Fig 3 - uploaded by Salomone Di Saverio
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(A) Computed tomography showing posterior intrathoracic herniation, just behind the heart, of more than half of the stomach (white thick arrow) and the omentum, small bowel loops (white thin arrows), and transverse colon (white arrowhead), with no evidence of free air or fluid within the hernia sac. (B) A plain anteroposterior view clearly shows a waist-like constriction (the " collar sign " ) in the midline (black arrows) corresponding to the oesophageal hiatus on axial images (C; broken white arrows). A large segment of colon, impacted with stools, was completely incarcerated in the chest, and surprisingly the transverse colon reached the anatomical level of the manubrium sterni, just above the aortic arch and overlapping with the base of the neck. Thus, a diagnosis of symptomatic giant type IV hiatus hernia with a large segment of colon incarcerated in the chest was made
Source publication
An 89 year old woman with chronic obstructive pulmonary disease presented to the emergency department with worsening shortness of breath (87% oxygen saturation in room air), retrosternal chest pain, mild abdominal pain, and subacute partial bowel obstruction over the past six days. On physical examination she was dehydrated and she had tachycardia...
Citations
... Many studies reported upper GI disorder such as gastroesophageal reflux disease, esophageal spasm, peptic ulcer disease, drug-induced esophagitis/gastritis, and cholecystitis as an etiology in developing chest pain (5)(6)(7)(8). There are few elderly case reports to associate lower GI diseases with chest pain (9,10). ...
The greatest advantages of laparoscopy, when compared to open surgery, are already recognized: less post-operative pain, faster and better postoperative recovery, shorter hospital stay, earlier discharge, and earlier return to normal daily, activity, such as physical exercise, and cost of the hospital stay. Nevertheless, laparoscopy today represents the undisputed standard of care for the treatment of elective surgery worldwide, and laparoscopy for emergency surgery is still considered too challenging and is not usually recommended. There are numerous reasons which include technical difficulties associated with diffuse peritonitis, large purulent collections and diffuse adhesions, anesthetic concerns in the presence or comorbidity and older patients, and last but not least, laparoscopic skills of the operator, and the limited operating room resources during night time and after-hours shifts. We have, therefore, reviewed the most recent scientific literature on advances in laparoscopy for acute care surgery and trauma in order to demonstrate the current indications and outcomes associated with a laparoscopic approach to the treatment of the most common emergency surgical conditions.
Acute chest pain is one of the most frequent requests for seeking medical attention in the emergency department. For patients suffering from chest pain, ruling out cardiovascular diseases is mandatory. Nevertheless, chest pain of noncardiac origin is frequent and includes a large variety of clinical conditions, such as parenchymal, pleural, musculoskeletal, oesophageal, psychogenic or neurologic diseases. Various imaging modalities, along with clinical and hematologic evaluation, are needed to evaluate and characterize such heterogeneous group of pathologies. Chest radiography (CXR) is almost always the first imaging technique used to define the underlying disease (i.e. parenchymal, pleural, musculoskeletal). Nevertheless, given its non-specific findings, further imaging techniques are frequently requested. A pivotal role is played by computed tomography (CT), the latter capable of determining location, nature and extent of various diseases. Ultrasonography (US), magnetic resonance imaging (MRI) and positron emission tomography (PET) play a secondary role for the evaluation of acute chest pain, being most frequently used in specific settings.
