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Koca F, Koch C, Schulze F, Pession U, Bechstein WO, Malkomes P. Excisional biopsy of perforated gastric ulcer: mandatory or potentially harmful? Langenbecks Arch Surg 2024; 409:205. [PMID: 38963438 PMCID: PMC11224112 DOI: 10.1007/s00423-024-03393-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE This study aimed to evaluate the morbidity associated with excisional biopsy in patients with spontaneous gastric perforation. METHODS A retrospective, single-center, observational study was performed. All consecutive patients with spontaneous gastric perforation who underwent surgical therapy were included. Outcomes were assessed concerning the performance of excisional biopsy. RESULTS A total of 135 adult patients were enrolled. Of these, 110 (81.5%) patients underwent excisional biopsy, while 17 (12.6%) did not. The remaining eight (5.9%) patients who underwent gastric resection were excluded from the analysis. Patients undergoing excisional biopsy developed significantly higher rates of postoperative complications (p = 0.007) and experienced more severe complications according to the Clavien-Dindo classification, particularly type III and above (p = 0.017). However, no significant differences were observed regarding in-hospital mortality, reoperation, suture dehiscence, or length of hospital stay. CONCLUSION Excisional biopsy for gastric perforation has been shown to be associated with increased morbidity. Surgical closure followed by early endoscopic biopsy may be a superior approach for gastric perforation management to rule out malignancy.
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Affiliation(s)
- Faruk Koca
- Department of General, Visceral, Transplant and Thoracic Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Christine Koch
- Department of Gastroenterology, Hepatology, Endocrinology and Nutrition, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Falko Schulze
- Senckenberg Institute of Pathology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Ursula Pession
- Department of General, Visceral, Transplant and Thoracic Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Wolf O Bechstein
- Department of General, Visceral, Transplant and Thoracic Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Patrizia Malkomes
- Department of General, Visceral, Transplant and Thoracic Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Steyn PF, Karusseit O. Gastric perforation biopsy: is it obsolete? Langenbecks Arch Surg 2024; 409:139. [PMID: 38676744 PMCID: PMC11055769 DOI: 10.1007/s00423-024-03325-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE The aim of the study was to test the established hypothesis that biopsies of spontaneous gastric perforations should be taken to rule out cancer. METHODS A prospective observational study was performed. Consecutive patients with spontaneous gastric perforation were included. Biopsies of the edges of the perforation were submitted for histological evaluation. The epithelial type as well as the nature of the pathology were evaluated. RESULTS Sixty-eight patients were included. Eight (12%) biopsies revealed duodenal origin. Sixty (88%) biopsies revealed gastric mucosa of which 33 (48%) could be specifically typed. All biopsies revealed benign ulceration. No malignancies were detected in these biopsies or on subsequent gastroscopic follow up. CONCLUSION This study suggests that routine intraoperative biopsy of gastric perforation may be questioned. Biopsy is probably better performed endoscopically after recovery.
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Affiliation(s)
- Petre Francois Steyn
- Department of Surgery, University of Pretoria Medical School, Pretoria, South Africa
| | - Otto Karusseit
- Department of Surgery, University of Pretoria Medical School, Pretoria, South Africa.
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Edelson S. Interesting Case of Contained Perforated Peptic Ulcer With Pancreatic Communication Causing Hemorrhagic Shock. Cureus 2024; 16:e56992. [PMID: 38681437 PMCID: PMC11045297 DOI: 10.7759/cureus.56992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
Peptic ulcer disease (PUD) is a common gastrointestinal diagnosis affecting the stomach and proximal duodenum. A contained perforation with pancreatic communication is an exceedingly rare subtype where gastroduodenal perforation is limited by the surrounding pancreas, preventing free leakage of gastric and pancreatic contents into the peritoneal cavity. A 48-year-old male with a history of perforated antral ulcer requiring surgical management and placement of a Graham patch presented with upper gastrointestinal bleeding. Initial esophagogastroduodenoscopy (EGD) showed a new clean-based antral ulcer; however, the patient continued to experience hematemesis post-procedure. A repeat EGD revealed the same antral ulcer now with suture material exposed near the prior site of the Graham patch, along with a soft tissue mass resembling the pancreas and no evidence of active bleeding. Following this EGD, the patient had profuse hematemesis with hemorrhagic shock and underwent emergent exploratory laparotomy confirming contained posterior perforation of the stomach with complete erosion of the stomach wall onto the head of the pancreas. This case highlights an atypical presentation for a perforated peptic ulcer (PPU) with pancreatic communication.
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Affiliation(s)
- Scott Edelson
- Department of Medicine, Brooke Army Medical Center (BAMC), San Antonio, USA
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Amalia R, Vidyani A, I’tishom R, Efendi WI, Danardono E, Wibowo BP, Parewangi ML, Miftahussurur M, Malaty HM. The Prevalence, Etiology and Treatment of Gastroduodenal Ulcers and Perforation: A Systematic Review. J Clin Med 2024; 13:1063. [PMID: 38398375 PMCID: PMC10888557 DOI: 10.3390/jcm13041063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Gastroduodenal perforation (GDP) is a life-threatening condition caused by a spontaneous or traumatic event. Treatment should be based on the mechanism of damage, timing, location, extent of the injury, and the patient's clinical condition. We aimed to examine several etiologic factors associated with gastroduodenal perforation and to search for the best method(s) for its prevention and treatment. (2) Methods: We conducted extensive literature reviews by searching numerous studies obtained from PubMed, Science Direct, and Cochrane for the following keywords: gastroduodenal perforation, Helicobacter pylori, NSAIDs' use, side effects of GDP, laparoscopy, and surgery. The primary outcome was the reported occurrence of GDP. (3) Results: Using keywords, 883 articles were identified. After applying the inclusion and exclusion criteria, 53 studies were eligible for the current analyses, with a total number of 34,692 gastroduodenal perforation cases. Even though the risk factors of gastroduodenal perforation are various, the prevalence of H. pylori among patients with perforation is considerably high. As technology develops, the treatment for gastric perforation will also improve, with laparoscopic surgery having a lower mortality and complication rate compared to open surgery for GDP treatment. (4) Conclusions: H. pylori infection plays the most significant role in GDP, more than NSAIDs, surgery, chemotherapy, or transplantation. Treatment of H. pylori infection is essential to decrease the prevalence of GDP and speed up its recovery. However, urgent cases require immediate intervention, such as laparoscopic or open surgery.
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Affiliation(s)
- Rizki Amalia
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu 879-5593, Japan;
- Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya 60286, Indonesia;
| | - Amie Vidyani
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Reny I’tishom
- Department of Medical Biology, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia;
| | - Wiwin Is Efendi
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia;
| | - Edwin Danardono
- Department of Surgery, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia;
| | - Bogi Pratomo Wibowo
- Department of Endocrinology, Saiful Anwar General Hospital, Malang 65111, Indonesia;
| | - Muhammad Lutfi Parewangi
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia;
| | - Muhammad Miftahussurur
- Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya 60286, Indonesia;
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Hoda M. Malaty
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya 60115, Indonesia
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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Patil M, Gharde P. Unveiling a Coalescing Catastrophe: Pre-pyloric Perforation Co-existing With Sigmoid Volvulus in a Middle-Aged Patient. Cureus 2024; 16:e55042. [PMID: 38550410 PMCID: PMC10974888 DOI: 10.7759/cureus.55042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
Sigmoid volvulus is a common cause of colonic obstruction worldwide and constitutes the majority of all cases of colonic volvulus. It is more prevalent in those who are older than 70 years. The sigmoid colon, an S-shaped portion of the large intestine, is susceptible to this condition due to its redundancy and mobile nature. Treatment involves endoscopic detorsion with sigmoidectomy. Laparoscopic surgery has been found to be useful in terms of reduced morbidity, blood loss, analgesics, and hospital stay; contrarily, surgical management has been found to be associated with reduced recurrence. Early diagnosis is crucial to prevent complications and recurrence rates. Gastroduodenal perforation, whether spontaneous or traumatic, is predominantly associated with peptic ulcer disease. Specifically, the majority of perforated peptic ulcers are attributed to Helicobacter pylori infection. The presence of perforation as a comorbidity complicates surgical management, particularly when the patient has a history of H. pylori infections, as evidenced in our case. Addressing these infections is crucial for optimizing treatment outcomes and reducing potential complications. Laparoscopic surgery is popular due to its benefits and faster recovery periods, especially in the aged population. This is a case presentation of a 48-year-old male who presented at our tertiary care center with abdominal pain, multiple episodes of vomiting, obstipation, and abdominal distention. The patient was diagnosed with sigmoid volvulus with pre-pyloric perforation which was managed surgically by initial detorsion followed by sigmoidectomy with modified Graham's patch technique. He recovered well with no post-operative complications.
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Affiliation(s)
- Mihir Patil
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Gharde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Ciuntu BM, Tanevski A, Buescu DO, Lutenco V, Mihailov R, Ciuntu MS, Zuzu MM, Vintila D, Zabara M, Trofin A, Cadar R, Nastase A, Lupascu Ursulescu C, Lupascu CD. Endoscopic Vacuum-Assisted Closure (E-VAC) in Septic Shock from Perforated Duodenal Ulcers with Abscess Formations. J Clin Med 2024; 13:470. [PMID: 38256604 PMCID: PMC10816729 DOI: 10.3390/jcm13020470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
This case report underscores the importance of utilizing E-VAC (endoscopic vacuum-assisted closure) in the treatment of a perforated duodenal ulcer complicated by the formation of a subphrenic abscess and septic shock. It showcases how E-VAC can effectively mitigate the risk of further complications, such as leakage, bleeding, or rupture, which are more commonly associated with traditional methods like stents, clips, or sutures. As a result, there is a significant reduction in mortality rates. A perforated duodenal ulcer accompanied by abscess formation represents a critical medical condition that demands prompt surgical intervention. The choice of the method for abscess drainage and perforation closure plays a pivotal role in determining the patient's chances of survival. Notably, in patients with a high ASA (American Association of Anesthesiologists) score of IV-V, the mortality rate following conventional surgical intervention is considerably elevated. The management of perforated duodenal ulcers has evolved from open abdominal surgical procedures, which were associated with high mortality rates and risk of suture repair leakage, to minimally invasive techniques like laparoscopy and ingestible robots. Previously, complications arising from peptic ulcers, such as perforations, leaks, and fistulas, were primarily addressed through surgical and conservative treatments. However, over the past two decades, the medical community has shifted towards employing endoscopic closure techniques, including stents, clips, and E-VAC. E-VAC, in particular, has shown promising outcomes by promoting rapid and consistent healing. This case report presents the clinical scenario of a patient diagnosed with septic shock due to a perforated duodenal ulcer with abscess formation. Following an exploratory laparotomy that confirmed the presence of a subphrenic abscess, three drainage tubes were utilized to evacuate it. Subsequently, E-VAC therapy was initiated, with the kit being replaced three times during the recovery period. The patient exhibited favorable progress, including weight gain, and was ultimately discharged as fully recovered. In the treatment of patients with duodenal perforated ulcers and associated abscess formation, the successful and comprehensive drainage of the abscess, coupled with the closure of the perforation, emerges as a pivotal factor influencing the patient's healing process. The positive outcomes observed in these patients underscore the efficacy of employing a negative pressure E-VAC kit, resulting in thorough drainage, rapid patient recovery, and low mortality rates.
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Affiliation(s)
- Bogdan Mihnea Ciuntu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Adelina Tanevski
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - David Ovidiu Buescu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Valerii Lutenco
- Department of General Surgery, Faculty of Medicine, “Dunarea de Jos” University of Medicine and Pharmacy, 800010 Galati, Romania; (V.L.); (R.M.)
- General Surgery Clinic, “St. Apostol Andrei” County Emergency Clinical Hospital, Strada Brăilei 177, 800578 Galati, Romania
| | - Raul Mihailov
- Department of General Surgery, Faculty of Medicine, “Dunarea de Jos” University of Medicine and Pharmacy, 800010 Galati, Romania; (V.L.); (R.M.)
- General Surgery Clinic, “St. Apostol Andrei” County Emergency Clinical Hospital, Strada Brăilei 177, 800578 Galati, Romania
| | - Madalina Stefana Ciuntu
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Mihai Marius Zuzu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Dan Vintila
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Mihai Zabara
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ana Trofin
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ramona Cadar
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Alexandru Nastase
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Corina Lupascu Ursulescu
- Department of Radiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Cristian Dumitru Lupascu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
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Turan B, Eroğlu H, Sultanoğlu B, Demirbakan K. Methamphetamine-related peptic ulcer perforation: a growing medical concern. ULUS TRAVMA ACIL CER 2023; 29:1357-1363. [PMID: 38073456 PMCID: PMC10767286 DOI: 10.14744/tjtes.2023.53146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/26/2023] [Accepted: 10/18/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Many studies have been done in the literature on perforations due to substance abuse, and there are limited publications on perforations related to inhaled methamphetamine. Recently, in our clinic, we observed an increase in the number of patients with perforated peptic ulcer, which we think is secondary to a significant increase in the consumption of this drug. The main purpose of this study is to determine whether the use of inhaled methamphetamine known as 'fire and ice' is a factor directly related to peptic perforation and its complications and also to determine the demographic variables of patients with peptic ulcer perforation due to this substance use, in the context of the literature. METHODS A retrospective study was conducted by examining the medical records of 29 gastric perforation patients who underwent surgical treatment in our clinic in 2021. Data were transferred to SPSS.23 (IBM Inc., Chicago, IL, USA) program and evaluated with statistical analysis. Normality assumptions of continuous variables were examined with Kolmogorov-Smirnov test, and variance homogeneity was examined with Levene's test. Bi-level comparisons, t-test if the data are normally distributed and Mann-Whitney U-test for bi-level comparisons where the data are not normally distributed were used. Relationships between categorical variables were examined by Chi-square test analysis. P<0.05 was accepted as the level of significance in all analyzes. RESULTS Twenty-nine patients were divided into two groups as methamphetamine users (n=13) and non-users (n=16). There was a statistically significant difference according to the lower age in the group using methamphetamine (31.69-48.8-P=0.025). The pres-ence of PU history differed significantly between the groups (P=0.009). Interestingly, aspartate transaminase alanine aminotransferase values were lower in substance dependents (P=0.020). Furthermore, there was a significant difference in localization between groups (P<0.001). There was no statistically significant difference between the two groups in terms of gender, clinical presentation, and other laboratory values. CONCLUSION Methamphetamine consumption, known as fire and ice, is an important risk factor for ulcer development and subsequent perforation, especially in young patients and long-term consumption of this narcotic substance. It has been determined that this risk factor, which is currently considered rare, has been seen in a very large number in a short time in our clinic. The use of this substance, which is considered a major social threat, is becoming more and more widespread, and this study is only a small part of the iceberg reflected in the general surgery clinic of a hospital.
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Affiliation(s)
- Bilal Turan
- General Surgery Clinic, Dr Ersin Arslan Training and Research Hospital, Gaziantep-Türkiye
| | - Hakan Eroğlu
- General Surgery Clinic, Dr Ersin Arslan Training and Research Hospital, Gaziantep-Türkiye
| | - Bülent Sultanoğlu
- General Surgery Clinic, Dr Ersin Arslan Training and Research Hospital, Gaziantep-Türkiye
| | - Kenan Demirbakan
- Department of General Surgery, Sanko University Faculty of Medicine, Gaziantep-Türkiye
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Ghosh A, Halder A, Sen N, Dhara A, Ghosh S, Stellone Singh K. A comparative analytical study on outcome of secondary peritonitis using Mannheim's peritonitis index in geographically diverse Indian patients. Turk J Surg 2023; 39:300-309. [PMID: 38694533 PMCID: PMC11057927 DOI: 10.47717/turkjsurg.2023.6043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/31/2023] [Indexed: 05/04/2024]
Abstract
Objectives Secondary peritonitis is caused by infection of the peritoneal cavity due to perforation of the alimentary tract. Mannheim's peritonitis ındex (MPI) is a prognostic scoring system that predicts outcomes in peritonitis. Increasing MPI scores correlate with poor outcomes and mortality. The objective of this study is to evaluate the effectiveness of MPI-based prognosis and its impact on Indian patients with secondary peritonitis. Material and Methods For understanding the effectiveness of the MPI scoring system, a cross-sectional data analysis of published studies on secondary peritonitis from 10 geographical locations in India was performed. The 10-site study results were compared with unpublished in-house study data for individual MPI parameters to analyze any variations of MPI score-based predictions across a diverse Indian population. Patients were divided into risk groups on the basis of MPI scores: <21 mild, MPI= 21-29 moderate, MPI> 29 severe risk. Results We observed a significant correlation between mortality with age and gender as reported worldwide. Site of perforations were prevalent in the upper alimentary tract with the majority being gastro-duodenal for the Indian population as opposed to distal parts in the western population. Higher lethality in India is often associated with evolution time, organ failure, and sepsis due to delayed presentation and poor management. Conclusion MPI scoring is effective in predicting risk across geographically diverse Indian populations. The sensitivity and specificity of MPI scores are more reliable and a score >29 specifically recommends aggressive resuscitation & monitoring of patients, initiation of broad-spectrum antibiotics, and intensive care support to reduce mortality and morbidity.
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Affiliation(s)
- Ankan Ghosh
- Department of General Surgery, All India Institute of Medical Sciences, Kalyani, India
| | - Anindya Halder
- Department of General Surgery, All India Institute of Medical Sciences, Kalyani, India
| | - Nirmalya Sen
- Division of Molecular Medicine, Bose Institute, Kolkata, India
| | - Aiindrila Dhara
- Department of Biological Science, Tata Institute of Fundamental Research, Mumbai, India
| | - Sourav Ghosh
- Department of Biochemistry and Biophysics, University of Kalyani, Kalyani, India
| | - Khulem Stellone Singh
- Department of General Surgery, Regional Institute of Medical Sciences (RIMS), Imphal, India
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Aladwani MM, Alrubaiaan MT, Alrayani YH, Alabdali TN. Adrenocorticotropic Hormone-Dependent Cushing's Syndrome Complicated With Gastric Ulcer Perforation in a 30-Year-Old Saudi Female: A Case Report and a Review of the Literature. Cureus 2023; 15:e48089. [PMID: 38046760 PMCID: PMC10690111 DOI: 10.7759/cureus.48089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Gastrointestinal perforation is a well-addressed complication of exogenous hypercortisolism; however, patients with endogenous Cushing's syndrome (CS) do not usually experience this condition in clinical practice. The literature on this subject is limited and consists solely of clinical case reports/series with only 23 instances of gastrointestinal perforation occurring in individuals with endogenous Cushing's syndrome. This is mainly attributed to the rarity of Cushing's syndrome itself and the low chance of occurrence of such complications. We report a case of a recently diagnosed adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome in a 30-years-old female who presented initially with a three-month history of progressive weight gain, generalized weakness, acne, menstrual irregularity, and severe hypokalemia, and then developed a gastric ulcer perforation only one month after her ACTH-dependent Cushing's syndrome diagnosis and was managed through emergent surgery.
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Affiliation(s)
| | - Mishari T Alrubaiaan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Yazeed H Alrayani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Tareq N Alabdali
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Li J, Lu H, Yu L, Li H, Chen X, Chen C, Tao E. Case report: Catastrophic event: neonatal gastric perforation and complication of capillary leak syndrome. Front Pediatr 2023; 11:1257491. [PMID: 37800010 PMCID: PMC10547872 DOI: 10.3389/fped.2023.1257491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023] Open
Abstract
Neonatal gastric perforation (NGP) is a rare, but life-threatening condition that can lead to serious conditions, such as capillary leak syndrome (CLS). Here, we present the case of a preterm male infant with NGP complicated by CLS after stomach repair. The patient was born at 33 2/7 weeks, weighed 1,770 g, and was diagnosed with respiratory distress syndrome. On the fourth day of life, the patient presented with distention and an unstable cardiovascular system. Routine blood tests revealed a white blood cell count of 2.4 × 109/L. Chest and abdominal radiography revealed a pneumoperitoneum, suggesting a gastrointestinal perforation. The patient was urgently transferred to a tertiary hospital for exploratory laparotomy, where a 2 cm diameter perforation was discovered in the stomach wall and subsequently repaired. Pathological findings indicated the absence of a muscular layer in the stomach wall. The patient unexpectedly developed CLS postoperatively, leading to multiorgan dysfunction and eventual death. The underlying pathological mechanism of NGP-induced CLS may be related to severe chemical peritonitis, sepsis, endothelial glycocalyx dysfunction, enhanced systemic inflammation, and translocation of the gut microbiota, causing endothelial hyperpermeability. Notablely, abdominal surgery itself can be a significant triggering factor for CLS occurrence. Complications of NGP and CLS are extremely dangerous. Investigating the mechanism by which NGP triggers CLS could potentially improve the prognosis. Conservative treatment for pneumoperitoneum secondary to gastric perforation may be a reasonable option, especially when the condition of the patient is unstable.
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Affiliation(s)
- Jie Li
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, China
| | - Hongping Lu
- Department of Neonatology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - LinJun Yu
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Haiting Li
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, China
| | - Xiyang Chen
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, China
| | - Caie Chen
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, China
| | - Enfu Tao
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, China
- Department of Science and Education, Wenling Maternal and Child Health Care Hospital, Wenling, China
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11
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Uttinger K, Plum P, Gockel I. [57/m-Abdominal pain for several days with known alcohol abuse : Preparation for the medical specialist examination: part 28]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:3-7. [PMID: 37171594 DOI: 10.1007/s00104-023-01857-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Konstantin Uttinger
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, Building 4, 04103, Leipzig, Deutschland.
| | - Patrick Plum
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, Building 4, 04103, Leipzig, Deutschland
| | - Ines Gockel
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, Building 4, 04103, Leipzig, Deutschland
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12
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Davoudi S, De Decker M, Willemsen P. Atypical fundal perforation: a case report. J Surg Case Rep 2023; 2023:rjad480. [PMID: 37645699 PMCID: PMC10460730 DOI: 10.1093/jscr/rjad480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/05/2023] [Indexed: 08/31/2023] Open
Abstract
Gastric perforations typically occur in the distal stomach, along the greater curvature or the antrum. The vast majority of upper gastrointestinal (GI) perforations are caused by peptic ulcer disease. We present a case of an atypical location of gastric perforation. A 31-year-old patient was experiencing nausea and severe abdominal pain. Explorative laparoscopy revealed a large fundal perforation. The patient underwent an abdominoplasty 5 days before with revisional surgery for hemorrhage. He had recently lost 42 kg after endoscopic sleeve gastroplasty (ESG) 8 months before. ESG is a minimally invasive alternative for bariatric surgery. Since its implementation, several studies have been published indicating the procedure as safe. However, some major adverse events, such as upper GI-bleeding, peri-gastric leak, and pneumoperitoneum, have been described. The atypical location of the perforation might be explained by a combination of events such as surgical stress, revisional surgery, major weight loss, and the history of ESG.
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Affiliation(s)
- Sadaf Davoudi
- Faculty of Medicine, KU Leuven University, Leuven 3000, Belgium
| | - Marjolein De Decker
- Department of General and Abdominal Surgery, ZNA Middelheim, Antwerp 2020, Belgium
| | - Paul Willemsen
- Department of General and Abdominal Surgery, ZNA Middelheim, Antwerp 2020, Belgium
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13
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Qu Z, Jiang D, Liu Y, Hou M. Liuwei Anxiao San protects gastric mucosa from gastric ulcer in rats by regulating the JAK2/STAT3 pathway. Tissue Cell 2023; 83:102145. [PMID: 37437331 DOI: 10.1016/j.tice.2023.102145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/02/2023] [Accepted: 06/16/2023] [Indexed: 07/14/2023]
Abstract
Mongolian medicine prescriptions are recognized as promising gastroprotective agents. This study is to explore the effects and mechanisms of Liuwei Anxiao San (LAS) in gastric ulcer (GU). GU rat models were established using acetic acid, followed by treatment with LAS at different doses and/or the JAK2 agonist Coumermycin A1 (CA1). The ulcerous area and inhibition rates were calculated. The mucosal damage and cell apoptosis in gastric tissues were assessed by H&E and TUNEL staining. The activities of SOD, GSH-Px, and CAT, and MDA levels were measured. The levels of pro-inflammatory and anti-inflammatory factors were determined by ELISA. The activation of the JAK2/STAT3 pathway was determined by Western blot. As the results suggested, LAS dose-dependently ameliorated gastric mucosal damage and inhibited oxidative stress and inflammatory response, evidenced by increased activities of SOD, GSH-Px, and CAT, decreased MDA level, increment of anti-inflammatory factors and decrement of pro-inflammatory factors, and inhibited the activation of the JAK2/STAT3 pathway in GU rats. CA1 partly abolished the function of LAS on gastric mucosal injury, oxidative stress, and inflammation in GU rats. In conclusion, LAS protects against gastric mucosal injury in GU rats through inhibition of oxidative stress and inflammation by suppressing the JAK2/STAT3 pathway.
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Affiliation(s)
- Ze Qu
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, China; Geriatrics Center, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, China
| | - Dong Jiang
- Hand and Foot Microscopy Center, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, China
| | - Yan Liu
- Department of Medical Administration, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, China
| | - Mingxing Hou
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, China; Department of Gastrointestinal Surgery, Affiliated Hospital of Inner Mongolia Medical University, No. 5, Xinhua West Street, Huimin District, Hohhot, Inner Mongolia 010050, China.
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14
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Mazepa MM, Pereira MA, Arabi AYM, Dias AR, Ribeiro U, Zilberstein B, D’Albuquerque LAC, Ramos MFKP. Gastroduodenal Perforation in Cancer Patients: Association with Chemotherapy and Prognosis. Med Sci (Basel) 2023; 11:medsci11020026. [PMID: 37092495 PMCID: PMC10123675 DOI: 10.3390/medsci11020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
Background: Gastroduodenal perforation stands out as one of the complications in cancer patients. Despite its high mortality, its characteristics are still poorly described. This study aimed to evaluate the characteristics and outcomes of cancer patients who had gastroduodenal perforation, and the influence of chemotherapy (CMT) in these cases. Method: A retrospective analysis of patients who underwent emergency surgery with an intraoperative finding of gastroduodenal perforation. Patients who performed CMT within 60 days before perforation were considered as the CMT group. Results: Among 45 patients included, 16 (35.5%) were classified as the CMT group and the remaining 29 (64.5%) patients as the non-CMT group. There was no difference between the groups regarding sex, age, BMI, comorbidity, and laboratory exams. ECOG 2-3 was significantly more frequent in the CMT group (68.8% vs. 34.5% p = 0.027). Major postoperative complications were similar between both groups (75% vs. 58.6%, p = 0.272). The sepsis of abdominal focus was the main postoperative complication. The 30-day mortality was 55.6%, with no difference between non-CMT and CMT groups (62.5% vs. 51.7%, respectively; p = 0.486). A multivariate analysis of risk factors showed that only an age of ≥65 years was related to 30-day mortality. Conclusions: Patients with gastroduodenal perforation and oncologic treatment present high mortality, regardless of receiving recent CMT.
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15
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Abosayed AK, Dayem AYA, Shafik I, Mashhour AN, Farahat MA, Refaat A. Prognostic value of free air under diaphragm on chest radiographs in correlation with peritoneal soiling intraoperatively. Emerg Radiol 2023; 30:99-106. [PMID: 36515771 DOI: 10.1007/s10140-022-02111-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Gastrointestinal perforation is a significant injury that originates mainly from gastrointestinal ulcers. It is associated with a high rate of morbidity and mortality. The height of the column of the air under the diaphragm can be used to estimate the amount of peritoneal soiling due to viscus perforation. This study aimed to determine the correlation between this estimate and the incidence of morbidity and mortality. METHODS To achieve this aim, a prospective cohort study was conducted on 83 patients at Kasr al ainy hospital who, between March 2021 and March 2022, presented to the emergency department with free air under the diaphragm at chest X-ray and required surgical intervention for a perforated viscus. For each case, the amount of peritoneal soiling and the amount of air under the diaphragm as determined by a chest X-ray were recorded. RESULTS The mean air under the diaphragm in a plain erect chest X-ray was 1.78 ± 1.92 cm, and the mean amount of peritoneal soiling was 1201.83 ± 948.99 CC. There are positive correlations between the amount of air under the diaphragm as shown on an X-ray and the size of the perforation (p = 0.034), the amount of peritoneal soiling (p = 0.003), and the mortality (p = 0.013). CONCLUSION There was a statistically significant correlation between air under the diaphragm according to X-ray and the amount of peritoneal soiling in patients with a perforated viscus. This measure can be used as a sensitive tool to predict morbidity and mortality as more free air in the chest X-ray is associated with significant mortality. These results may enhance the decision making using sensitive and available tool of diagnosis.
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Affiliation(s)
| | | | | | | | | | - Ahmed Refaat
- Faculty of Medicine, Cairo University, Cairo, Egypt
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16
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Park YS. A Case of Gastric Perforation Caused by Excessive Insufflation during Upper Gastrointestinal Endoscopy: Nonoperative Management. Case Rep Gastroenterol 2023; 17:327-332. [PMID: 38020464 PMCID: PMC10651181 DOI: 10.1159/000534866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Upper gastrointestinal endoscopy is used to diagnose and treat upper gastrointestinal diseases, but it can also cause complications, including perforation. Perforation is a serious complication, so it is important to be aware of the risk factors in advance and to take precautions to prevent it. Case Presentation We report a case of gastric perforation caused by excessive insufflation during upper gastrointestinal endoscopy in a 64-year-old man with a history of multiple active gastric ulcers. During the endoscopy, the patient did not cooperate and insufflation was performed for a prolonged period of time. This led to a mucosal laceration and a hole suspected to be a perforation on the lesser curvature of the gastric body. The patient was treated nonsurgically with fasting, intravenous fluids, antibiotics, intravenous proton pump inhibitors, and blood transfusions. No leakage was observed on the follow-up computed tomography scan, and the perforation site was completely healed 2 months later. Conclusion In this case, the patient was successfully treated with conservative therapy alone. The treatment of gastric perforation caused by endoscopy has shifted toward conservative therapy in recent years.
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Affiliation(s)
- Youn Su Park
- Department of Internal Medicine, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang-si, South Korea
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17
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López-Lorenzo Y, Sánchez-Mendoza ME, Arrieta-Baez D, Perez-Ruiz AG, Arrieta J. Gastroprotective activity of ( E)-ethyl-12-cyclohexyl-4,5-dihydroxydodec-2-enoate, a compound isolated from Heliotropium indicum: role of nitric oxide, prostaglandins, and sulfhydryls in its mechanism of action. PHARMACEUTICAL BIOLOGY 2022; 60:1207-1213. [PMID: 35764528 PMCID: PMC9248942 DOI: 10.1080/13880209.2022.2087690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/26/2022] [Accepted: 06/05/2022] [Indexed: 06/15/2023]
Abstract
CONTEXT The gastroprotective effect of Heliotropium indicum L. (Boraginaceae), a plant traditionally used in Mexico to treat gastric ulcers, has been previously reported. However, no active compound was identified. OBJECTIVE The current contribution aimed to isolate, through a bioassay-guided study, at least one compound from H. indicum with considerable gastroprotective activity, examine its effect on ethanol-induced gastric lesions in mice, and explore possible mechanisms of action. MATERIALS AND METHODS Three extracts (hexane, dichloromethane, and methanol) were obtained from H. indicum leaves. Their 30 and 100 mg/kg doses were assessed on ethanol-induced gastric lesions in male CD1 mice. Since the dichloromethane extract was the most active, successive chromatographies were carried out leading to the identification of the most active compound. This compound (at 3-100 mg/kg) was compared to carbenoxolone (at 10-100 mg/kg) in biological evaluations in mice. Pre-treatments with indomethacin (10 mg/kg, s.c.), L-NAME (70 mg/kg, i.p.), and NEM (10 mg/kg, s.c.) were performed independently to determine the participation of prostaglandins, nitric oxide, and/or sulfhydryl groups, respectively, in the mechanism of action of the compound. RESULTS (E)-Ethyl-12-cyclohexyl-4,5-dihydroxydodec-2-enoate, a compound isolated from H. indicum, afforded dose-dependent gastroprotective activity. The maximum effect was observed at 100 mg/kg (90.13 ± 3.08%), with an ED50 of 5.92 ± 2.48 mg/kg. Gastroprotection was not modified by pre-treatment with indomethacin, L-NAME, or NEM. CONCLUSIONS (E)-Ethyl-12-cyclohexyl-4,5-dihydroxydodec-2-enoate, isolated from H. indicum, was found to produce a substantial gastroprotective effect. Prostaglandins, nitric oxide, and non-protein sulfhydryl groups are not involved in its mechanism of action.
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Affiliation(s)
- Yaraset López-Lorenzo
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Colonia Casco de Santo Tomás, Mexico City, Mexico
| | - María Elena Sánchez-Mendoza
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Colonia Casco de Santo Tomás, Mexico City, Mexico
| | - Daniel Arrieta-Baez
- Centro de Nanociencias y Micro y Nanotecnologías-Instituto Politécnico Nacional, Unidad Profesional Adolfo López Mateos, Mexico City, Mexico
| | - Adriana Guadalupe Perez-Ruiz
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Colonia Casco de Santo Tomás, Mexico City, Mexico
| | - Jesús Arrieta
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Colonia Casco de Santo Tomás, Mexico City, Mexico
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18
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[38/m-Acute onset of severe upper abdominal pain : Preparation for the medical specialist examination: part 19]. CHIRURGIE (HEIDELBERG, GERMANY) 2022; 93:85-87. [PMID: 36416913 DOI: 10.1007/s00104-022-01761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/24/2022]
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19
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Safadi MF, Shamma H, Berger M. The Visible Stomach: Elusive Diffuse-Type Adenocarcinoma Presents With Gastric Outlet Obstruction. Cureus 2022; 14:e25554. [PMID: 35783885 PMCID: PMC9249010 DOI: 10.7759/cureus.25554] [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: 05/31/2022] [Indexed: 11/15/2022] Open
Abstract
The diagnosis of diffuse-type gastric cancers may be challenging due to their submucosal infiltration. A male in his early 60s was diagnosed with signet-ring cell adenocarcinoma of the diffuse type based on a biopsy from a perforated gastric ulcer. Postoperative workup was negative, including repeated esophagogastroduodenoscopy, gastric biopsies, tumor markers, computed tomography (CT), and positron emission tomography (PET). Six months after the operation, the patient presented to our center with abdominal discomfort and nausea. The clinical examination showed an enlarged visible stomach due to gastric outlet obstruction. The patient underwent total gastrectomy after confirmation of malignancy using an intraoperative frozen section. However, the tumor was already advanced locally and regionally. Confirmed malignancy in biopsies from perforated gastric ulcers should be never considered false positivity. To avoid missing a diffuse gastric cancer, endoscopic biopsies should be obtained using advanced techniques such as submucosal dissection under endosonographic guidance.
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20
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Rosa F, Covino M, Fransvea P, Cozza V, Quero G, Fiorillo C, Simeoni B, La Greca A, Sganga G, Gasbarrini A, Franceschi F, Costamagna G, Alfieri S. Gastric emergencies in older adults: not always the same old story! A tertiary care emergency department observational cohort study. BMJ Open 2022; 12:e056981. [PMID: 35078851 PMCID: PMC8796243 DOI: 10.1136/bmjopen-2021-056981] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To analyse and compare the clinical outcomes between patients ≥80 years and 65-79 years, who presented to our emergency department (ED) with the two most common gastric emergency (GE) clinical presentation, that is, gastric bleeding and gastric perforation. DESIGN Single-centre retrospective cohort study. PARTICIPANTS A total of 1011 patients were enrolled: 421 patients aged ≥80 years were compared with a group of 590 patients aged 65-79 years. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was to compare the overall mortality. Secondary outcomes included major complications, in-hospital length of stay (LOS) and need for surgical procedures. RESULTS Patients ≥80 years with GE had different presentations at ED compared with younger patients: they had higher gastrointestinal bleeding (24.9% vs 16.3%, p=0.001), anemisation (14.5% vs 8.8%, p=0.005) and shock (10.9% vs 5.1%, p=0.001) rates. Median LOS, cumulative major complications and mortality rates were similar among the two groups.Multivariate analysis identified shock, gastric malignancy and gastric fistula as independent predictors for survival. CONCLUSIONS Patients ≥80 years with GE did not have a higher mortality rate and cumulative major complications as compared to younger elderly patients. Invasive treatments were not associated with a different prognosis in this age group.
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Affiliation(s)
- Fausto Rosa
- Digestive Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Marcello Covino
- Emergency Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Pietro Fransvea
- Emergency Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Valerio Cozza
- Emergency Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giuseppe Quero
- Digestive Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Claudio Fiorillo
- Digestive Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Benedetta Simeoni
- Emergency Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Antonio La Greca
- Emergency Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Gabriele Sganga
- Emergency Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Antonio Gasbarrini
- Internal Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Francesco Franceschi
- Emergency Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Guido Costamagna
- Digestive Endoscopy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Sergio Alfieri
- Digestive Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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21
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Chung D. Ischaemic gastritis and perforation. Ann Med Surg (Lond) 2022; 73:103212. [PMID: 35070284 PMCID: PMC8767231 DOI: 10.1016/j.amsu.2021.103212] [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: 10/16/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Gastric perforation is a common general surgical emergency. Ischaemia of the stomach is uncommon due to its rich vascular supply, and is an uncommon cause of perforation. Minimal literature is available on the topic of ischaemic gastritis, with the few cases available linked to gastric dilation. Presentation of case A 52 year old lady presents with a syncopal episode, nausea, vomiting, malaise, and abdominal discomfort. A chest X-ray identified free subdiaphragmatic gas, and her examination revealed a peritonitic abdomen, prompting urgent surgical intervention. She was found to have ischaemic gastritis with multiple perforations along the greater curvature, necessitating a sleeve gastrectomy. Her post-operative course was stormy, requiring significant haemodynamic and respiratory support in the intensive care unit with progressive multi-organ dysfunction. She eventually developed extensive bowel ischaemia, and further management was considered futile. She passed away 13 days post-operatively. Clinical discussion The vascular supply of the stomach is rich with collaterals, making ischaemia unlikely. Its occurrence requires either a proximal insult, global ischaemia from pressure, or a systemic coagulopathy. Aside from perforation, it may also present with GI bleeding. Depending on its aetiology, the disease has been managed successfully either conservatively, interventionally, or operatively. Conclusion Ischaemic gastritis is uncommon and likely underdiagnosed. Timely recognition of its aetiology early in its course is important, for choosing the appropriate management and to improve patient outcomes. Its management is dependent on the aetiology of the perforation. Ischaemic gastritis is uncommon owing to the rich vasculature of the stomach. It may present as upper GI bleeding resulting in underdiagnosis. Ischaemia requires either a proximal insult, pressure related ischaemia, or coagulopathy. Depending on its aetiology, it may be managed conservatively, angriographically, or operatively. Delayed presentation significantly worsens outcomes.
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Affiliation(s)
- Douglas Chung
- Campbelltown Hospital, Therry Road, Campbelltown, NSW, 2560, Australia
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22
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Qiu TT, Fu R, Luo Y, Ling WW. Diagnosis of upper gastrointestinal perforation complicated with fistula formation and subphrenic abscess by contrast-enhanced ultrasound: A case report. World J Clin Cases 2021; 9:8858-8863. [PMID: 34734067 PMCID: PMC8546811 DOI: 10.12998/wjcc.v9.i29.8858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/19/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal perforation complicated by subphrenic abscess is a surgical emergency. Its diagnosis relies mainly on X-ray or computed tomography (CT), while the value of ultrasound, especially contrast-enhanced ultrasound (CEUS), has been underestimated.
CASE SUMMARY A 37-year-old man presented with fever and edema of the lower extremities for 10 d. He had a history of laparoscopic repair of gastroduodenal perforation 6 mo prior. His first-time intravenous CEUS indicated a diagnosis of subphrenic abscess. He received antibiotic therapy and ultrasound-guided percutaneous drainage of the abscess. However, second-time intravenous CEUS revealed an unsatisfactory therapeutic effect. Intracavitary CEUS was proposed, and this examination detected communication between the abscess and the stomach. Upper gastrointestinal perforation complicated by fistula formation and subphrenic abscess was diagnosed with the help of CEUS. Abdominal CT and esophagogastroduodenoscopy confirmed the diagnosis. The patient recovered after the perforation was repaired by surgery.
CONCLUSION Intravenous and intracavitary CEUS provides helpful information for the diagnosis of upper gastrointestinal perforation complicated by fistula formation and subphrenic abscess.
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Affiliation(s)
- Ting-Ting Qiu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Rong Fu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan Luo
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wen-Wu Ling
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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23
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Hernandez Cervantes BY, Martínez Lopez D, Guzman Lambert R, Rodríguez Gonzalez M, Meah M. Acute traumatic abdominal wall hernia-value of the physical examination: case report. J Surg Case Rep 2021; 2021:rjab314. [PMID: 34316351 PMCID: PMC8301642 DOI: 10.1093/jscr/rjab314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/26/2021] [Indexed: 12/22/2022] Open
Abstract
Acute traumatic abdominal wall hernia (TAWH) is a rare type of hernia that occurs after a low or high velocity impact of the abdominal wall against a blunt object with few cases reported. Perforations of the hollow viscera commonly follow abdominal trauma and likely require surgery for hemorrhage and sepsis source control. We report a case where a high velocity impact of the abdominal wall against the stump of a felled tree caused a TAWH with concomitant gastric perforation in a 20-year-old male patient who required exploratory laparotomy with primary repair of the stomach and fascia. The physical examination findings without previous history of abdominal hernia and pneumoperitoneum in the chest X-ray made suspect our diagnosis and it was confirmed intraoperatively. At 3 months postoperatively the patient has a strong abdominal wall. It is imperative to emphasize the importance of the physical examination goal of not losing diagnosis of TAWH.
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Affiliation(s)
| | - Duniesky Martínez Lopez
- Department of Internal Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Radisnay Guzman Lambert
- Department of Surgery, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Mariuska Rodríguez Gonzalez
- Department of Internal Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Mary Meah
- Department of Surgery, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Peng X, Xia X, Xu X, Yang X, Yang B, Zhao P, Yuan W, Chiu PWY, Bian L. Ultrafast self-gelling powder mediates robust wet adhesion to promote healing of gastrointestinal perforations. SCIENCE ADVANCES 2021; 7:7/23/eabe8739. [PMID: 34078598 PMCID: PMC8172133 DOI: 10.1126/sciadv.abe8739] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/15/2021] [Indexed: 05/20/2023]
Abstract
Achieving strong adhesion of bioadhesives on wet tissues remains a challenge and an acute clinical demand because of the interfering interfacial water and limited adhesive-tissue interactions. Here we report a self-gelling and adhesive polyethyleneimine and polyacrylic acid (PEI/PAA) powder, which can absorb interfacial water to form a physically cross-linked hydrogel in situ within 2 seconds due to strong physical interactions between the polymers. Furthermore, the physically cross-linked polymers can diffuse into the substrate polymeric network to enhance wet adhesion. Superficial deposition of PEI/PAA powder can effectively seal damaged porcine stomach and intestine despite excessive mechanical challenges and tissue surface irregularities. We further demonstrate PEI/PAA powder as an effective sealant to enhance the treatment outcomes of gastric perforation in a rat model. The strong wet adhesion, excellent cytocompatibility, adaptability to fit complex sites, and easy synthesis of PEI/PAA powder make it a promising bioadhesive for numerous biomedical applications.
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Affiliation(s)
- Xin Peng
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Xianfeng Xia
- Department of Endoscopy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
- Chow Yuk Ho Technology Center for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Xiayi Xu
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Xuefeng Yang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Boguang Yang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Pengchao Zhao
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Weihao Yuan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Philip Wai Yan Chiu
- Chow Yuk Ho Technology Center for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR 999077, China.
- Department of Surgery and State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Liming Bian
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR 999077, China.
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518172, China
- China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, Zhejiang 310058, China
- Centre for Novel Biomaterials, The Chinese University of Hong Kong, Hong Kong 999077, China
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