RESUMEN
Gastrojejunostomy without gastric resection is performed to bypass the distal stomach or the duodenum. Gastrojejunal stoma (GJ) obstruction is an unusual complication. Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities or intraoperatively, as the classic features are absent during the first 24 h and even for several days. Symptoms of injury to other intra-abdominal organs or structures commonly mask or supersede that of pancreatic injury, both early and late in the course of trauma. Hence, these injuries are often overlooked. We present a case of gastrojejunal stoma obstruction after a primary repair of traumatic American Association for the Surgery of Trauma" (AAST) grade IV duodenal injury. The surgery included repair of the duodenum over a T-tube, a pyloric occlusion, a retrocolic loop gastrojejunostomy, and feeding jejunostomy. And thereafter, successful management of postoperative complication with adhesiolysis, necrosectomy, and revised antecolic isoperistaltic Roux-en-Y gastrojejunostomy for retrocolic GJ stoma obstruction due to post-traumatic pancreatitis.
RESUMEN
Pheochromocytoma, is a rare neuroendocrine tumor, which usually presents as hypertension. We report a young male patient, who presented with intracerebral hemorrhage and intractable hypertension. On further evaluation, for uncontrolled secondary hypertension, he was diagnosed to have right adrenal pheochromocytoma. After hemodynamic stabilization, laparoscopic adrenelectomy was performed. Pheochromocytoma crisis presenting as intracerebral hemorrhage and cardiomyopathy is an uncommon phenomena. Even though it is a crisis, it is not a surgical emergency. Proper preoperative hemodynamic stabilization is essential before surgery is performed. An experienced anesthetist, to manage intraoperative fallacies, is warranted. Postoperatively, they must be on lifelong follow-up to watch for recurrence.
RESUMEN
Corrosive upper aerodigestive tract strictures are conventionally treated by open surgery. Surgical advancements permit these strictures to be addressed with minimal invasion. Corrosive strictures treated minimally invasively over a 2-year period (2014-2015) were audited. Colonic mobilization and retrosternal tunneling were performed laparoscopically. The left colic vessel-based isoperistaltic colonic/ileocolonic segment was transposed substernally into the neck, aided by miniceliotomy. Proximal anastomosis was side-to-side esophagocolic in all patients except those who underwent pharyngolaryngectomy or partial laryngectomy, where pharyngocolic/pyriform fossa-ileal anastomosis was employed. Distal anastomoses were colo-jejunal and colocolic/ileocolic in all the patients. Enteral nutrition and ambulation were commenced on the first postoperative day. Oral nutrition was commenced following a normal contrast swallow on the seventh postoperative day. Patients were followed up on an outpatient basis. Ten adults, aged between 19 and 40 years, were treated for acid-induced strictures. Esophagus and stomach were multiply strictured in all patients. Additionally, duodenum was involved in two patients while pharynx and larynx were strictured in three patients. Two patients underwent pharyngolaryngectomy. One patient underwent partial laryngectomy. The average operative time was 240 minutes (range: 210-300 minutes). The mean blood loss was 150 mL (range: 100-200 mL). One patient (10%) had cervical anastomotic leak on the ninth postoperative day, which was resolved spontaneously. One patient (10%) had proximal anastomotic stricture, requiring dilatation thrice. One patient (10%) had the transient left recurrent laryngeal nerve paresis, which was resolved spontaneously. All the patients are on oral solid diet. The followup ranged from 5 months to 2 years. Minimal access substernal colonic transposition is feasible and efficacious in restoring alimentary continuity in corrosive strictures.
