Gastric conduit reconstruction after esophagectomy with right gastroepiploic artery absence: a case report

Gastric conduit reconstruction is the standard choice after esophagectomy. Conduit's vascular supply is of primary importance mainly based on right gastroepiploic vessels. A 57-year-old male with absent right gastroepiploic artery, due to a duodenal bleeding ulcer treated with gastroduodenal artery ligation 10 years ago, was treated for gastroesophageal cancer and required esophagectomy. Surgical merits of this troublesome scenario are highlighted. Previous surgical history is highly important for patients requiring complex surgery as esophagectomy. The use of the stomach as conduit after esophagectomy is always the primary option; however vascular supply of it should not be compromised. Variations are rare and careful planning may overcome obstacles as in this case.

[Intracerebral hemorrhage as the cause of low-flow priapism : A rare association]

Priapism is a painful erection of the penis lasting for more than 4h and is independent of sexual stimulation. It represents a urological emergency and necessitates rapid treatment. Etiologically, approximately 20% are caused by drugs, 50% are a combination of hematological diseases (e.g. sickle cell anemia), leukemia, injections in the corpora cavernosa, paraneoplastic processes and neurological or infectious causes. Ultimately, 30% have an idiopathic origin. Priapism as a result of traumatic intracerebral hemorrhage has so far rarely been described. This article presents the case of a 48-year-old male patient who presented to the emergency department with a traumatic subarachnoid hemorrhage. During the hospital stay the patient suffered from low-flow priapism, which was initially punctured and ultimately operatively treated.

Psychiatric patient with Chilaiditi's syndrome

BACKGROUND

Chilaiditi's sign is defined as the interposition of bowels between the liver and the right diaphragm. When the patient is symptomatic due to the intestinal obstruction, the case is referred to as Chilaiditi's syndrome.

OBJECTIVE

To emphasize the importance of accurate diagnose of Chilaiditi's syndrome in patients with psychotic disturbances.

METHOD

A 46 years old male was admitted to our department suffering from a constant epigastric and right upper quadrant pain with radiation to the right shoulder. The pain started 10 hours before the admission of the patient and was accompanied with vomiting. Patient has a history of schizophrenia and intellectual disability. He was in a stimulatory situation and unable to give any information about his state of health.

RESULTS

Patient was afebrile, tachycardic and laboratory results were normal. The chest and abdomen x-ray showed the Chilaiditi's sign. With the ultrasound procedure the case of the pneumoperitoneum was excluded. A conservative treatment with IV fluid hydration, pain management, diet modification, laxatives and enemas, was used. After a week of hospitalization, the patient felt well, having proper diet and regular evacuations and at the Chilaiditi's sign was no more observed.

DISCUSSION

The etiology of the Chilaiditi's syndrome is multifactoral and it has been reported that it is associated with psychotropic medication and intellectual disability.

CONCLUSIONS

The diagnosis of the syndrome is vital in order to avoid unnecessary and dangerous surgical interventions. Only few publications of a Chilaiditi syndrome in patients with psychosis are cited in the literature.

Management of gastrointestinal bezoars: an analysis of 23 cases

Bezoars (BZs) represent the most common foreign bodies of the gastrointestinal tract. Clinical symptoms varying from no symptoms to acute abdominal obstruction. Our goal is to present our experience with a review of the literature. In this study, 23 patients with BZs of the upper gastrointestinal system (GIS) were treated in the surgical department of two generals hospitals in northwest Greece. The size of BZs, localization, predisposing factors, clinical symptoms, morbidity, and mortality were analyzed. Conservative treatment, endoscopic procedures, and surgical treatment were also parameters under consideration. Nineteen patients presenting with phytobezoars and four female patients presented with psychological disorders and mental retardation with trichobezoars. More than one half of them (57%) had previous gastric surgery. Surgical morbidity rate was 28%, whereas the endoscopic morbidity was 11%. Mortality was 4% and 0% for the surgical and endoscopic groups, respectively. The differences in morbidity and mortality rates between the two groups were not statistically significant. BZs are commonly found in the stomach and small intestine, especially in patients who underwent previous gastric surgery. Small bowel obstruction is the most common complication. When uncomplicated, endoscopic or surgical removal of the BZs can be performed easy and effectively.