Acute Kidney Injury with Severe Metabolic Alkalosis Caused by Habitual Vomiting in an Alcohol Abuser with Pyloric Stenosis.

A 47-year-old man was complaining of consciousness disorder. He had acute kidney injury, hypokalemia, and severe metabolic alkalosis. Initial treatment using intravenous infusion of 0.9% saline and potassium chloride improved his consciousness. It was clarified that he was a severe alcohol abuser who habitually self-vomited. We diagnosed him with volume depletion and pseudo-Bartter's syndrome due to loss of chloride by habitual vomiting. Gastrointestinal endoscopy demonstrated pyloric stenosis, which was ameliorated by Helicobacter pylori eradication therapy. We should consider volume depletion and pseudo-Bartter's syndrome as differential diagnoses when we encounter patients with acute kidney injury and severe metabolic alkalosis.

Endoscopic assessment of presumed acquired pyloric narrowing in cats: A retrospective study of 27 cases.

Acquired pyloric narrowing is a rare and poorly-documented condition in cats, but the endoscopic appearance of pyloric narrowing has never previously been reported. The objectives of this study were to describe the clinical, endoscopic and histological features in cats with gastrointestinal signs where the pylorus could not be passed during endoscopy, and to compare these data with a control group. Medical files of cats that underwent upper GI endoscopy by the same operator between 2006 and 2015 were reviewed. Cats for which the pylorus could not be passed were assigned to the case group, whilst those with an easily-passable pylorus were assigned to the control group. The case group comprised 27 cats and control group comprised 35 cats. Median age and weight were not different between groups, but there were more Siamese cats in the case group (6/27) compared with the control group (1/35; P = 0.04). Chronic vomiting was the main clinical sign in both groups, but the vomitus was more likely to contain food in case group (23/25) than in cats in control group (17/30; P < 0.01). Endoscopic findings confirmed gastric inflammation in both groups, whilst histological findings revealed similar lymphoplasmacytic infiltration of the gastric mucosa and the duodenum in most cases, neoplastic features being infrequent. Acquired pyloric narrowing is probably an underdiagnosed condition in adult cats. A possible association between pyloric narrowing and gastrointestinal inflammatory disease requires further study but, for now, it is recommended that multiple gastric, pyloric, and duodenal biopsies be acquired during the endoscopy.

Pyloric stenosis as a manifestation of isolated gastric Crohn's disease responding to intralesional steroid injection and balloon dilation: a case report.

BACKGROUND: Crohn's disease is a chronic inflammatory condition that can affect the gut from mouth to anus. Gastroduodenal involvement is seen in less than 5% of all patients with Crohn's disease. Among those cases, isolated gastric Crohn's disease is even rarer. Although most patients with isolated gastric involvement have nonspecific complaints, very few of them do develop features of pyloric obstruction. There is a paucity of data on specific management of gastric Crohn's disease owing to its rarity and its frequent coexistence with colonic or ileal disease. We report a case of a patient who had pyloric stenosis as a manifestation of isolated gastric Crohn's disease responding to intralesional steroid injection and balloon dilation. CASE PRESENTATION: A previously healthy woman presented with recurrent postprandial vomiting, epigastric discomfort, and unintentional weight loss over 6 months. She had no diarrhea or extraintestinal manifestations. Clinically, she was pale and dehydrated. Examination of systems was unremarkable except for mild epigastric tenderness. Her initial laboratory findings were normocytic normochromic anemia, high inflammatory markers, and hypokalemia. Esophagogastroduodenoscopy revealed an inflamed pyloric mucosa with features of pyloric obstruction. Furthermore, magnetic resonance enterography confirmed the pyloric stenosis. Histopathological examination of a biopsy from the pylorus revealed noncaseating granuloma with superficial ulceration. Tuberculosis and sarcoidosis were excluded by appropriate investigations, and a diagnosis of gastric Crohn's disease was made. Following the initial resuscitation, intralesional steroid injection and controlled radial expansion balloon dilation of the pylorus were carried out. The patient was commenced on azathioprine as a maintenance treatment, which led to a successful dilation and remarkable symptom improvement. CONCLUSION: Symptoms of pyloric obstruction as a manifestation of isolated gastric Crohn's disease are extremely unusual in clinical practice, awareness of which would facilitate early appropriate investigations and treatment.

Twisting of sleeve gastrectomy: two ways of clinic presentation.

Laparoscopic sleeve gastrectomy is an increasingly widespread bariatric surgical technique thanks to its good outcomes and apparent simplicity. However, complications may arise, including hemorrhage, gastric fistula, and stenosis, which can be either organic or functional. Functional stenosis is caused by gastric tube twisting. We present two cases of patients who underwent laparoscopic sleeve gastrectomy and who were subsequently diagnosed with gastric twisting. Both cases required conversion to laparoscopic gastric bypass. Accompanying symptoms may vary but they commonly include early satiety, epigastric pain associated with food intake, gastroesophageal reflux and early vomiting. Although diagnose is mainly clinical, it requires high suspicion since endoscopy and gastrointestinal studies are not conclusive. The principal therapeutic options are endoscopic dilatations, serotomy and conversion to gastric bypass.

Milk vomiting or regurgitation in the first 3 months of life: Something old-something new.

The age of presentation of reflux symptoms and their self-cure in babies without a sliding hernia parallel those of mild pyloric stenosis of infancy (PS). It is proposed that this is because PS and, at least some cases of reflux, share the same cause-a temporary hold-up at the pyloric sphincter owing to acid provoked hypertrophy of the pyloric sphincter. In support of this theory, the written observations of John Thomson, Pediatrician from Edinburgh, in 1921 and Isabella Forshall, Pediatric Surgeon from Alder Hey Hospital, Liverpool, in 1958 are revisited. An analysis of both papers provides supportive evidence that, in at least some cases diagnosed as simple reflux, an underlying temporary hold up is present owing to early hypertrophy of the sphincter. It is recommended that sphincter thickness measurements should be made by ultrasonic assessment whenever uncomplicated reflux is diagnosed within the first 3 months of life.

Association between duration or etiology of gastroparesis and clinical response after gastric per-oral endoscopic pyloromyotomy.

BACKGROUND AND AIMS: Gastric per-oral endoscopic pyloromyotomy (GPOEM) is a novel procedure with promising potential for the treatment of gastroparesis but with limited data regarding predictors of clinical response. This study aims to evaluate the safety and efficacy of the procedure and explore the impact of duration and etiology (diabetic vs nondiabetic) of gastroparesis on clinical outcome as measured by the Gastroparesis Cardinal Symptom Index (GCSI). METHODS: A single-center retrospective longitudinal study at a tertiary care hospital was performed over an 18-month period. Forty patients with refractory gastroparesis (25 nondiabetic and 15 diabetic patients) were included. RESULTS: GCSI significantly improved throughout the study period (F[2.176, 17.405] = 10.152, P = .001). The nausea/vomiting subscale showed sustained improvement through 18 months (F[2.213, 17.704] = 15.863, P < .00001). There was no significant improvement in bloating (F[2.099, 16.791] = 1.576, P = .236). Gastric scintigraphy retention was significantly reduced by 41.7% (t = -7.90; P < .00001). Multivariate linear regression modeling revealed a significant correlation between the duration of disease and a GCSI improvement at 12 months (P = .02), with a longer duration of disease associated with a poorer long-term response. The etiology of gastroparesis was not associated with clinical improvement (P = .16). Adverse events (7.5%) included 1 capnoperitoneum, 1 periprocedure chronic obstructive pulmonary disease exacerbation, and 1 mucosotomy closure site disruption. CONCLUSIONS: GPOEM appears to be a safe and effective minimally invasive therapy for refractory gastroparesis, especially for patients with predominant nausea/vomiting and shorter duration of disease, regardless of the etiology. We propose the clinical criteria for undergoing GPOEM should be a GCSI of at least 2.0 and a gastric retention of greater than 20%.

[Gastric tricobezoar: a rare cause of tumoral syndrome and pyloric obstruction]. / Tricobezoar gástrico: una causa poco frecuente de síndrome tumoral y de obstrucción pilórica.

UNLABELLED: A Trichobezoar is a rare tumoral mass of the gastrointestinal tract, formed mainly from the ingestion of hair. It contains also mucus and foods debris. CASE PRESENTATION: A 22 years old female with a 10 years history of surgery secondary to gastric foreign body (trichobezoar), presents with abdominal pain, swelling, nausea and vomiting. Physical examination of the abdomen revealed a palpable mass in the epigastric and left upper quadrant regions. It was also noted areas of alopecia of the scalp. DISCUSSION: Ninety percent of the trichobezoars present in females with a high frequency between 10-19 years. The treatment of bezoars (unless small in size) is mainly surgical. A psychiatric evaluation and follow up is important after surgery hence in most cases there is a psychological disorder that lead to the ingestion of hair.

Strangulated perforated hiatus hernia due to pyloric stenosis.

The first patient with strangulated hiatus hernia due to pyloric stenosis is reported. A 70-year-old male patient presented as an emergency with severe left-sided chest pain, tachycardia, tachypnea, dysphagia, and nausea but no vomiting. The diagnosis of strangulated hiatus hernia due to pyloric stenosis was suspected, because a CT scan done 24 h following a barium meal showed much retained barium in both infra- and supradiaphragmatic parts of the stomach. Recognition of this condition is important since absence of pneumoperitoneum should not delay the diagnosis. In this complication, the perforation is likely to be at the hiatus, not the fundus as occurs in other causes of strangulation. A gastric drainage procedure should be an essential part of treatment.