Mucosal diaphragms of the gastric antrum in adults

Fifty-six adult patients with antral mucosal diaphragms have been reported in the literature. These abnormalities are located at the antrum of the stomach at variable distances from the pylorus and are composed of mucosa which encloses a membrane of submucosa without involvement of muscularis or serosa. They may be congenital in origin or secondary to chronic peptic ulcer disease. Symptoms are episodic and obstructive in nature and imply a diaphragmatic aperture of less than 1 centimeter. The diagnosis relies on the history, contrast roentgenologic studies and endoscopic findings. Unfortunately, the changes observed are many times either overlooked or misinterpreted and, not infrequently, the diagnosis will be made at laparotomy by gastrotomy. Surgical treatment is uniformly successful in symptomatic patients and is recommended for patients who have obstructive symptoms. The surgical procedures have been variable but as long as the obstruction is alleviated, it appears that there is no preference for one particular operation. When complicated with ulcer disease, a complementary ulcer operation is recommended. Antral diaphragm, although rare, should be considered in the differential diagnosis of upper gastrointestinal obstructive symptoms in patients of any age.

Abdominal wound dehiscence and evisceration: contributing factors and improved mortality

a retrospective review of 18,120 abdominal procedures produced 70 patients who developed abdominal wound dehiscence and/or evisceration. Our mortality rate of 5.5% was considerably lower than the previously reported high mortality rates in patients with these complications. Surprisingly, the mortality rate of patients with evisceration was the same as those patients with dehiscence only. The predominant factor association with wound dehiscence in our group of patients was exogenous obesity.