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International Journal of Surgery... Sep 2015In patients affected by distal biliary obstruction deemed unsuitable for pancreatoduodenectomy, biliary diversion is the only proposable option. Defined goals of this...
BACKGROUND
In patients affected by distal biliary obstruction deemed unsuitable for pancreatoduodenectomy, biliary diversion is the only proposable option. Defined goals of this treatment are: relief from jaundice preventing its related complications, reduction of in-hospital stay and adequate control of pain. Palliation can be obtained either by surgical or conservative procedures (endoscopic stenting or percutaneous treatment). Considering early complications' incidence, surgical approach has always been reserved for low surgical risk patients with longer survival perspectives, while recently developed long-lasting patency stents enlarged mini-invasive application resort. Comparative studies on these therapeutic options favour the conservative one in respect of conventional open surgery, but data on minimally invasive surgery to pursue palliative aims are lacking. We present our six-years casuistic and results referring to laparoscopic biliary diversions.
METHODS
We analyzed results obtained in distal biliary neoplastic obstruction management between December 2008 and November 2014. During this period, selected patients considered unsuitable for pancreatoduodenectomy were scheduled to receive a laparoscopic biliary decompression. Perioperative variables and 30-days postoperative outcomes have been prospectively collected.
RESULTS
In the six-years period, 12 patients affected by distal biliary neoplastic obstruction were submitted to laparoscopic palliative bypass. Four procedures were proposed for distal biliary cancer, one for advanced periampullary cancer and seven for pancreatic head cancer. Ten hepatico-jejunal bypasses and two choledochoduodenostomies have been performed. No conversions to open surgery were encountered in this series. Main operative time was 85 min, main blood loss was 75 ml and main hospitalization was 4.5 days. According to Clavien Dindo Classification one class II and one class IIIb complications occurred.
CONCLUSIONS
Although the restricted number of patients, our results suggest that laparoscopic biliary bypass could be a valid option in managing distal biliary obstructions, resulting in low perioperative morbidity, effective long term palliation of symptoms and improved quality of life.
Topics: Aged; Aged, 80 and over; Bile Duct Neoplasms; Cholestasis; Decompression, Surgical; Female; Humans; Laparoscopy; Length of Stay; Male; Palliative Care; Pancreatic Neoplasms; Quality of Life
PubMed: 26118614
DOI: 10.1016/j.ijsu.2015.04.092 -
BMJ Case Reports Apr 2018Intussusception is the invagination of a proximal part of intestine into the adjacent distal part. Reported frequently in children, it forms a rare presentation in... (Review)
Review
Intussusception is the invagination of a proximal part of intestine into the adjacent distal part. Reported frequently in children, it forms a rare presentation in adults and can be difficult to diagnose pre operatively. Imaging modalities are increasingly being used for preoperative diagnosis with almost all cases in adults being secondary to an intestinal lesion. Intraoperative management of such lesions in adults was mostly reported to be done by en bloc resection without attempts at reduction, especially where a preoperative diagnosis of a benign lesion was not in hand. We present a case of a female patient with a background of active metastatic lung cancer presenting with symptoms and signs of high intestinal obstruction, found to have a jejunal intussusception on CT scan and managed conservatively initially, followed by definitive surgical management. Literature review of similar presentations, diagnostic and treatment modalities are discussed thereafter.
Topics: Adult; Endoscopy, Gastrointestinal; Female; Humans; Intussusception; Jejunal Diseases; Lung Neoplasms; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 29666094
DOI: 10.1136/bcr-2017-224051 -
BMC Surgery Jul 2020At present, the gastric tube is the first choice for esophageal reconstruction after esophagectomy for various benign and malignant diseases. However, when the stomach...
BACKGROUND
At present, the gastric tube is the first choice for esophageal reconstruction after esophagectomy for various benign and malignant diseases. However, when the stomach is not available, a pedicled jejunum or colon is used to reconstruct the esophagus. The present study aimed to compare the postoperative outcomes and quality of life of patients receiving jejunal and colonic conduits.
METHODS
In the present retrospective study, the clinical data of 71 patients with esophageal carcinoma, who received jejunal reconstruction (jejunum group, n = 34) and colonic reconstruction (colon group, n = 37) from 2005 to 2015, were compared.
RESULTS
Compared with the colon group, the jejunum group had a lower incidence of postoperative anastomotic leakage, lesser duration of postoperative drainage, and faster recovery. Furthermore, the scores were better in the jejunum group than in the colon group, in terms of short-term overall quality of life, physical function and social relationships. Moreover, the jejunal group had a significantly lower frequency of pH < 4 simultaneous reflux time > 5 min (N45) and the longest reflux time (LT) at 24 weeks after surgery.
CONCLUSION
In esophageal cancer, when gastric tube construction is not feasible, a pedicled jejunum may be preferred over a colonic conduit due to lower incidence of acid reflux, anastomotic leakage and higher postoperative short-term quality of life, and rapid postoperative recovery.
Topics: Aged; Colon; Esophageal Neoplasms; Esophagectomy; Female; Humans; Jejunum; Male; Middle Aged; Quality of Life; Plastic Surgery Procedures; Retrospective Studies
PubMed: 32677925
DOI: 10.1186/s12893-020-00810-y -
Journal of the American Veterinary... Apr 2017
Topics: Animals; Animals, Zoo; Diagnosis, Differential; Jejunal Neoplasms; Leiomyoma; Male; Spheniscidae
PubMed: 28306493
DOI: 10.2460/javma.250.7.755 -
International Journal of Surgery Case... 2018Spontaneous free perforation of the small bowel is unusual. There are many causes of spontaneous small bowel free perforation such as: immune-mediated or inflammatory,...
INTRODUCTION
Spontaneous free perforation of the small bowel is unusual. There are many causes of spontaneous small bowel free perforation such as: immune-mediated or inflammatory, infections, drugs and biological agents, congenital, metabolic, vascular and neoplasm. A severe adverse effect of antipsychotic drugs is intestinal ischemia, which could lead to perforation.
CASE PRESENTATION
The authors report the clinical case of a 42-year-old schizophrenic patient, smoker, medicated with clozapine 600 mg per day, admitted to the emergency room with diffuse abdominal pain. On physical examination the patient presented abdominal rebound tenderness and peritoneal sign with raised inflammation markers and the abdominal tomography revealed pneumoperitoneum. An emergency laparotomy revealed multiple jejunal and ileal perforations. The patient was subject to small bowel resection complicated with anastomosis dehiscence, respiratory tract infection and intra-abdominal abscess. Histologic specimens showed nonspecific inflammatory findings with ischemia. The main infectious, inflammatory, congenital, auto-immune and vascular causes of spontaneous perforations were excluded.
DISCUSSION
Spontaneous free perforation of the small bowel is uncommon. An intestinal ischemia might be a rare adverse effect of antipsychotics. However, only colon perforations due to ischemic colitis are described in the literature. While diagnosis of the precise cause might be challenging, and after excluding other causes, these perforations may be attributed to an adverse effect of clozapine.
CONCLUSION
The cause was attributed to clozapine as the other etiologies were excluded. The clozapine's reintroduction is controversial. In this case the clozapine dose was reduced successfully.
PubMed: 30447547
DOI: 10.1016/j.ijscr.2018.10.067 -
Current Oncology (Toronto, Ont.) May 2022Esophagojejunal anastomosis (EJA) complications after total gastrectomy are related to significant morbidity and mortality. The aim of this study was to evaluate the...
Esophagojejunal anastomosis (EJA) complications after total gastrectomy are related to significant morbidity and mortality. The aim of this study was to evaluate the association between arterial calcifications and EJA complications such as leak and stricture for gastric cancer. Between January 2014 and October 2019, 30 patients with EJA complications after total gastrectomy were enrolled and matched to 30 patients without complications through retrospective data review. Arterial calcification grade on preoperative computed tomography (CT) was reported in the abdominal aorta and superior mesenteric artery (SMA) as “absent”, “minor”, or “major”, and in the jejunal vascular arcade (JVA) and left inferior phrenic artery (LIPA) as “absent” or “present”. A Chi-square test was used to compare the variables between the two groups. p-Value < 0.050 was considered statistically significant. Among 30 patients, the numbers of patients with leak and stricture were 23 and seven, respectively. Aortic calcifications were not associated with EJA complications regardless of their grade (p = 0.440). Only major SMA calcifications were associated with EJA complications, as they were present in five patients (16.7%) in the complication group and absent in the non-complication group (p = 0.020). Major SMA calcifications were more related to anastomotic stricture than leak. Three (13.0%) out of 23 patients with leak and two (28.6%) out of seven with stricture had major SMA calcifications (p = 0.028). No calcifications were detected in the JVA or LIPA in any of the 60 patients. Major SMA calcifications were found to be associated with EJA complications, especially in stricture.
Topics: Anastomosis, Surgical; Constriction, Pathologic; Gastrectomy; Humans; Retrospective Studies; Stomach Neoplasms; Vascular Calcification
PubMed: 35621652
DOI: 10.3390/curroncol29050262 -
Nigerian Journal of Clinical Practice Mar 2023Melanoma is a relatively rare tumour with tendency to metastasize to the gastrointestinal tract. Metastasis to the intestine constitutes a majority of the...
Melanoma is a relatively rare tumour with tendency to metastasize to the gastrointestinal tract. Metastasis to the intestine constitutes a majority of the gastrointestinal tract melanoma metastases and confers a poor prognosis. While post-mortem studies detect that more than half of the melanoma patients have gastrointestinal tract metastasis, only minority are diagnosed, and even rarer present with intussusception. Intussusception, mainly a paediatric entity, is also seen among adult patients with underlying inflammatory bowel disease or tumour. In this report, we describe a patient with a melanoma in remission who presented with intestinal obstruction after months of vague abdominal complaints. Laparotomy revealed jejunal intussusception and histopathological staining confirmed the melanoma diagnosis. No other distant metastases other than the jejunum were revealed after extensive investigation.
Topics: Adult; Humans; Child; Intussusception; Jejunum; Neoplasm Recurrence, Local; Melanoma; Intestinal Obstruction; Syndrome
PubMed: 37056115
DOI: 10.4103/njcp.njcp_675_22 -
Molecular Imaging and Radionuclide... Jun 2023Neuroendocrine tumors are slow-growing tumors originating from neuroendocrine cells and capable of metastasis. Most of them are found in the gastrointestinal tract;...
Neuroendocrine tumors are slow-growing tumors originating from neuroendocrine cells and capable of metastasis. Most of them are found in the gastrointestinal tract; however, they can also be rarely seen in other organs. Testicular neuroendocrine tumors account for less than 1% of all testicular neoplasms. They may present as primary testicular or secondary tumors from extratesticular sources. Jejunal neuroendocrine tumor metastasis to the testis is extremely rare. We present the case of a 61-year-old man with a jejunal neuroendocrine tumor and metastases to bilateral testicles revealed on Gallium-68-DOTATATE positron emission tomography/computed tomography.
PubMed: 37337848
DOI: 10.4274/mirt.galenos.2022.06926 -
Chirurgia (Bucharest, Romania : 1990) 2020Numerous procedures for reconstruction after total gastrectomy have been proposed in order to achieve the lowest postoperative morbidity. Roux-en-Y esojejunostomy is... (Review)
Review
Numerous procedures for reconstruction after total gastrectomy have been proposed in order to achieve the lowest postoperative morbidity. Roux-en-Y esojejunostomy is widely accepted as a standard reconstruction technique due to its simplicity and its satisfactory nutritional outcomes. The construction of a gastric pouch and the maintenance of the duodenal transit have been proposed to ameliorate the quality of life of patients with gastric cancer. The aim of this study is to assess the quality of life of patients with different types of reconstruction after total gastrectomy. Material and Method: A systematic literature search was performed in PubMed, Science Direct, Wiley Online, Springer Link, up to December 1, 2019. Only original articles published in English were included. Quality of life was measured using different instruments. Postoperative aspects of reflux oesophagitis, dumping syndrome, food intake and weight status were evaluated. 15 studies were included in this research. Three techniques for restoring the digestive tract continuity were compared: Roux-en-Y eso-jejunostomy, jejunal interposition and gastric pouch construction. The statistical results of the included studies were evaluated in terms of quality of life or weight status. The length of the alimentary limb for prophylaxis of eso-jejunal reflux should be at least 50 cm, but not more than 60 cm for the prevention of malabsorption. The quality of life was significantly better in patients with gastric pouch. Maintaining the duodenal transit does not seem to bring any benefit in quality of life or weight status, even if this is a physiological way.
Topics: Anastomosis, Roux-en-Y; Esophagus; Gastrectomy; Humans; Jejunum; Quality of Life; Randomized Controlled Trials as Topic; Plastic Surgery Procedures; Stomach Neoplasms; Treatment Outcome
PubMed: 32155396
DOI: 10.21614/chirurgia.115.1.12 -
World Journal of Radiology Sep 2015Small-bowel carcinoid tumors are the most common form (42%) of gastrointestinal carcinoids, which by themselves comprise 70% of neuroendocrine tumors. Although primary... (Review)
Review
Small-bowel carcinoid tumors are the most common form (42%) of gastrointestinal carcinoids, which by themselves comprise 70% of neuroendocrine tumors. Although primary small bowel neoplasms are overall rare (3%-6% of all gastrointestinal neoplasms), carcinoids still represent the second most common (20%-30%) primary small-bowel malignancy after small bowel adenocarcinoma. Their imaging evaluation is often challenging. State-of-the-art high-resolution multiphasic computed tomography together with advanced postprocessing methods provides an excellent tool for their depiction. The manifold interactive parameter choices however require knowledge of when to use which technique. Here, we discuss the imaging appearance and evaluation of duodenal, jejunal and ileal carcinoid tumors, including the imaging features of the primary tumor, locoregional mesenteric nodal metastases, and distant metastatic disease. A protocol for optimal lesion detection is presented, including the use of computed tomography enterography, volume acquisition, computed tomography angiography and three-dimensional mapping. Imaging findings are illustrated with a series of challenging cases which illustrate the spectrum of possible disease in the small bowel and mesentery, the range of possible appearances in the bowel itself on multiphase data and extraluminal findings such as the desmoplastic reaction in mesentery and hypervascular liver metastases. Typical imaging pitfalls and pearls are illustrated.
PubMed: 26435774
DOI: 10.4329/wjr.v7.i9.220