Castaing syndrome

Castaing syndrome - a combination of hiatal hernia, chronic cholecystitis and duodenal ulcer

Diagnosis is difficult. Patients usually are treated as suffering from a stomach ulcer, cholecystitis, angina or pleurisy. Known erroneous puncture of the pleural cavity and puncture or drainage of a hollow organ (in his practice saw as twice the drainage pipe was installed in the bottom of the stomach) in connection with suspected exudative pleurisy.
Triad Senta: hiatal hernia, gallstone disease, diverticulosis of the colon

Diagnosis is difficult. Patients usually are brand viagra online treated as suffering from gallstone disease or chronic colitis. Detected more frequently during surgery for acute calculous cholecystitis or acute intestinal obstruction in the infringement of the colon in the hernia.

X-ray examination can help. But it helped us make the correct diagnosis and to select the optimal tactics for patients admitted to the clinic of acute destructive cholecystitis. The patient performed cholecystectomy, removal of irreducible hernia esophageal opening with resection of the transverse colon and descending gut, herniorrhaphy with ezofagofundoplikatsiey Nissen.

A crucial role in diagnosis is x-ray examination. The diagnosis of hiatal hernia is the main diagnostic method - x-ray. Quincke position (feet above head). Direct symptoms of hiatal hernia include swelling of the cardia and body of the stomach, increased mobility of the abdominal esophagus, the lack of smoothness of the angle-branch block, anastaltic movement of the esophagus (throat dance), prolapsed mucosa of the esophagus into the stomach. Herniation of up to 3 cm in diameter are regarded as small, from 3 to 8 - as the average and more than 8 cm - as large.

The second highest information content are endoscopic approaches, which in combination with X-ray examination can bring the percentage of detection of the disease to 98.5%. Characterized by:

1) decreasing the distance from the front incisors to the cardia;

2) the presence of hernial cavity;

3) the presence of "second input" into the stomach;

4) dehiscence or partial closure of the cardia;

5) transkardialnye migration slizitoy shell;

6) gastrezofagealny reflux;

7) signs of hernia gastritis and reflux esophagitis (RE);

8) the presence of contractile ring;

9) the presence of foci of epithelial ectomy - "Barrett's esophagus.

Vnutripischevodnaya pH-metry reveals ER in 89% of patients. Manometric method for determining the state of NPCs. With paraesophageal hernia type proposed diagnostic thoracoscopy.

Laboratory studies have played a secondary role. A significant amount of patients with esophageal hernia and esophagitis suffer generic levitra as duodenal ulcer or gastric hypersecretion characteristic of peptic ulcer disease. The heavier esophagitis and associated disorders, more often in patients with concomitant ulcer is 12 duodenal ulcer. In order to clarify the diagnosis in doubtful cases, the test is performed Bernstein. At the lower end of the esophagus and gastric tube is introduced through it pours 0.1% solution of hydrochloric acid so that the patient could not see. The introduction of hydrochloric acid causes the patient's symptoms of esophagitis.

Treatment. Conservative treatment with a sliding hernia with esophagitis usually does not bring much success. Necessary to exclude tobacco, coffee, alcohol. Eat small meals should be, it must contain a minimum amount of fat remaining in the stomach for a long time. The rise of the cerebral end of the bed reduces the possibility of occurrence of reflux. Medication antiulcer therapy is appropriate, although its efficiency is low. Antiseptics are contraindicated because they increase congestion in the stomach. The indications for surgery are: failure of conservative therapy and complications (esophagitis, impaired patency of the esophagus, severe deformity of the stomach, etc.).

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