THE stomach is a rare occupant of the sac of an inguinal hernia and is yet more rarely found in a femoral hernia. The discovery of the stomach in the inguinal hernia of a patient of ours led to a prolonged but fascinating search of world literature in an effort to trace all the recorded cases. Towards the end of this search one of us was asked to see a patient with a very large femoral hernia and a barium meal confirmed our suspicions that the stomach might be in the sac. We are able, therefore, to report two new cases-one of stomach in an inguinal hernia and one of stomach in a femoral hernia, together with a summary of the cases already published. STOMACH IN INGUINAL HERNIA CASE REPORTHISTORY.--. A., a man of 61, was sent into hospital by his doctor as a case of strangulated left inguinal hernia. He was a house painter and had had a left inguinal hernia for about forty years. He had worn a truss intermittently. There was no history of dyspepsia nor had he noticed any alteration in the size of his large hernia after eating or drinking. The hernia had-always been reducible up to the day before admission to hospital.He had only worked for one month during the past year because of bronchitis and he had been in bed for the last two months with dyspncea and oedema of the feet. Six weeks previously he had a right-sided pulmonary embolus.Two days before admission he vomited dark fluid on about ten occasions but had a normal bowel action. The day before admission he vomited continuously and was not able to reduce his hernia, which became painful. There was no abdominal pain.ON EXAMINATION.-A frail looking man, who was pale, cyanosed, very dyspnoeic, and constantly vomiting. No edema of legs.Abdomen : Markedly distended and tense. Very large left scrota1 hernia, which was neither tense nor tender and varied in size as he strained to vomit. The hernia could not be reduced.Chest : Very poor expansion, with scattered rhonchi and basal riles.Cardiovascular System: The pulse was of poor volume. Rhythm regular and apex beat in the anterior axillary line. B.P. 120/80.TREATMENT.-A Ryle's tube was passed and aspirated 137 02. (3.89 1.) of dark fluid, smelli?g of bile, and some of which had the 'coffee grounds appearance. The aspiration produced a dramatic improvement, the abdomen being greatly reduced in size and quite lax. The hernia could be reduced and the left external ring was found to admit three fingers and the right two. He was much less dyspnoeic and the pulse volume improved.He was put on an intravenous drip and gastric suction till the fourth day, when the aspirations were of such quantity and quality that oral feeding was commenced. A straight radiograph of the abdomen had not shown any fluid levels. Three days later, as he was feeling nauseated, I tube was passed and a litre of brown fluid aspirated It was then thought that he had wic stenosis rather than a mechanical obstruction, and ?m the stomach. the hernia appeared to be unrelated to the symptoms for which he was admitted. However, the following was reported aft...
EDITORIAL SYNOPSIS This is a study based on 587 patients with acute bleeding from the upper alimentary tract. After excluding 17 with carcinoma of the stomach and 11 with oesophageal varices, the overall mortality was 7-7 %. No fewer than 51 % of patients were over 60 years of age. Emergency surgery was needed in 14-3 %. From follow-up studies it is concluded that elective gastrectomy should be performed in patients with gastric ulcer in whom bleeding ceases after admission. MATERIALDuring the four-year period 1957-60 there were 618 admissions to this unit for the treatment of haemorrhage from the upper alimentary tract. Some patients were admitted on more than one occasion and the total number of patients involved was 587 (Table I). Of this total, 11 (1.9%) were found to be bleeding from oesophageal varices and 17 (2-9 %) from carcinoma of the stomach. Of the remaining 559 patients who are the subject of more detailed study, 285 (51 %) were over the age of 60 and 232 (42%) were women. The age distiibution of the cases is shown in Figure 1. DUODENAL ULCER There were 210 patients in the series found to have a duodenal ulcer: 88 (42%) were over the age of 60 and 47 (22-4 %) were women. There were 10 deaths (4-8 %), the mortality rising to 10% over the age of 60 years. Emergency surgery was undertaken in 25 cases (11-9%), of which five were women, and there were three deaths.GASTRIC ULCER There were 155 patients bleeding from a gastric ulcer and of these 98 (63 5%) were over the age of 60, and 77 (49-5%) were women.There were 26 deaths (168 Y%), the mortality rising to 24-5 % over the age of 60 years. Emergency surgery was undertaken in 51 cases (33 %), of which 23 were women, and there were nine deaths.
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