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Muhammed MM, Bwala KJ, Okoruwa JO. Typhoid Fever Presenting with Ileal Perforation and Gastric Perforation. West Afr J Med 2024; 41:92-96. [PMID: 38412528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Typhoid fever is caused by Salmonella typhi and Salmonella paratyphi. It is a disease of developing countries and is seen among people of low socio-economic status. Patients can develop complications like typhoid intestinal perforation which is associated with higher mortality. A 15-year-old female presented to the emergency pediatric unit with fever, abdominal pain and abdominal distension. She was septic, in respiratory distress, and had marked generalized abdominal tenderness with guarding. An assessment of generalized peritonitis secondary to typhoid intestinal perforation was made. She had exploratory laparotomy with intra-operative findings of ileal perforation and gastric perforation. She had repair of the intestinal and gastric perforations. Our patient presented late with concurrent use of NSAIDs and overwhelming sepsis which likely contributed to the gastric perforation as this is not a usual finding in patients with typhoid intestinal perforation. Gastric perforation is an unusual finding in patients with typhoid intestinal perforation. Typhoid fever and its complications can be easily prevented by the provision of safe water, proper facilities for sanitation, and practicing good hygiene.
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Affiliation(s)
- M M Muhammed
- Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria. +2348061666943
| | - K J Bwala
- Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria. +2348061666943
| | - J O Okoruwa
- Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria. +2348061666943
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Bian D, Chen Z, Ouyang Y, Wang S, Wang M, Chen W. Ultrafast self-gelling, sprayable, and adhesive carboxymethyl chitosan/poly-γ-glutamic acid/oxidized dextran powder for effective gastric perforation hemostasis and wound healing. Int J Biol Macromol 2024; 254:127960. [PMID: 37963505 DOI: 10.1016/j.ijbiomac.2023.127960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/29/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023]
Abstract
The rapid and effective hemostasis of gastrointestinal bleeding sites remains an urgent clinical challenge. In this study, an ultrafast self-gelling, sprayable, and adhesive carboxymethyl chitosan/poly-γ-glutamic acid/oxidized dextran (CPO) powder was designed for gastric perforation hemostasis and healing. When the CPO powder was sprayed to the gastric perforation site, the CPO powder absorbed water from the blood and concentrate blood cells and clotting factors to achieve the purpose of rapid hemostasis. During the hemostasis, the CPO powder formed a hydrogel in situ through the formation of amide bonds and Schiff base bonds within 15 s, forming a physical barrier to cover the wound surface. Concurrently, the aldehyde group (-CHO) of oxidized dextran formed additional Schiff base bonds with the amino group (-NH2) of the tissue, enabling the CPO powder with wound surface adhesion. Moreover, the CPO powder was shown to have excellent in vitro and in vivo antibacterial properties and it was able to promote the healing of infected wounds in a mouse model. In summary, CPO powder provides a promising idea for the rational design of gastrointestinal hemostatic agents.
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Affiliation(s)
- Dejian Bian
- Department of Gastroenterology, the First Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Emergency, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, PR China
| | - Zheng Chen
- School of Materials and Chemistry, University of Shanghai for Science and Technology, No. 516 Jungong Road, Shanghai 200093, PR China
| | - Yongliang Ouyang
- School of Materials and Chemistry, University of Shanghai for Science and Technology, No. 516 Jungong Road, Shanghai 200093, PR China
| | - Shige Wang
- School of Materials and Chemistry, University of Shanghai for Science and Technology, No. 516 Jungong Road, Shanghai 200093, PR China
| | - Meitang Wang
- Department of Emergency, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, PR China.
| | - Weichang Chen
- Department of Gastroenterology, the First Affiliated Hospital of Soochow University, Suzhou, PR China.
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Di Buono G, Russo G, Amato G, Micheli M, Geraci G, Agrusa A. A rare presentation of gastric phytobezoar: Simultaneous bleeding and perforation. combined laparoscopic and endoscopic approach. Report of a case. Int J Surg Case Rep 2023; 112:108841. [PMID: 37832358 PMCID: PMC10667765 DOI: 10.1016/j.ijscr.2023.108841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Bezoars are intraluminal conglomerates of indigestible foreign materials that accumulate in the gastrointestinal tract. We describe our experience with a patient with gastric perforation and concomitant gastric haemorrhage with severe anaemia, in whom we successfully extracted a giant gastric phytobezoar by cooperative laparoscopic and endoscopic surgery. CASE PRESENTATION A 68-year-old man was admitted with melena and septic shock. CT scan revealed a gastric perforation. We performed a combined laparoscopic and endoscopic approach with gastrotomy, removal of the phytobezoar and laparoscopic gastric suture. The suture was examined for leakage with the endoscopic hydropneumatic test to obtain direct vision of the suture and no evidence of leakage by insufflation of the area. DISCUSSION Gastric bezoars can be managed conservatively, endoscopically or surgically. Endoscopic removal, if effective, would be an attractive alternative for bezoar treatment. Usually endoscopic attempts are unsuccessful because of the large size of the bezoar and the difficulty in fragmentation. The laparoscopic approach for bezoar seems to have better postoperative outcomes. The main criticisms of the technique are abdominal spillage with risk of contamination as well as longer operative times. CONCLUSION In our case we simultaneously performed laparoscopic surgery and endoscopic operative procedure in accordance with the principles of laparoscopic and endoscopic cooperative surgery to treat the gastric bezoar in order to overcome the limits of a single technique.
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Affiliation(s)
- Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
| | - Gaia Russo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Amato
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Matilde Micheli
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Girolamo Geraci
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
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Belhadj A, Touati MD, Othmane MRB, Khefacha F, Saidani A, Chebbi F. Revelation of Rapunzel syndrome: A rare case report of gastric trichobezoar-induced acute purulent peritonitis. Int J Surg Case Rep 2023; 111:108860. [PMID: 37748384 PMCID: PMC10520814 DOI: 10.1016/j.ijscr.2023.108860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The Rapunzel syndrome embodies an uncommon variation of trichobezoar, predominantly observed among individuals with a history of psychiatric conditions, trichotillomania, and trichophagia. This combination of factors predisposes to the eventual formation of gastric bezoars. Trichobezoars, infrequent gastric masses composed of hair, can lead to complications if left untreated. CASE REPORT A 19-year-old female hairdresser with a history of trichophagia sought medical attention due to abdominal pain and episodes of vomiting. With an elevated body temperature and abdominal rigidity, imaging revealed the presence of a trichobezoar, accompanied by pneumoperitoneum and intraperitoneal effusion. Urgent surgical intervention confirmed the diagnosis of generalized purulent acute peritonitis, triggered by a gastric perforation caused by a 20 cm trichobezoar with an extension into the duodenum, which defines the Rapunzel syndrome. Gastrotomy was performed to remove the trichobezoar, followed by thorough peritoneal lavage. CLINICAL DISCUSSION Trichobezoar is a rare condition that involves the abnormal accumulation of solid substances, particularly hair, within the stomach. Known as "Rapunzel syndrome," it can extend into the duodenum or jejunum. Commonly associated with emotional disorders, trichobezoar can lead to symptoms like epigastric discomfort, vomiting, and weight loss. Diagnosis is through endoscopy, and treatments include fluid intake, endoscopic extraction, chemical dissolution, and surgical removal. Surgical intervention is often preferred, with laparoscopic approaches considered. Psychiatric management is often required for patients. CONCLUSION This case underscores the uncommon Rapunzel syndrome presentation, emphasizing timely surgical measures and multidisciplinary care for trichobezoars causing acute peritonitis.
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Affiliation(s)
- Anis Belhadj
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Med Dheker Touati
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia.
| | - Mohamed Raouf Ben Othmane
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Fahd Khefacha
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Ahmed Saidani
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Faouzi Chebbi
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
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Foula MS, Amer NM, Zakaria H, Ismail MH, Alshomimi SJ, Al Bisher HM, Alsaleem H, Almulhim K, Aldabaeab AE, Alratrout H, Alsadery HA, Alarfaj MA, Aljehani YM, El Damati AM. Surgical Management of Intra-gastric Balloon Complications, Single-Center Experience, and Literature Review. Obes Surg 2023; 33:2718-2724. [PMID: 37452985 DOI: 10.1007/s11695-023-06716-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION In Saudi Arabia, the prevalence of obesity has multiplied in the last decades leading to a surge in bariatric surgery and other endoscopic modalities. The intra-gastric balloon (IGB) is the most used endoscopic modality. Surgical management for IGB complications is required for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications. MATERIALS AND METHODS A retrospective descriptive study was conducted in King Fahd University Hospital, Saudi Arabia, from Jan 2017 to Dec 2021, including all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively or endoscopically. RESULTS A total of 326 patients were admitted with different complications after bariatric procedures. Of them, six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation, and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had an esophageal rupture that required left thoracotomy, pleural flap, and insertion of an esophageal stent. All cases were discharged and followed up with no related complications. CONCLUSION IGB is an endoscopic alternative, within specific indications, for the management of obesity. However, surgical management may be necessary to manage its complications, including gastrointestinal perforation, IGB migration, and failure of endoscopic removal.
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Affiliation(s)
- Mohammed S Foula
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia.
| | - Nasser M Amer
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hazem Zakaria
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Mona H Ismail
- Division of Gastroenterology, Department of Internal Medicine, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Saeed J Alshomimi
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hassan M Al Bisher
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hassan Alsaleem
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Khalifa Almulhim
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Abdulaziz E Aldabaeab
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hefzi Alratrout
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Humood A Alsadery
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Mosab A Alarfaj
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Yasser M Aljehani
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Ahmed M El Damati
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Chen SC, Liu NZ, Song XQ, Qu AJ. [Two cases of dichlorvos poisoning complicated with gastric perforation]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2023; 41:632-635. [PMID: 37667164 DOI: 10.3760/cma.j.cn121094-20221109-00531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Severe acute dichlorvos poisoning is characterized by rapid onset, swift disease progression and serious complications. It frequently involves multiple organ failure (central, respiratory and circulatory systems), severe acidosis, and rare occurrences of gastric perforation. When secondary gastric perforation occurs, treatment becomes difficult and the prognosis of patients is poor. Thus, early and sufficient gastrointestinal decontamination is crucial. This article presented two cases of gastric perforation secondary to dichlorvos poisoning and discussed the causes of gastric perforation, as well is clinical diagnostic and treatment methods.
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Affiliation(s)
- S C Chen
- Department of Emergency Medicine, Liaocheng People's Hospital, Liaocheng 252000, China
| | - N Z Liu
- Department of Emergency Medicine, Liaocheng People's Hospital, Liaocheng 252000, China
| | - X Q Song
- Department of Emergency Medicine, Liaocheng People's Hospital, Liaocheng 252000, China
| | - A J Qu
- Department of Emergency Medicine, Liaocheng People's Hospital, Liaocheng 252000, China
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Ogo T, Nishiyama Y, Ishihara K, Tsukahara K, Inokuchi M. A case of conservatively managed gastric perforation at a recurrent hiatal hernia site after laparoscopic paraesophageal repair. Int J Surg Case Rep 2023; 106:108266. [PMID: 37156199 DOI: 10.1016/j.ijscr.2023.108266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Gastric perforation due to a hiatal hernia is a rare cause of acute abdominal pain that often requires surgical intervention. Conservative management for this condition is an effective option in certain cases, although fewer reports of this exist. Herein, we report a unique case of gastric perforation caused by a recurrent hiatal hernia that was successfully treated with conservative management. CASE PRESENTATION A 74-year-old man developed a high fever and an elevated inflammatory response on the third day after a laparoscopic paraesophageal hernia repair using a mesh. Computed tomography confirmed the recurrence of the hiatal hernia, with gastric fundal prolapse into the mediastinum and surgical emphysema in the gastric wall. This was followed by a gastric perforation within the mediastinum. The patient was treated using an ileus tube through the perforation site. CLINICAL DISCUSSION In similar cases, if the clinical symptoms are mild, there are no signs of serious infection, and the perforation remains in the mediastinum and can be appropriately drained, conservative treatment is considered an option. CONCLUSION Under favorable conditions, conservative management can be an option for gastric perforation in patients with recurrent hiatal hernias, which is a serious potential postoperative complication.
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Affiliation(s)
- Taichi Ogo
- Department of Surgery, Musashino Red Cross Hospital, Japan.
| | - Yu Nishiyama
- Department of Surgery, Musashino Red Cross Hospital, Japan
| | - Kei Ishihara
- Department of Surgery, Musashino Red Cross Hospital, Japan
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Warnung L, Sattler S, Haiden E, Schober S, Pahr D, Reisinger A. A mechanically validated open-source silicone model for the training of gastric perforation sewing. BMC Med Educ 2023; 23:261. [PMID: 37076839 PMCID: PMC10116820 DOI: 10.1186/s12909-023-04174-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/17/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Gastrointestinal perforation is commonly seen in emergency departments. The perforation of the stomach is an emergency situation that requires immediate surgical treatment. The necessary surgical skills require regular practical training. Owing to patient`s safety, in vivo training opportunities in medicine are restricted. Animal tissue especially porcine tissue, is commonly used for surgical training. Due to its limiting factors, artificial training models are often to be preferred. Many artificial models are on the market but to our knowledge, none that mimic the haptic- and sewing properties of a stomach wall at the same time. In this study, an open source silicone model of a gastric perforation for training of gastric sewing was developed that attempts to provide realistic haptic- and sewing behaviour. METHODS To simulate the layered structure of the human stomach, different silicone materials were used to produce three different model layups. The production process was kept as simple as possible to make it easily reproducible. A needle penetration setup as well as a systematic haptic evaluation were developed to compare these silicone models to a real porcine stomach in order to identify the most realistic model. RESULTS A silicone model consisting of three layers was identified as being the most promising and was tested by clinical surgeons. CONCLUSIONS The presented model simulates the sewing characteristics of a human stomach wall, is easily reproducible at low-costs and can be used for practicing gastric suturing techniques. TRIAL REGISTRATIONS Not applicable.
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Affiliation(s)
- Lukas Warnung
- Department of Anatomy and Biomechanics, Division Biomechanics, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria.
- Division of Radiotherapy-Radiation Oncology, University Hospital Krems, Mitterweg 10, Krems, 3500, Austria.
| | - Stefan Sattler
- Department of Surgery, University Hospital Tulln, Alter Ziegelweg 10, Tulln, 3430, Austria
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria
| | - Elmar Haiden
- Department of Surgery, University Hospital Tulln, Alter Ziegelweg 10, Tulln, 3430, Austria
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria
| | - Sophie Schober
- Medical Science and Human Medicine study programme, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria
| | - Dieter Pahr
- Department of Anatomy and Biomechanics, Division Biomechanics, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria
- Institute for Lightweight Design and Structural Biomechanics, University of Technology Vienna, Getreidemarkt 9, Wien, 1060, Austria
| | - Andreas Reisinger
- Department of Anatomy and Biomechanics, Division Biomechanics, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria
- Institute for Lightweight Design and Structural Biomechanics, University of Technology Vienna, Getreidemarkt 9, Wien, 1060, Austria
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Chennavasin P, Phoopat J, Udomchaisakul P, Gururatsakul M. Delayed gastric perforation following transarterial chemoembolization: Case report. Int J Surg Case Rep 2023; 104:107965. [PMID: 36893704 PMCID: PMC10018544 DOI: 10.1016/j.ijscr.2023.107965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/18/2023] [Accepted: 02/26/2023] [Indexed: 03/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Transarterial chemoembolization (TACE) is widely employed to control acute bleeding in ruptured hepatocellular carcinoma (rHCC). Ischemia leading to perforation of the gastrointestinal tract (GIT) after TACE is a rare complication. We report a patient who presented with rHCC and who suffered gastric perforation post-TACE. CASE REPORT A 70-year-old woman presented with rHCC. Emergency TACE was undertaken to control bleeding, and was successful. The patient was discharged 5 days post TACE. Two weeks after TACE, she presented with acute abdominal pain. Computed tomography of the abdomen showed perforation at the lesser curvature of the stomach. The angiogram from TACE was reviewed: the small vessels from an accessory branch of the left gastric artery originating from the left hepatic artery that had been embolized were likely responsible for gastric ischemia and subsequent perforation. The patient underwent operation with simple closure and omental patch repair. Postoperative gastric leak was not observed. Unfortunately, the patient died due to severe decompensated liver disease ∼4 weeks after TACE. CLINICAL DISCUSSION Gastrointestinal tract (GIT) perforation after TACE is a rare complication. We suspected that perforation of the lesser curve of the stomach was secondary to ischemia due to non-target embolization to the accessory branch of the left gastric artery from the left hepatic artery, combined with stress and hemodynamic instability from rHCC. CONCLUSIONS rHCC is a life-threatening condition. Variation in vascular structures must be clarified carefully. Significant adverse events in the GIT post-TACE are rare, but high-risk patients must be cautiously monitored.
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Affiliation(s)
- Papawee Chennavasin
- Department of Surgery, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand.
| | - Jatuporn Phoopat
- Department of Surgery, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Preechapon Udomchaisakul
- Division of Interventional Radiology, Department of Radiology, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Montri Gururatsakul
- Department of Gastroenterology and Hepatology Chulabhorn Hospital, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Hu H, Choi JDW, Edye MB, Aitken T, Kapurubandara S. Gastric Injury at Laparoscopy for Gynecologic Indications: A Systematic Review. J Minim Invasive Gynecol 2022; 29:1224-1230. [PMID: 36184063 DOI: 10.1016/j.jmig.2022.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This systematic review aims to identify causes of increased risk for and location and mechanism of gastric injury at laparoscopy for gynecologic indications and determine optimal management. DATA SOURCES A prospectively registered systematic review (PROSPERO: CRD42021237999) was undertaken and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases searched included Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Medline, Embase, Web of Science, SCOPUS, and Google Scholar from 1960 to 2021. METHODS OF STUDY SELECTION All study types were included involving female patients of any age with gastric injury at laparoscopy for gynecologic indication. TABULATION, INTEGRATION, AND RESULTS A total of 6294 articles were screened, from which 67 studies were selected for a full-text review. Twenty-eight articles were included, which contained 42 cases drawn from 7 observational studies, 4 case series, and 17 case reports. Of these, 93% (39/42) were at the time of laparoscopic entry, with Veress entry technique used in 79% of these cases (31/39). Eighteen cases reported an entry point, with 77% (14/18) occurring at the periumbilical entry point and 11% (2/18) occurring at Palmer's point. Of the cases with reported etiology for gastric distention or displacement, 64% (9/14) were owing to anesthetic cause. The most common sites of gastric injury were on the anterior stomach wall (n = 8) and the greater curvature (n = 5). Among patients with reported management (32/42), a similar proportion were managed conservatively (11) when compared with repair through laparotomy (13) or laparoscopy (8). All injuries were detected intraoperatively with no reported short-term sequelae. CONCLUSION This systematic review of the literature reveals that gastric injury at laparoscopy for gynecologic indications is a rare complication predominantly occurring during laparoscopic entry, most commonly at the periumbilical entry point. When detected intraoperatively, conservative management, laparoscopic, or open repair in the appropriate patient has been performed with no short-term sequelae. The limitations of this review include paucity of cases, detail, and timeline of publications.
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Affiliation(s)
- Hillary Hu
- Department of Obstetrics and Gynaecology, Westmead Hospital (Drs. Hu and Kapurubandara), Sydney, New South Wales, Australia.
| | - Joseph Do Woong Choi
- Department of Surgery, Blacktown and Mount Druitt Hospitals (Drs. Choi and Edye), Sydney, New South Wales, Australia
| | - Michael B Edye
- Department of Surgery, Blacktown and Mount Druitt Hospitals (Drs. Choi and Edye), Sydney, New South Wales, Australia; Western Sydney Universit (Dr. Edye), Sydney, New South Wales, Australiay
| | - Tess Aitken
- University of Sydney Library (X Aitken), Sydney, New South Wales, Australia
| | - Supuni Kapurubandara
- Department of Obstetrics and Gynaecology, Westmead Hospital (Drs. Hu and Kapurubandara), Sydney, New South Wales, Australia; University of Sydney (Dr. Kapurubandara), Sydney, New South Wales, Australia; Sydney West Advanced Pelvic Surgery Unit (Dr. Kapurubandara), Sydney, New South Wales, Australia
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12
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Scarascia A, Atallah E, Pineda MDA, Rosenwasser R, Judy K. Gastric perforation from a migrating ventriculoperitoneal shunt: A case report and review of literature. Radiol Case Rep 2022; 17:4899-4902. [PMID: 36281285 PMCID: PMC9587122 DOI: 10.1016/j.radcr.2022.09.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/14/2022] [Accepted: 09/18/2022] [Indexed: 11/01/2022] Open
Abstract
Ventriculoperitoneal (VP) shunts represent a surgical option for patients affected by increased intracranial hypertension when medical management fails or is contraindicated. Complications following implantation include shunt obstruction, infection, over and under drainage, migration or disconnection of the tube, formation of a pseudocyst, and allergy to the silicone tube. We report the case of a 31-year-old woman who presented to the emergency room with nausea and generalized malaise, found to have the distal segment of the VP catheter perforating her gastric wall into the stomach lumen which required surgical intervention. In this report, we describe a rare complication associated with the implantation of ventriculoperitoneal shunt (VPS) catheters and the subsequent management plan.
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Affiliation(s)
- Alessio Scarascia
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome RM, Italy,Corresponding author.
| | - Elias Atallah
- Thomas Jefferson University, 1020 Walnut St, Philadelphia, PA 19107, USA
| | | | - Robert Rosenwasser
- Thomas Jefferson University, 1020 Walnut St, Philadelphia, PA 19107, USA
| | - Kevin Judy
- Thomas Jefferson University, 1020 Walnut St, Philadelphia, PA 19107, USA
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13
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Hassan A, Lawlis S, Landmann A, Ruiz-Elizalde A, Middleman A. Not just an upset stomach: gastric perforation in a patient with anorexia nervosa. Eat Weight Disord 2022; 27:1907-1911. [PMID: 34731455 DOI: 10.1007/s40519-021-01312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/20/2021] [Indexed: 10/19/2022] Open
Abstract
Gastric perforation in patients with anorexia nervosa is a rare entity associated with high morbidity and mortality [Norris in Int J Eat Disord 49:216-237, 2016]. In cases reported in the literature, the perforation was often preceded by a binge episode, and the subsequent clinical presentation was rapid and acutely deteriorating with a fatality rate as high as 80% [Norris in Int J Eat Disord 49:216-237, 2016, Pitre in J Med Case Rep 15:61, 2021]. We present a case of gastric perforation in the context of restrictive anorexia nervosa unique both for the absence of a premorbid binge episode as well as delayed clinical manifestations of medical distress, leading to abdominal compartment syndrome.Level IV Evidence obtained from multiple time series analysis such as case studies.
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Affiliation(s)
- Ahmad Hassan
- The University of Oklahoma, Oklahoma City, OK, USA.
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14
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Swed S, Ezzdean W, Sawaf B. Chronic gastric dilatation with gastric fundus perforation in anorexia nervosa patient. Int J Surg Case Rep 2022; 90:106645. [PMID: 34991050 PMCID: PMC8741521 DOI: 10.1016/j.ijscr.2021.106645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION As a complication of anorexia or bulimia nervosa, gastrointestinal problems such as stomach dilatation and necrosis are extremely rare. Our purpose is this case to pay attention on anorexia and bulimia patients to envisage the occurrence of chronic digestive injuries by performing the accurate diagnosis and selective prompt treatment. CASE PRESENTATION A 40-year old female patient admitted to the emergency department with complaints of digestive symptoms. In his history there was just anorexia nervosa. Computed tomography and X-rays showed major gastric distension reaching the pelvis and perforation of the fundus. The large curvature of the stomach and the necrotic part was removed surgically. But the patient died in the second day after admission in the hospital because he was affected by a septic shock as a complication of distribution the infection because the doctors didn't resect whole the stomach during the open surgery. DISCUSSION We report a rare case that shows gastric dilatation and necrosis post-anorexia nervosa, which requires accurate X-ray and CT scan, but treatment depends on whether or not gastric necrosis is present and the size of the necrosis. According to what mentioned in the medical literature this is the second case that cause death of the patient after surgery for treatment the gastric dilatation as a complication of anorexia nervosa. CONCLUSION The thing that distinguishes this case is the large size of the extension of the stomach from the diaphragm to the pelvis and the perforation of the fundus with a diameter of 5 cm and the death of the patient after surgery, so we can add it in the medical literature to avoid the complications of these psychiatric diseases.
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Affiliation(s)
- Sarya Swed
- Faculty of Human Medicine, Aleppo University, Aleppo, Syria
| | - Weaam Ezzdean
- Department of Urology, Ibn Al Nafees Hospital, Damascus, Syria.
| | - Bisher Sawaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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15
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Stoddard N, Grewal M, Lavoie N, Krishna A. Fatal Clostridium septicum myonecrosis from gastric perforation: A case report. Anaerobe 2021; 72:102445. [PMID: 34571154 DOI: 10.1016/j.anaerobe.2021.102445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
Clostridial myonecrosis is a medical and surgical emergency which requires early and aggressive intervention to reduce mortality. We report a rare case of Clostridium septicum myonecrosis that disseminated hematogenously from a gastric perforation. The patient was afebrile and hemodynamically stable upon admission. He rapidly developed spontaneous clostridial myonecrosis and succumbed to septic shock 36 hours after presentation. In our extensive literature review this is the only case with blood cultures confirming Clostridium septicum bacteremia with a surgically confirmed gastric perforation source in the setting of spontaneous clostridial myonecrosis.
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16
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Muñoz-Murillo KL, Muñoz-Murillo WJ, Hernández-López UJ, Aponte-Ceballos LM, Lozada-Martínez ID, Rahman S. First case report of spontaneous perinatal gastric perforation in premature neonate with potter sequence and syndrome. Int J Surg Case Rep 2021; 86:106297. [PMID: 34391013 DOI: 10.1016/j.ijscr.2021.106297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction and importance The Potter sequence is defined as a series of congenital defects related to severe oligohydramnios, associated with polycystic kidney disease, bilateral renal agenesis, pulmonary hypoplasia, obstructive uropathy and premature rupture of membrane, which compromises the life of the neonate sometime after birth. Within the evidence published so far, which is very little, no perforation of the gastrointestinal tract has been reported as a complication of this condition. Case presentation Male neonate born preterm with prenatal diagnosis of pulmonary hypoplasia, polycystic renal dysplasia and severe oligohydramnios (Potter sequence), presented acute respiratory distress syndrome 10 min after birth, requiring mechanical ventilation and admission to the intensive care unit. During her stay in intensive care, he developed abdominal distension and presence of biliary content in the nasogastric tube. An abdominal X-ray was performed and showed signs of pneumoperitoneum, evidencing gastric perforation on exploratory laparotomy. Clinical discussion Gastric perforation in neonates is a condition that causes high health costs, morbidity, high risk of mortality and disability, regardless of the cause. The management of gastric perforation in Potter syndrome, as well as any other complication, represents a challenge due to the prognosis of these patients. Renal failure and acute respiratory distress syndrome are disorders that compromise the function of various structures and organs such as the heart and brain. Conclusion Gastric perforation is a possible complication of the Potter sequence or syndrome. In addition, there is no literature describing the benefits or disadvantages of specific surgical techniques in the resolution of perforation. Spontaneous perinatal gastric perforation is a complication of Potter's syndrome. Pathophysiological mechanism of gastric perforation in these cases is unknown. There is a lack of evidence on the management of potter's syndrome.
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17
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Yuda Handaya A, Andrew J, Hanif AS, Tjendra KR, Kresna Aditya AF. Omental plug using double horizontal mattress suture for gastric perforation on elderly patients with boey score 3: A case series. Ann Med Surg (Lond) 2021; 68:102647. [PMID: 34401131 PMCID: PMC8347816 DOI: 10.1016/j.amsu.2021.102647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Gastric perforation is a life-threatening condition. Patients with gastric perforation with Boey score 3 has very high mortality rate. Immediate source control is required for primary repair and preventing further complications. Furthermore, elderly patients pose a greater risk of morbidity and mortality in cases of gastric perforation, especially during and after emergency surgery. CASE PRESENTATION We present two cases of elderly patients with gastric perforation with Boey score 3. We performed omental plugging technique with double horizontal mattress suture type. In these cases, we decided not to perform biopsy and margin freshening of the perforation. DISCUSSION We performed omental plugging technique because we are confident that it could cover the perforation completely without causing gastric outlet obstruction. An emergency source control surgery can be effectively done with this omental plugging procedure. During surgery, margin freshening and biopsy is not performed to perform source control more quickly. This surgical procedure aligned with "quick in-quick out" concept that we adopted for treating patients with gastric perforation. Omental plugging also allows patient to undergo ERAS program for better and faster recovery. The patients were discharged from the hospital without further complications and long-term follow-up showed good results. CONCLUSION Omental plugging has the least risk of complications than other perforation repair techniques and can be done for small and large perforation. Based on our case series, omental plug with double mattress suture is an effective and safe procedure to be performed in elderly patients with gastric perforation with Boey score 3.
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Affiliation(s)
- Adeodatus Yuda Handaya
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Joshua Andrew
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Ahmad Shafa Hanif
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Kevin Radinal Tjendra
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Azriel Farrel Kresna Aditya
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
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18
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Chauhan D, Kilic Y, Segal JP, Patel N, Koizia L. An Unusual Cause of Gastrointestinal Perforation in an Adolescent Patient With Beta-Thalassemia on Deferasirox and SARS-CoV-2 Infection. J Hematol 2021; 10:76-79. [PMID: 34007369 PMCID: PMC8110227 DOI: 10.14740/jh815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 12/15/2022] Open
Abstract
Chelation therapy is recognized as a safe and effective treatment option in patients with beta-thalassemia with iron overload. We report an 18-year-old male with acute abdomen and gastrointestinal bleeding with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection secondary to gastric perforation due to chelation therapy. This patient had a prolonged intensive care stay with complications of SARS-CoV-2 and a small bowel obstruction post-surgery that resolved after conservative management. Given the acute presentation, chelation therapy use and concomitant SARS-CoV-2 infection, clinicians should keep an open mind on the differential diagnosis of acute abdomen in patients with beta-thalassemia.
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Affiliation(s)
- Devkishan Chauhan
- The Hillingdon Hospital, London, UK.,These authors contributed equally and are joint first authors
| | - Yakup Kilic
- The Hillingdon Hospital, London, UK.,These authors contributed equally and are joint first authors
| | | | | | - Louis Koizia
- Cutrale Perioperative and Ageing Group, Imperial College, London, UK
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19
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Akgunduz F, Sozutek A, Irkorucu O, Yaman A. The Adjunctive Effect of DuraSeal® vs. 2-Octyl-Cyanoacrylate on Delayed Repair of Gastric Perforation: An Experimental Study. J INVEST SURG 2021; 35:542-548. [PMID: 33645439 DOI: 10.1080/08941939.2021.1887414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Delayed primary suture closure of gastric perforation is prone to dehiscence hence the repaired area should be buttressed to avoid re-operation. We aimed to investigate whether DuraSeal®(DS) has a potent adjunctive effect on delayed closure of gastric perforation comparing with 2-octly-cyanoacrylate(CYN) in an experimental model. METHODS Sixty rats were randomly divided into 6 groups. All subjected to gastric perforation, subsequently perforation areas were repaired by primary suturing, delayed repair was performed 12 h after surgery. According to DS or CYN application on anastomosis, the groups were classified as control(C), delayed control(CD), closure with CYN(CYN), delayed closure with CYN(D-CYN), closure with DS(DS), delayed closure with DS(D-DS).After euthanization on POD 7,anastomotic bursting pressure(ABP) were measured. Tissue samples were taken for histopathological examination and hydroxyproline(TH) assessment. RESULTS Delayed condition significantly reduced ABP and TH levels in CD group comparing with all groups(p < 0.01).Either CYN or DS application on delayed repaired area significantly raised the measure of ABP and TH up to the levels of C group(p < 0.05,comparing with CD).Microscopically,either CYN or DS application significantly improved tissue necrosis, submucosal bridging and collagen formation comparing with CD group(p < 0.012).There were no difference regarding ABP, TH and tissue healing between each CYN and DS groups. CONCLUSION DuraSeal® application on sutured gastric perforation area yielded a significant adjunctive effect both in normal and delayed conditions. However, DuraSeal® revealed no superior effect to CYN in both condition.Our results demonstrated that the clinical use of DuraSeal® can be considered for reinforcing the sutured line in patients undergoing delayed surgery for gastric perforation.
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Affiliation(s)
- Fatih Akgunduz
- General Surgery, Health Sciences University, Adana Training and Research Hospital, Adana, Turkey
| | - Alper Sozutek
- Gastroenterological Surgery, Health Sciences University, Adana Training and Research Hospital, Adana, Turkey
| | - Oktay Irkorucu
- General Surgery, Health Sciences University, Adana Training and Research Hospital, Adana, Turkey
| | - Abit Yaman
- General Surgery, Health Sciences University, Adana Training and Research Hospital, Adana, Turkey
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20
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Vinod VC, Younis MU, Mubarik H, Rivas H. A rare case of gastric perforation by a 5-year-old Intra-gastric Balloon in situ: Case report and review of literature. Int J Surg Case Rep 2020; 76:480-483. [PMID: 33207414 PMCID: PMC7586043 DOI: 10.1016/j.ijscr.2020.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022] Open
Abstract
5-Year-old Intra-gastric Balloon. Gastric perforation. Acute abdomen. Bariatric surgery.
Introduction Insertion of an Intra gastric Balloon (IGB) has widely been used as a minimally invasive procedure for the treatment of obesity. Gastric balloons are usually inserted for a period of six months only. They have a high safety profile and one of their rare, reported, serious complications include gastric or esophageal perforation, which are usually early and require immediate operative management. Presentation of case We report a 26-year-old lady who presented to the ED with signs and symptoms of acute abdomen and five-year history of endoscopic placement of Intra-gastric Balloon. Emergent endoscopic removal of the balloon revealed a large pressure ulcer at gastric incisura with central necrosis. Laparoscopy confirmed gastric perforation along lesser curvature with extensive soilage of peritoneal cavity. Extensive irrigation and drainage and Graham omental patch repair were carried out laparoscopically, and the perforation sealed satisfactorily. She recovered well from surgery and within days she was tolerating a diet. Broad spectrum IV antibiotics were given for 10 days. Discussion Gastric perforation is a rare complication reported in 0.1% of patients undergoing IGB insertion. It can ensue as early as days after placement or late at weeks to months. In our review of literature, we found the maximum time frame in which a patient presented with an IGB induced gastric perforation was at 22 months. This makes our case unique as the patient was able to tolerate it for 5 years (60 months) before presenting to the emergency with this sinister complication. Conclusion Very late Gastric perforations in patients with IGB placement are rare. An upper gastrointestinal endoscopy should be arranged as soon as possible to remove the balloon and assess the stomach visualize the perforation followed by a laparoscopic approach to repair the defect if expertise is available.
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Affiliation(s)
- Vijay Chander Vinod
- Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
| | | | - Humera Mubarik
- Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
| | - Homero Rivas
- Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
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21
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Yamasaki T, Sakata Y, Suekane T, Nebiki H. Perforation of a Gastric Tear during Esophageal Endoscopic Submucosal Dissection under General Anesthesia. Clin Endosc 2020; 54:916-919. [PMID: 33176411 PMCID: PMC8652158 DOI: 10.5946/ce.2020.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/15/2020] [Indexed: 11/14/2022] Open
Abstract
Mallory-Weiss tears (MWT) are occasionally encountered during endoscopic procedures. Esophageal endoscopic submucosal dissection (ESD) is widely performed under general anesthesia to avoid unexpected body movements. We present the case of a 68-year-old woman with squamous cell carcinoma. Although ESD was performed under general anesthesia, a gastric perforation at the MWT caused by gastric inflation was observed after the procedure. The perforation was closed endoscopically, and she was discharged without any sequelae. Although general anesthesia is useful for esophageal ESD, it should be noted that it can cause MWT, and in rare cases, gastric perforation, due to gastric inflation during the procedure.
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Affiliation(s)
- Tomoaki Yamasaki
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Yuhei Sakata
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Takehisa Suekane
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Hiroko Nebiki
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
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22
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Theodorou CM, Chen P, Vanover MA, Saadai P, Brown EG, Haas KB, Hirose S. Total gastrectomy with delayed Hunt-Lawrence pouch reconstruction for neonatal gastric perforation presenting with hematemesis. J Pediatr Surg Case Rep 2020; 63. [PMID: 33184604 DOI: 10.1016/j.epsc.2020.101686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The differential for neonatal hematoma sis ranges from benign etiologies to life-threatening emergencies. Neonatal gastric perforation is a rare cause of neonatal hematoma sis but is a deadly condition, requiring prompt diagnosis and treatment. The etiology is usually related to conditions predisposing to over distension of the stomach, such as positive pressure ventilation or distal obstruction, but in some cases cannot be determined. Patients generally present with abdominal distension and respiratory distress. We present a case of a 1-day old term baby girl who developed sudden onset hematoma sis and clinical deterioration, who was found to have a large proximal gastric perforation requiring emergent total gastrectomy with delayed reconstruction.
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Affiliation(s)
- Christina M Theodorou
- University of California, Davis Medical Center. Department of Surgery, Division of Pediatric General, Thoracic and Fetal Surgery, United States
| | - Peggy Chen
- University of California, Davis Medical Center. Department of Pediatrics, Division of Neonatology, United States
| | - Melissa A Vanover
- University of California, Davis Medical Center. Department of Surgery, Division of Pediatric General, Thoracic and Fetal Surgery, United States
| | - Payam Saadai
- University of California, Davis Medical Center. Department of Surgery, Division of Pediatric General, Thoracic and Fetal Surgery, United States
| | - Erin G Brown
- University of California, Davis Medical Center. Department of Surgery, Division of Pediatric General, Thoracic and Fetal Surgery, United States
| | - Kelly B Haas
- University of California, Davis Medical Center. Department of Pediatrics, Division of Pediatric Gastroenterology, United States
| | - Shinjiro Hirose
- University of California, Davis Medical Center. Department of Surgery, Division of Pediatric General, Thoracic and Fetal Surgery, United States
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23
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Lucido FS, Scotti L, Scognamiglio G, Gambardella C, Brusciano L, Del Genio G, Pizza F, Ruggiero R, Parmeggiani D, Nesta G. Gastric perforation by intragastric balloon: Laparoscopic gastric wedge resection can be a strategy? Int J Surg Case Rep 2020; 77S:S88-S91. [PMID: 33041259 PMCID: PMC7876839 DOI: 10.1016/j.ijscr.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 12/03/2022] Open
Abstract
Gastric perforation caused by intragastric balloon represents a rare but life-threatening complication. There is a lack of information about perforation in the same day of surgery. An endoscopic and laparoscopic approach with a gastric wedge resection was performed.
Introduction IGB (Intragastric Balloon) is acknowledged to be a safe and secure device, whose outcomes in terms of weight loss are widely discussed. Bariatric community has soon noted tolerance and benefit of this tool, considered a first and easy step before bariatric surgery. Nevertheless, some authors have described a series of complications that, although rare, could be life threatening and hard to manage, as a gastric perforation. Presentation of case We reported a case of a 55-year-old obese woman, undergone placement of IGB device heisting in a gastric perforation. In the same day of surgery, we performed an emergency, applying a combined endoscopic and laparoscopic approach, to remove the balloon and to close perforation by a gastric resection. Discussion. Short term outcome was satisfactory, and the patient had a successful further follow up and weight loss. Conclusion IGB is a valuable tool among bariatric procedure, nevertheless the surgeon has to consider the possible and life-threatening complications and to provide a multidisciplinary equip to face this occurrence.
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Affiliation(s)
- Francesco Saverio Lucido
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Luigi Scotti
- General and Bariatric Surgery Unit, Camilliani Hospital, Casoria, Italy
| | | | - Claudio Gambardella
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy; Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy
| | - Luigi Brusciano
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gianmattia Del Genio
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Pizza
- Division of Surgery, Hospital "A. Rizzoli", Lacco Ameno, Naples, Italy
| | - Roberto Ruggiero
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Domenico Parmeggiani
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giusiana Nesta
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
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Di Buono G, Bonventre G, Badalamenti G, Buscemi S, Romano G, Agrusa A. Duodenal perforation as presentation of gastric neuroendocrine tumour: A case report. Int J Surg Case Rep 2020; 77S:S105-S108. [PMID: 32981880 PMCID: PMC7876995 DOI: 10.1016/j.ijscr.2020.09.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 11/15/2022] Open
Abstract
Gastric neuroendocrine neoplasms (g-NENs) represent the most frequent digestive NENs and are increasingly recognized thanks to diffusion of upper gastrointestinal endoscopy. g-NENs can be sporadic or associated with multiple endocrine neoplasia type 1 (MEN-1) and present with a functional Zollinger-Ellison syndrome. We described a case of a 60 years old Caucasian male came to emergency room with diffuse abdominal pain and leukocytosis on blood tests. At the level of the pyloric portion we found irregularly thickened walls associated with a small fluid collection and bubbles of free air. On exploratory laparoscopy we found a large perforation (about 5 cm of size) in the first duodenum portion. Histological examination revealed a gastric NET perforation as a consequence of hypergastrinemia secondary to gastrinoma.
Introduction Neuroendocrine tumors (NETs) represent uncommon neoplasms with different characteristics. They can be asymptomatic and benign or they can also proliferate and manifest themselves with neoplastic mass symptoms such as intestinal occlusion or with carcinoid syndrome. Gastric neuroendocrine neoplasms (g-NENs) are the most frequent digestive NENs while duodenal neuroendocrine neoplasms (d-NENs) may be sporadic or associated with multiple endocrine neoplasia type 1 (MEN-1) and present a functional syndrome (e.g. gastrinoma with Zollinger-Ellison syndrome). Presentation of case We report a case of duodenal perforation due to a unknown gastrinoma responsible of Zollinger-Ellison Syndrome. He underwent an emergency contrast enhanced CT abdominal scan that showed a perforation. We performed a distal gastrectomy. The histopathological examination revealed a g-NET configuring a possible picture of Zollinger-Ellison Syndrome. Discussion The management of NETs is diffulcult and controversial because of their rarity. It is useful to know the pathologic assessment of tumor differentiation and/or grade, evaluate surgical resectability and control the carcinoid syndrome symptoms. Conclusion This case report shows that gastric NETs can be found in cases of duodenal perforation. Our future goal is to evaluate the possibilities to diagnose the Zollinger Ellison Syndrome as early as possible and to treat it with targeted therapy in order to prevent its related complications.
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Affiliation(s)
- Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Giulia Bonventre
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Giuseppe Badalamenti
- Department of Surgical, Oncological and Oral Sciences, Section of Oncology, University of Palermo, Italy.
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
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Saeed MI, Stephens R, Nwogbo O, Gani IY, Kapoor R, Doroodchi A. Cytomegalovirus pancreatitis in an immunocompetent patient. IDCases 2020; 22:e00932. [PMID: 33299793 PMCID: PMC7708617 DOI: 10.1016/j.idcr.2020.e00932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/19/2022] Open
Abstract
Cytomegalovirus (CMV) is a double-stranded DNA virus, which infects a large portion of the adult population. In immunocompetent patients, it typically is asymptomatic or manifests as mild and self-limiting flu-like illness symptoms, whereas in immunocompromised patients, CMV can cause significant disease. Herein we report an unusual case of CMV pancreatitis in an immunocompetent 75-year-old female. Patient developed severe significant pancreatic necrosis that failed non-operative management, and ultimately underwent pancreatic necrosectomy. Later on, she developed three spontaneous gastric perforations. The first two perforations were managed operatively, but after the third perforation family decided not to undergo another operation. The CMV pancreatitis diagnosis was based on pancreatic histopathology and confirms by a prompt response to ganciclovir. Patient was promptly started on intravenous (IV) ganciclovir which resulted in clinical recovery and she remained asymptomatic more than one-year post op. This is a rare case of CMV pancreatitis with gastric perforations in an immunocompetent patient. High degree of suspicion and appropriate treatment are important for such clinical scenarios.
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Key Words
- ALT, alanine transferase
- AST, aspartate transferase
- BMI, body mass Index
- CKD, chronic kidney disease
- CMV, cytomegalovirus
- CT, computed tomography
- Cytomegalovirus
- DIC, disseminated intravascular coagulation
- EBV, Epstein Barr virus
- EGD, esophagogastroduodenoscopy
- GI, gastrointestinal
- Ganciclovir
- Gastric perforation
- ICU, intensive care unit
- OR, operating room
- PCR, polymerase chain reaction
- POD, post-operative day
- Pancreatic necrosis
- Pancreatitis
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Affiliation(s)
- Muhammad I. Saeed
- Division of Transplant Surgery, Department of Surgery, Augusta University Medical Center, Augusta, GA, United States
| | - Rachel Stephens
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, United States
| | - Okechukwu Nwogbo
- Department of Pathology, Augusta University Medical Center, Augusta, GA, United States
| | - Imran Y. Gani
- Division of Nephrology, Hypertension and Transplant Medicine Department of Medicine, Augusta University Medical Center, Augusta, GA, United States
| | - Rajan Kapoor
- Division of Nephrology, Hypertension and Transplant Medicine Department of Medicine, Augusta University Medical Center, Augusta, GA, United States
| | - Atbin Doroodchi
- Division of Transplant Surgery, Department of Surgery, Augusta University Medical Center, Augusta, GA, United States
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Ouédraogo NLM, Sanogo K, Traoré MS, Simporé J, Traoré SS. A case report of management of gastric perforation in situs inversus totalis in a 45-year-old adult. A case report. Int J Surg Case Rep 2020; 74:69-72. [PMID: 32799055 DOI: 10.1016/j.ijscr.2020.07.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 11/23/2022] Open
Abstract
We report the very first case Management of gastric perforation in situs inversus totalis in a 45-year-old adult. The symptoms of acute peritoneal syndrome have evolved about 48 h. The thoraco-abdomino-pelvic scan confirmed the diagnosis of gastric perforation and situs inversus totalis. The patient underwent laparotomy (suture of gasturic perforation, appendicectomy) with uneventful postoperative course.
Introduction Situs inversus is a rare congenital malformation often discovered during childhood. It can cause diagnosis errors in adulthood. Its association with gastric perforation is an extremely rare event in the literature. Its diagnosis is made by an adequate morphological assessment. Presentation of case A 45-years-old man, was admitted to the surgical emergency department for generalized acute abdominal pain initially sitting in the right hypochondrium, accompanied by bilious vomiting and a stop in intestinal transit, progressing for 48 h. He had no known surgical history. The clinical examination noted an altered general state (WHO III) and a peritoneal syndrome. A diagnosis of generalized acute peritonitis has been made. An x-ray of the abdomen without preparation revealed a bilateral pneumoperitoneum with a cardiac point on the right. The thoraco-abdomino-pelvic CT scan confirmed the diagnosis. After resuscitation, the patient underwent a laparotomy with gastroraphy and appendectomy. The postoperative follow-ups were without an uneventful, over a 15-month follow-up. Discussion Situs inversus totalis is an uncomon event. Its exact etiology is still unknown. Some authors incriminate an autosomal recessive gene. In our context, its diagnosis is a surprise. Its revelation by gastric perforation is an extremely rare event. Surgical treatment must be performed early. Prognosis is generally better. Conclusion In developing countries the diagnosis of situs inversus is a surprise during a pathology which led the patient to a medical consultation. CT-scan is one of the key paraclinic exams for its diagnosis.
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Lopez CM, Kovler ML, Jelin EB. Case report of extreme gastric distention and perforation with pathologic Sarcina ventriculi colonization and Rett syndrome. Int J Surg Case Rep 2020; 73:210-2. [PMID: 32702650 DOI: 10.1016/j.ijscr.2020.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/06/2020] [Accepted: 07/11/2020] [Indexed: 11/22/2022] Open
Abstract
Rett syndrome is associated with pathologic aerophagia. Rett syndrome associated aerophagia can lead to gastric perforation. Sarcina ventriculi colonization is also a risk factor for gastric perforation. It is unknown how Sarcina ventricula colonization and Rett syndrome interact as risk factors for gastric perforation.
Here we describe a case of a 15-year-old child with Rett syndrome who presented with extreme gastric distension and fatal perforation in the setting of long-standing aerophagia and pathologic colonization with Sarcina ventriculi, a rare bacteria implicated in gastric perforation. This is the first report of gastric perforation associated with colonization by Sarcina in a patient with pathologic aerophagia. Gastric colonization with Sarcina should be considered in intellectually disabled children with pathologic air swallowing who present with severe gastric dilation and/or perforation.
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Dong H, Qiu M, Gao Q, Li X, Li L. Revisit of gastromalacia: a report of three cases and review of the literature. Forensic Sci Med Pathol 2020; 16:489-492. [PMID: 32710247 DOI: 10.1007/s12024-020-00274-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Abstract
Gastromalacia, a postmortem dissolution of the stomach, is caused by endogenous enzymes resulting in thinning and softening of the stomach wall with focal perforation. Thus, identifying gastromalacia and differentiating it from other causes of gastric perforation is essential to avoid misdiagnosis. Herein, three cases of gastromalacia are described. The victims died due to hyperthermia, leukemia complicated by cerebral hemorrhage, and asphyxia due to inhaled vomitus, respectively. The macroscopic and microscopic appearance in three cases indicated gastromalacia, although multiple factors confused the diagnosis. Furthermore, the differential diagnosis and the underlying mechanism are discussed.
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Affiliation(s)
- Hongmei Dong
- Forensic Center, Shandong University of Political Science and Law, 63 Jiefang East Road, Jinan, 250014, Shandong, China. .,Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, People's Republic of China.
| | - Mingjie Qiu
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, People's Republic of China
| | - Qing Gao
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, People's Republic of China
| | - Xuebo Li
- Forensic Center, Shandong University of Political Science and Law, 63 Jiefang East Road, Jinan, 250014, Shandong, China
| | - Liangliang Li
- Forensic Center, Shandong University of Political Science and Law, 63 Jiefang East Road, Jinan, 250014, Shandong, China
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Cappuccio S, Marinucci B, Bove V, Turco LC, Cosentino F, Scambia G, Costamagna G, Boškoski I. Rare Case of Endoscopic Treatment for Bevacizumab-Related Gastric Perforation in a Patient with Ovarian Cancer. Chemotherapy 2020; 65:54-57. [PMID: 32615577 DOI: 10.1159/000508556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/08/2020] [Indexed: 11/19/2022]
Abstract
Antiangiogenic chemotherapy is a common treatment option for patients with advanced ovarian cancer (OC) and has been proven to be effective and generally safe. Nevertheless, in rare cases, these drugs can give serious complications such as gastrointestinal perforations that can be even mortal or very difficult to treat and can heavily impact the clinical management. We present a rare case of bevacizumab-induced gastric perforation in a patient with advanced OC occurred during bevacizumab-including chemotherapy in an adjuvant setting. Surgical treatment was not possible due to the frailty of the clinical condition of the patient and the gastric perforation was successfully treated with endoscopic suturing.
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Affiliation(s)
- Serena Cappuccio
- Department of Woman's, Child's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
| | - Benito Marinucci
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Carlo Turco
- Gynecology and Breast Care Unit, Mater Olbia Spa, Olbia, Italy.,Gynecologic Oncology, Gemelli Molise Spa, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Cosentino
- Gynecologic Oncology, Gemelli Molise Spa, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Giovanni Scambia
- Department of Woman's, Child's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Guido Costamagna
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy.,Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ivo Boškoski
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy.,Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Surve A, Cottam D, Medlin W, Richards C, Belnap L. A Video Case Report of Gastric Perforation Following Endoscopic Sleeve Gastroplasty and its Surgical Treatment. Obes Surg 2019; 29:3410-1. [PMID: 31376132 DOI: 10.1007/s11695-019-03992-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Endoscopic sleeve gastroplasty (ESG) is a novel weight loss procedure that reduces the size of the stomach using an endoscopic suturing device. There are severe adverse events that have been reported following ESG (Brethauer et al. Surg Obes Relat Dis. 6:689-94, 2010; Abu Dayyeh et al. Gastrointest Endosc. 78:530-5, 2013; Nava et al. Endoscopy. 47:449-52, 2015; Nava et al. Endosc Int Open. 4(2):E222-7, 2016). However, complications like gastric perforation following ESG have not been reported. This video presents a case with gastric perforation following ESG and its surgical treatment. METHODS A 44-year-old female patient with an initial body mass index (BMI) of 38 kg/m2 underwent an ESG. Her comorbidities include gastroesophageal reflux disease (GERD) and polycystic ovary syndrome (PCOS). On postoperative day six, the patient presented with lower abdominal pain. The patient refused to get an esophagogastroduodenoscopy (EGD) or laparoscopy done. An upper gastrointestinal series (UGI) was performed, and a large ileus was noted with no evidence of leak or free air. On postoperative day seven, a computed tomography (CAT) scan showed a large amount of free air and fluid throughout the abdomen and pelvis. The patient was taken to the operating room (OR) for an exploratory laparoscopy. RESULTS Upon entering the abdomen, a large amount of pus and free fluid was noted. This was irrigated free from the abdominal cavity until it came back clear. We noted six sutures that went intraluminally to extraluminally and entered the anterior abdominal wall. These sutures were taken down until we found the perforation. A GIA stapler was placed over the perforation, and the defect was closed. The staple line was then imbricated. Once done with the imbrication, we spent a significant amount of time laparoscopically irrigating the abdomen with 12 L of fluid. In total, three drains were placed to assist with draining the abdomen. CONCLUSION ESG is a feasible endobariatric option, but complications like gastric perforation can occur. For such complication, immediate surgical treatment is indicated.
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He J, Chen BS, Zhou PH, Zhong YS, Chen WF, Zhang YQ, Li QL, Hu JW. [A novel and simplified closure method for defect closure after endoscopic full-thickness resection of gastric submucosal tumors: short-term outcomes of "Shao-Mai" closure method]. Zhonghua Wei Chang Wai Ke Za Zhi 2020; 23:183-187. [PMID: 32074800 DOI: 10.3760/cma.j.issn.1671-0274.2020.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the feasibility and short-term efficacy of a novel and simplified closure method developed by our team for the defect closure after endoscopic full-thickness resection (EFTR) for gastric submucosal tumors (SMT) in the gastric wall. Methods: A prospective single-arm clinical study was used. Inclusion criteria: (1) the lesion was located in the fundus or the greater curvature of the stomach, and was confirmed to originate from the muscularis propria layer; (2) the diameter of the tumor was ≤3.5 cm, and the tumor had no extensive adhesion to the peritoneal tissues and organs in extraperitoneal cavity; (3) the tumor had no malignant features under ultrasound endoscopy; (4) the patient agreed to participate in the study; (5) patients with severe complications were excluded. Based on the above criteria, 20 patients with gastric SMT at the Endoscopy Center of Zhongshan Hospital of Fudan University from January 2015 to March 2018 were enrolled in this study, including 5 males and 15 females with mean age of 61.1 (38 to 70) years. Grasping forceps-assisted endo-loop snare ligation device which is called "Shao-Mai" method was used to close the defect site. All the patients underwent EFTR and "Shao-Mai" method to perform defect closure. After successful tumor resection by EFTR, an endo-loop was anchored onto the edge of the gastric defect with grasping forceps assistance and closed tightly. The observation indicators included tumor size, en bloc resection, operation time, postoperative complications and hospital stay. The follow-up indicators included tumor residual, local recurrence, and metachronous lesions. Results: All the 20 lesions were located in the muscularis propria with a size of 0.5-3.5 (mean 1.4) cm. Three of them were located in the greater curvature of the mid-upper gastric body, 17 were located in the fundus. The endoscopic "Shao-Mai" closure was successfully performed after EFTR in all the 20 cases. Endoscope was used uniquely through the entire process, without laparoscopic assistance. The operative time was 20-100 (mean 43.8) minutes, while the "Shao-Mai" closure procedure took a range of 3-30 (mean 10.1) minutes. The en bloc resection rate was 100%. The pathological diagnosis included 17 gastrointestinal stromal tumors and 3 leiomyomas. No major complications occurred during or after surgery. All the patients were discharged 1-11 (mean 3.1) days after operation. The wounds of all the cases were healed completely six months after operation and only scar was observed without ulcer. No residual lesion, tumor recurrence or metastasis, leakage or fistula of digestive tract were found during the follow-up period of 15-54 (median 41) months. Conclusion: The endoscopic "Shao-Mai" closure method is a simplified novel way, which is feasible, effective, and safe for closing the gastric defect after EFTR.
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Affiliation(s)
- J He
- Endoscopy Center of Xiamen Hospital of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - B S Chen
- Endoscopy Center of Xiamen Hospital of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - P H Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy, Shanghai 200032, China
| | - Y S Zhong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy, Shanghai 200032, China
| | - W F Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy, Shanghai 200032, China
| | - Y Q Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy, Shanghai 200032, China
| | - Q L Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy, Shanghai 200032, China
| | - J W Hu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy, Shanghai 200032, China
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Sachdev AH, Iqbal S, Ribeiro IB, de Moura DTH. Use of omental patch and endoscopic closure technique as an alternative to surgery after endoscopic full thickness resection of gastric intestinal stromal tumors: A series of cases. World J Clin Cases 2020; 8:120-125. [PMID: 31970177 PMCID: PMC6962076 DOI: 10.12998/wjcc.v8.i1.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/26/2019] [Accepted: 12/13/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) originate from interstitial cells of Cajal. GISTs can occur anywhere along the gastrointestinal tract. Large lesions have traditionally been removed surgically. However, with recent innovations in advanced endoscopy, GISTs located within the stomach are now removed endoscopically. We describe a new innovative endoscopic technique to close large and hard to access defects after endoscopic full-thickness resection of gastric GISTs.
CASE SUMMARY We present a series of three patients who were diagnosed with a gastric GIST. All patients underwent full-thickness endoscopic resection. In all cases, for closure of the surgical bed, conventional endoscopic techniques including hemoclips, endoloop and suturing were unsuccessful. We performed a new technique in which we pulled omental fat into the gastric lumen and completely closed the defect using endoscopic devices. All patients performed well post-procedure and computed tomography was carried out one day after the procedures which showed no extravasation of contrast.
CONCLUSION The omental plug technique may be used as an alternative to surgery in selected cases of gastric perforation.
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Affiliation(s)
- Amit H Sachdev
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | | | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
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Zhou GJ, Jin P, Jiang SY. Gastric perforation following improper cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Pak J Med Sci 2020; 36:296-298. [PMID: 32063979 PMCID: PMC6994888 DOI: 10.12669/pjms.36.2.1363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022] Open
Abstract
Gastric perforation is a rare complication of cardiopulmonary resuscitation (CPR), mostly resulting from incorrect airway management. If left unrecognized, it is associated with high mortality and morbidity. We present a case of gastric perforation after improper CPR. A 56-year-old drunken male was sent to the emergency department due to coma after fall onto the ground. He was thought to have cardiac arrest at scene and was saved with CPR maneuver by his friends who has never been trained before. He was taken to the hospital by emergency medical service personnel and presented with abdominal distention and extensive pneumoperitoneum. Emergency laparotomy was performed which revealed gastric perforation at the lesser curvature of the stomach. The laceration was repaired without any difficulty and the patient was discharged home without any neurological deficit. The aim of this report is to remind the public and emergency physicians that gastric perforation should be suspected in patients with distended abdomen and pneumoperitoneum after CPR. Because the most common risk factor for CPR-related gastric perforation is the bystander-provided resuscitation, it is encouraged for the public to take formal CPR training.
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Affiliation(s)
- Guang-Ju Zhou
- Guang-Ju Zhou, Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou 310009, China
| | - Ping Jin
- Ping Jin, Department of Emergency Medicine, Zhejiang Yuyao People’s Hospital, Yuyao 315400, China
| | - Shou-Yin Jiang
- Shou-Yin Jiang. Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou 310009, China
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Karasuno T, Sata H, Noda Y, Imakita M, Yasumi M. Invasive candidiasis leading to gastric perforation in an immunocompromised patient. IDCases 2019; 18:e00627. [PMID: 31516828 PMCID: PMC6727104 DOI: 10.1016/j.idcr.2019.e00627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/18/2019] [Accepted: 08/18/2019] [Indexed: 01/05/2023] Open
Abstract
Invasive candidiasis remains an important cause of mortality and morbidity in patients with underlying diseases. Here, we report a case of gastric perforation due to Candia glabrata infection in a 74-year-old-male with Paroxysmal nocturnal hemoglobinuria (PNH) who received long-term corticosteroid treatment of hemophagocytic syndrome associated with acute cholecystitis. Total gastrectomy was performed, and he was treated liposomal amphotericin B. The patient was extubated successfully on the 2nd postoperative day, but the patient died of Pneumocystis jirovecii pneumonia (PJP). An autopsy revealed that there was a small amount of the cystic form of Pneumocystic jirovecii, but there was not the presence of Candida spp. Concerning the prophylaxis of invasive candidiasis, there is no strong evidence-based data in clinical practice in immunocompromised patients, such as those receiving long-term immunomodulatory therapy or corticosteroids. Our present case suggests the importance of fungal management and may indicate the need for a new approach to the fungal prophylaxis in such patients.
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Affiliation(s)
- Takahiro Karasuno
- Department of Hematology, Rinku General Medical Center, Japan
- Corresponding author at: 2-3 Ourai-Kita, Rinku, Izumisano, Osaka, 598-8577, Japan.
| | - Hiroshi Sata
- Department of Hematology, Rinku General Medical Center, Japan
| | - Yuri Noda
- Department of Pathology, Kaizuka City Hospital, Japan
| | - Masami Imakita
- Department of Pathology, Rinku General Medical Center, Japan
| | - Masato Yasumi
- Department of Hematology, Rinku General Medical Center, Japan
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Abstract
BACKGROUND Paraesophageal hernias are usually asymptomatic; however, they can cause serious complications such as necrosis or incarceration-induced perforation. Necrosis usually occurs in the incarcerated portion of the hernia. Here, we report the case of a patient with gastric necrosis secondary to an incarcerated paraesophageal hernia in which the necrotic lesion was outside the hernia sac. CASE PRESENTATION A 91-year-old woman presented with severe abdominal pain and vomiting. A physical examination showed hypotension and a diffusely tender and rigid abdomen. Computed tomography showed a paraesophageal hernia, massive ascites, and free air around the stomach. A laparotomy was performed to treat the upper gastrointestinal perforation. The stomach was incarcerated within the paraesophageal hernia sac. After reducing the stomach, we identified a large perforation on the posterior wall of the gastric fundus. Full-thickness necrosis involving part of the stomach necessitated total gastrectomy. She remained physiologically unstable and her condition deteriorated; she died 2 days postoperatively. CONCLUSIONS A hiatal hernia can be associated with an ischemic gastric perforation outside the hernia sac.
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Affiliation(s)
- Shota Fukai
- Department of Surgery, Tokyo Bay Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, Japan.
| | - Tadao Kubota
- Department of Surgery, Tokyo Bay Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, Japan
| | - Ken Mizokami
- Department of Surgery, Tokyo Bay Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, Japan
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Sayad P, Tan AZ. A case report of a gastric perforation in a giant inguinoscrotal hernia: A two-step approach. Int J Surg Case Rep 2019; 55:174-178. [PMID: 30743219 PMCID: PMC6369136 DOI: 10.1016/j.ijscr.2019.01.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 11/19/2022] Open
Abstract
Gastric perforation in a giant inguinal hernia is a rare and morbid complication. Repair of a giant inguinal hernia complicated by gastric perforation should be delayed when possible. Gastric rupture in a giant inguinal hernia is the result of the downward pulling exerted by the hernia content.
Introduction An inguinoscrotal hernia is defined as giant if descending below the midpoint of the inner thigh of a patient in upright position. It is an uncommon condition and rarely encountered in clinical practice that can lead to severe complications such as gastric perforation. Presentation of case We present a case of a 50-year old male suffering from a gastric perforation in a giant inguinoscrotal hernia that was managed in a two-step approach. Discussion In our patient, we opted for a two-step approach. The initial phase consisted in the release of the stomach, repair of the perforation, the control of the infection and the stabilization of the patient. The repair of the hernia was performed uneventfully three months later in the second phase. Conclusion In a giant inguinal hernia with gastric perforation, delaying the hernia repair when possible can decrease the complexity of the procedure and most likely its morbidity and mortality.
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Affiliation(s)
- Paul Sayad
- Department of General Surgery, HealthBay Polyclinic, Dubai, United Arab Emirates.
| | - Audrey Zhen Tan
- Department of General Surgery, HealthBay Polyclinic, Dubai, United Arab Emirates
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Oshiro M, Kanda H, Oshiro A, Kure K, Kanao-Kanda M, Kamiya H, Kunisawa T. Conservative management for iatrogenic gastric perforation by transesophageal echocardiography. JA Clin Rep 2018; 4:52. [PMID: 32025952 PMCID: PMC6966747 DOI: 10.1186/s40981-018-0189-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/18/2018] [Indexed: 12/21/2022] Open
Abstract
Background Though several cases of upper gastrointestinal tract injury caused by transesophageal echocardiography (TEE) have been reported, gastric perforation is very rare. Herein, we report the case of TEE-associated gastric perforation that was successfully treated conservatively. Case presentation An 82-year-old man underwent mitral valve repair. Postoperative esophagogastroduodenoscopy and computed tomography revealed gastric perforation. Surgical treatment was initially considered, but conservative management was selected to avoid increasing operative stress, to minimize the need for total gastrectomy (including the lower esophagus), and to minimize the risk of a potential intraperitoneal infection spreading to the thoracic cavity. Conclusion Conservative management of gastric perforation can be successful even when the perforation is recognized later than 12 h following the event, provided that there are no abdominal symptoms and no signs of peritoneal effusion or sepsis. Our experience suggests that conservative management is a feasible option for treating TEE-associated gastric perforation in appropriately selected cases.
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Affiliation(s)
- Masaya Oshiro
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Hirotsugu Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Akane Oshiro
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Kenta Kure
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Megumi Kanao-Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Takayuki Kunisawa
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
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Nafatalewa DK, Misenga JB, Musapudi EM, Yebalaya PM, Mujinga DT, Ilunga GN. [Spontaneous neonatal gastric perforation: about a case]. Pan Afr Med J 2018; 30:72. [PMID: 30344856 PMCID: PMC6191244 DOI: 10.11604/pamj.2018.30.72.13205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/31/2018] [Indexed: 11/14/2022] Open
Abstract
La perforation gastrique néonatale spontanée est rare. Nous rapportons un cas survenu chez un nouveau-né de 4 jours issu d'une grossesse à terme. L’enfant a nécessité une réanimation à sa naissance. Au deuxième jour de sa vie, une distension abdominale importante était notée. La radiographie de l'abdomen sans préparation a montré un pneumopéritoine. La laparotomie a objectivé une perforation au niveau de la petite courbure gastrique de 1,5cm de diamètre qui a bénéficié d’une suture simple chirurgicale. L'évolution était marquée par le décès au premier jour post opératoire.
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Affiliation(s)
- Dimitri Kanyanda Nafatalewa
- Université de Lubumbashi, Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Service de Chirurgie, République Démocratique du Congo
| | - Jeff Bukasa Misenga
- Université de Lubumbashi, Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Service de Chirurgie, République Démocratique du Congo
| | - Eric Mbuya Musapudi
- Université de Lubumbashi, Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Service de Chirurgie, République Démocratique du Congo
| | - Pascal Monga Yebalaya
- Université de Lubumbashi, Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Service de Chirurgie, République Démocratique du Congo
| | - Didier Tshibangu Mujinga
- Université de Lubumbashi, Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Service de Chirurgie, République Démocratique du Congo
| | - Guy Nday Ilunga
- Université de Lubumbashi, Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Service de Chirurgie, République Démocratique du Congo
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Abstract
Obesity is considered the most common nutritional disorder in Western countries and is related to multiple morbidity and mortality. There are different options for obesity treatment, including diet, behavioral therapy, medications, and surgery. If patients do not meet the criteria for bariatric surgery, intragastric balloons may be used to achieve weight reduction. Currently, the intragastric balloon is one of the most common bariatric procedures in obese patients in Europe. Gastric perforation associated with intragastric balloon is a rare but dangerous complication. We report a case of a 42-year-old female patient who presented to the emergency department with acute abdomen. Chest x-ray in an erect posture indicated free gas under the diaphragm. She had undergone placement of an intragastric adjustable balloon device 13 months earlier and was overdue for removal of the balloon. In the emergency theater, a large perforated ulcer was found in the posterior wall of the stomach, which was repaired laparoscopically. Her postoperative course was uneventful. We also review the literature on intragastric balloon-induced gastric perforation. Our case is a very rare report of late gastric perforation after adjustable intragastric balloon placement. We recommend regular follow-up and removal in proper time after insertion of the gastric balloon.
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Affiliation(s)
- Ahmed Arifur Rahman
- St. George Hospital and The Sutherland Hospital, Kogarah, New South Wales, Australia.
| | - Ken Loi
- St. George Hospital and The Sutherland Hospital, Kogarah, New South Wales, Australia
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40
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Babayigit A, Ozaydın S, Cetinkaya M, Sander S. Neonatal gastric perforations in very low birth weight infants: a single center experience and review of the literature. Pediatr Surg Int 2018; 34:79-84. [PMID: 29079904 DOI: 10.1007/s00383-017-4205-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Gastric perforation is a rare condition with high mortality rates in preterm infants. The aim of this retrospective study was to define the risk factors and prognosis in very low birth weight (VLBW) infants with gastric perforations. METHODS VLBW infants with a diagnosis of gastric perforation between 2012 and 2016 were included. The data including birth weight, gestational age, gender, risk factors, time and location of the perforation and prognosis were recorded. RESULTS A total of eight infants were identified. The median gestational age and birth weight of the infants were 26 weeks and 860 g, respectively. Five were male and 6 (75%) had a diagnosis of hemodynamically significant patent ductus arteriosus (PDA), early sepsis, persistent hypotension, and drug administration (paracetamol, ibuprofen). The main clinical finding was abdominal distension and pneumoperitoneum was detected in all infants. The median diagnosis was 6 days of life. The median perforation size was 2.5 cm and curvature major and anterior wall were the most common locations. The mortality rate was 62.5%. CONCLUSION Male gender, chorioamnionitis, early sepsis, asphyxia, hemodynamic PDA, persistent hypotension, ibuprofen and paracetamol usage, and orogastric catheter administration were the main risk factors for gastric perforations in VLBW infants.
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Affiliation(s)
- Aslan Babayigit
- Department of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey
| | - Seyithan Ozaydın
- Department of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey.,Department of Pediatric Surgery, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey
| | - Merih Cetinkaya
- Department of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey.
| | - Serdar Sander
- Department of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey.,Department of Pediatric Surgery, Kanuni Sultan Suleyman Training and Research Hospital, Turgut Ozal Caddesi No:1 34303 Altınsehir, Kucukcekmece, Istanbul, Turkey
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41
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Johnson S, McCracken J, Baidoun F. Tension pneumoperitoneum after bystander cardiopulmonary resuscitation: A case report. Int J Surg Case Rep 2017; 42:227-232. [PMID: 29291538 PMCID: PMC5752217 DOI: 10.1016/j.ijscr.2017.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 12/27/2022] Open
Abstract
Abdominal visceral injuries following cardiopulmonary resuscitation are relatively infrequent. Tension pneumoperitoneum is a serious condition where free intraperitoneal air causes significant pressure decreasing venous return and cardiac output. Gastric perforation after CPR is identified on the lesser curvature, where the area has fewer mucosal folds and is fixed by the hepatogastric ligament. Veress needle desufflation can be an effective means of decompressing an abdomen under increased pressure from free intraperitoneal air.
Introduction Abdominal visceral injuries after cardiopulmonary resuscitation (CPR) are infrequent though can be significant complications of CPR requiring invasive interventions. We present a case of a gastric perforation as a result of bystander CPR. This resulted in tension pneumoperitoneum necessitating abdominal decompression prior to laparotomy and repair. Presentation of case 37-year-old female complained of abdominal pain and distension after return of spontaneous circulation from successful CPR following a drug overdose and cardiopulmonary arrest. Abdominal imaging showed significant amounts of free intraperitoneal air causing compression of the abdominal visceral organs. Patient underwent exploratory laparotomy. Prior to induction of general anesthesia with potential cardiovascular collapse from the tension pneumoperitoneum, the abdomen was decompressed with a spring-loaded insufflation (Veress) needle while the patient was awake. Upon exploration, there were two three-centimeter gastric perforations that were primarily repaired with omental patch. The patient had an uneventful recovery and discharged home on postoperative day four. Conclusion The Veress needle, usually used for insufflating the abdomen during laparoscopy, can also be an effective tool to decompress the abdomen when presented with tension pneumoperitoneum. Abdominal visceral injuries are rare following CPR but do occur and will likely require an invasive intervention. Surviving cardiac arrest as a young person and living without deficits outweighs the risk of a surgical correction for a visceral injury. While resuscitation measures are critical for survival, medical personnel need to be aware of potential complications from resuscitative efforts and potential management strategies.
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Affiliation(s)
- Sherry Johnson
- Henry Ford Wyandotte Hospital, 2333 Biddle Ave, Wyandotte, MI 48192, USA.
| | - Jessica McCracken
- Henry Ford Wyandotte Hospital, 2333 Biddle Ave, Wyandotte, MI 48192, USA.
| | - Fadi Baidoun
- Henry Ford Wyandotte Hospital, 2333 Biddle Ave, Wyandotte, MI 48192, USA.
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42
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Nonaka H, Onishi H, Ozaki M, Kuriyama K, Komiyama T, Saito R. Serious gastric perforation after second stereotactic body radiotherapy for peripheral lung cancer that recurred after initial stereotactic body radiotherapy: a case report. J Med Case Rep 2017; 11:343. [PMID: 29223168 PMCID: PMC5723405 DOI: 10.1186/s13256-017-1504-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 10/31/2017] [Indexed: 12/25/2022] Open
Abstract
Background In recent reports, re-irradiation with stereotactic body radiotherapy for lung tumors in patients previously treated with thoracic radiation therapy resulted in several serious toxicities. Serious non-lung toxicities were observed mostly in patients with central tumors, but we experienced a case of fatal gastric perforation after a second stereotactic body radiotherapy in a patient with a peripheral lung tumor. Case presentation An 83-year-old Asian man was diagnosed with T2N0M0 lung cancer in the form of squamous cell carcinoma in the lower lobe of his left lung. He was treated with stereotactic body radiotherapy of 40 Gy in 4 fractions and the tumor decreased in size in partial response. The local tumor recurred 8 months after the first stereotactic body radiotherapy, and he was re-irradiated with a second stereotactic body radiotherapy of 50 Gy in 4 fractions. A Sengstaken–Blakemore tube was inserted below his diaphragm by laparoscopic surgery before the second stereotactic body radiotherapy in order to reduce the stomach dose by keeping his stomach apart from the tumor. Two months after the second stereotactic body radiotherapy, he developed fatal gastric perforation and gastropleural fistula penetrating his diaphragm. Conclusions To the best of our knowledge, this is the first report about a gastric perforation after stereotactic body radiotherapy for lung tumors and it warns of serious complication of stereotactic body radiotherapy in not only centrally located but also peripherally located tumors like in this case.
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Affiliation(s)
- Hotaka Nonaka
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo City, Yamanashi, 409-3898, Japan.
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo City, Yamanashi, 409-3898, Japan
| | - Masatoki Ozaki
- Department of Radiation Oncology, Shizuoka City Shimizu Hospital, 1231 Miyakami, Shimizu Ward, Shizuoka City, Shizuoka, 424-8636, Japan
| | - Kengo Kuriyama
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo City, Yamanashi, 409-3898, Japan
| | - Takafumi Komiyama
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo City, Yamanashi, 409-3898, Japan
| | - Ryo Saito
- Department of Radiology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi Ward, Shizuoka City, Shizuoka, 420-8527, Japan
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43
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Abstract
Gastric perforations following blunt abdominal trauma are rare, accounting for < 2% of all blunt abdominal injuries. Isolated blunt gastric ruptures are uncommon. They are usually associated with other solid visceral injuries. Injuries to the stomach are associated with the highest mortality of all hollow viscus injuries. Severity of the injury, timing of presentation and presentation following the last meal as well as concomitant injuries are important prognostic factors. Imaging modalities may be unreliable in making a diagnosis and thus clinical vigilance is mandatory. We present a patient with gastric perforation following blunt abdominal trauma and review the literature.
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Affiliation(s)
| | | | | | - S. Mewa Kinoo
- Corresponding author at: Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 719 Umbilo Road, Congella 4013, Durban, South Africa.Department of SurgeryNelson R Mandela School of MedicineUniversity of KwaZulu-Natal719 Umbilo RoadCongella 4013DurbanSouth Africa
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44
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Poris S, Fontaine A, Glener J, Kubovec S, Veldhuis P, Du Y, Pepe J, Eubanks S. Routine versus selective upper gastrointestinal contrast series after omental patch repair for gastric or duodenal perforation. Surg Endosc 2017; 32:400-404. [PMID: 28664428 DOI: 10.1007/s00464-017-5695-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/22/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are no guidelines on the routine or selective use of contrast upper gastrointestinal series (UGI) after omental patch repair (OPR) of a gastric (GP) or duodenal perforation (DP). This study aims to elucidate whether the use of selective versus routine contrast study will lead to worse clinical outcomes. METHODS A retrospective analysis of 115 (n = 115) patients with OPR of GP or DP was performed. Data were obtained from seven Florida Hospital campuses. Patients aged 18 and older from 2006 to 2016 were identified by ICD9 billing information. Patients were divided into two groups: UGI and no UGI. The UGI group was subdivided into selective versus routine. A selective UGI was defined as one or more of the following after post-operative day 3: WBC >12,000, peritonitis, fever >100.4 F, tachycardia >110 bpm on three or more assessments, and any UGI performed after POD 7. Perioperative symptoms, perforation location, size, abdominal contamination, laparoscopic or open, leak detection, length of stay, mortality, and reoperation within 2 weeks were also examined. RESULTS No differences between the UGI group and non-UGI group relating to preoperative symptoms, leak detection, death, and reoperation rate were revealed. Differences in length of stay were found to be statistically significant with the UGI group and non-UGI at a median of 15.5 and 8 days, respectively. In the UGI subgroup, 20 of the 29 patients received selective studies. There were no statistical differences identified in leak detection, death, and reoperation. CONCLUSIONS Rates of leak detection, reoperation, and death in patients with GP or DP repaired with omental patch utilizing an UGI study were not statistically significant. An increased length of stay was observed within the UGI group. There was no advantage demonstrated between a selective versus routine UGI; therefore, the use of selective UGI should be based upon clinical indications.
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Affiliation(s)
- Stephenie Poris
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA.
| | - Andrew Fontaine
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Julie Glener
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Stacey Kubovec
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Paula Veldhuis
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA
| | - Yuan Du
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA
| | - Julie Pepe
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA
| | - Steve Eubanks
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA
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Marique L, Wirtz M, Henkens A, Delchambre E, Rezaï M, Venet C, Staudt JP. Gastric Perforation due to Giant Trichobezoar in a 13-Year-Old Child. J Gastrointest Surg 2017; 21:1093-1094. [PMID: 27659788 DOI: 10.1007/s11605-016-3272-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/06/2016] [Indexed: 01/31/2023]
Abstract
Trichotillomania and trichotillophagia can cause the formation of enormous intragastric hairballs. We report the case of a 13-year-old girl who was brought to the emergency service for evaluation of an acute abdomen. Abdominal CT scanner showed a giant gastric trichobezoar which had to be removed by susombilical laparotomy and transverse gastrotomy. This case illustrates the fairly uncommon perforation risk of these gastric bezoars.
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Affiliation(s)
- Lancelot Marique
- Service de Chirurgie Digestive, Thoracique et Endocrine, 32, Boulevard du Jardin Botanique, B-1000, Brussels, Belgium.
| | - Michel Wirtz
- Service de Chirurgie Digestive, Thoracique et Endocrine, 32, Boulevard du Jardin Botanique, B-1000, Brussels, Belgium
| | - Arnaud Henkens
- Service de Chirurgie Digestive, Thoracique et Endocrine, 32, Boulevard du Jardin Botanique, B-1000, Brussels, Belgium
| | - Emilie Delchambre
- Service de Chirurgie Digestive, Thoracique et Endocrine, 32, Boulevard du Jardin Botanique, B-1000, Brussels, Belgium
| | - Monfred Rezaï
- Service de Radiologie, Clinique Saint-Jean, Boulevard du Jardin Botanique 32, B-1000, Brussels, Belgium
| | - Christian Venet
- Service de Radiologie, Clinique Saint-Jean, Boulevard du Jardin Botanique 32, B-1000, Brussels, Belgium
| | - Jean-Pierre Staudt
- Service de Chirurgie Digestive, Thoracique et Endocrine, 32, Boulevard du Jardin Botanique, B-1000, Brussels, Belgium
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Yoshizawa J, Ishizone S, Ikeyama M, Nakayama J. Gastric hepatoid adenocarcinoma resulting in a spontaneous gastric perforation: a case report and review of the literature. BMC Cancer 2017; 17:368. [PMID: 28545511 PMCID: PMC5445331 DOI: 10.1186/s12885-017-3357-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/15/2017] [Indexed: 12/14/2022] Open
Abstract
Background Gastric hepatoid adenocarcinoma (GHAC) is an atypical form of gastric cancer (GC) that has similar tissue morphology to hepatocellular carcinoma and frequently produces alpha-fetoprotein. We present an exceedingly rare case of GHAC resulting in a spontaneous gastric perforation. Case presentation A 61-year-old man presented at our institution complaining of abdominal and back pain. A computed tomography scan revealed a spontaneous gastric perforation with a solitary liver tumor and lymph node swelling. Following a diagnosis of advanced-stage GC with a gastric perforation, perforative peritonitis, multiple lymph node metastases, and a solitary metastasis of the lateral segment of the liver, the patient underwent distal gastrectomy. Histopathology of the resected specimen revealed that the tumor cells were arranged in a hepatoid pattern. On immunohistochemical staining, the tumor cells were positive for alpha-fetoprotein and Sal-like protein 4. Thus, the patient was diagnosed with GHAC. Hepatic resection of the solitary liver metastasis was performed. However, recurrence occurred and the patient achieved complete response following tegafur/gimeracil/oteracil-based chemotherapy. Conclusions GHAC is a highly malignant histological subtype of GC. We reported on an extremely rare case of GHAC resulting in a spontaneous gastric perforation and reviewed the literature, including epidemiological data, treatment regimens, and the association between GHAC and alpha-fetoprotein-producing GC.
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Affiliation(s)
- Junichi Yoshizawa
- Department of Surgery, North Alps Medical Center Azumi Hospital, 3207-1 Ikeda, Ikeda-machi, Kitaazumi-gun, Nagano Prefecture, 399-8695, Japan. .,Present Address: Suwa Red Cross Hospital, 5-11-50 Kogandori, Suwa-shi, Nagano Prefecture, 392-8510, Japan.
| | - Satoshi Ishizone
- Department of Surgery, North Alps Medical Center Azumi Hospital, 3207-1 Ikeda, Ikeda-machi, Kitaazumi-gun, Nagano Prefecture, 399-8695, Japan
| | - Meguru Ikeyama
- Department of Molecular Pathology, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano Prefecture, 390-8621, Japan
| | - Jun Nakayama
- Department of Molecular Pathology, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano Prefecture, 390-8621, Japan
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Piplani R, Acharya SK, Bagga D. Congenital Duodenal Obstruction, Situs Inversus Totalis, and Gastric Perforation in a Neonate. J Neonatal Surg 2017; 6:35. [PMID: 28770132 PMCID: PMC5538601 DOI: 10.21699/jns.v5i4.463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/04/2016] [Indexed: 11/12/2022] Open
Abstract
We report a rare case of incomplete congenital duodenal obstruction (Type 1 duodenal atresia) in association with situs inversus totalis presenting with gastric perforation in a neonate. The infantogram was suggestive of perforation with air under diaphragm along with dextrocardia. On exploration, a pin point perforation at fundus near lesser curvature along with situs inversus was noted. Primary closure of gastric perforation was done. Patient was then discharged on full breast feeds but was readmitted with intolerance to feeds and recurrent bilious vomiting. Further, upper GI contrast study revealed partial duodenal obstruction. On re-exploration, duodenal web with central aperture was seen and duodeno-duodenostomy was done.
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Affiliation(s)
- Rajat Piplani
- Department of Pediatric Surgery, V.M.M.C & Safdarjang Hospital, New Delhi
| | - Samir K Acharya
- Department of Pediatric Surgery, V.M.M.C & Safdarjang Hospital, New Delhi
| | - Deepak Bagga
- Department of Pediatric Surgery, V.M.M.C & Safdarjang Hospital, New Delhi
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Hu JW, Ge L, Zhou PH, Li QL, Zhang YQ, Chen WF, Chen T, Yao LQ, Xu MD, Chu Y. A novel grasp-and-loop closure method for defect closure after endoscopic full-thickness resection (with video). Surg Endosc. 2017;31:4275-4282. [PMID: 28374258 DOI: 10.1007/s00464-017-5473-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 02/15/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic full-thickness resection (EFTR) is a minimally invasive method for en bloc resection of gastrointestinal (GI) lesions originating from the muscularis propria layer. Successful closure of the wall defect is a critical step. OBJECTIVE The aim of this study was to evaluate the feasibility and efficacy of a novel and simplified endoscopic grasp-and-loop (GAL) closure method using an endo-loop assisted with grasping forceps for defect closure. METHODS From January 2015 to March 2016, 13 patients with submucosal tumors (SMTs) originating from the muscularis propria (MP) layer underwent EFTR and were enrolled in this study. After successful tumor resection, an endo-loop was anchored onto the circumferential margin of the gastric defect with grasping forceps assistance and tightened gently. Patient characteristics, tumor size, en bloc resection, and postoperative complications were evaluated. RESULTS Of the 13 lesions in the stomach, two were located in the greater curvature of the mid-upper body, 11 were located in the fundus. The endoscopic GAL closure method was successfully performed after EFTR in all the 13 patients without laparoscopic assistance. The mean procedure time was 43.5 min (range 20-80 min), while the GAL closure procedure took a mean of 9.4 min (range 3-18 min). The mean resected lesion size was 1.5 cm (range 0.5-3.5 cm). Pathological diagnoses of these lesions were 11 gastrointestinal stromal tumors (GISTs) and two leiomyomas. No major adverse events occurred during or after the procedure. All the patients were discharged after a mean time of 2.4 days (range 1-4 days). No residual lesion or tumor recurrence was found during the follow-up period (median, 5 months; range, 1-15 months). CONCLUSIONS The endoscopic GAL closure method is feasible, effective, and safe for closing the gastric defect after EFTR in patients.
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Ikeno M, Abe S, Kurahashi H, Takasu M, Shimizu T, Okumura A. Gastric perforation and critical illness polyneuropathy after steroid treatment in a patient with encephalitis/encephalopathy with transient splenial lesion. Brain Dev 2017; 39:356-60. [PMID: 27856098 DOI: 10.1016/j.braindev.2016.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 11/24/2022]
Abstract
The outcome of mild encephalitis/encephalopathy with reversible splenial lesion (MERS) is favorable whether or not specific treatment is performed. We report a patient with MERS treated with methylprednisolone, complicated by gastric perforation followed by critical illness polyneuropathy. The patient was a 14-year-old male with mildly impaired consciousness and hyponatremia who was treated with methylprednisolone pulse therapy. High fever appeared after methylprednisolone pulse therapy and free air was recognized on an abdomen roentgenogram. Gastric perforation was recognized on emergent endoscopic surgery and omental implantation repair was performed. His consciousness was fully recovered after surgery, whereas he was noted to have motor and sensory impairment of the lower extremities and vesico-rectal disturbance. Nerve conduction studies revealed decreased compound muscle action potentials with preserved motor conduction velocity and decreased sensory nerve action potentials. He was diagnosed as having critical illness polyneuropathy, and bedside physical rehabilitation was initiated. His neurological symptoms resolved within 6months. Our patient highlighted possible serious adverse events associated with steroid treatment for children with MERS.
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Abou Chaar MK, Meyers ML, Tucker BD, Galan HL, Liechty KW, Crombleholme TM, Marwan AI. Twin pregnancy complicated by esophageal atresia, duodenal atresia, gastric perforation, and hypoplastic left heart structures in one twin: a case report and review of the literature. J Med Case Rep 2017; 11:64. [PMID: 28314387 PMCID: PMC5357333 DOI: 10.1186/s13256-016-1195-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/28/2016] [Indexed: 12/12/2022] Open
Abstract
Background The antenatal diagnosis of a combined esophageal atresia without tracheoesophageal fistula and duodenal atresia with or without gastric perforation is a rare occurrence. These diagnoses are difficult and can be suspected on ultrasound by nonspecific findings including a small stomach and polyhydramnios. Fetal magnetic resonance imaging adds significant anatomical detail and can aid in the diagnosis of these complicated cases. Upon an extensive literature review, there are no reports documenting these combined findings in a twin pregnancy. Therefore we believe this is the first case report of an antenatal diagnosis of combined pure esophageal and duodenal atresia in a twin gestation. Case presentation We present a case of a 30-year-old G1P0 white woman at 22-week gestation with a monochorionic-diamniotic twin pregnancy discordant for esophageal atresia, duodenal atresia with gastric perforation, hypoplastic left heart structures, and significant early gestation maternal polyhydramnios. In this case, fetal magnetic resonance imaging was able to depict additional findings including area of gastric wall rupture, hiatal hernia, dilation of the distal esophagus, and area of duodenal obstruction and thus facilitated the proper diagnosis. After extensive counseling at our multidisciplinary team meeting, the parents elected to proceed with radiofrequency ablation of the anomalous twin to maximize the survival of the normal co-twin. The procedure was performed successfully with complete cessation of flow in the umbilical artery and complete cardiac standstill in the anomalous twin with no detrimental effects on the healthy co-twin. Conclusions Prenatal diagnosis of complex anomalies in twin pregnancies constitutes a multitude of ethical, religious, and cultural factors that come into play in the management of these cases. Fetal magnetic resonance imaging provides detailed valuable information that can assist in management options including possible prenatal intervention. The combination of a cystic structure with peristalsis-like movement above the diaphragm (for example, “the upper thoracic pouch sign”), polyhydramnios, and progressive distention of the stomach and duodenum should increase suspicion for a combined pure esophageal and duodenal atresia.
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Affiliation(s)
- Mohamad K Abou Chaar
- Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA
| | - Mariana L Meyers
- Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA.,Department of Pediatric Radiology, University of Colorado Denver, Anschutz Medical Center, Denver, USA
| | - Bethany D Tucker
- Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA.,Department of Pediatrics, University of Colorado Denver, Anschutz Medical Center, Denver, USA
| | - Henry L Galan
- Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA.,Department of Obstetrics and Gynecology - Maternal Fetal Medicine, University of Colorado Denver, Anschutz Medical Center, Denver, USA
| | - Kenneth W Liechty
- Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA.,Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Center, Denver, USA
| | - Timothy M Crombleholme
- Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA.,Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Center, Denver, USA
| | - Ahmed I Marwan
- Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA. .,Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Center, Denver, USA. .,Surgery and Pediatrics, Colorado Fetal Care Center - Children's Hospital Colorado, 13123 East 16th Avenue, 328, Aurora, Colorado, 80045, USA.
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