Perforation of gastric ulcer associated with paraesophageal hernia causing diffuse peritonitis

BACKGROUND/AIMS: Free peritoneal perforation of a gastric ulcer associated with paraesophageal hernia causing diffuse peritonitis is an extremely rare event. METHODS: Two new cases of this rare condition and the specificities of management are described. RESULTS: One patient recovered well after surgery, while the other died with signs of persisting sepsis and multiple system organ failure. CONCLUSION: In the wide spectrum of complications related to paraesophageal hernia, free peritoneal perforation of an associated ulcer seems to be one of the gravest. Early elective repair of the paraesophageal hernia is justified.     

Perforation of gastric cancer]

An analysis of treatment of 85 patients with perforating cancerous tumor of the stomach is presented. Males--63, females--22. The patients' age ranged from 32 to 85 years. Sixty seven patients were operatd upon, 35 of them died. Eighteen patients were not subjected to surgery, all of them died. The following variants of complications associated with gastric cancer are noted: cancer perforation--in 32, hemorrhage and the perforation--in 35, perforation and hemorrhage occurred simultaneously--in 15, perforation followed by hemorrhage--in 3. High mortality rate was due to grave patients' condition, difficulties and errors of diagnosis, inadequacy of therapeutic measures, late operative interventions. The results obtained are described.     

Perforation of a giant duodenal ulcer]

The results of operative treatment of 20 patients with a perforated giant duodenal ulcer have been analysed. The difficulties associated with closure of a perforated hole and duodenal stump management in performance of gastric resection were noted. It was established that closure of a giant perforated duodenal ulcer was a palliative measure, which saved the patients from death but entailed the disease recurrence requiring reoperation.     

A case of inguinal bladder hernia]

Pyelocystography on a 61-year-old man with a ureteral stone incidentally revealed the inguinal bladder hernia. He had no complaint of urinary disturbances. During the operation for the hernia, we could not find the bladder without transurethral saline instillation; only the intestine covered with peritoneum was in sight. Utility of preoperative cystography on the cases of inguinal hernia is discussed.     

Principles of surgical treatment of inguinal hernia]

The work is based on the analysis of the results of surgical treatment of inguinal hernias in 198 patients in the period from 1983 to 1988. Most of the patients were over 60 years of age, a lesser number were under 35 (11.1%). Hernias of a complicated and transitional form were found in 174 patients and mild forms only in 24 patients. The hernias were recurrent in 45 and sliding in 59 patients. Proceeding from the specific features of the surgical anatomy of the inguinal space, all patients, irrespective of their age and the form and type of the hernia, were treated by operation with plastics of the opening of the hernial sac to the back of the elements of the spermatic cord. The only exception were patients under 35 years of age with a mild form of oblique inguinal hernia, in which case variants of operations with enforcement of the anterior wall of the inguinal canal were carried out. The Schouldies and McVay methods were preferred, in recurrent and all complicated forms of inguinal hernias they were combined with operations of the Endrews and Postempsky types; the last named was mostly used in individuals over 60 years of age and in repeatedly recurring hernias. The late-term results were studied in follow-up periods of 2 to 7 years in 176 patients in the group of 198 individuals who were operated on. In 77.7% of them 3-6 years have passed since the operation. Almost all patients of mature age have resumed their occupation, there are complaints neither of pain at the site of the operation nor of changes in sexual potency. Recurrent hernias were not detected.     

Surgical and experimental-biological aspects of inguinal hernia]

In experiment on 57 animals the method of plasty of anterior wall of inguinal channel by forming of the aponeurosis of m. abdominis obliqus ext. and suturing together the aponeurotic edges was simulated. The results of surgical correction of inguinal hernia in 257 patients were analysed. The correlational connection of immunological changes in organism with the degree of destructive changes of hematotesticular barrier (HTB) and spermatogenic epithelium was established. Considering the testicle autoimmunity the application of protective operative methods of pharmacological defense of HTB and spermatogenic epithelium are proposed.     

A new method for inguinal hernia repair]

We report 60 operations for groin hernia which were performed with Artschvadze's new method. 45 operations were carried out under local anaesthesia, 15 under general anaesthesia. 46 primary and 14 recurrent hernias were included in the study. During a follow-up of 6-30 months no recurrences were seen.