Use of real-time near-infrared fluorescence to assess gastric viability in dogs with gastric dilatation volvulus: A case-control study.

OBJECTIVE: To describe near-infrared fluorescence (NIRF) for assessment of gastric viability and describe NIRF's influence on the surgeon's operative strategy in dogs with gastric dilatation and volvulus (GDV). STUDY DESIGN: Prospective clinical trial. ANIMALS: Twenty dogs with GDV and 20 systemically healthy dogs. METHODS: Following gastric derotation, the surgeon's subjective assessment of gastric viability was recorded prior to near-infrared imaging. Changes in the surgeon's initial assessment of viability based on the visual pattern of gastric fluorescence was recorded. If nonviable (lack of defined vessels), a partial gastrectomy was performed and submitted for histopathology. The stapled gastrectomy line was imaged. Viable (defined vessels) and nonviable fluorescence intensities were compared with healthy dogs undergoing surgery for nongastrointestinal disease. RESULTS: Subjective assessment diagnosed 17 viable and three nonviable GDVs (2 fundi; 1 cardia). Near-infrared imaging demonstrated nonviable gastric fluorescence in 4 dogs (3 fundi/cardia; 1 fundus). The surgeon's margins for resection were altered in 3/20 dogs. Fluorescence intensity (cardia, fundus, body, pylorus) was lower in GDV viable (30.59%, p = .04; 38.17%, p < .01; 51.18%, p < .01; 44.12%, p= .01) and nonviable (11.00%, p < .01; 4.33%, p < .01; 57.67%, p = .22; 54.33%, p = .72) dogs compared to healthy controls (44.7%, 70.05%, 84.00%, 63.95%). Fundic fluorescence was less in nonviable gastric tissue in comparison with viable gastric tissue (p = .03). Fluorescence of the gastrectomy staple line approximated that of viable tissue. CONCLUSION: Near-infrared fluorescence can identify histologically confirmed nonviable gastric tissue. CLINICAL SIGNIFICANCE: These results provide enough evidence to support the implementation of NIRF as an adjunct to gross examination of the gastric wall in dogs with GDV.

A healthy young patient with hepatic portal vein gas due to acute gastric dilatation: a case report.

Hepatic portal vein gas (HPVG) is caused by the influx of gastrointestinal gas into the intrahepatic portal vein as a result of gastrointestinal wall fragility due to ischemia or necrosis. Gastrointestinal tract necrosis is fatal in severe cases. We observed a case of food intake-induced acute gastric dilatation (AGD) in a healthy young male who developed HPVG and underwent conservative treatment. A 25-year-old male presented to our hospital with epigastric pain and nausea the day after excessive food intake. Computed tomography (CT) revealed gas along the intrahepatic portal vein and marked gastric dilatation with large food residue. AGD-induced HPVG was considered. Esophagogastroduodenoscopy (EGD) was not performed at this stage because of the risk of HPVG and AGD exacerbation, and the patient was followed up with intragastric decompression via a nasogastric tube. Food residue and approximately 2 L of liquid without blood were vomited 1 h after the nasogastric tube placement. His symptoms improved after the vomiting episode. An EGD was performed 2 days after undergoing CT. Endoscopic findings revealed extensive erosions and the presence of a whitish coat extending from the fornix to the lower body of the stomach, indicating AGD. HPVG disappeared on the CT scan taken during EGD. Thereafter, symptom relapse and HPVG recurrence were not observed.

An atypical gastric duplication cyst as a rare cause of gastric dilatation: the key role of the endoscopy ultrasound.

We have written a "letter to Editor" about a case of gastric dilatation caused by a symptomatic gastric duplication cyst with ectopic pancreas ingrowth, in a 13 years old boy. The Endoscopy Ultra Sound characterized the lesion and permitted the aspiration of the internal liquid. The patient underwent to laparoscopic excision of the mass and the histology revealed a gastric duplication cyst with ectopic pancreas ingrowth.

Gastritis enfisematosa. Reporte de un caso en el adulto mayor / Emphysematous gastritis. Report of a case in the elderly

Introducción: la gastritis enfisematosa es una patología poco común pero con alta mortalidad, su presentación clínica es insidiosa, la imagen por tomografía se distingue por un patrón de burbujas lineales con engrosamiento de la pared gástrica. Caso clínico: paciente masculino de 78 años, previamente sano, funcional, que fue ingresado por fractura pertrocantérica de cadera izquierda, quien durante la hospitalización presenta delirium hiperactivo, distención abdominal con disminución de perístalsis además de hipotensión arterial, se realiza tomografía abdominal con evidencia de dilatación gástrica y múltiples burbujas de aire en pared. Es manejado con antibiótico de amplio espectro, fluidoterapia y nutrición parenteral, con respuesta favorable.Conclusiones: la edad avanzada no conlleva por sí misma un peor pronóstico de la enfermedad, la evidencia apoya que un diagnóstico precoz y la intervención terapéutica temprana, son las medidas que han demostrado ser efectivas para la disminución de la mortalidad en pacientes con gastritis enfisematosa

Introduction: Emphysematous gastritis is an uncommon pathology but with high mortality, its clinical presentation is insidious, the tomography image is distinguished by a pattern of linear bubbles with thickening of the gastric wall.Background: This is a 78-year-old male, previously healthy, functional, who was admitted for pertrochanteric fracture of the left hip, who during hospitalization presented hyperactive delirium, abdominal distention with decreased perstalsis in addition to arterial hypotension, an abdominal tomography with evidence of gastric dilation and multiple air bubbles in the wall. He is managed with a broad spectrum antibiotic, fluid therapy and parenteral nutrition, with a favorable response.Conclusions: Advanced age does not in itself lead to a worse disease prognosis, the evidence supports that early diagnosis and early therapeutic intervention are the easures that have proven to be more effective in reducing mortality in patients with emphysematous gastritis.

Hepatic portal vein gas associated with intestinal ischemia and acute gastric dilatation: a case report.

Hepatic portal vein gas (HPVG) is a rare and alarming radiographic finding for patients especially those who had intestinal ischemia. Some surgeons may learn it from books, literature and internet while they may not treat it in a real patient. It often indicates a very serious infection which could result in septic shock even death within a very short time, even though the mortality of patients with HPVG went down with the increased use of computed tomography and ultrasound which allows early and highly sensitive detection of such severe illnesses. Here I report a case in which an 84-year-old man was admitted to emergency department for three days of vomiting and two days of abdominal distension after eating an apple who had HPVG associated with intestinal ischemia and acute gastric dilatation and then died of septic shock in a short time. And the pathogenesis of HPVG is not completely clear at present, while three hypotheses may explain the relation between them. Attention must be paid closely to the patient who has HPVG associated with intestinal ischemia, and something must be done because it may indicate a life-threatening acute abdomen.

Type 2 Myocardial Infarction Resulted from the Left Thoracic Stomach.

The universal definition of myocardial infarction (MI) provides five subtypes of acute myocardial infarction (AMI). We present an interesting case of a type 2 myocardial infarction caused by the dilation of the left thoracic stomach.

Groove pancreatitis: a rare cause of severe gastric dilation.

A 57-year-old male with a history of chronic pancreatitis related to heavy smoking and alcohol abuse was evaluated in the emergency department due to a 3-day history of epigastric pain and postprandial vomiting. Abdominal computed tomography (CT) was performed and revealed a severe gastric dilation that reached the pelvis. There was a marked concentric mural thickening at the duodenal level and an intramural cysts that caused a narrowing of the light and a retrograde gastric dilation. There were no findings suggestive of chronic pancreatitis. A diagnosis was made of duodenal obstruction due to groove pancreatitis with severe secondary gastric dilatation.

Type 2 myocardial infarction resulted from the left thoracic stomach

Abstract The universal definition of myocardial infarction (MI) provides five subtypes of acute myocardial infarction (AMI). We present an interesting case of a type 2 myocardial infarction caused by the dilation of the left thoracic stomach.

Acute massive gastric dilatation: a rare, forgotten complication of fundoplication.

An 8-year-old boy with a history of multiple neonatal laparotomies, including congenital diaphragmatic hernia repair and an open fundoplication, presented acutely with severe abdominal pain, distension, vomiting and shock. A large abnormal opacity in the left upper quadrant was visible on a plain abdominal radiograph. The patient was taken to the theatre for emergency laparotomy and was found to have a massively distended stomach, the fundus and body of which were necrotic. A subtotal gastrectomy was performed, sparing the viable tissue. The patient went on to make a full recovery. Acute massive gastric dilatation (AMGD) is a rare condition characterised by severe gastric distension. Gastric ischaemia results when intragastric pressure exceeds venous pressure, obstructing venous outflow. It is important to recognise AMGD as a severe complication of fundoplication due to closed-loop gastric obstruction. It should prompt consideration of an early laparotomy in cases where the diagnosis is suspected.

Laparoscopic treatment of acute abdomen due to a massive gastric dilatation.

We present the case of a 23-year-old female patient with a past medical history of achalasia and laparoscopic seromiotomy. She presented to the Emergency Department with an acute abdomen, characterized by abdominal pain, fever and diffuse tenderness on palpation.