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3.
Am J Case Rep ; 20: 1966-1968, 2019 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-31885033

RESUMO

BACKGROUND Ectopic or heterotopic pancreas is relatively rare pathology described as pancreatic tissue lacking communication with the normal pancreas. Ectopic pancreatic tissue can be found along the gastrointestinal tract, with the most common location the stomach along the greater curvature. This congenital condition could be identified incidentally, or present with symptoms that range from pain and bleeding to obstruction and malignant transformation. CASE REPORT We report a case of a 30-year-old female, who underwent laparoscopic sleeve gastrectomy for morbid obesity of body mass index (BMI) of 46 kg/m², and who was found to have a 3 cm submucosal mass at the lesser curvature while dividing the stomach. The sleeved stomach tube's intraoperative gastroscopy showed a submucosal mass at the posterior stomach wall towards the lesser curvature, increasing the suspicion of gastrointestinal stromal tumor (GIST) tumor. The choice was to continue with a secure margin and conversion to roux-en-y gastric bypass with gastric tumor resection. It turned out that the final pathology was submucosal ectopic pancreas. Despite being a rare pathology, for any submucosal gastric mass, ectopic pancreas should be on the differential diagnosis list. During the sleeve surgery, the mass was found, and the approach was changed to intraoperatively subtotal gastrectomy and roux-en-y gastric bypass. CONCLUSIONS Before any bariatric operation, even in asymptomatic young patients, it is worth doing routine upper endoscopy to prevent surprising intraoperative pathology.


Assuntos
Coristoma/patologia , Achados Incidentais , Pâncreas , Gastropatias/patologia , Adulto , Coristoma/cirurgia , Feminino , Gastrectomia , Humanos , Gastropatias/cirurgia
4.
J S Afr Vet Assoc ; 90(0): e1-e4, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31714114

RESUMO

Cases of rumen impaction caused by ingestion of Gonometa postica cocoons occurred at a farm in eastern-central Namibia. Ten animals died on the farm over the previous 5 months. Rumenotomies were successfully performed on three affected animals. The authors were of the opinion that the affected animals ingested the cocoons around the time of weaning, which then resulted in tangled masses that gradually stretched and enlarged because of entrapment of ingesta, eventually causing impaction of the rumen in the young adult animals. These are the first reported cases of ruminal impaction attributable to G. postica cocoon ingestion in Namibia.


Assuntos
Doenças dos Bovinos/etiologia , Mariposas , Gastropatias/veterinária , Animais , Bovinos , Doenças dos Bovinos/cirurgia , Ingestão de Alimentos , Feminino , Masculino , Namíbia , Rúmen/cirurgia , Gastropatias/etiologia , Gastropatias/cirurgia
5.
Indian J Tuberc ; 66(3): 411-417, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31439189

RESUMO

Tuberculosis of the stomach is an extremely rare manifestation of Mycobacterium tuberculosis infection and mimics gastric carcinoma in its presentation. Most of our knowledge about this rare disease comes from case reports and there are only a few case series published on this disease and thus the majority of the part remains uncovered. Diagnosis is made commonly only after a major surgery. Endoscopy and guided biopsy are the diagnostic modality of choice. Surgery is indicated in cases which present with complications. Patients respond well to antituberculous therapy. The authors encountered 4 cases of gastric tuberculosis over 5 years. This study summarises the available literature and gives comprehensive update on this rare disease.


Assuntos
Gastropatias/diagnóstico , Tuberculose Gastrointestinal/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Terapia Combinada , Diagnóstico Diferencial , Feminino , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Gastropatias/tratamento farmacológico , Gastropatias/patologia , Gastropatias/cirurgia , Tuberculose Gastrointestinal/tratamento farmacológico , Tuberculose Gastrointestinal/patologia , Tuberculose Gastrointestinal/cirurgia , Adulto Jovem
7.
Medicine (Baltimore) ; 98(22): e15825, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145321

RESUMO

RATIONALE: Spontaneous gastric perforation in young children is rare, and gastric perforation caused by Candida albicans infection is even rarer. PATIENT CONCERNS: A 4-month-old infant presented with frequent retching. The results of X-rays showed obvious pneumoperitoneum but gastric vacuole was not seen. DIAGNOSIS: The infant was diagnosed as spontaneous gastric perforation caused by C albicans infection based on blood culture, peritoneal fluid culture, and postoperative histopathology. INTERVENTIONS: An emergency exploratory laparotomy was performed and a gastric perforation repair was done. The infant received antishock, antiinfection, and intravenous nutrition treatment. OUTCOMES: After operation and antiinfective symptomatic treatment, the infant recovered. LESSONS: This case emphasized the rare C albicans infection as a cause of the gastric perforation in infant. The C albicans infection should always be thought of as an etiology for the gastric perforation in infant, to reduce the significant mortality. The early detection is necessary to treat Candida infections.


Assuntos
Candidíase/complicações , Gastropatias/etiologia , Gastropatias/cirurgia , Candida albicans , Humanos , Lactente , Masculino , Pneumoperitônio
8.
Khirurgiia (Mosk) ; (4): 94-99, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31120455

RESUMO

AIM: To obtain the most reliable information about surgical treatment of ulcerative pyloroduodenal stenosis based on the methodology of evidence-based medicine. MATERIAL AND METHODS: Searching platforms were elibrary, Cochrane Library and PubMed database. The probability of major systematic errors in randomized controlled trials (RCTs) was evaluated. RESULTS: Systematic review included 20 RCTs for the period 1968-2009 with overall sample of 1794 patients. Evaluation of external validity allows to generalize the results of these studies to the entire population of patients with ulcerative pyloroduodenal stenosis. Assessment of internal validity based on the number of systematic errors showed that 7 (35%) of 20 of RCTs corresponded to the highest level of evidence (level 1), 13 (65%) of 20 had systematic errors and were downgraded in the rating (level 1-). Significant heterogeneity of RCTs impedes metaanalysis. Conclusions and practical recommendations for the treatment of ulcerative pyloroduodenal stenosis are formed according to the results of individual RCTs. CONCLUSION: Selective vagotomy may be performed for functional stenosis. In case of organic stenosis, truncal vagotomy should be combined with drainage surgery (pyloroplasty, gastroenterostomy) or Roux/Billroth-1 antrectomy. Treatment of decompensated stenosis within evidence-based medicine is unclear. We have not identified target researches with evidence level 1 for this form of stenosis.


Assuntos
Úlcera Péptica/cirurgia , Estenose Pilórica/cirurgia , Duodenopatias/cirurgia , Gastroenterostomia , Humanos , Antro Pilórico/cirurgia , Piloromiotomia , Ensaios Clínicos Controlados Aleatórios como Assunto , Gastropatias/cirurgia , Vagotomia
9.
Medicine (Baltimore) ; 98(17): e15295, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027092

RESUMO

RATIONALE: Gastritis cystica profunda (GCP) is a rare gastric lesion involving cystic dilation of the gastric glands extending into the submucosa. It is usually observed at anastomotic sites in the stomach of patients who have undergone gastric procedures. Bile reflux GCP is rare in patients who have not undergone gastric surgery. Here, we report a rare case of a patient with GCP associated with bile reflux, who had no history of gastric surgery. PATIENT CONCERNS: A 50-year-old man presented with intermittent abdominal fullness for 2 years, along with nausea. He had never undergone gastric surgery. Endoscopic ultrasonography (EUS) showed a thickened gastric wall and an echo-poor submucosal layer of the gastric fundus. A 3 cm × 2 cm × 1.5 cm lesion was noted. DIAGNOSIS: Bile reflux GCP INTERVENTIONS:: Endoscopic retrograde cholangiopancreatography and endoscopic submucosal dissection (ESD) were performed, and the lesion was removed. Conventional pathological examination revealed GCP with glands hyperplasia and a yellow-brown deposit, which was considered bile. The findings were consistent with a diagnosis of GCP without malignancy. OUTCOMES: Upper gastrointestinal barium meal revealed postoperative changes at the gastric fundus. Gastroscopy performed at 6 months after surgical resection showed superficial gastritis with bile reflux. LESSONS: The findings suggest that GCP etiology varies and that GCP can be caused by bile reflux but without malignancy. Additionally, GCP is not limited to patients who have previously undergone gastric surgery. Moreover, it is difficult to identify. EUS and ESD might be good approaches for the diagnosis and treatment of GCP.


Assuntos
Refluxo Biliar/complicações , Cistos/etiologia , Gastropatias/etiologia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Cistos/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Gastropatias/cirurgia
10.
Rev Gastroenterol Mex ; 84(2): 263-266, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31014750

RESUMO

INTRODUCTION AND AIM: Enteric perforations and fistulas are difficult to manage due to comorbidities, poor nutritional status, and anatomic challenges related to multiple interventions in those patients. The use of endoscopic methods as a nonsurgical approach is increasing. The aim of the present study was to describe the clinical experience with the use of the Ovesco Over-The-Scope Clip system in the closure of perforations, fistulas, and other indications in the digestive tract at a tertiary care hospital center. MATERIALS AND METHODS: A case series was carried out on patients that underwent lesion closure with the Ovesco clip, within the time frame of January 2015 to December 2017. RESULTS: The Ovesco clip was used for closure in 14 patients ranging in age from 21-90 years, with different indications: iatrogenic perforations; anastomotic leaks and fistulas; tracheoesophageal fistulas; and esophagogastric perforation. Technical success was achieved in 100% of the patients and clinical success in 78.57%. No complications were reported. CONCLUSIONS: The Ovesco Over-The-Scope Clip system is a safe and effective method for managing gastrointestinal acute perforations and fistulas.


Assuntos
Endoscopia Gastrointestinal/instrumentação , Endoscopia Gastrointestinal/métodos , Fístula/cirurgia , Gastroenteropatias/cirurgia , Perfuração Intestinal/cirurgia , Gastropatias/cirurgia , Instrumentos Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
12.
BMC Surg ; 19(1): 27, 2019 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-30813940

RESUMO

BACKGROUND: Gastroparesis is a syndrome characterized by delayed gastric emptying with associated symptoms. It was reported that the symptoms of diabetic gastroparesis had been greatly improved by transpyloric stent placement. However, the use of stents in benign conditions is considered to be contraindicated because of the increasing risk of complications, such as stent migration, reflux, perforation, bleeding, and, most importantly, new strictures caused by stent-induced tissue hyperplasia. While temporary placement of a self-expanding metallic stent (SEMC) can drastically reduce the risk of complications, few reports are available on the treatment of refractory PSG by temporary transpyloric stent. Does it have a long-term clinical effect after the stent being retrieved? CASE PRESENTATION: After accepting partial resection of the lesser curvature in another hospital, a patient developed refractory gastroparesis. The symptoms hadn't been improved after long-term drug therapy and balloon dilation therapy. Four months after surgery, a fully covered SEMC was placed by endoscopy in our hospital. Gastroparesis had been greatly improved. Two weeks later, the transpyloric stent was retrieved and the patient didn't show recurrent symptoms. Follow-ups were arranged at 3 months, 6 months and 1 year respectively, and there was no evidence of recurrence was found. CONCLUSIONS: This case indicates that temporary transpyloric SEMC is a safe, effective and less invasive alternative for post-surgical gastroparesis patients.


Assuntos
Gastrectomia/efeitos adversos , Gastroparesia/cirurgia , Implantação de Prótese , Piloro/cirurgia , Stents , Adulto , Coristoma/cirurgia , Constrição Patológica/cirurgia , Endoscopia , Feminino , Gastroparesia/diagnóstico por imagem , Gastroparesia/etiologia , Humanos , Masculino , Pâncreas/cirurgia , Piloro/diagnóstico por imagem , Gastropatias/diagnóstico por imagem , Gastropatias/cirurgia , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(12): e14820, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30896625

RESUMO

RATIONALE: Gastric duplication cyst is an anomaly that primarily occurs to children. Apart from the conventional use of surgical resection, few cases using endoscopic treatment have been reported. PATIENT CONCERNS: A 5-month-old female infant was hospitalized with the chief complaint of gastric cyst. No significant abnormalities were identified by physical examination. INTERVENTIONS: Endoscopic submucosal dissection (ESD) was performed successfully for the infant and the duration was less than 20 minutes. The patient showed no postoperative complications. OUTCOMES: At 4 months during the follow-up, upper endoscopy revealed a small scar at the previous site of the lesion and no recurrence. LESSONS: According to the results of PUBMED review, she was the youngest with gastric duplication cyst removed with ESD. The less invasive ESD should be considered an effective therapeutic option to remove gastric duplication cyst in children.


Assuntos
Cistos/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Gastropatias/cirurgia , Feminino , Mucosa Gástrica , Humanos , Lactente , Duração da Cirurgia
15.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(1): 79-84, 2019 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-30703798

RESUMO

OBJECTIVE: To establish a modified endoscopic Freka Trelumina placement (mEFTP) for modifying or substituting the traditional endoscopic Freka Trelumina placement (EFTP) and to explore the safety and feasibility of mEFTP in patients requiring enteral nutrition and gastrointestinal decompression in general surgery. METHODS: A retrospective cohort study was conducted to analyze the clinical data of patients undergoing EFTP or mEFTP at General Surgery Department of 920 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2016 to January 2018. INCLUSION CRITERIA: the function of lower digestive tract was normal; patients who could not eat through mouth or nasogastric tube needed to have enteral nutrition and gastrointestinal decompression; the retention time of Freka Trelumina (FT) was not expected to exceed 2 months. EXCLUSION CRITERIA: contraindication for gastroscopy; suspected shock or digestive tract perforation; suspected mental diseases; infectious diseases of digestive tract; thoracoabdominal aortic aneurysm. mEFIP procedure was as follow. FT was inserted into stomach through one side nasal cavity, gastroscope was inserted into stomach cavity, and the front part of FT was clamped with biopsy forceps through biopsy hole. Biopsy forceps and FT were inserted into the pylorus or anastomosis under gastroscope, and they were pushed into the duodenum or output loop. During pushing, the gastroscope did not pass through the duodenum or output loop. The biopsy forceps was released and pushed out, and FT was pushed with biopsy forceps synchronously into the duodenum or output loop more than 5 cm. The foreign body forceps was inserted through the biopsy hole, and the FT tube was held in the stomach and pushed to the duodenum or output loop. The previous steps repeated until the suction cavity reached the pylorus or anastomosis. The gastroscope was exited gently; the guide wire was pulled out slowly. EFTP procedure: foreign body forceps was used to clamp the front part of FT, and gastroscope, foreign body forceps and FT pass the pylorus or anastomosis simultaneously to reach the descendent duodenum or output loop as a whole. The time of catheterization was recorded and position of FT was examined by X-ray within 1 h after catheterization. The success rate of catheterization and morbidity of complications after catheterization were evaluated and compared between the two groups. RESULTS: A total of 141 patients were enrolled, 72 in the mEFTP group and 69 in the EFTP group. In mEFTP group, 45 cases were males and 27 were females with an average age of 55.8(37-76) years; 27 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 17 cases, due to rectal cancer in 10 cases) and 45 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 18 cases and anastomotic block after gastroenterostomy in 27 cases). In the EFTP group, 41 were males and 28 were females with an average age of 55.3(36-79) years; 33 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 20 cases, due to rectal cancer in 13 cases) and 36 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 15 cases and anastomotic block after gastroenterostomy in 21 cases). In patients with normal upper digestive tract anatomy, the average catheterization time of mEFTP was (4.9±1.7) minutes which was shorter than (7.6±1.7) minutes of EFTP(t=6.683, P<0.001). In patients of gastric cancer with pyloric obstruction, the average catheterization time of mEFTP was (6.6±1.6) minutes which was shorter than (10.5±2.6) minutes of EFTP (t=4.724, P<0.001). In patients with anastomotic block after gastroenterostomy, the average catheterization time of mEFTP was (11.3±2.5) minutes which was shorter than (15.1±3.5) minutes of EFTP (t=4.513, P<0.001). In patients with normal upper gastrointestinal anatomy, there were no significant differences in the success rate of catheterization and the morbidity of catheterization complication between mEFTP and EFTP (all P>0.05). In patients with upper gastrointestinal anatomic changes, the success rate of catheterization in mEFTP was even higher than that in EFTP, but the difference was not significant [97.8%(41/45) vs. 86.1%(31/36), χ²=2.880, P=0.089]; while the morbidity of catheterization complication in mEFTP was lower than that in EFTP [0 vs. 8.3%(3/36), χ²=3.894, P=0.048]. CONCLUSIONS: Whether the upper gastrointestinal anatomy is normal or not, mEFTP presents shorter catheterization time, higher success catheterization rate than EFTP, and is safety. mEFTP can be widely applied to clinical practice for patients requiring enteral nutrition and gastrointestinal decompression.


Assuntos
Descompressão Cirúrgica/instrumentação , Nutrição Enteral/instrumentação , Gastroscopia/instrumentação , Intubação Gastrointestinal/instrumentação , Intubação Gastrointestinal/métodos , Gastropatias/cirurgia , Adulto , Idoso , Descompressão Cirúrgica/métodos , Nutrição Enteral/métodos , Feminino , Obstrução da Saída Gástrica/etiologia , Obstrução da Saída Gástrica/cirurgia , Gastroparesia/etiologia , Gastroparesia/cirurgia , Gastroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Gastropatias/etiologia
16.
Clin J Gastroenterol ; 12(3): 279-284, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30684138

RESUMO

A 37-year-old woman was diagnosed by esophagogastroduodenoscopy (EGD) as having a 15-mm subepithelial lesion (SEL) in the gastric body. For 2 years, she experienced epigastric pain and anemia; she then underwent emergency EGD, which revealed a significant morphological change of the lesion. The SEL had a disintegrated tip and its submucosal portion was substantially exposed out of the mucosa, showing an "erect penis like appearance". Based on the pathological findings of biopsied samples from the exposed portion and the endoscopic features, an inflammatory fibroid polyp (IFP) was suspected. This lesion was considered responsible for the anemia and was removed by endoscopic submucosal dissection (ESD). The pathological findings confirmed the lesion to be IFP. This report presents a case of gastric IFP that showed a marked morphological change and unique endoscopic features and was successfully removed by ESD.


Assuntos
Ressecção Endoscópica de Mucosa , Pólipos/patologia , Pólipos/cirurgia , Gastropatias/patologia , Gastropatias/cirurgia , Adulto , Endoscopia do Sistema Digestório , Feminino , Humanos
17.
Paediatr Int Child Health ; 39(1): 76-78, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29057712

RESUMO

Rapunzel syndrome is a rare form of gastric trichobezoar. A 4-year-old girl presented with generalised oedema and an epigastric mass. Her family was of a relatively low socio-economic background. There was microcytic hypochromic anaemia, hypoalbuminaemia and an elevated α1-antitrypsin clearance. Abdominal ultrasound and non-contrast computed tomography demonstrated a heterogeneous mass related to the stomach. Upper gastro-intestinal tract endoscopy failed to remove it. Surgical laparotomy was undertaken through a single anterior gastrotomy incision and a large mass was extracted which was a cast of the duodenum and stomach and had a tail of approximately 60 cm in length which extended to the jejunum. Low socio-economic status, child neglect and pica are risk factors for trichobezoars. Surgical laparotomy is the optimal treatment of large bezoars.


Assuntos
Bezoares/diagnóstico , Bezoares/patologia , Edema/etiologia , Edema/patologia , Gastropatias/diagnóstico , Gastropatias/patologia , Bezoares/diagnóstico por imagem , Bezoares/cirurgia , Pré-Escolar , Endoscopia Gastrointestinal , Feminino , Humanos , Lactente , Laparotomia , Masculino , Pica , Radiografia Abdominal , Fatores de Risco , Fatores Socioeconômicos , Gastropatias/diagnóstico por imagem , Gastropatias/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia
18.
Langenbecks Arch Surg ; 404(1): 93-101, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30552508

RESUMO

PURPOSE: This observational study explored the association between hospital volume and short-term outcome following gastric resections for non-bariatric indication, aiming to contribute to the discussion on centralization of complex visceral surgery in Germany. METHODS: Based on complete national hospital discharge data from 2010 to 2015, the association between hospital volume and in-hospital mortality was evaluated according to volume quintiles and volume deciles. Case-mix differences regarding surgical indication, age, sex, and comorbidities were considered for risk adjustment. In addition, rates of major complications and failure to rescue were analyzed across hospital volume categories. RESULTS: Inpatient episodes (72,528) with gastric resection were analyzed. Risk-adjusted mortality in patients treated in very low volume hospitals (median volume of 5 surgeries per year) was higher (12.0% [95% CI 11.4 to 12.5]) compared to those treated in very high volume hospitals (50 surgeries per year; 10.6% [10.0 to 11.1]). Failure to rescue patients with complications was 28.1% [27.0 to 29.3] in very low volume hospitals and 22.7% [21.6 to 23.8] in very high volume hospitals. Differences were similar within the subgroup of patients operated for gastric cancer. CONCLUSIONS: Treatment in very high volume hospitals is associated with a lower in-hospital mortality compared to treatment in very low volume hospitals. This effect seems to be determined by the ability to rescue patients who experience complications. As the observed benefit is only related to very high volumes, the results do not clearly indicate that centralization may improve short-term results substantially, unless a very high degree of centralization would be achieved. Possibly, further research focusing on other outcome measures, such as clinical processes or long-term results, might lead to divergent conclusions.


Assuntos
Gastrectomia/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Gastropatias/cirurgia , Idoso , Grupos Diagnósticos Relacionados , Falha da Terapia de Resgate/estatística & dados numéricos , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/mortalidade , Alemanha , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Gastropatias/mortalidade , Gastropatias/patologia
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