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Montel DB, Bronzeado LLC, Oliveira IRC, Araújo GV, Carvalho BBM, Santos BC, Lima DMV, Rangel DA, Venkatesh SK, Albuquerque KS, Lewin F. Early Postoperative Gastrointestinal Tract Evaluation: Expected Findings and Complications. Radiographics 2024; 44:e230198. [PMID: 39088362 DOI: 10.1148/rg.230198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Affiliation(s)
- Daniel B Montel
- From the Department of Radiology, Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Dr Cesário Mota Júnior, 112 Vila Buarque, São Paulo, SP 01221-010, Brazil (D.B.M., L.L.C.B., I.R.C.O., G.V.A., B.B.M.C., B.C.S., D.A.R., F.L.); Department of Surgery, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, Brazil (D.M.V.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, Hospital Samaritano, São Paulo, Brazil (K.S.A)
| | - Louise L C Bronzeado
- From the Department of Radiology, Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Dr Cesário Mota Júnior, 112 Vila Buarque, São Paulo, SP 01221-010, Brazil (D.B.M., L.L.C.B., I.R.C.O., G.V.A., B.B.M.C., B.C.S., D.A.R., F.L.); Department of Surgery, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, Brazil (D.M.V.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, Hospital Samaritano, São Paulo, Brazil (K.S.A)
| | - Igor R C Oliveira
- From the Department of Radiology, Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Dr Cesário Mota Júnior, 112 Vila Buarque, São Paulo, SP 01221-010, Brazil (D.B.M., L.L.C.B., I.R.C.O., G.V.A., B.B.M.C., B.C.S., D.A.R., F.L.); Department of Surgery, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, Brazil (D.M.V.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, Hospital Samaritano, São Paulo, Brazil (K.S.A)
| | - Gustavo V Araújo
- From the Department of Radiology, Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Dr Cesário Mota Júnior, 112 Vila Buarque, São Paulo, SP 01221-010, Brazil (D.B.M., L.L.C.B., I.R.C.O., G.V.A., B.B.M.C., B.C.S., D.A.R., F.L.); Department of Surgery, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, Brazil (D.M.V.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, Hospital Samaritano, São Paulo, Brazil (K.S.A)
| | - Bruna B M Carvalho
- From the Department of Radiology, Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Dr Cesário Mota Júnior, 112 Vila Buarque, São Paulo, SP 01221-010, Brazil (D.B.M., L.L.C.B., I.R.C.O., G.V.A., B.B.M.C., B.C.S., D.A.R., F.L.); Department of Surgery, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, Brazil (D.M.V.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, Hospital Samaritano, São Paulo, Brazil (K.S.A)
| | - Bárbara C Santos
- From the Department of Radiology, Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Dr Cesário Mota Júnior, 112 Vila Buarque, São Paulo, SP 01221-010, Brazil (D.B.M., L.L.C.B., I.R.C.O., G.V.A., B.B.M.C., B.C.S., D.A.R., F.L.); Department of Surgery, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, Brazil (D.M.V.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, Hospital Samaritano, São Paulo, Brazil (K.S.A)
| | - Daniel M V Lima
- From the Department of Radiology, Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Dr Cesário Mota Júnior, 112 Vila Buarque, São Paulo, SP 01221-010, Brazil (D.B.M., L.L.C.B., I.R.C.O., G.V.A., B.B.M.C., B.C.S., D.A.R., F.L.); Department of Surgery, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, Brazil (D.M.V.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, Hospital Samaritano, São Paulo, Brazil (K.S.A)
| | - Daniel A Rangel
- From the Department of Radiology, Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Dr Cesário Mota Júnior, 112 Vila Buarque, São Paulo, SP 01221-010, Brazil (D.B.M., L.L.C.B., I.R.C.O., G.V.A., B.B.M.C., B.C.S., D.A.R., F.L.); Department of Surgery, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, Brazil (D.M.V.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, Hospital Samaritano, São Paulo, Brazil (K.S.A)
| | - Sudhakar K Venkatesh
- From the Department of Radiology, Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Dr Cesário Mota Júnior, 112 Vila Buarque, São Paulo, SP 01221-010, Brazil (D.B.M., L.L.C.B., I.R.C.O., G.V.A., B.B.M.C., B.C.S., D.A.R., F.L.); Department of Surgery, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, Brazil (D.M.V.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, Hospital Samaritano, São Paulo, Brazil (K.S.A)
| | - Kamila S Albuquerque
- From the Department of Radiology, Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Dr Cesário Mota Júnior, 112 Vila Buarque, São Paulo, SP 01221-010, Brazil (D.B.M., L.L.C.B., I.R.C.O., G.V.A., B.B.M.C., B.C.S., D.A.R., F.L.); Department of Surgery, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, Brazil (D.M.V.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, Hospital Samaritano, São Paulo, Brazil (K.S.A)
| | - Fabio Lewin
- From the Department of Radiology, Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Dr Cesário Mota Júnior, 112 Vila Buarque, São Paulo, SP 01221-010, Brazil (D.B.M., L.L.C.B., I.R.C.O., G.V.A., B.B.M.C., B.C.S., D.A.R., F.L.); Department of Surgery, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, Brazil (D.M.V.L.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, Hospital Samaritano, São Paulo, Brazil (K.S.A)
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Jeong SH, Lee JK, Seo KW, Min JS. Treatment and Prevention of Postoperative Leakage after Gastrectomy for Gastric Cancer. J Clin Med 2023; 12:3880. [PMID: 37373575 DOI: 10.3390/jcm12123880] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Anastomotic leakage is one of the common causes of serious morbidity and death after gastrectomy. The use of surgical treatment for leakage decreased due to the development of nonsurgical management. However, if nonsurgical management fails to control the spread of intra-abdominal infection, emergency surgical treatment is required. The authors wished to determine in which cases surgical treatment is needed for postoperative leakage and to identify treatment and prevention strategies. If a patient's vital signs are stable, local abscesses can be cured by conservative treatment after percutaneous drain insertion; if there is no improvement in anastomotic leakage, endoscopic treatment such as clipping, vacuum, and stent placement can be performed. If a patient's vital signs are unstable or patient shows diffuse peritonitis, surgical treatment should be performed. A surgical plan can be established according to leakage location. The duodenal stump may first require conservative treatment. It is recommended that surgical treatment be attempted first for anastomotic leakage of gastrojejunostomy site and gastric stump in remnant stomach. In conclusion, the need for surgical treatment is determined depending on vital signs and presence of diffuse peritonitis. During surgical treatment, a strategic approach is required according to the patient's condition and the anatomical location of leakage.
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Affiliation(s)
- Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University School of Medicine & Gyoengsang National University Changwon Hospital, Changwon 51471, Republic of Korea
| | - Jin-Kwon Lee
- Department of Surgery, Gyeongsang National University School of Medicine & Gyoengsang National University Changwon Hospital, Changwon 51471, Republic of Korea
| | - Kyung Won Seo
- Department of Surgery, Kosin University Gospel Hospital, Busan 49267, Republic of Korea
| | - Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan 46033, Republic of Korea
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Ali M, Parkash O, Shahid J. An Unusual Presentation of Obstructive Jaundice Due to Dilated Proximal Small Bowel Loops After Gastrojejunostomy: Afferent Loop Syndrome. Cureus 2022; 14:e21258. [PMID: 35178314 PMCID: PMC8841727 DOI: 10.7759/cureus.21258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 11/05/2022] Open
Abstract
Afferent loop syndrome is reported to be one of the very rare complications after gastrojejunostomy. The usual presentation in patients is with abdominal pain, distension and vomiting. It may present acutely because of complete obstruction, usually occurs early after surgery and is lethal in its course unless treated promptly with surgical management. In chronic cases obstruction is intermittent. There may be a reflux of bowel material into the biliary system and because of bacterial overgrowth patient may present with ascending cholangitis and obstructive jaundice. Here we report a case of 43-year-old gentleman presenting with jaundice, diffuse abdominal pain and distension. Later on, he was found to have a recurrence of gastric carcinoma associated with peritoneal carcinomatosis after subtotal gastrectomy and gastrojejunostomy for gastric carcinoma one year ago. He was diagnosed to be a case of afferent loop syndrome presenting as obstructive jaundice. The patient was managed conservatively by endoscopic decompression after confirmation of the diagnosis of afferent loop syndrome.
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Abstract
Surgery is an essential component of curative-intent treatment strategies for gastric cancer. However, the care of each patient with gastric cancer must be individualized based on patient and tumor characteristics. It is important that all physicians who will be caring for patient with gastric cancer understand the current best practices of surgical management to provide patients with the highest quality of care. This article aims to provide this information while acknowledging areas of surgical management that are still controversial.
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Affiliation(s)
- Ian Solsky
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue Block Building #112, New York, NY 10461, USA
| | - Haejin In
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue Block Building #112, New York, NY 10461, USA; Department of Surgery, Albert Einstein College of Medicine, New York, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA.
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No way out: Causes of duodenal and gastric outlet obstruction. Clin Imaging 2020; 65:37-46. [DOI: 10.1016/j.clinimag.2020.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/26/2020] [Accepted: 04/07/2020] [Indexed: 11/17/2022]
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Endoscopic Ultrasound-Guided Enteroenterostomy for Afferent Limb Syndrome. ACG Case Rep J 2020; 7:e00442. [PMID: 32821770 PMCID: PMC7423902 DOI: 10.14309/crj.0000000000000442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 06/08/2020] [Indexed: 11/17/2022] Open
Abstract
Afferent limb syndrome (ALS) is a rare complication of duodenopancreatectomy, resulting from the mechanical obstruction of the afferent limb usually after local malignancy recurrence. Management of ALS (ie, surgery and palliative therapy) is often unsatisfactory. We present 5 cases of endoscopic ultrasound-guided internal drainage of the afferent limb using lumen-apposing metal stents. All procedures were successful, with no related complications; 2 patients had a complete regression of their symptoms, one experienced cholangitis recurrence, and 2 patients died after some weeks because of their malignancies. Endoscopic ultrasound-guided enteroenterostomy offers a convenient and safe palliative solution for patients presenting ALS.
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Pejic M, Parsee AA. Afferent Loop Syndrome with Intestinal Ischemia due to Internal Hernia after Whipple Operation for T2N1M0 Pancreatic Cancer. J Clin Imaging Sci 2020; 10:43. [PMID: 32754378 PMCID: PMC7395522 DOI: 10.25259/jcis_90_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/26/2020] [Indexed: 11/14/2022] Open
Abstract
Afferent loop syndrome is an uncommon complication of Whipple procedure. The often vague and non-specific presentation results in difficulty and/or delay in diagnosis, which may lead to bowel ischemia or perforation. CT can demonstrate characteristic features, yield the diagnosis of afferent loop syndrome, and predict the cause before surgical intervention. We present a rare etiology of acute afferent loop syndrome in a patient 6 weeks after Whipple procedure who was reportedly recovering well, which resulted in prompt surgical intervention.
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Affiliation(s)
- Marijan Pejic
- Department of Radiology, University of South Florida, 2 Tampa General Circle, STC 7028, United States
| | - Arthur A. Parsee
- Department of Radiology, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Dr, Tampa, Florida, United States,
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Abstract
Afferent loop syndrome (ALS) is a mechanical complication that arises after gastric surgery with gastrojejunostomy reconstruction. This condition was first described in 1950 by Roux, Pedoussaut, and Marchal to post-gastrectomy patients with bilious vomiting. Acute ALS is associated with complete obstruction and considered a surgical emergency, whereas chronic ALS is mostly related to partial obstruction of the afferent loop. The delay in diagnosis may lead to intestinal ischemia, perforation and can be associated with a high mortality rate up to 60%. Surgery is usually the mainstay treatment of ALS, but endoscopic therapy, including stent placement in malignancy-related, anastomotic stricture dilation, has been evolving over the past recent years.
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Song KB, Yoo D, Hwang DW, Lee JH, Kwon J, Hong S, Lee JW, Youn WY, Hwang K, Kim SC. Comparative analysis of afferent loop obstruction between laparoscopic and open approach in pancreaticoduodenectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 26:459-466. [PMID: 31290285 DOI: 10.1002/jhbp.656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Afferent loop obstruction (ALO) is a rare mechanical complication of pancreaticoduodenectomy (PD) and is associated with a high rate of morbidity and mortality. METHODS Data from patients who underwent PD between May 2007 and July 2017 at a single large-volume center were retrospectively reviewed. RESULTS Of the 3,223 patients who underwent PD, 67 developed ALO. More patients in the laparoscopic PD (LPD) group had developed ALO due to internal herniation than did those in the open PD (OPD) group (46.2 vs. 4.7%, P < 0.001). Patients in the LPD group also showed earlier occurrence of ALO (ALO occurrence within 60 days: 76.9 vs. 22.2%, P < 0.001) and more frequent requirement for surgical treatment (76.9 vs. 18.9%, P < 0.001) than did those in the OPD group. CONCLUSIONS The characteristics of ALO were significantly different between patients who had received LPD and OPD. The most common cause of ALO in the LPD group was internal herniation occurring in the early postoperative period. Internal herniation following LPD may be prevented by routine closure of mesocolic window and should be treated by emergency surgery if it occurs.
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Affiliation(s)
- Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Daegwang Yoo
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jaewoo Kwon
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sarang Hong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jong Woo Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Woo Young Youn
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Kyungyeon Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Kawano F, Tashiro K, Nakao H, Fujii Y, Ikeda T, Takeno S, Nakamura K, Nanashima A. Jejunogastric intussusception after distal gastrectomy with Roux-en-Y reconstruction: A case report. Int J Surg Case Rep 2018; 44:105-109. [PMID: 29499512 PMCID: PMC5910517 DOI: 10.1016/j.ijscr.2017.12.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 12/09/2017] [Accepted: 12/14/2017] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Jejunogastric intussusception is a rare complication after gastric operation. Intussusception after gastric operation occurs mostly at the gastrojejunal anastomosis site and Braun anastomosis site of Billroth II reconstruction, and at the Y anastomosis site of Roux-en-Y reconstruction. However, jejunogastric intussusception after distal gastrectomy with Roux-en-Y reconstruction is very rare. We report a surgical case of jejunogastric intussusception after distal gastrectomy for gastric cancer treatment. PRESENTATION OF CASE An 82-year-old woman underwent laparoscopic distal gastrectomy for early gastric cancer treatment. Reconstruction was performed using Roux-en-Y anastomosis. Oral intake was started on postoperative day 4, however vomiting and high-grade fever occurred on postoperative day 12, after which oral intake became difficult. DISCUSSION Anastomotic stenosis of the gastrojejunostomy was suspected, and various examinations were performed. Gastroendoscopy and computed tomography revealed an elevated lesion with ring-like folds protruding through the anastomosis site into the remnant stomach. Reoperation was performed on postoperative day 28 after a diagnosis of jejunogastric intussusception was made. It failed to reduce the intussusception, so partial resection of the gastrojejunal anastomosis was performed and Roux-en-Y reconstruction was repeated. Reconstruction was conducted after taking into consideration the recurrence of intussusception. CONCLUSION Jejunogastric intussusceptions after distal gastrectomy is a rare complication; however, when it occurs, early diagnosis and appropriate management are necessary.
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Affiliation(s)
- Fumiaki Kawano
- Faculty of Medicine, University of Miyazaki, Department of Surgery, Japan.
| | - Kousei Tashiro
- Faculty of Medicine, University of Miyazaki, Department of Surgery, Japan
| | - Hironobu Nakao
- Faculty of Medicine, University of Miyazaki, Department of Surgery, Japan
| | - Yoshirou Fujii
- Faculty of Medicine, University of Miyazaki, Department of Surgery, Japan
| | - Takuto Ikeda
- Faculty of Medicine, University of Miyazaki, Department of Surgery, Japan
| | - Shinsuke Takeno
- Faculty of Medicine, University of Miyazaki, Department of Surgery, Japan
| | - Kunihide Nakamura
- Faculty of Medicine, University of Miyazaki, Department of Surgery, Japan
| | - Atsushi Nanashima
- Faculty of Medicine, University of Miyazaki, Department of Surgery, Japan
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Correlation Between Bile Reflux Gastritis and Biliary Excreted Contrast Media in the Stomach. J Comput Assist Tomogr 2017; 41:696-701. [PMID: 28240637 DOI: 10.1097/rct.0000000000000585] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study aimed to evaluate the relationship between biliary excreted contrast media in the stomach and the presence of bile reflux gastritis. METHODS Consecutive 111 patients who underwent both gadoxetic acid-enhanced magnetic resonance cholangiography (gadoxetic MRC) and gastric endoscopy were included in this study. We performed a review of the gadoxetic-MRC image sets acquired 60 minutes after intravenous injection of contrast media and endoscopic images. We recorded amount of contrast media in the stomach. The sensitivity, specificity, and accuracy of duodenogastric bile reflux diagnosis were evaluated for the gadoxetic MRC. Statistical analysis was performed using the Fisher exact test and the linear-by-linear association test. RESULTS Among the 111 patients, 39 had 60-minute delayed images showing the presence of contrast media in the stomach. Of these 39 patients, 13 had bile reflux gastritis and 5 showed bile in the stomach without evidence of erythematous gastritis. Of the 72 patients who did not show contrast media in the stomach, none had bile reflux gastritis and 2 patients showed bile staining in the stomach without evidence of erythematous gastritis. Bile reflux gastritis was significantly more frequent in patients with contrast media in the stomach on gadoxetic MRC than in those without. Patients with high-grade extension of contrast media in the stomach had significantly frequent bile reflux gastritis than did those with low-grade extension. CONCLUSION Biliary excreted contrast media in the stomach on 60-minute delayed gadoxetic MRC has a correlation with the presence of bile reflux gastritis on endoscopic examination.
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Oka S, Sakuramoto S, Chuman M, Aratani K, Wakata M, Miyawaki Y, Gunji H, Sato H, Okamoto K, Yamaguchi S, Koyama I. Successful treatment of refractory complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy: a case report. BMC Res Notes 2017; 10:267. [PMID: 28693546 PMCID: PMC5504729 DOI: 10.1186/s13104-017-2589-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 06/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background Anastomotic leakage after total gastrectomy occurs despite improvements in surgical techniques and patient management. Although many cases of dehiscence can be managed non-operatively, major leakage requires a second surgery and can potentially lead to death. Therefore, accurate and immediate diagnosis and treatment are essential. Case presentation In this report, we describe a 66-year-old Japanese man who was diagnosed with a complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy with oral contrast radiography using Gastrografin®. The severe complication was successfully treated by re-anastomosis after two emergency drainage surgeries. After the second surgery, the esophageal end formed a fistula with the jejunum, but balloon dilation failed to open the fistula. Therefore, oral ingestion and conservative treatment were considered unsuitable, and we performed esophagojejunal re-anastomosis 7 months after the first surgery. At a follow-up examination 2 years after re-anastomosis, the patient weighed 47 kg, and his ingestion had recovered to 80% of that before surgery. Conclusions Complete separation of an esophagojejunal anastomosis is a rare but severe complication of total gastrectomy. Therefore, we consider that once separation is diagnosed, aggressive and urgent re-operation and effective drainage are useful. Moreover, it is necessary to take great care to minimize the operative morbidity associated with esophagojejunal anastomosis.
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Affiliation(s)
- Shinichi Oka
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
| | - Shinichi Sakuramoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Motohiro Chuman
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Kenichi Aratani
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Mitsuo Wakata
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yutaka Miyawaki
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hisashi Gunji
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hiroshi Sato
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Koujun Okamoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Isamu Koyama
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
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Low Prevalence of Clinically Significant Endoscopic Findings in Outpatients with Dyspepsia. Gastroenterol Res Pract 2017; 2017:3543681. [PMID: 28210269 PMCID: PMC5292197 DOI: 10.1155/2017/3543681] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/20/2016] [Accepted: 12/18/2016] [Indexed: 12/17/2022] Open
Abstract
Background. The value of endoscopy in dyspeptic patients is questionable. Aims. To examine the prevalence of significant endoscopic findings (SEFs) and the utility of alarm features and age in predicting SEFs in outpatients with dyspepsia. Methods. A retrospective analysis of outpatient adults who had endoscopy for dyspepsia. Demographic variables, alarm features, and endoscopic findings were recorded. We defined SEFs as peptic ulcer disease, erosive esophagitis, malignancy, stricture, or findings requiring specific therapy. Results. Of 650 patients included in the analysis, 51% had a normal endoscopy. The most common endoscopic abnormality was nonerosive gastritis (29.7%) followed by nonerosive duodenitis (7.2%) and LA-class A esophagitis (5.4%). Only 10.2% had a SEF. Five patients (0.8%) had malignancy. SEFs were more likely present in patients with alarm features (12.6% versus 5.4%, p = 0.004). Age ≥ 55 and presence of any alarm feature were associated with SEFs (aOR 1.8 and 2.3, resp.). Conclusion. Dyspeptic patients have low prevalence of SEF. The presence of any alarm feature and age ≥ 55 are associated with higher risk of SEF. Endoscopy in young patients with no alarm features has a low yield; these patients can be considered for nonendoscopic approach for diagnosis and management.
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Thomaz Araújo TM, Barra WF, Khayat AS, de Assumpção PP. Insights into gastric neuroendocrine tumors burden. Chin J Cancer Res 2017; 29:137-143. [PMID: 28536492 PMCID: PMC5422415 DOI: 10.21147/j.issn.1000-9604.2017.02.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Type 1 gastric neuroendocrine tumors (gNETs) are usually small lesions, restricted to mucosal and sub-mucosal layers of corpus and fundus, with low aggressive behavior, for the majority of cases. Nevertheless, some cases present aggressive behavior. The increasing incidence of gNETs brings together a new relevant problem: how to identify potentially aggressive type 1 gNETs. The challenging problem seems to be finding out signs or features able to predict potentially aggressive cases, allowing a tailored approach, since the involved societies dedicated to provide guidelines for management of these neoplasms apparently failed in producing staging systems able to accurately predict prognosis of these tumors. Additionally, it is also important to try to find out explanations for increasing incidence, as well as to identify potential targets aiming to reach better control of this neoplasia. Here, we discuss potential pathways implicated in aggressive behavior, as well as new strategies to improve clinical management of these tumors.
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Affiliation(s)
| | | | - André Salim Khayat
- Oncology Research Center, Federal University of Pará, Pará 66073-005, Brazil
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15
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Kakaei F, Beheshtirouy S, Nejatollahi SMR, Rashidi I, Asvadi T, Habibzadeh A, Oliaei-Motlagh M. Effects of adding Braun jejunojejunostomy to standard Whipple procedure on reduction of afferent loop syndrome - a randomized clinical trial. Can J Surg 2016; 58:383-8. [PMID: 26574829 DOI: 10.1503/cjs.005215] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Whipple surgery (pancreaticodeudenectomy) has a high complication rate. We aimed to evaluate whether adding Braun jejunojejunostomy (side-to-side anastomosis of afferent and efferent loops distal to the gastrojejunostomy site) to a standard Whipple procedure would reduce postoperative complications. METHODS We conducted a randomized clinical trial comparing patients who underwent standard Whipple surgery (standard group) and patients who underwent standard Whipple surgery with Braun jejunojejunostomy (Braun group). Patients were followed for 1 month after the procedure and postoperative complications were recorded. RESULTS Our study included 30 patients: 15 in the Braun and 15 in the standard group. In the Braun group, 4 (26.7%) patients experienced 6 complications, whereas in the standard group, 7 (46.7%) patients experienced 11 complications (p = 0.14). Complications in the Braun group were gastrointestinal bleeding and wound infection (n = 1 each) and delayed gastric emptying and pulmonary infection (n = 2 each). Complications in the standard group were death, pancreatic anastomosis leak and biliary anastomosis leak (n = 1 each); gastrointestinal bleeding (n = 2); and afferent loop syndrome and delayed gastric emptying (n = 3 each). There was no significant difference between groups in the subtypes of complications. CONCLUSION Our results showed that adding Braun jejunojejunostomy to standard Whipple procedure was associated with lower rates of afferent loop syndrome and delayed gastric emptying. However, more studies are needed to define the role of Braun jejunojejunostomy in this regard. TRIAL REGISTRATION IRCT2014020316473N1 (www.irct.ir).
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Affiliation(s)
- Farzad Kakaei
- From the Department of Surgery, Tabriz University of medical sciences, Imam Reza Hospital, Tabriz, Iran (Kakaei, Beheshtirouy, Rashidi, Asvadi, Habibzadeh, Oliaei-Motlagh); and the Department of Surgery, Shahid Beheshti University of Medical Sciences, Ayatollah Taleghani Hospital, Evin, Tehran, Iran (Nejatollahi)
| | - Samad Beheshtirouy
- From the Department of Surgery, Tabriz University of medical sciences, Imam Reza Hospital, Tabriz, Iran (Kakaei, Beheshtirouy, Rashidi, Asvadi, Habibzadeh, Oliaei-Motlagh); and the Department of Surgery, Shahid Beheshti University of Medical Sciences, Ayatollah Taleghani Hospital, Evin, Tehran, Iran (Nejatollahi)
| | - Seyed Moahammad Reza Nejatollahi
- From the Department of Surgery, Tabriz University of medical sciences, Imam Reza Hospital, Tabriz, Iran (Kakaei, Beheshtirouy, Rashidi, Asvadi, Habibzadeh, Oliaei-Motlagh); and the Department of Surgery, Shahid Beheshti University of Medical Sciences, Ayatollah Taleghani Hospital, Evin, Tehran, Iran (Nejatollahi)
| | - Iqbal Rashidi
- From the Department of Surgery, Tabriz University of medical sciences, Imam Reza Hospital, Tabriz, Iran (Kakaei, Beheshtirouy, Rashidi, Asvadi, Habibzadeh, Oliaei-Motlagh); and the Department of Surgery, Shahid Beheshti University of Medical Sciences, Ayatollah Taleghani Hospital, Evin, Tehran, Iran (Nejatollahi)
| | - Touraj Asvadi
- From the Department of Surgery, Tabriz University of medical sciences, Imam Reza Hospital, Tabriz, Iran (Kakaei, Beheshtirouy, Rashidi, Asvadi, Habibzadeh, Oliaei-Motlagh); and the Department of Surgery, Shahid Beheshti University of Medical Sciences, Ayatollah Taleghani Hospital, Evin, Tehran, Iran (Nejatollahi)
| | - Afshin Habibzadeh
- From the Department of Surgery, Tabriz University of medical sciences, Imam Reza Hospital, Tabriz, Iran (Kakaei, Beheshtirouy, Rashidi, Asvadi, Habibzadeh, Oliaei-Motlagh); and the Department of Surgery, Shahid Beheshti University of Medical Sciences, Ayatollah Taleghani Hospital, Evin, Tehran, Iran (Nejatollahi)
| | - Mohammad Oliaei-Motlagh
- From the Department of Surgery, Tabriz University of medical sciences, Imam Reza Hospital, Tabriz, Iran (Kakaei, Beheshtirouy, Rashidi, Asvadi, Habibzadeh, Oliaei-Motlagh); and the Department of Surgery, Shahid Beheshti University of Medical Sciences, Ayatollah Taleghani Hospital, Evin, Tehran, Iran (Nejatollahi)
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16
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Afferent Loop Syndrome After Subtotal Gastrectomy With Billroth-II Reconstruction: Etiology and Treatment. Int Surg 2016. [DOI: 10.9738/intsurg-d-15-00137.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate the clinical characteristics, treatment, and prognosis of afferent loop syndrome (ALS) following radical subtotal gastrectomy with B-II reconstruction in gastric cancer patients. ALS is an infrequent mechanical complication, which occurs after reconstruction of Billroth-II (B-II) gastrojejunostomy or Roux-en-Y esophagojejunosotomy. From 2002 through 2010, 672 patients who had undergone subtotal gastrectomy with B-II reconstruction for gastric cancer were enrolled. Clinical data, symptom interval, cause, and treatment of 13 ALS patients were reviewed. The body mass index (BMI) of patients who suffered ALS was significantly less than that of patients who did not (P = 0.0244). And, there were significant differences in rates of recurrence (P = 0.0032) and follow-up duration (P = 0.0119) between the two groups. Acute ALS within 1 month occurred in 5 patients (38.5%). Obstructive jaundice or acute pancreatitis occurred in 4 patients (30.1%). The most frequent cause was anastomosis inflammation (6 patients). Only 2 patients required surgery. Most patients with ALS were treated conservatively with or without percutaneous transhepatic biliary drainage (PTBD). Clinical suspicion is of significant importance because ALS is not common and the symptoms are nonspecific. ALS occurs more frequently in low BMI patients than high. PTBD can be considered as a primary treatment option for ALS if rupture of the afferent loop is not present.
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17
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Jenny HE, Ogando PA, Fujitani K, Warner RRP, Divino CM. Laparoscopic antrectomy: a safe and definitive treatment in managing type 1 gastric carcinoids. Am J Surg 2016; 211:778-82. [PMID: 26992358 DOI: 10.1016/j.amjsurg.2015.08.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 08/15/2015] [Accepted: 08/18/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Treatment for type 1 gastric carcinoid (T1GC) includes esophagogastroduodenoscopy (EGD), polypectomy, and antrectomy, but few studies compare outcomes. This study assessed risk-benefit ratio to determine the most effective treatment for T1GC. METHODS A retrospective review of 52 T1GC patients (ages 30 to 88 years; 77% female) presenting to Mount Sinai Medical Center between 2004 and 2012 was conducted. Patient demographics, procedures, and outcomes were reviewed, and patient satisfaction was assessed using a phone-administered validated questionnaire. Data were analyzed using SPSS version 20 software. RESULTS Average EGDs needed per follow-up year was significantly lower for antrectomy than polypectomy or EGD surveillance (.395 vs 1.038 vs 1.380, P = .002). Antrectomy patients exhibited decreased recurrence risk than polypectomy patients (11% vs 44%, P = .049), despite longer follow-up time (6.10 vs 4.39 years, P = .023). CONCLUSIONS Antrectomy treats T1GC with lower recurrence risk and less postintervention monitoring, whereas allowing patients to avoid the discomfort of repeated EGD surveillance and anxiety over a lingering condition.
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Affiliation(s)
- Hillary E Jenny
- Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1259, New York, NY, 10029, USA
| | - Paul A Ogando
- Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1259, New York, NY, 10029, USA
| | - Kenji Fujitani
- Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1259, New York, NY, 10029, USA
| | - Richard R P Warner
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Carcinoid and Neuroendocrine Tumors, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Celia M Divino
- Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1259, New York, NY, 10029, USA; Center for Carcinoid and Neuroendocrine Tumors, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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18
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Kang EG, Kim C, Lee J, Cha MU, Kim JH, Park SH, Kim MD, Lee DY, Rha SY. Deep vein thrombosis caused by malignant afferent loop obstruction. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.2.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Eun Gyu Kang
- Department of Internal Medicine, Hongik Hospital, Seoul, Korea
| | - Chan Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jeungeun Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min-uk Cha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Hoon Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seo-Hwa Park
- Department of Internal Medicine, Hongik Hospital, Seoul, Korea
| | - Man Deuk Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Do Yun Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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19
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Nageswaran H, Belgaumkar A, Kumar R, Riga A, Menezes N, Worthington T, Karanjia ND. Acute afferent loop syndrome in the early postoperative period following pancreaticoduodenectomy. Ann R Coll Surg Engl 2015; 97:349-53. [PMID: 26264085 DOI: 10.1308/003588414x14055925061036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Afferent loop syndrome (ALS) is a recognised complication of foregut surgery caused by mechanical obstruction at the gastrojejunostomy anastomosis itself or at a point nearby. Acute ALS has only been reported following pancreaticoduodenectomy (PD) after several years due to recurrence of malignancy at the anastomotic site. We report five cases of acute ALS in the first postoperative week. METHODS The presentation, clinical findings and successful management of the 5 patients with ALS were obtained from a prospectively collected database of 300 PDs. All five patients with early acute ALS presented with signs and symptoms of a bile leak. Since the fifth patient, the surgical technique has been modified with the creation of a larger window in the transverse mesocolon and a Braun enteroenterostomy. RESULTS There have been no further incidents of ALS since the adoption of these modifications to the standard technique of PD and there has also been a reduction in postoperative bile leaks (6.4% vs 3.6%, p=0.416). CONCLUSIONS Acute ALS is a rare but important complication in the immediate postoperative period following PD and causes disruption to adjacent anastomoses, resulting in a bile leak. A prophylactic Braun anastomosis and wide mesocolic window may prevent this complication and subsequent deterioration.
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Affiliation(s)
- H Nageswaran
- Royal Surrey County Hospital NHS Foundation Trust , UK
| | - A Belgaumkar
- Royal Surrey County Hospital NHS Foundation Trust , UK
| | - R Kumar
- Royal Surrey County Hospital NHS Foundation Trust , UK
| | - A Riga
- Royal Surrey County Hospital NHS Foundation Trust , UK
| | - N Menezes
- Royal Surrey County Hospital NHS Foundation Trust , UK
| | - T Worthington
- Royal Surrey County Hospital NHS Foundation Trust , UK
| | - N D Karanjia
- Royal Surrey County Hospital NHS Foundation Trust , UK
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20
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Blouhos K, Boulas KA, Tsalis K, Hatzigeorgiadis A. Management of afferent loop obstruction: Reoperation or endoscopic and percutaneous interventions? World J Gastrointest Surg 2015; 7:190-195. [PMID: 26425267 PMCID: PMC4582236 DOI: 10.4240/wjgs.v7.i9.190] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/21/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
Afferent loop obstruction is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy. The operations most commonly associated with this complication are gastrectomy with Billroth II or Roux-en-Y reconstruction, and pancreaticoduodenectomy with conventional loop or Roux-en-Y reconstruction. Etiology of afferent loop obstruction includes: (1) entrapment, compression and kinking by postoperative adhesions; (2) internal herniation, volvulus and intussusception; (3) stenosis due to ulceration at the gastrojejunostomy site and radiation enteritis of the afferent loop; (4) cancer recurrence; and (5) enteroliths, bezoars and foreign bodies. Acute afferent loop obstruction is associated with complete obstruction of the afferent loop and represents a surgical emergency, whereas chronic afferent loop obstruction is associated with partial obstruction. Abdominal multiple detector computed tomography is the diagnostic study of choice. CT appearance of the obstructed afferent loop consists of a C-shaped, fluid-filled tubular mass located in the midline between the abdominal aorta and the superior mesenteric artery with valvulae conniventes projecting into the lumen. The cornerstone of treatment is surgery. Surgery includes: (1) adhesiolysis and reconstruction for benign causes; and (2) by-pass or excision and reconstruction for malignant causes. However, endoscopic enteral stenting, transhepatic percutaneous enteral stenting and direct percutaneous tube enterostomy have the principal role in management of malignant and radiation-induced obstruction. Nevertheless, considerable limitations exist as a former Roux-en-Y reconstruction limits endoscopic access to the afferent loop and percutaneous approaches for enteral stenting and tube enterostomy have only been reported in the literature as isolated cases.
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21
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Kim KH, Lee HB, Kim SH, Kim MC, Jung GJ. Role of percutaneous transhepatic biliary drainage in patients with complications after gastrectomy. Int Surg 2015; 101:78-83. [PMID: 26024411 DOI: 10.9738/intsurg-d-15-00117.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to elucidate the role of PTBD in patients with DSL and ALS post-gastrectomy for malignancy or benign ulcer perforation. SUMMARY OF BACKGROUND DATA Percutaneous transhepatic biliary drainage (PTBD) is an interventional radiologic procedure used to promote bile drainage. Duodenal stump leakage (DSL) and afferent loop syndrome (ALS) can be serious complications after gastrectomy. METHODS From January 2002 through December 2014, we retrospectively reviewed 19 patients who underwent PTBD secondary to DSL and ALS post-gastrectomy. In this study, a PTBD tube was placed in the proximal duodenum near the stump or distal duodenum in order to decompress and drain bile and pancreatic fluids. RESULTS Nine patients with DSL and 10 patients with ALS underwent PTBD. The mean hospital stay was 34.3 days (range, 12-71) in DSL group and 16.4 days (range, 6-48) in ALS group after PTBD. A liquid or soft diet was started within 2.6 days (range, 1-7) in the ALS group and within 3.4 days (range, 0-15) in the DSL group after PTBD. One patient with DSL had PTBD changed, and 2 patients with ALS underwent additional surgical interventions after PTBD. CONCLUSIONS The PTBD procedure, during which the tube was inserted into the duodenum, was well-suited for decompression of the duodenum as well as for drainage of bile and pancreatic fluids. This procedure can be an alternative treatment for cases of DSL and ALS post-gastrectomy.
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Affiliation(s)
- Ki Han Kim
- a Dong-A University College of Medicine, Busan, 602-715, Korea, Republic of
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22
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Kim TH, Kim JH, Shin CI, Kim SH, Han JK, Choi BI. CT findings suggesting anastomotic leak and predicting the recovery period following gastric surgery. Eur Radiol 2015; 25:1958-66. [PMID: 25708962 DOI: 10.1007/s00330-015-3608-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 01/09/2015] [Accepted: 01/15/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess diagnostic performance of routine CT for detecting anastomotic leak after gastric surgery, and analyse the relationship between recovery period and CT findings. METHODS We included 179 patients who underwent immediate CT and fluoroscopy after gastric surgery. Two reviewers retrospectively rated the possibility of leak on CT using a five-point scale focused on predefined CT findings. They also evaluated CT findings. Patients were categorised as: Group I, leak on fluoroscopy; Group II, possible leak on CT but negative on fluoroscopy; Group III, no leak. We analysed the relationship between recovery period and group. RESULTS Area under the curve for detecting leak on CT was 0.886 in R1 and 0.668 in R2 with moderate agreement (к = 0.482). Statistically common CT findings for leak included discontinuity, large amount of air-fluid and wall thickening at anastomosis site (p < 0.05). Discontinuity at anastomosis site and a large air-fluid collection were independently associated with leak (p < 0.05). The recovery period including hospitalisation and postoperative fasting period was longer in Group I than Group II or III (p < 0.05). Group II showed a longer recovery period than Group III (p < 0.05). CONCLUSIONS Postoperative routine CT was useful for predicting anastomotic leak using specific findings, and for predicting length of recovery period. KEY POINTS • Anastomotic leakage remains a significant clinical problem following gastric surgery. • Routine CT without oral contrast is useful for predicting anastomotic leaking. • Wall discontinuity at anastomosis sites was an independent predictor for leaking. • CT is also useful for predicting recovery period following gastric surgery.
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Affiliation(s)
- Tae Ho Kim
- Department of Radiology, Institute of Radiation Medicine, Seoul National University College of Medicine, 01 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea
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23
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Smith N, Morris M, Berch B, Westmoreland T, Blewett C. Jejunogastric intussusception in a child: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Chhabra P, Singh Rana S, Sharma V, Sharma R, Gupta R, Kumar Bhasin D. An unusual cause of simultaneous common bile and pancreatic duct dilation. Gastroenterol Rep (Oxf) 2014; 3:258-61. [PMID: 24939738 PMCID: PMC4527257 DOI: 10.1093/gastro/gou032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/28/2014] [Indexed: 12/28/2022] Open
Abstract
Simultaneous dilation of both the common bile duct and the pancreatic duct (double-duct sign) is usually because of ampullary or pancreatic tumours. Here we report an unusual cause of double-duct dilation; we describe the case of a 49-year-old female who developed afferent loop syndrome after pylorus-preserving pancreaticoduodenectomy: cross-sectional imaging of the abdomen revealed a double-duct sign.
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Affiliation(s)
- Puneet Chhabra
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India and
| | - Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India and
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India and
| | - Ravi Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India and
| | - Rajesh Gupta
- Department of Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak Kumar Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India and
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Verma AR, Patel VM, Mikhail S, Zacharakis E. An unusual presentation of late oesophagojejunal anastomotic leak after total D2 gastrectomy. Ann R Coll Surg Engl 2012; 94:e106-8. [PMID: 22391379 DOI: 10.1308/003588412x13171221589450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Oesophagojejunal anastomotic leak usually presents in the early post-operative period with abdominal pain and sepsis. We report a case of late anastomotic leak presenting as epigastric pain with hyperamylasaemia and discuss the differential diagnosis.
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Affiliation(s)
- A R Verma
- Imperial College Healthcare NHS Trust, UK
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26
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Kim JK, Park CH, Huh JH, Park JY, Park SW, Song SY, Chung J, Bang S. Endoscopic management of afferent loop syndrome after a pylorus preserving pancreatoduodenecotomy presenting with obstructive jaundice and ascending cholangitis. Clin Endosc 2011; 44:59-64. [PMID: 22741115 PMCID: PMC3363051 DOI: 10.5946/ce.2011.44.1.59] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 08/19/2011] [Accepted: 09/05/2011] [Indexed: 02/06/2023] Open
Abstract
Afferent loop syndrome is a rare complication of gastrojejunostomy. Patients usually present with abdominal distention and bilious avomiting. Afferent loop syndrome in patients who have undergone a pylorus preserving pancreaticoduodenectomy can present with ascending cholangitis. This condition is related to a large volume of reflux through the biliary-enteric anastomosis and static materials with bacterial overgrowth in the afferent loop. Patients with afferent loop syndrome after pylorus preserving pancreaticoduodenectomy frequently cannot be confirmed as surgical candidates due to poor medical condition. In that situation, a non-surgical palliation should be considered. Herein, we report two patients with afferent loop syndrome presenting with obstructive jaundice and ascending cholangitis. The patients suffered from the recurrence of pancreatic cancer after pylorus preserving pancreaticoduodenectomy. The diagnosis of afferent loop syndrome was confirmed, and the patients were successfully treated by inserting an endoscopic metal stent using a colonoscopic endoscope.
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Affiliation(s)
- Jae Kyung Kim
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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27
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Clinical implication of positive oral contrast computed tomography for the evaluation of postoperative leakage after gastrectomy for gastric cancer. J Comput Assist Tomogr 2010; 34:537-42. [PMID: 20657221 DOI: 10.1097/rct.0b013e3181dbe579] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the clinical usefulness of positive oral contrast computed tomography (CT) for the detection of leakage and its relationship with the immediate postoperative outcome after gastrectomy for gastric cancer. METHODS A total of 210 patients with a clinical suspicion of leakage after gastrectomy for gastric cancer underwent a positive oral contrast CT. Two radiologists retrospectively reviewed the CT images, recorded the presence of extraluminal contrast leakage, and graded the amount of leaked contrast. The rate of postoperative intervention treatment, the length of postoperative hospital stay, and mortality rates were correlated with the presence and grades of leakage. Matching accuracy between CT and other diagnostic studies in detection of leakage was also evaluated. RESULTS There were 162 patients without extraluminal contrast leakage (77.1%), 13 with grade 1 leakage (6.2%), 19 with grade 2 (9.0%), and 16 with grade 3 (7.6%). Postoperative intervention rate, hospital stay, and mortality were significantly higher in patients with extraluminal contrast than those in patients without extraluminal contrast (P < 0.05). Postoperative hospital stays increased as the leakage grades increased (P = 0.0008). The matching accuracy between CT and other studies was 82.1% (n = 32/39). CONCLUSIONS Positive oral contrast CT can be a reliable tool for diagnosing postoperative leakage that requires further intervention after gastrectomy in gastric cancer patients, and the immediate postoperative outcome may be related with the grade of leaked contrast on CT.
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Acute afferent loop necrosis after Roux-en-Y cholangiojejunostomy. Clin J Gastroenterol 2010; 3:165-7. [PMID: 26190125 DOI: 10.1007/s12328-010-0148-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 03/16/2010] [Indexed: 10/19/2022]
Abstract
Afferent loop necrosis after Roux-en-Y cholangiojejunostomy biliary reconstruction is rare. We present the case of a 36-year-old woman with acute necrotic afferent loop obstruction. The peripheral area of the Roux-en-Y limb, including the cholangiojejunostomy portion, was twisted just proximal to the cholangiojejunostomy. Cholangiojejunostomy was completely separated due to necrosis of the Roux-en-Y jejunum. In addition to the case report, we discuss features of cholangiojejunostomy that require special attention.
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Acute cholangitis due to afferent loop syndrome after a Whipple procedure: a case report. CASES JOURNAL 2009; 2:6339. [PMID: 19918578 PMCID: PMC2769288 DOI: 10.4076/1757-1626-2-6339] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 08/12/2009] [Indexed: 12/28/2022]
Abstract
Introduction Patients with resection of stomach and especially with Billroth II reconstruction (gastro jejunal anastomosis), are more likely to develop afferent loop syndrome which is a rare complication. When the afferent part is obstructed, biliary and pancreatic secretions accumulate and cause the distention of this part. In the case of a complete obstruction (rare), there is a high risk developing necrosis and perforation. This complication has been reported once in the literature. Case presentation A 54-year-old Greek male had undergone a pancreato-duodenectomy (Whipple procedure) one year earlier due to a pancreatic adenocarcinoma. Approximately 10 months after the initial operation, the patient started having episodes of cholangitis (fever, jaundice) and abdominal pain. This condition progressively worsened and the suspicion of local recurrence or stenosis of the biliary-jejunal anastomosis was discussed. A few days before his admission the patient developed signs of septic cholangitis. Conclusion Our case demonstrates a rare complication with serious clinical manifestation of the afferent loop syndrome. This advanced form of afferent loop syndrome led to the development of huge enterobiliary reflux, which had a serious clinical manifestation as cholangitis and systemic sepsis, due to bacterial overgrowth, which usually present in the afferent loop. The diagnosis is difficult and the interventional radiology gives all the details to support the therapeutic decision making. A variety of factors can contribute to its development including adhesions, kinking and angulation of the loop, stenosis of gastro-jejunal anastomosis and internal herniation. In order to decompress the afferent loop dilatation due to adhesions, a lateral-lateral jejunal anastomosis was performed between the afferent loop and a small bowel loop.
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Ridereau-Zins C, Lebigot J, Moubarak E, Hamy A, Azoulay R, Aubé C. Imagerie post-opératoire du cardia et de l’estomac. ACTA ACUST UNITED AC 2009; 90:937-53. [DOI: 10.1016/s0221-0363(09)73233-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Hajj IIE, Hawchar M, Soweid A, Maasri K, Tawil A, Barada KA. Giant sporadic fundic gland polyp: Endoscopic and endosonographic features and management. World J Gastroenterol 2008; 14:6593-5. [PMID: 19030221 PMCID: PMC2773355 DOI: 10.3748/wjg.14.6593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Fundic gland polyps are the most common gastric polyps. They are usually small in size, sporadic and asymptomatic. We present a case of giant fundic gland polyp. Our case is particular because of the clinical presentation, the endoscopic and endosonographic documented findings, and the treatment options followed.
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Tonouchi H, Mohri Y, Tanaka K, Ohi M, Kobayashi M, Yamakado K, Kusunoki M. Diagnostic sensitivity of contrast swallow for leakage after gastric resection. World J Surg 2007; 31:128-31. [PMID: 17180629 DOI: 10.1007/s00268-006-0246-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We examined the clinical manifestations and computed tomography findings of patients with leakage after gastrectomy for cancer and determined the sensitivity of the contrast swallow for the leakage diagnosis. METHODS The medical records of 331 consecutive patients undergoing gastrectomy between January 1992 and December 2003 were reviewed. Routine contrast swallow was performed in all patients before oral intake. Once leakage was suspected, an emergency contrast swallow was performed and its diagnostic sensitivity determined. RESULTS In total, leakage was diagnosed 9 of 17 times by the contrast swallow, for a diagnostic sensitivity of 53%. The clinical signs or another imaging modality often corrected the misdiagnosis. CONCLUSIONS The diagnostic sensitivity of contrast swallow for leakage after gastrectomy was low. Therefore, if we employ the contrast swallow technique, we should keep in mind its low sensitivity.
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Affiliation(s)
- Hitoshi Tonouchi
- Department of Innovative Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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