Gastroenterology and Hepatology Services

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    Spontaneous right-sided diaphragmatic hernia: a rare cause of small bowel obstruction.
    (Cureus, 2024-04-29) Mohamedahmed, Ali Yasen
    Abstract: Diaphragmatic hernia (DH) is an uncommon cause of small bowel obstruction (SBO), particularly in the absence of trauma. This rarity can pose a diagnostic challenge, leading to significant delays in treatment and increased morbidity. We report a case of a 79-year-old male patient who presented with acute signs of small bowel obstruction. The patient had no reported history of trauma. Computed tomography (CT) of the abdomen revealed a diaphragmatic hernia causing small bowel obstruction. The patient underwent an initial laparoscopy, which was converted to laparotomy, small bowel resection, and subsequent hernia repair. The patient made a good recovery, and two weeks after his initial presentation, he was discharged home. This case highlights the importance of considering diaphragmatic hernia in differential diagnosis for small bowel obstruction, even in the absence of trauma. Introduction: A diaphragmatic hernia (DH) occurs when abdominal contents protrude into the thoracic cavity due to a defect within the diaphragm [1]. DH can be congenital or acquired. Congenital diaphragmatic hernia (CDH) is the most common type and refers to a developmental defect of the diaphragm. It typically presents in newborns with respiratory distress in the first few hours of life. The incidence of CDH varies significantly across the population and is estimated to be between 0.8 and 5/10,000 births. It is slightly more common in males than in females [2]. Left-sided CDH is more common than right-sided CDH and accounts for about 75% of cases. However, right-sided CDH is often associated with higher morbidity and mortality [3]. CDH can be classified into two types: Morgagni hernia and Bochdalek hernia. Bochdalek hernias are more common and present as a defect in the left posterolateral diaphragm, while Morgagni hernias present as an anterior defect [4]. Acquired diaphragmatic hernias (ADH) occur most often secondary to blunt or penetrating trauma to the abdomen, which results in diaphragmatic rupture [1]. However, ADH can also be iatrogenic following surgery. Diaphragmatic injuries are generally uncommon and represent less than 1% of all traumatic injuries [5]. Diaphragmatic rupture from trauma occurs in about 0.8%-3.6% of cases, with incidents of herniation following such injuries being relatively low [6,7]. The left side is more commonly affected than the right side in ADH. Injury to the left side of the hemidiaphragm is estimated to occur about three times more often than the right side [8]. We report a case of a right-sided anterior diaphragmatic hernia with no associated history of trauma. Case Presentation: A 79-year-old male presented to Queen's Hospital Burton, United Kingdom, complaining of two days of increasing pain in the upper right quadrant of his abdomen, vomiting, and constipation. He had no history of trauma and had previously experienced gastric acid reflux and hypertension. On admission, he was hemodynamically stable, but there was tenderness and guarding in the upper abdomen. Blood tests revealed a raised lactate level of 4.7 mmol/L, a white blood cell count (WCC) of 14.7×109/L, and a C-reactive protein (CRP) level of 187 mg/L. The possible diagnoses were a perforated peptic ulcer or acute cholecystitis. A computed tomography (CT) scan of his abdomen and pelvis revealed a right-sided anterior diaphragmatic hernia, causing a small bowel obstruction (SBO) (Figure 1).
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    Antibiotic Prophylaxis for ERCP.
    (2024-04-12) Menon, Shyam
    No abstract available.
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    Reply to Beaton et al.
    (Wiley online library, 2014-01-16) Haboubi, N; Hill, J; Williams, Graham
    No abstract available
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    Twitter debate: should upper gastrointestinal bleeding training and certification be formalised?
    (BMJ Journals, 2024-04-05) Veitch, Andrew
    This #FGDebate explored the rationale for a formalised pathway for training and certification for the endoscopic management of AUGIB but it remains unclear as to whether trainees, trainers, endoscopy units, training programme directors and JAG will be to circumvent all the challenges discussed. Patients with AUGIB might have a reasonable expectation that the clinician managing their bleeding episode, particularly as part of an out of hours emergency service, should be able to demonstrate competence. We believe that all stakeholders should be consulted prior to implementing a formal certification process.