Treatment of Esophageal Perforation: A Single-Center Expertise.

BACKGROUND AND AIMS: Esophageal perforation is a rare diagnosis, which is associated with a high morbidity and mortality. There is only small scientific background regarding the best choice of treatment. Parameters indicating a good clinical outcome seem to be localization, depth of the defect, pre-existing risk factors, and time interval between the event and start of treatment. MATERIAL AND METHODS: We evaluate retrospective data from 39 patients who were treated with a esophageal perforation in our hospital between 2004 and 2012. RESULTS AND CONCLUSIONS: Our collected data agree with the available published literature. Endoscopic treatment seems to be favorable in early diagnosis.

[Duodenal adenoma--a rare cause of upper gastrointestinal hemorrhage]. / Adenomul duodenal--cauza rara de hemoragie digestiva superioara.

The tumors of the small bowel are rare entities, whose incidence comprises ca. 1-5% of the total amount of tumors in the digestive tract. Most of the cases involve the ileum and duodenum is least involved. The most frequently encountered duodenal tumors are the Brunner's Gland Adenomas. We can encounter unique or multiple lesions, sessile or pedunculated which develop proximal to duodenal papilla and are usually less than 1 cm in diameter although 12 cm lesions have been reported. In most of the cases they remain asymptomatic and constitute incidental discoveries. Sometimes they can present complications such as obstruction, hemorrhage and malignant transformation. Diagnosis is difficult due to the lack of symptoms and is delayed by an average of 6 months from symptoms onset. Barium contrast studies and superior digestive endoscopy is performed in most of the cases to reveal the diagnosis, but other methods, such as CT or ultrasound can be useful. A case of duodenal adenoma is described; the patient was admitted suffering digestive hemorrhage, which resulted in melena, secondary anemia, and ulcerous dyspeptic syndrome.

[Gastrojejunocolic fistula--a rare complication of stomach surgery]. / Fistula gastrojejunocolica--complicatie rara a chirurgiei stomacului.

The gastrojejunocolic fistula represents a clinical entity that occurs very rarely following gastro-jejunal anastomoses and manifests itself clinically and paraclinically by a severe malabsorption syndrome. The results of the physiopathological approach may be summed up as follows: reduced level of seric proteins, fluid and electrolytic depletion, deficiencies in the absorption of the vitamins soluble in fats and water, which may all vary from mildness to severeness, depending on the flow rate of the fistula. Most often, the diagnosis is set by performing barium enema, which is positive for all cases, whereas the barium passage is less efficient, enabling diagnosis in only 33% of the cases. The radiological image may be reduced on principle to one single sign: the abnormal fistulous trajectory (barium passes from the stomach directly into the colon or the enema fills the gastric lumen). It is recommended that surgical treatment be performed in a single stage, by resecting the entire fistula and re-establishing the gastro-jejunal and colic continuity. We report a case of gastrojejunocolic fistula in a patient that underwent 2/3 gastric resection for gastric ulcer 9 years ago.