[Gastric rupture as a complication of anorexia nervosa]. / Maagruptuur als complicatie van anorexia nervosa.

BACKGROUND: Anorexia nervosa may cause several gastro-intestinal complications. CASE DESCRIPTION: A 21-year-old woman presented herself with abdominal pain and vomiting a day after her first binge-eating episode. In her recent history she had lost 40 kg in weight and her BMI was 15 at presentation. Imaging showed gastric distension and ascites in all quadrants, suspicious of a gastric rupture. A blow-out of the stomach was seen during a diagnostic laparotomy, which was treated with a gastric sleeve procedure. Following surgery, the patient was diagnosed with anorexia nervosa of the restrictive type with a first episode of binge-eating. CONCLUSION: Gastric rupture is a rare and unknown complication of anorexia nervosa with a high mortality.

Gastric perforation biopsy: is it obsolete?

PURPOSE: The aim of the study was to test the established hypothesis that biopsies of spontaneous gastric perforations should be taken to rule out cancer. METHODS: A prospective observational study was performed. Consecutive patients with spontaneous gastric perforation were included. Biopsies of the edges of the perforation were submitted for histological evaluation. The epithelial type as well as the nature of the pathology were evaluated. RESULTS: Sixty-eight patients were included. Eight (12%) biopsies revealed duodenal origin. Sixty (88%) biopsies revealed gastric mucosa of which 33 (48%) could be specifically typed. All biopsies revealed benign ulceration. No malignancies were detected in these biopsies or on subsequent gastroscopic follow up. CONCLUSION: This study suggests that routine intraoperative biopsy of gastric perforation may be questioned. Biopsy is probably better performed endoscopically after recovery.

Ruptura gástrica consequente a barotrauma: relato de caso / Gastric rupture consequent to barotrauma: case report / Rotura gástrica por barotrauma: reporte de caso

Introdução: A ruptura gástrica é uma complicação incomum da distensão e aumento da pressão intragástrica, podendo ter diversas etiologias, não sendo necessariamente relacionada a lesões pré-existentes. O quadro clínico pode ser inespecífico, sendo necessário exame de imagem complementar. Objetivos: Identificar as características fisiopatológicas da lesão gástrica por barotrauma, bem como discutir acerca dos diagnósticos diferencias e prognóstico desta condição. Método: Relato de caso realizado através de revisão de prontuário e exames de um paciente com rotura gástrica por barotrauma. Relato de caso: Paciente de 84 anos, com quadro clínico compatível com rotura gástrica por barotrauma após intubação esofágica inadvertida, cujos exames admissionais demonstravam a presença de importante pneumoperitônio. Foi submetido a tratamento cirúrgico, com rafia primária de lesão de 5 cm em parede gástrica, seguido de encaminhamento para UTI. Conclusão: A redução da incidência de lesões iatrogênicas associadas a ventilação mecânica faz-se necessária. Os médicos devem ser treinados corretamente para realização do procedimento, como também para suspeitarem de antemão das complicações ­ particularmente em pacientes com intubação difícil.(AU)

Introduction: Gastric rupture is an uncommon complication of distension and increased intragastric pressure, and may have several etiologies, not necessarily related to pre-existing lesions. The clinical picture may be nonspecific, requiring complementary imaging. Objectives: To identify the pathophysiological characteristics of the gastric lesion by barotrauma, as well as to discuss the differential diagnoses and prognosis of this condition. Method: Case report performed through medical record review and examination of a patient with gastric rupture by barotrauma. Case Report: Patient of 84 years, with clinical picture compatible with gastric rupture by barotrauma after inadvertent esophageal intubation, whose admissional exams demonstrated the presence of important pneumoperitoneum. He was submitted to surgical treatment, with primary raphy of lesion of 5 cm in the gastric wall, followed by referral to ICU. Conclusion: The reduction of incidence of iatrogenic lesions associated with mechanical ventilation is necessary. Physicians should be properly trained to perform the procedure, as well as to suspect in advance of complications - particularly in patients with difficult intubation.(AU)

Introducción: La rotura gástrica es una complicación infrecuente de distensión y aumento de la presión intragástrica, pudiendo tener diferentes etiologías, no necesariamente relacionadas con lesiones preexistentes. El cuadro clínico puede ser inespecífico, requiriendo un examen de imagen complementario. Objetivos: Identificar las características fisiopatológicas de la lesión gástrica por barotrauma, así como discutir los diferentes diagnósticos y pronósticos de esta patología. Método: Reporte de caso realizado mediante la revisión de historias clínicas y exámenes de un paciente con ruptura gástrica por barotrauma. Caso clínico: Paciente de 84 años con cuadro clínico compatible con rotura gástrica por barotrauma tras intubación esofágica inadvertida, cuyos exámenes de ingreso mostraron la presencia de un neumoperitoneo importante. Se sometió a tratamiento quirúrgico, con rafia primaria de una lesión de 5 cm en la pared gástrica, seguida de derivación a UCI. Conclusíon: Es necesario reducir la incidencia de lesiones iatrogénicas asociadas con la ventilación mecánica. Los médicos deben estar debidamente capacitados para realizar el procedimiento, así como para sospechar complicaciones con anticipación, particularmente en pacientes con intubación difícil.(AU)

Estallido gástrico secundario a oclusión producida por un balón intragástrico / Gastric burst due to occlusion caused by an intragastric balloon

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Primary gastric rupture in 20 horses from Midwestern Brazil: case report / Ruptura gástrica primária em 20 equinos no Centro-Oeste do Brasil: relato de caso

An 11-year (2007-2018) survey of epidemiological, clinical and pathological findings of horses with primary gastric rupture (PGR) was conducted. Twenty horses presented PGR, nine (45%) horses were clinically evaluated, eleven (55%) were sent dead, and all animals were necropsied. PGR contributed to a prevalence of 0.31% (9/2,868) of all equid attendances, 1.83% (9/491) of colic cases, and 4.1% (20/487) of all equid necropsies. Highly fermentable feed (n=7), gastric impaction (n=4), and perforating gastric ulcer (n=1) were the main causes of PGR; whilst eight horses presented idiopathic gastric rupture. Clinically evaluated horses were tachycardic, tachypneic, febrile, dehydrated, with increased abdominal tension, abnormal mucous membranes and reduced to absent intestinal borborygmi. Improper dietary management, such as the ingestion of low-quality roughage and highly fermentable feedstuffs were detected as the main factors associated with PGR in Midwestern Brazil. It is important to raise awareness in horse owners about proper feed management to minimize PGR.(AU)

Foi realizado um levantamento de 11 anos (2007-2018) dos achados epidemiológicos, clínicos e patológicos de equinos com ruptura gástrica primária (RGP). Vinte equinos apresentaram RGP, dos quais nove (45%) foram avaliados clinicamente e 11 (55%) foram enviados mortos, sendo todos os animais necropsiados. A RGP contribuiu com prevalência de 0,31% de todos os atendimentos de equídeos (9/2.868), 1,83% (9/491) dos casos de cólica, e 4,1% (20/487) das necropsias em equídeos. Alimentos altamente fermentáveis (n=7), compactação gástrica (n=4) e perfuração de úlcera gástrica (n=1) foram as principais causas de RGP, enquanto oito equinos tiveram ruptura gástrica idiopática. Os equinos avaliados clinicamente apresentaram-se taquicárdicos, taquipneicos, febris, desidratados, com mucosas anormais, aumento da tensão abdominal e motilidade intestinal reduzida. O manejo inadequado da dieta, como a ingestão de forragens de baixa qualidade e alimentos altamente fermentáveis, foi o principal fator de risco associado à RGP no Centro-Oeste do Brasil. É importante aumentar a conscientização dos proprietários de equinos sobre o manejo alimentar adequado para minimizar a RGP.(AU)

Esofagitis enfisematosa con perforación gástrica / Emphysematous esophagitis with gastric perforation

La esofagitis enfisematosa es una entidad extremadamente infrecuente sin prácticamente ningún caso descrito en la literatura. Presentamos el caso de una paciente con esofagitis y gastritis enfisematosa con afectación de toda la pared del esófago y el estómago al diagnóstico. Fue intervenida quirúrgicamente por perforación gástrica en dos ocasiones, realizándose cierre primario en ambas con evolución posterior favorable. Pese a la gran extensión de la esófago-gastritis enfisematosa al diagnóstico y la presencia de una perforación gástrica, es seguro realizar un manejo semejante a la gastritis enfisematosa siendo lo más conservadores posibles en caso de precisar cirugía

Emphysematous esophagitis is an extremely rare disease and there are very few previous reports in the literature. We report a case of emphysematous esophagitis and gastritis with complete affectation of the gastric and esophageal wall at diagnosis. Two surgical interventions were performed due to gastric perforation that was treated in both cases with primary closure. The post-operative recovery was satisfactory. Despite the large emphysematous esophago-gastritis affectation at diagnosis and the presence of gastric perforation, it is safe to perform the same management principles as with emphysematous gastritis. This should be as conservative as possible in case a surgical procedure is required

Desgarro de mucosa gástrica secundario a extracción de prótesis biliar / Tear of the secondary gastric mucous membrane to the extraction of the biliary prosthesis

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Resolución endoscópica de perforación gástrica con penetración a páncreas por espina de pescado / Endoscopic resolution of gastric perforation with pancreas penetration by a fish bone

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Perforación gástrica por balón intragástrico en paciente con funduplicatura de Nissen. Respuesta del Grupo Español de Endoscopia Bariátrica / Gastric perforation by intragastric balloon in a patient with Nissen fundoplication. Response of the Spanish Bariatric Endoscopy Group

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Perforación gástrica durante la broncoscopia al administrar oxigenoterapia por cánula nasofaríngea / Gastric Perforation During Bronchoscopy For The Delivery Of Oxygen Therapy By Nasopharyngeal Cannula

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Perforación gástrica por balón intragástrico en paciente con funduplicatura de Nissen / Gastric perforation by intragastric balloon in patient with Nissen fundoplication

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Pneumoperitoneum due to Gastroesophageal Junction Rupture after Prolonged Cardiopulmonary Resuscitation with Supraglottic Airway

Gastric rupture after cardiopulmonary resuscitation (CPR) is a rare complication. In most cases, it is associated with bystander-provided CPR, bag-mask ventilation, and difficult airway management. To the best of our knowledge, there has been only one previous case report in the literature regarding gastric rupture after CPR via supraglottic airway. We present a case of a gastroesophageal junction rupture secondary to CPR with supraglottic airway. Healthcare providers should consider that gastric rupture can be a complication from performing CPR.

Resistance to rupture of the equine stomach / Resistência à ruptura do estômago equino

Equine colic is an important and common cause of disease and death in horses. Gastric rupture has been extensively described in the literature, and is known to affect expressive numbers of horses. Gastric dilatation, which precedes rupture, may be observed when the animal consumes large amounts of recently harvested grass or drinks water too fast, though diagnosis criteria also include infestation with Gastherophilus and the presence of ileus and distal intestinal obstructions. The objective of the present study was to determine the resistance to rupture of the equine stomach to air (mm Hg) and water (L) injection. Forty stomachs of young horses (20 geldings and 20 mares) with no defined breed were analyzed. Total organ length (cm), weight (g), greater curved length (cm), lesser curved length (cm) and height (cm) were measured, with no statistical difference between males and females (p > .05). However, stomachs of horses were larger than those of mares and therefore presented higher volumetric capacity (p<0.05). No difference between males and females was observed in the pressure assay (93mmg Hg). Rupture occurred along the greater curvature (99%) and on the visceral (80%) and diaphragmatic (20%) surfaces, across all layers of the gastric wall. Although the equine stomach is relatively small, the organ is considerably resistant to rupture, whether by injection of air or liquid. Horses and mares exhibit similar resistance values, although the stomach of females has smaller volumetric capacity.(AU)

A cólica é um dos problemas mais comuns na clínica de equinos sendo responsável por grande número de mortes. A ruptura gástrica tem sido amplamente descrita na literatura e acomete número expressivo de animais. A dilatação gástrica, que antecede a ruptura, pode advir do consumo excessivo de capim recém-cortado, ingestão rápida de água, infestação por Gastherophilus, ocorrência de íleo paralítico e obstruções intestinais distais. A ruptura gástrica tem sido amplamente descrita na literatura e acomete um número expressivo de animais. Este estudo objetivou determinar a resistência à ruptura do estômago equino mediante a insuflação de ar atmosférico (mmHg) e do preenchimento com água (L). Foram utilizados 40 estômagos de equinos adultos jovens (20 machos castrados e 20 fêmeas) sem raça definida. Medidas relativas ao comprimento total do órgão (cm), peso do órgão (g), curvatura maior (cm), curvatura menor (cm) e altura (cm) foram aferidas e não diferiram entre machos e fêmeas (p>0,05). No entanto, os estômagos dos machos apresentaram medidas superiores as das fêmeas e por assim serem, comportaram um maior volume de água (p<0,05). No teste de resistência mediante insuflação de ar atmosférico não houve diferença entre machos e fêmeas (93mmHg). Os rompimentos ocorreram ao longo da curvatura maior (99%) nas faces visceral (80%) e diafragmática (20%) e abrangeram todas as camadas da parede gástrica. Apesar de ser um órgão relativamente pequeno, o estômago dos equinos apresenta considerável resistência à ruptura, seja por líquido ou por ar atmosférico. Machos e fêmeas possuem resistência gástrica semelhante, embora o estômago das fêmeas equinas comporte um menor volume.(AU)

Complicaciones de la reanimación cardiopulmonar asistida telefónicamente / Complications of cardiopulmonary resuscitation telephone assisted

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Comparison of gastric and other bowel perforations in preterm infants: a review of 20 years' experience in a single institution / 소아과

PURPOSE: In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations. METHODS: The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed. RESULTS: Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was 4.4+/-1.7 days of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed. CONCLUSION: Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants.

Advanced Gastric Cancer Perforation Mimicking Abdominal Wall Abscess

Surgeons occasionally encounter a patient with a gastric cancer invading an adjacent organ, such as the pancreas, liver, or transverse colon. Although there is no established guideline for treatment of invasive gastric cancer, combined resection with radical gastrectomy is conventionally performed for curative purposes. We recently treated a patient with a large gastric cancer invading the abdominal wall, which was initially diagnosed as a simple abdominal wall abscess. Computed tomography showed that an abscess had formed adjacent to the greater curvature of the stomach. During surgery, we made an incision on the abdominal wall to drain the abscess, and performed curative total gastrectomy with partial excision of the involved abdominal wall. The patient received intensive treatment and wound management postoperatively with no surgery-related adverse events. However, the patient could not receive adjuvant chemotherapy and expired on the 82nd postoperative day.

Hidroneumomediastino secundario a perforación de vólvulo gástrico en paciente con hernia de hiato gigante / Hydropneumomediastinum Secondary to Gastric Volvulus Perforation in a Patient With Giant Hiatal Hernia

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Harpic (hydrochloric acid) ingestion causing "isolated" gastric fundus perforation

Accidental or suicidal ingestion of acid usually affects the lower oesophagus and stomach. Harpic is a commonly used toilet cleaning solution and contains hydrochloric acid as the active ingredient, whose ingestion can affect both the stomach and intestines in the form of gangrene and perforation. Symptomatic treatment aims at dilution of the ingested corrosive and specific management involves correcting metabolic imbalances, coagulopathy and emergency surgical intervention for severe injury and late sequelae. We present the case of a 20 year old male with suicidal ingestion of Harpic, who presented with severe abdominal pain and signs of generalised peritonitis. He underwent an emergency laparotomy and was found to have only the gastric fundus to be gangrenous with total sparing of rest of the stomach and intestines, which required only a wedge resection of the stomach. The patient made a good postoperative recovery and is free from complications at the end of one year of follow-up

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