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The Journal of Trauma and Acute Care... Jul 2022Peptic ulcer disease (PUD), once primary a surgical problem, is now medically managed in the majority of patients. The surgical treatment of PUD is now strictly reserved...
BACKGROUND
Peptic ulcer disease (PUD), once primary a surgical problem, is now medically managed in the majority of patients. The surgical treatment of PUD is now strictly reserved for life-threatening complications. Free perforation, refractory bleeding and gastric outlet obstruction, although rare in the age of medical management of PUD, are several of the indications for surgical intervention. The acute care surgeon caring for patients with PUD should be facile in techniques required for bleeding control, bypass of peptic strictures, and vagotomy with resection and reconstruction. This video procedures and techniques article demonstrates these infrequently encountered, but critical operations.
CONTENT VIDEO DESCRIPTION
A combination of anatomic representations and videos of step-by-step instructions on perfused cadavers will demonstrate the key steps in the following critical operations. Graham patch repair of perforated peptic ulcer is demonstrated in both open and laparoscopic fashion. The choice to perform open versus laparoscopic repair is based on individual surgeon comfort. Oversewing of a bleeding duodenal ulcer via duodenotomy and ligation of the gastroduodenal artery is infrequent in the age of advanced endoscopy and interventional radiology techniques, yet this once familiar procedure can be lifesaving. Repair of giant duodenal or gastric ulcers can present a challenging operative dilemma on how to best repair or exclude the defect. Vagotomy and antrectomy, perhaps the least common of all the aforementioned surgical interventions, may require more complex reconstruction than other techniques making it challenging for inexperienced surgeons. A brief demonstration on reconstruction options will be shown, and it includes Roux-en-Y gastrojejunostomy.
CONCLUSION
Surgical management of PUD is reserved today for life-threatening complications for which the acute care surgeon must be prepared. This presentation provides demonstration of key surgical principles in management of bleeding and free perforation, as well as gastric resection, vagotomy and reconstruction.
LEVEL OF EVIDENCE
Video procedure and technique, not applicable.
Topics: Duodenal Ulcer; Gastrectomy; Humans; Peptic Ulcer; Peptic Ulcer Perforation; Vagotomy
PubMed: 35358158
DOI: 10.1097/TA.0000000000003636 -
Medicine Oct 2021Sporadic non-ampullary duodenal adenoma (SNADA) is a rare disease, and therefore, its clinical characteristics have not been comprehensively investigated. Furthermore,... (Observational Study)
Observational Study
Sporadic non-ampullary duodenal adenoma (SNADA) is a rare disease, and therefore, its clinical characteristics have not been comprehensively investigated. Furthermore, owing to the high complication rates and severity of endoscopic resection, treatment strategies vary among facilities. In the present study, we aimed to clarify the clinical characteristics and course of SNADA.We extracted clinical and histological records of SNADA cases diagnosed in 11 hospitals between September 1999 and August 2014. The patients were divided into "no-resection" and "resection" groups based on the initial treatment approach. We investigated the long-term outcome of the "no-resection" group and treatment results of the "resection" group, with particular interest in endoscopic resection.Overall, 299 patients were diagnosed with SNADA. The median age at diagnosis was 67 years (range, 31-88 years), with approximately twice as many men as women. The median tumor size was 8.0 mm (2-60 mm). In total, 161 patients were initially selected for no-resection and 138 underwent resection. Age >70 years and the presence of either severe illness or poor performance status were significantly related to opting for no-resection. In the no-resection group, 101 patients underwent endoscopic follow-up for at least 1 year. During the observational period (2.5 ± 2.2 years), 27 lesions (27%) disappeared following cold forceps biopsy, and 13 lesions (14%) presented lateral growth. Four lesions (4%) changed to mucosal carcinoma, 3 were treated endoscopically, and 1 was surgically resected. Nineteen patients died; however, no one died of duodenal carcinoma. In the endoscopic resection group, en bloc resection was achieved in 78% of patients. However, the complication rate for perforation was 7%, and endoscopic submucosal dissection was associated with a 36% perforation rate.With the low incidence of cancer development and no disease specific death, the strategy of initially not performing resection could be considered especially for the older adults, poor-prognosis patients, or small lesions.
Topics: Adenomatous Polyps; Adult; Aged; Aged, 80 and over; Disease Progression; Duodenal Neoplasms; Endoscopy; Female; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 34596158
DOI: 10.1097/MD.0000000000027382 -
European Journal of Vascular and... Dec 2022
Topics: Humans; Endovascular Aneurysm Repair; Intestinal Fistula; Duodenal Diseases; Aortic Diseases; Gastrointestinal Hemorrhage
PubMed: 36209965
DOI: 10.1016/j.ejvs.2022.10.012 -
Journal of Feline Medicine and Surgery Oct 2022The aim of this study was to describe the endoscopic appearance of gastroduodenal ulcers (GDUs), and to assess the clinical, ultrasonographic and histological data, as...
OBJECTIVES
The aim of this study was to describe the endoscopic appearance of gastroduodenal ulcers (GDUs), and to assess the clinical, ultrasonographic and histological data, as well as long-term follow-up, in cats.
METHODS
The medical record databases of five veterinary endoscopists were evaluated between January 2016 and 2020, in a retrospective study. Cats with at least one gastric or duodenal ulcer detected by endoscopic examination were included. All the medical records of the selected cats were reviewed and information was collected regarding breed, age, sex, neuter status, medical history, clinical signs, and ultrasonographic, endoscopic and histological findings. The cats were evaluated at 6, 12 and 18 months.
RESULTS
Sixty-one cats with a median age of 9.0 years (range 2.0-16.0) were included in the study. The most common complaints were vomiting (n = 55; 90%) and hyporexia (n = 40; 66%); haematemesis was reported in 12 (20%) cats. Endoscopy showed GDUs in the following locations: gastric body in 28 cats (46%), antropyloric area in 34 cats (56%), fundus in 13 cats (21%) and duodenum in eight cats (13%). A single GDU was found in 42 cats (69%) and multiple GDUs were seen in 19 cats (31%). Histopathological evaluation revealed benign lesions in 33 (54%) cats and malignant lesions in 28 (46%; 24 high-grade lymphoma, one low-grade lymphoma and three carcinoma). High-grade lymphoma was detected only in the stomach. Cats diagnosed with malignant GDUs (median 10.5, range 4-16) were significantly older than cats with benign lesions ( = 0.002).
CONCLUSIONS AND RELEVANCE
GDUs are common and were detected in 5.1% of cats undergoing an upper gastrointestinal endoscopy. The risk of a malignant ulcer increases proportionally with each year of increasing age. GDU location, number and morphological appearance do not provide any indication of the nature of the ulcer; however, duodenal ulcers are frequently benign. Endoscopic examination facilitates the early and minimally invasive detection of GDUs in cats.
Topics: Animals; Cat Diseases; Cats; Duodenal Ulcer; Duodenum; Lymphoma, Non-Hodgkin; Retrospective Studies; Ulcer
PubMed: 35848606
DOI: 10.1177/1098612X221109802 -
GeroScience Apr 2024The detailed comorbidity patterns of community-dwelling older adults have not yet been explored. This study employed a network-based approach to investigate the...
The detailed comorbidity patterns of community-dwelling older adults have not yet been explored. This study employed a network-based approach to investigate the comorbidity patterns of community-dwelling older adults living alone. The sample comprised a cross-sectional cohort of adults 65 or older living alone in a Korean city (n = 1041; mean age = 77.7 years, 77.6% women). A comorbidity network analysis that estimates networks aggregated from measures of significant co-occurrence between pairs of diseases was employed to investigate comorbid associations between 31 chronic conditions. A cluster detection algorithm was employed to identify specific clusters of comorbidities. The association strength was expressed as the observed-to-expected ratio (OER). As a result, fifteen diseases were interconnected within the network (OER > 1, p-value < .05). While hypertension had a high prevalence, osteoporosis was the most central disease, co-occurring with numerous other diseases. The strongest associations among comorbidities were found between thyroid disease and urinary incontinence, chronic otitis media and osteoporosis, gastric duodenal ulcer/gastritis and anemia, and depression and gastric duodenal ulcer/gastritis (OER > 1.85). Three distinct clusters were identified as follows: (a) cataracts, osteoporosis, chronic otitis media, osteoarthritis/rheumatism, low back pain/sciatica, urinary incontinence, post-accident sequelae, and thyroid diseases; (b) hyperlipidemia, diabetes mellitus, and hypertension; and (c) depression, skin disease, gastric duodenal ulcer/gastritis, and anemia. The results may prove valuable in guiding the early diagnosis, management, and treatment of comorbidities in older adults living alone.
Topics: Humans; Female; Aged; Male; Independent Living; Cross-Sectional Studies; Duodenal Ulcer; Home Environment; Comorbidity; Hypertension; Osteoporosis; Gastritis; Anemia; Otitis Media; Urinary Incontinence
PubMed: 37924440
DOI: 10.1007/s11357-023-00987-z -
The Turkish Journal of Gastroenterology... Jul 2020This study aimed to investigate the differences and relevance of various common duodenal diseases in different parts in the aspects of age, gender, helicobacter pylori... (Comparative Study)
Comparative Study
BACKGROUND/AIMS
This study aimed to investigate the differences and relevance of various common duodenal diseases in different parts in the aspects of age, gender, helicobacter pylori (H. pylori) infection, application of nonsteroidal anti-inflammatory drugs (NSAIDs), smoking, or alcohol consumption.
MATERIALS AND METHODS
The medical records of various duodenal diseases were collected and tested for difference using the χ2 test or the Fisher exact probability method.
RESULTS
1) The proportions of duodenal ulcer (DU), inflammation, and duodenal bulb diseases in the adult group (A) (47.98%, 36.70%, and 66.63%) were higher than those in the elderly group (E) (41.38%, 29.83%, and 56.82%), but the proportions of duodenal diverticulum (DD) and tumor diseases in the descending and ascending segments (2.95%, 1.43%, 9.14%, and 0.14%) were lower than those in group E (13.73%, 3.69%, 19.41%, and 0.76%) (p<0.001). 2) The positive rate of H. pylori (63.64%) in the duodenal bulb diseases was higher than that in the bulb-descending segment (53.75%), but the application rate of NSAIDs (16.44%) in the duodenal bulb-descending diseases was lower than that in the descending segment (24.81%) (p<0.001).
CONCLUSION
1) DU, inflammation, and duodenal bulb diseases are common in adults, but DD and tumor diseases in the descending and ascending segments are more common in the elderly. 2) Compared with the duodenal bulb-descending diseases, the application of NSAIDs has greater impact on the diseases in the descending segment, and the rate of H. pylori infection is higher in duodenal bulb diseases.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Alcohol Drinking; Anti-Inflammatory Agents, Non-Steroidal; Chi-Square Distribution; China; Duodenal Diseases; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Sex Factors; Smoking; Young Adult
PubMed: 32897221
DOI: 10.5152/tjg.2020.18712 -
Acta Chirurgica Belgica Feb 2022Secondary aorto-duodenal fistula (SADF) is a rare and serious event occurring in up to 45% of aortic prosthesis infections. The clinical manifestations are variable...
Secondary aorto-duodenal fistula (SADF) is a rare and serious event occurring in up to 45% of aortic prosthesis infections. The clinical manifestations are variable ranging from isolated signs of graft infection such as fever to massive gastrointestinal bleeding. The diagnosis is based on CT scan and is generally oriented by an inconstant association of indirect signs. Despite a high early severe postoperative morbidity and mortality, especially in presence of a preoperative shock, emergency surgery allows for the diagnosis and treatment of SADF with multidisciplinary management allowing favorable midterm outcomes among surviving patients. The images that we present in this manuscript highlight some indirect signs of SADF on CT scan that should alert clinicians to warrant on time surgical management with an illustration of per operative diagnosis of the fistula.
Topics: Aorta, Abdominal; Aortic Diseases; Blood Vessel Prosthesis; Duodenal Diseases; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Vascular Fistula
PubMed: 34931941
DOI: 10.1080/00015458.2021.2021719 -
Stem Cell Research & Therapy Sep 2021Peptic ulcer is one of the most common gastrointestinal tract disorders worldwide, associated with challenges such as refractory morbidity, bleeding, interference with... (Review)
Review
Peptic ulcer is one of the most common gastrointestinal tract disorders worldwide, associated with challenges such as refractory morbidity, bleeding, interference with use of anticoagulants, and potential side effects associated with long-term use of proton pump inhibitors. A peptic ulcer is a defect in gastric or duodenal mucosa extending from muscularis mucosa to deeper layers of the stomach wall. In most cases, ulcers respond to standard treatments. However, in some people, peptic ulcer becomes resistant to conventional treatment or recurs after initially successful therapy. Therefore, new and safe treatments, including the use of stem cells, are highly favored for these patients. Adipose-derived mesenchymal stem cells are readily available in large quantities with minimal invasive intervention, and isolation of adipose-derived mesenchymal stromal stem cells (ASC) produces large amounts of stem cells, which are essential for cell-based and restorative therapies. These cells have high flexibility and can differentiate into several types of cells in vitro. This article will investigate the effects and possible mechanisms and signaling pathways of adipose tissue-derived mesenchymal stem cells in patients with refractory peptic ulcers.
Topics: Humans; Mesenchymal Stem Cells; Peptic Ulcer; Proton Pump Inhibitors; Stomach Ulcer
PubMed: 34565461
DOI: 10.1186/s13287-021-02584-3 -
Arquivos Brasileiros de Cirurgia... 2021
Topics: Duodenal Diseases; Humans; Intestinal Fistula; Tuberculosis
PubMed: 34008711
DOI: 10.1590/0102-672020190004e1570 -
Asia Pacific Journal of Clinical... 2022Peptic ulcer disease is a common digestive system disease. However, whether peptic ulcer disease and obesity are related is unclear. We assessed the associations of...
BACKGROUND AND OBJECTIVES
Peptic ulcer disease is a common digestive system disease. However, whether peptic ulcer disease and obesity are related is unclear. We assessed the associations of obesity and metabolic status with peptic ulcer disease.
METHODS AND STUDY DESIGN
We conducted a cross-sectional study of 3561 individuals from the Wuwei cohort. We evaluated the associations of general and abdominal adiposity, as defined by different anthropometric indices, with peptic ulcer disease. Odds ratios and 95% confidence intervals were determined through binary logistic regression.
RESULTS
The odds ratio for peptic ulcer disease was 2.37 (1.46-3.84) for women with obesity, compared with the normal group. The association remained significant in Models 2 and 3, with odds ratios of 2.23 (1.35-3.69) and 2.03 (1.19-3.49), respectively. In Model 1, women with obesity had an odds ratio for duodenal ulcer of 2.76 (1.41-5.42) compared with the control group; this result remained significant in Models 2 and 3, with odds ratios of 2.52 (1.24-5.13) and 2.44 (1.13-5.28), respectively. In Model 1, women with metabolically healthy and unhealthy obesity had odds ratios for peptic ulcer disease of 2.26 (1.19-4.28) and 2.15 (1.12-4.15), respectively, compared with the control group. After adjustments for major covariates and H. pylori status, these respective odds ratios became 2.27 (1.20-4.30) and 2.17 (1.12-4.20) in Model 2 and 2.2 (1.15-4.20) and 2.16 (1.11-4.19) in Model 3.
CONCLUSIONS
General adiposity defined by body mass index is associated with peptic ulcer disease in women.
Topics: Cohort Studies; Cross-Sectional Studies; Female; Helicobacter pylori; Humans; Obesity; Peptic Ulcer
PubMed: 35766565
DOI: 10.6133/apjcn.202206_31(2).0015