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Thu Nov 5 04:14:42 GMT 2009

Is this a paraesophageal hh or mimicking one due to the paralyzed diaphragm.dn
------Original Message------
From: Errington Thompson
Sender: trauma-list-bounces at trauma.org
To: 'Trauma-List [TRAUMA.ORG]'
ReplyTo: Trauma-List [TRAUMA.ORG]
Subject: gastric issue
Sent: Nov 4, 2009 22:23

I have a 60 year old male whose only previous operation was a
mini-thoracotomy for pacemaker lead placement. For the last 6 - 8 months (3
years after the pacemaker), the patient has been unable to eat as much as he
normally did. He has lost weight because he can't eat like he should. He has
lost about 50 lbs (he is now down to 250lbs). He got an upper GI which shows
the distal portion of his stomach flipped up on top of the proximal portion
causing a pseudo-obstruction. The dye does pass thru the stomach slowly and
into the duodenum. CT of the abd - reveals the same thing. Nothing else. He
also had a snuff test which was done under flouro which shows that his left
hemidiaphragm is paralysed. 

Any thoughts?

Errington C. Thompson, MD, FACS, FCCM
Trauma/Critical Care
Talk Show Host - WPEK 880 AM
www.whereistheoutrage.net

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