Malignant peritoneal mesothelioma is a rare aggres-sive tumor of the peritoneum. An increasing number of malignant mesothelioma cases have been reported in recent years. We report here a very rare case of malignant pe...Malignant peritoneal mesothelioma is a rare aggres-sive tumor of the peritoneum. An increasing number of malignant mesothelioma cases have been reported in recent years. We report here a very rare case of malignant peritoneal mesothelioma with both umbilical hernia and umbilical metastasis which is also called Sister Mary Joseph's nodule. We performed laparoscopy which showed specific laparoscopic findings, and the pathological findings of the biopsy specimen led to the diagnosis. This case was associated with umbilical her-nia which could be induced by massive ascites. A newly developed abdominal hernia should be noted as a primary symptom of malignant peritoneal mesothelioma, as shown in the present case.展开更多
BACKGROUND Inguinal hernia repair is one of the most common general surgical operations worldwide.We present a case of indirect inguinal hernia containing an expanded portosystemic shunt vessel.CASE SUMMARY We report ...BACKGROUND Inguinal hernia repair is one of the most common general surgical operations worldwide.We present a case of indirect inguinal hernia containing an expanded portosystemic shunt vessel.CASE SUMMARY We report a 72-year-old man who had a 4 cm×4 cm swelling in the right inguinal region,which disappeared with light manual pressure.Abdominal-pelvic computed tomography(CT)revealed a right inguinal hernia containing an expanded portosystemic shunt vessel,which had been noted for 7 years due to liver cirrhosis.We performed Lichtenstein’s herniorrhaphy and identified the hernia sac as being indirect and the shunt vessel existing in the extraperitoneal cavity through the internal inguinal ring.Then,we found two short branches between the expanded shunt vessel and testicular vein in the middle part of the inguinal canal and cut these branches to allow the shunt vessel to return to the extraperitoneal cavity of the abdomen.The hernia sac was returned as well.We encountered no intraoperative complications.After discharge,groin seroma requiring puncture at the outpatient clinic was observed.CONCLUSION If an inguinal hernia patient has portal hypertension,ultrasound should be used to determine the contents of the hernia.When atypical vessels are visualized,they may be shunt vessels and additional CT is recommended to ensure the selection of an adequate approach for safe hernia repair.展开更多
BACKGROUND Benign symmetric lipomatosis(BSL)was first described by Brodie in 1846 and defined as Madelung’s disease by Madelung in 1888.At present,about 400 cases have been reported worldwide.Across these cases,surgi...BACKGROUND Benign symmetric lipomatosis(BSL)was first described by Brodie in 1846 and defined as Madelung’s disease by Madelung in 1888.At present,about 400 cases have been reported worldwide.Across these cases,surgical resection remains the recommended treatment.Here we report a case of neck BSL with concomitant thick fatty deposit in the inguinal region,which concealed the signs of a right incarcerated femoral hernia.CASE SUMMARY A 69-year-old male patient was admitted to our hospital with“abdominal pain,abdominal distension,nausea-vomiting and difficult defecation for half a month”.Moreover,he had a mass in the right inguinal region for more than 10 years.An egg-sized neck mass also developed 15 years ago and had developed into a full neck enlargement 1 year later.In addition,the patient had a history of heavy alcohol consumption for more than 40 years.With the aid of computerized tomography scan,the patient was diagnosed with BSL and a low intestinal mechanical obstruction caused by a right inguinal incarcerated hernia.Under general anesthesia,right inguinal incarcerated femoral hernia loosening and tension-free hernia repair was performed.However,this patient did not receive BSL resection.After a 1-year follow-up,no recurrence of the right inguinal femoral hernia was found.Moreover,no increase in fat accumulation was found in the neck or other areas.CONCLUSION Secretive intraperitoneal fat increase may be difficult to detect,but a conservative treatment strategy can be adopted as long as it does not significantly affect the quality-of-life.展开更多
The presence of the appendix in an inguinal hernia sac has been referred to as Amyand’s hernia.Vermiform appendix located in an external hernia sac is not an uncommon condition,and the incidence of these cases is app...The presence of the appendix in an inguinal hernia sac has been referred to as Amyand’s hernia.Vermiform appendix located in an external hernia sac is not an uncommon condition,and the incidence of these cases is approximately 1%.In Amyand’s hernias,appendices are frequently found in the hernia sac;but an incarceration particularly on the left side is a very unusual sight.In this report we present 32-year-old male with Amyand’s hernia on the left side.展开更多
Meckel's diverticula incarcerated in a hernia were first described anecdotally by Littré, a French surgeon, in 1700. Meckel, a German anatomist and surgeon, explained the pathophysiology of this disease 100 y...Meckel's diverticula incarcerated in a hernia were first described anecdotally by Littré, a French surgeon, in 1700. Meckel, a German anatomist and surgeon, explained the pathophysiology of this disease 100 years later. In addition, a congenital paraduodenal mesocolic hernia, known as a Treitz hernia, is a rare cause of small bowel obstruction. These hernias are caused by an abnormal rotation of the primitive midgut, resulting in a right or left paraduodenal hernia. We treated a patient presenting with pain and diagnosed extraluminal air in the abdomen after a computed tomography examination. We performed a laparotomy and found a combination of these two seldomly occurring congenital diseases, incarceration and perforation of Meckel's diverticulum in a left paraduodenal hernia. We performed a thorough review of the literature, and this report is the first to describe a patient with a combination of these two rare conditions. We considered the case regarding the variety of terminology as well as the treatment options of these conditions.展开更多
The presence of vermiform appendix in inguinal hernia is rare and is known as Amyand＇s hernia. We report an Amyand＇s hernia, where the appendix was found in a right inguinal hernia in one male cadaver aged ninety tw...The presence of vermiform appendix in inguinal hernia is rare and is known as Amyand＇s hernia. We report an Amyand＇s hernia, where the appendix was found in a right inguinal hernia in one male cadaver aged ninety two years.展开更多
A postoperative complication after Altemeier operation, so far never reported,is described in a 42 years old mentally disabled patient with external full thickness rectal prolapse who usually had prolonged straining a...A postoperative complication after Altemeier operation, so far never reported,is described in a 42 years old mentally disabled patient with external full thickness rectal prolapse who usually had prolonged straining at defecation.After 6 d from perineal rectosigmoidectomy, the patient,was discharged free of complications.Four days later he was readmitted in emergency for stran-gulated perineal trans-anastomotic ileal hernia that occurred at home during efforts to defecate.The clinical feature required an emergency operation for repositioning the ileal loops into the abdomen,resection of the necrotic ileum,and end colostomy.The outcome of the second operation was free of complication and the patient was discharged on the 6th postoperative day.In conclusion,after Altemeier operation prolonged straining at defecation should be carefully展开更多
Background-Unusual contents of hernia sac are uncommon, but are likely to be encountered by a surgeon in his career due to the frequency of hernia repair. The aim of this study, is to present our experience of unusual...Background-Unusual contents of hernia sac are uncommon, but are likely to be encountered by a surgeon in his career due to the frequency of hernia repair. The aim of this study, is to present our experience of unusual contents in inguinal hernia sac, discuss its management and review the relevant literature with regards to others experience. Patients and methods-Retrospective study of 662 patients who underwent inguinal hernia repair over an 8 year period from 2000 to 2008 was carried out. Results-Seven patients presented with unusual contents in inguinal hernia sac;an incidence of 1.05%. Three of them had vermiform appendix, with acute appendicitis (Amyand’s Hernia) noted in one of them. All patients underwent appendicectomy with repair of hernia, with mesh being employed only in patients with normal appendix. In 2 cases urinary bladder had herniated and there was one case each of ovarian cyst and fallopian tube with ovary as its content. In all these patients hernia repair was carried out after carefully reducing the contents. Conclusion-Unusual contents of hernia may pose a surgical dilemma during hernia repair even to an experienced surgeon. Although rare, a hernia may contain vermiform appendix and exceptionally it may be acutely inflamed. Tubal and ovarian herniation in an inguinal hernia may be found in adult and perimenopausal women, though the incidence is reported to be more common in children. Urinary bladder herniation occurs with similar incidence as tubo ovarian hernia;however it requires special attention because of the risk of iatrogenic bladder injury during inguinal dissection. Though appendix as a content is dealt with by appendicectomy followed by hernioplasty, every effort should be made to preserve other organs found in the hernia sac to achieve an uneventful postoperative period.展开更多
A three-month-old boy was admitted by red, firm, painful swelling in the right groin and vomiting. Surgical repair with appendectomy was performed. We want to emphasize that if the patient has an irreducible strangula...A three-month-old boy was admitted by red, firm, painful swelling in the right groin and vomiting. Surgical repair with appendectomy was performed. We want to emphasize that if the patient has an irreducible strangulated inguinal hernia, appendix or bowel necrosis can be found in the hernia sac.展开更多
We describe a very rare case of an internal hernia associated with a Meckel’s diverticulum, which lead to the death of a young 3 year old boy. The case describes symptoms of abdominal pain and vomiting, on a backgrou...We describe a very rare case of an internal hernia associated with a Meckel’s diverticulum, which lead to the death of a young 3 year old boy. The case describes symptoms of abdominal pain and vomiting, on a background of previous intermittent abdominal pain. The possibility of small bowel obstruction was suspected, and appropriate imaging was performed. This case illustrates the need for a high index of suspicion for small bowel obstruction, with appropriate investigations and review. It also highlights the limitations of imaging modalities in identifying complications of Meckel’s diverticulum. It is important to raise awareness of this fatal cause for small bowel obstruction and to help identify suggestive imaging features, which may point towards a possible complicated Meckel’s diverticulum. Earlier recognition and diagnosis could reduce morbidity and mortality.展开更多
Purpose: Femoral hernia is a kind of ventral hernia that surgeons commonly encounter, second in frequency only to inguinal hernia. Femoral hernias often require emergency surgery because of incarceration or strangulat...Purpose: Femoral hernia is a kind of ventral hernia that surgeons commonly encounter, second in frequency only to inguinal hernia. Femoral hernias often require emergency surgery because of incarceration or strangulation of the intestine. In addition, intestinal resection may need to be considered based on intestinal viability. Definitive preoperative diagnosis and strategic planning for surgery are thus important. The surgeon should consider the operation in the context of the clinical anatomy of the abdominal cavity. Therefore the essence of the clinical anatomy and treatment of femoral hernia is described. Methods: The medical records of 38 patients who underwent femoral hernia repair between March 2006 and November 2011 were retrospectively analyzed. Results: Femoral hernioplasty was performed with original mesh repair or Ruggi’s repair plus iliopubic tract repair (or Bassini’s repair). The mean patient age was 76.7 years, and a female predominance was apparent. Twenty-four patients underwent emergency surgery with a diagnosis of incarcerated femoral hernia. Nine patients showed intestinal strangulation and underwent resection of the small intestine. Four patients developed complications. One patient died due to aspiration pneumonia. No recurrences were encountered after 6 months to 6 years of follow-up. Conclusion: Femoral hernia is an important surgical condition with high rates of incarceration/strangulation and intestinal resection. Correct preoperative diagnosis of femoral hernia and a strict operative strategy are important. The original mesh repair is effective and easy to perform.展开更多
We present a case of a 57 years old moderately obese woman with a known 12 cmincisional hernia, who subsequently developed an incarcerated acute appendicitis. The patient underwent an uneventful orthotopic liver and r...We present a case of a 57 years old moderately obese woman with a known 12 cmincisional hernia, who subsequently developed an incarcerated acute appendicitis. The patient underwent an uneventful orthotopic liver and renal transplant five years prior, and was compliant with ongoing immunosuppression without rejection. She presented with 8 hours of acute onset right lower quadrant pain, associated with anorexia, documented fevers, and nausea. Noncontrast CT demonstrated a blind-ending tubular structure with an enhancing and thickened wall within a hernia defect of the right lower quadrant. The patient underwent emergent laparotomy and a non-perforated appendix was completely excised at its base. Discussion: There have been documented reports of an acute appendicitis associated with inguinal hernias, given the eponym Amyand’s hernia. Appendicitis may present within hernias, and there should be a low threshold for radiologic assessment of its components when there is clinical doubt about the symptoms associated with the hernia. Our recommendation prompts early use of non-contrast CT scan in transplant patients with known hernias on examination and abdominal tenderness over the renal allograft considering the high risk of perforation of acute appendicitis and strangulation.展开更多
AIM: To determine the effect of ethnicity on the severity of reflux esophagitis (RE) and its complications. METHODS: A retrospective search of the endoscopy database at the University of Florida Health Science Center/...AIM: To determine the effect of ethnicity on the severity of reflux esophagitis (RE) and its complications. METHODS: A retrospective search of the endoscopy database at the University of Florida Health Science Center/Jacksonville for all cases of reflux esophagitis and its complications from January 1 to March 31, 2001 was performed. Inclusion criteria were endoscopic evidence of esophagitis using the LA classif ication, reflux related complications and self-reported ethnicity. The data obtained included esophagitis grade, presence of a hiatal hernia, esophageal ulcer, stricture and Barrett's esophagus, and endoscopy indication. RESULTS: The search identified 259 patients with RE or its complications, of which 171 were non-Hispanic whites and 88 were African Americans. The mean ages and male/female ratios were similar in the two groups. RE grade, esophageal ulcer, stricture and hiatal hernia frequency were likewise similar in the groups. Barrett's esophagus was present more often in non-Hispanic whites than in African Americans (15.8% vs 4.5%; P < 0.01). Heartburn was a more frequent indication for endoscopy in non-Hispanic whites with erosive esophagitis than in African Americans (28.1% vs 7.9%; P < 0.001). CONCLUSION: Distribution of RE grade and frequency of reflux-related esophageal ulcer, stricture andhiatal hernia are similar in non-Hispanic whites and African Americans. Heartburn was more frequently and nausea/vomiting less frequently reported as the primary endoscopic indication in non-Hispanic whites compared with African Americans with erosive esophagitis or its complications. African Americans have a decreased prevalence of Barrett's esophagus compared with non-Hispanic whites.展开更多
Meckel's diverticulum is a very common congenital anomaly of the gastrointestinal tract but many cases remain asymptomatic and are diagnosed incidentally during laparoscopic or other surgical procedures. Cases of ...Meckel's diverticulum is a very common congenital anomaly of the gastrointestinal tract but many cases remain asymptomatic and are diagnosed incidentally during laparoscopic or other surgical procedures. Cases of femoral hernia involving Meckel's diverticulum are rare, with less than 50 cases reported in the literature since Littre published the first description of this coincident condition over 300 years ago. While all true "Littre's hernias" contain a Meckel's diverticulum, the involved anatomical sites are various, the most common being the inner groin(inguinal), the outer groin(femoral), and the belly button(umbilical). Complications of Littre's hernias include incarceration, strangulation, necrosis, and perforation. Herein, we describe a case of Littre's hernia that involved an incarcerated Meckel's diverticulum in a femoral hernia that was diagnosed upon investigation of symptomology manifesting from perforation and was successfully managed by surgical resection with stapler devices.展开更多
文摘Malignant peritoneal mesothelioma is a rare aggres-sive tumor of the peritoneum. An increasing number of malignant mesothelioma cases have been reported in recent years. We report here a very rare case of malignant peritoneal mesothelioma with both umbilical hernia and umbilical metastasis which is also called Sister Mary Joseph's nodule. We performed laparoscopy which showed specific laparoscopic findings, and the pathological findings of the biopsy specimen led to the diagnosis. This case was associated with umbilical her-nia which could be induced by massive ascites. A newly developed abdominal hernia should be noted as a primary symptom of malignant peritoneal mesothelioma, as shown in the present case.
文摘BACKGROUND Inguinal hernia repair is one of the most common general surgical operations worldwide.We present a case of indirect inguinal hernia containing an expanded portosystemic shunt vessel.CASE SUMMARY We report a 72-year-old man who had a 4 cm×4 cm swelling in the right inguinal region,which disappeared with light manual pressure.Abdominal-pelvic computed tomography(CT)revealed a right inguinal hernia containing an expanded portosystemic shunt vessel,which had been noted for 7 years due to liver cirrhosis.We performed Lichtenstein’s herniorrhaphy and identified the hernia sac as being indirect and the shunt vessel existing in the extraperitoneal cavity through the internal inguinal ring.Then,we found two short branches between the expanded shunt vessel and testicular vein in the middle part of the inguinal canal and cut these branches to allow the shunt vessel to return to the extraperitoneal cavity of the abdomen.The hernia sac was returned as well.We encountered no intraoperative complications.After discharge,groin seroma requiring puncture at the outpatient clinic was observed.CONCLUSION If an inguinal hernia patient has portal hypertension,ultrasound should be used to determine the contents of the hernia.When atypical vessels are visualized,they may be shunt vessels and additional CT is recommended to ensure the selection of an adequate approach for safe hernia repair.
文摘BACKGROUND Benign symmetric lipomatosis(BSL)was first described by Brodie in 1846 and defined as Madelung’s disease by Madelung in 1888.At present,about 400 cases have been reported worldwide.Across these cases,surgical resection remains the recommended treatment.Here we report a case of neck BSL with concomitant thick fatty deposit in the inguinal region,which concealed the signs of a right incarcerated femoral hernia.CASE SUMMARY A 69-year-old male patient was admitted to our hospital with“abdominal pain,abdominal distension,nausea-vomiting and difficult defecation for half a month”.Moreover,he had a mass in the right inguinal region for more than 10 years.An egg-sized neck mass also developed 15 years ago and had developed into a full neck enlargement 1 year later.In addition,the patient had a history of heavy alcohol consumption for more than 40 years.With the aid of computerized tomography scan,the patient was diagnosed with BSL and a low intestinal mechanical obstruction caused by a right inguinal incarcerated hernia.Under general anesthesia,right inguinal incarcerated femoral hernia loosening and tension-free hernia repair was performed.However,this patient did not receive BSL resection.After a 1-year follow-up,no recurrence of the right inguinal femoral hernia was found.Moreover,no increase in fat accumulation was found in the neck or other areas.CONCLUSION Secretive intraperitoneal fat increase may be difficult to detect,but a conservative treatment strategy can be adopted as long as it does not significantly affect the quality-of-life.
文摘The presence of the appendix in an inguinal hernia sac has been referred to as Amyand’s hernia.Vermiform appendix located in an external hernia sac is not an uncommon condition,and the incidence of these cases is approximately 1%.In Amyand’s hernias,appendices are frequently found in the hernia sac;but an incarceration particularly on the left side is a very unusual sight.In this report we present 32-year-old male with Amyand’s hernia on the left side.
文摘Meckel's diverticula incarcerated in a hernia were first described anecdotally by Littré, a French surgeon, in 1700. Meckel, a German anatomist and surgeon, explained the pathophysiology of this disease 100 years later. In addition, a congenital paraduodenal mesocolic hernia, known as a Treitz hernia, is a rare cause of small bowel obstruction. These hernias are caused by an abnormal rotation of the primitive midgut, resulting in a right or left paraduodenal hernia. We treated a patient presenting with pain and diagnosed extraluminal air in the abdomen after a computed tomography examination. We performed a laparotomy and found a combination of these two seldomly occurring congenital diseases, incarceration and perforation of Meckel's diverticulum in a left paraduodenal hernia. We performed a thorough review of the literature, and this report is the first to describe a patient with a combination of these two rare conditions. We considered the case regarding the variety of terminology as well as the treatment options of these conditions.
文摘The presence of vermiform appendix in inguinal hernia is rare and is known as Amyand＇s hernia. We report an Amyand＇s hernia, where the appendix was found in a right inguinal hernia in one male cadaver aged ninety two years.
文摘A postoperative complication after Altemeier operation, so far never reported,is described in a 42 years old mentally disabled patient with external full thickness rectal prolapse who usually had prolonged straining at defecation.After 6 d from perineal rectosigmoidectomy, the patient,was discharged free of complications.Four days later he was readmitted in emergency for stran-gulated perineal trans-anastomotic ileal hernia that occurred at home during efforts to defecate.The clinical feature required an emergency operation for repositioning the ileal loops into the abdomen,resection of the necrotic ileum,and end colostomy.The outcome of the second operation was free of complication and the patient was discharged on the 6th postoperative day.In conclusion,after Altemeier operation prolonged straining at defecation should be carefully
文摘Background-Unusual contents of hernia sac are uncommon, but are likely to be encountered by a surgeon in his career due to the frequency of hernia repair. The aim of this study, is to present our experience of unusual contents in inguinal hernia sac, discuss its management and review the relevant literature with regards to others experience. Patients and methods-Retrospective study of 662 patients who underwent inguinal hernia repair over an 8 year period from 2000 to 2008 was carried out. Results-Seven patients presented with unusual contents in inguinal hernia sac;an incidence of 1.05%. Three of them had vermiform appendix, with acute appendicitis (Amyand’s Hernia) noted in one of them. All patients underwent appendicectomy with repair of hernia, with mesh being employed only in patients with normal appendix. In 2 cases urinary bladder had herniated and there was one case each of ovarian cyst and fallopian tube with ovary as its content. In all these patients hernia repair was carried out after carefully reducing the contents. Conclusion-Unusual contents of hernia may pose a surgical dilemma during hernia repair even to an experienced surgeon. Although rare, a hernia may contain vermiform appendix and exceptionally it may be acutely inflamed. Tubal and ovarian herniation in an inguinal hernia may be found in adult and perimenopausal women, though the incidence is reported to be more common in children. Urinary bladder herniation occurs with similar incidence as tubo ovarian hernia;however it requires special attention because of the risk of iatrogenic bladder injury during inguinal dissection. Though appendix as a content is dealt with by appendicectomy followed by hernioplasty, every effort should be made to preserve other organs found in the hernia sac to achieve an uneventful postoperative period.
文摘A three-month-old boy was admitted by red, firm, painful swelling in the right groin and vomiting. Surgical repair with appendectomy was performed. We want to emphasize that if the patient has an irreducible strangulated inguinal hernia, appendix or bowel necrosis can be found in the hernia sac.
文摘We describe a very rare case of an internal hernia associated with a Meckel’s diverticulum, which lead to the death of a young 3 year old boy. The case describes symptoms of abdominal pain and vomiting, on a background of previous intermittent abdominal pain. The possibility of small bowel obstruction was suspected, and appropriate imaging was performed. This case illustrates the need for a high index of suspicion for small bowel obstruction, with appropriate investigations and review. It also highlights the limitations of imaging modalities in identifying complications of Meckel’s diverticulum. It is important to raise awareness of this fatal cause for small bowel obstruction and to help identify suggestive imaging features, which may point towards a possible complicated Meckel’s diverticulum. Earlier recognition and diagnosis could reduce morbidity and mortality.
文摘Purpose: Femoral hernia is a kind of ventral hernia that surgeons commonly encounter, second in frequency only to inguinal hernia. Femoral hernias often require emergency surgery because of incarceration or strangulation of the intestine. In addition, intestinal resection may need to be considered based on intestinal viability. Definitive preoperative diagnosis and strategic planning for surgery are thus important. The surgeon should consider the operation in the context of the clinical anatomy of the abdominal cavity. Therefore the essence of the clinical anatomy and treatment of femoral hernia is described. Methods: The medical records of 38 patients who underwent femoral hernia repair between March 2006 and November 2011 were retrospectively analyzed. Results: Femoral hernioplasty was performed with original mesh repair or Ruggi’s repair plus iliopubic tract repair (or Bassini’s repair). The mean patient age was 76.7 years, and a female predominance was apparent. Twenty-four patients underwent emergency surgery with a diagnosis of incarcerated femoral hernia. Nine patients showed intestinal strangulation and underwent resection of the small intestine. Four patients developed complications. One patient died due to aspiration pneumonia. No recurrences were encountered after 6 months to 6 years of follow-up. Conclusion: Femoral hernia is an important surgical condition with high rates of incarceration/strangulation and intestinal resection. Correct preoperative diagnosis of femoral hernia and a strict operative strategy are important. The original mesh repair is effective and easy to perform.
文摘We present a case of a 57 years old moderately obese woman with a known 12 cmincisional hernia, who subsequently developed an incarcerated acute appendicitis. The patient underwent an uneventful orthotopic liver and renal transplant five years prior, and was compliant with ongoing immunosuppression without rejection. She presented with 8 hours of acute onset right lower quadrant pain, associated with anorexia, documented fevers, and nausea. Noncontrast CT demonstrated a blind-ending tubular structure with an enhancing and thickened wall within a hernia defect of the right lower quadrant. The patient underwent emergent laparotomy and a non-perforated appendix was completely excised at its base. Discussion: There have been documented reports of an acute appendicitis associated with inguinal hernias, given the eponym Amyand’s hernia. Appendicitis may present within hernias, and there should be a low threshold for radiologic assessment of its components when there is clinical doubt about the symptoms associated with the hernia. Our recommendation prompts early use of non-contrast CT scan in transplant patients with known hernias on examination and abdominal tenderness over the renal allograft considering the high risk of perforation of acute appendicitis and strangulation.
文摘AIM: To determine the effect of ethnicity on the severity of reflux esophagitis (RE) and its complications. METHODS: A retrospective search of the endoscopy database at the University of Florida Health Science Center/Jacksonville for all cases of reflux esophagitis and its complications from January 1 to March 31, 2001 was performed. Inclusion criteria were endoscopic evidence of esophagitis using the LA classif ication, reflux related complications and self-reported ethnicity. The data obtained included esophagitis grade, presence of a hiatal hernia, esophageal ulcer, stricture and Barrett's esophagus, and endoscopy indication. RESULTS: The search identified 259 patients with RE or its complications, of which 171 were non-Hispanic whites and 88 were African Americans. The mean ages and male/female ratios were similar in the two groups. RE grade, esophageal ulcer, stricture and hiatal hernia frequency were likewise similar in the groups. Barrett's esophagus was present more often in non-Hispanic whites than in African Americans (15.8% vs 4.5%; P < 0.01). Heartburn was a more frequent indication for endoscopy in non-Hispanic whites with erosive esophagitis than in African Americans (28.1% vs 7.9%; P < 0.001). CONCLUSION: Distribution of RE grade and frequency of reflux-related esophageal ulcer, stricture andhiatal hernia are similar in non-Hispanic whites and African Americans. Heartburn was more frequently and nausea/vomiting less frequently reported as the primary endoscopic indication in non-Hispanic whites compared with African Americans with erosive esophagitis or its complications. African Americans have a decreased prevalence of Barrett's esophagus compared with non-Hispanic whites.
文摘Meckel's diverticulum is a very common congenital anomaly of the gastrointestinal tract but many cases remain asymptomatic and are diagnosed incidentally during laparoscopic or other surgical procedures. Cases of femoral hernia involving Meckel's diverticulum are rare, with less than 50 cases reported in the literature since Littre published the first description of this coincident condition over 300 years ago. While all true "Littre's hernias" contain a Meckel's diverticulum, the involved anatomical sites are various, the most common being the inner groin(inguinal), the outer groin(femoral), and the belly button(umbilical). Complications of Littre's hernias include incarceration, strangulation, necrosis, and perforation. Herein, we describe a case of Littre's hernia that involved an incarcerated Meckel's diverticulum in a femoral hernia that was diagnosed upon investigation of symptomology manifesting from perforation and was successfully managed by surgical resection with stapler devices.
