diagnosis is discussed. The distinction from hernia traversing the lesser sac is indicated and a possible case is described briefly.

Transverse colon in a right inguinal hernia with a confusing distortion of the stomach

Summary A case of herniation of the transverse colon into an inguinal hernia is presented. An accompanying and related distortion and displacement of the stomach caused by traction on the gastrocolic ligament gave rise to a radiographic picture that was confused with a retrogastric mass. Surgical repair of the hernia restored both stomach and colon to their normal positions.