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Journal of Investigative Medicine High... 2024Diverticular disease is a major cause of hospitalizations, especially in the elderly. Although diverticulosis and its complications predominately affect the colon, the...
Diverticular disease is a major cause of hospitalizations, especially in the elderly. Although diverticulosis and its complications predominately affect the colon, the formation of diverticula in the small intestine, most commonly in the duodenum, is well characterized in the literature. Although small bowel diverticula are typically asymptomatic, and diagnosed incidentally, a complication of periampullary duodenal diverticulum is Lemmel syndrome. Lemmel syndrome is an extremely rare condition whereby periampullary duodenal diverticula, most commonly without diverticulitis, leads to obstruction of the common bile duct due to mass effect and associated complications including acute cholangitis and pancreatitis. Here, we present the first case, to our knowledge, of periampullary duodenal diverticulitis complicated by Lemmel syndrome with concomitant colonic diverticulitis with colovesical fistula. Our case and literature review emphasizes that Lemmel syndrome can present with or without suggestions of obstructive jaundice and can most often be managed conservatively if caught early, except in the setting of emergent complications.
Topics: Humans; Duodenal Diseases; Tomography, X-Ray Computed; Male; Aged; Intestinal Fistula; Diverticulitis, Colonic; Female; Sigmoid Diseases; Diverticulitis
PubMed: 38742534
DOI: 10.1177/23247096241253342 -
Radiology Case Reports Dec 2023Bouveret's syndrome is an uncommon cause of gastrointestinal obstruction. It's a result of the passage of a gallstone through a fistula connecting the gallbladder with...
Bouveret's syndrome is an uncommon cause of gastrointestinal obstruction. It's a result of the passage of a gallstone through a fistula connecting the gallbladder with the duodenum or stomach. The diagnosis is challenging due to its atypical clinical manifestations. There have been a few reported cases of Bouveret syndrome presenting with gastrointestinal bleeding. Treatment options include both endoscopic and surgical approaches. We present the case of a 92-year-old woman admitted to the emergency department for upper gastrointestinal bleeding. Gastroscopy revealed gastric stasis upstream of a calculus inducing an obstruction of the bulb. The computed tomography (CT) scan showed a cholecystoduodenal fistula with a calculus lodged in the bulb. The patient underwent a gastrostomy with extraction of the calculus. Postoperative course was uneventful and the patient was discharged home. In the majority of cases, Bouveret's syndrome is revealed by an upper gastrointestinal obstruction, but other signs, such as gastrointestinal bleeding, can be seen. The diagnosis is confirmed by an imaging method that highlights Rigler's triad. The management can be either endoscopic or surgical depending on the patient's general condition. The diagnosis is often difficult due to the lack of specificity in the symptoms. Presently, there exists no consensus concerning the appropriate approach for its management.
PubMed: 37868004
DOI: 10.1016/j.radcr.2023.09.052 -
Journal of Medical Case Reports Apr 2024Postoperative delayed bleeding of gastric cancer is a complication of radical gastrectomy with low incidence rate and high mortality.
BACKGROUND
Postoperative delayed bleeding of gastric cancer is a complication of radical gastrectomy with low incidence rate and high mortality.
CASE PRESENTATION
This case report presents the case of a 63-year-old female patient of Mongolian ethnicity who was diagnosed with gastric malignancy during a routine medical examination and underwent Billroth's I gastric resection in our department. However, on the 24th day after the surgery, she was readmitted due to sudden onset of hematemesis. Gastroscopy, abdominal CT, and digital subtraction angiography revealed postoperative anastomotic fistula, rupture of the duodenal artery, and bleeding from the abdominal aorta. The patient underwent three surgical interventions and two arterial embolizations. The patient's condition stabilized, and she was discharged successfully.
CONCLUSION
Currently, there are no specific guidelines for the diagnosis and treatment of pseudoaneurysms in the abdominal cavity resulting from gastric cancer surgery. Early digital subtraction angiography examination should be performed to assist in formulating treatment plans. Early diagnosis and treatment contribute to an improved overall success rate of rescue interventions.
Topics: Humans; Female; Stomach Neoplasms; Middle Aged; Gastrectomy; Postoperative Hemorrhage; Angiography, Digital Subtraction; Embolization, Therapeutic; Aneurysm, False; Aorta, Abdominal; Tomography, X-Ray Computed; Hematemesis; Duodenum; Treatment Outcome
PubMed: 38658989
DOI: 10.1186/s13256-024-04531-1 -
Revista Espanola de Enfermedades... Jan 2024Gastrointestinal fistulas can be a complication of severe acute pancreatitis, and their incidence is low and sporadically reported in the literature. The most frequently...
Gastrointestinal fistulas can be a complication of severe acute pancreatitis, and their incidence is low and sporadically reported in the literature. The most frequently reported site is in the colon, followed by duodenal fistulas. Psoas abscess is a rare condition. Iliopsoas abscesses are classified as primary or secondary. Secondary abscesses develop by spreading infection from contiguous anatomical structures, such as the gastrointestinal tract. We present the case of a recurrent left psoas abscess secondary to a duodenal fistula as a late complication of necrotizing pancreatitis resolved by endoscopic treatment.
PubMed: 38205700
DOI: 10.17235/reed.2024.10141/2023 -
BMC Gastroenterology Jan 2024To investigate the feasibility of a deformable self-assembled magnetic anastomosis ring (DSAMAR), designed and developed by us, for endoscopic gastrointestinal bypass...
BACKGROUND
To investigate the feasibility of a deformable self-assembled magnetic anastomosis ring (DSAMAR), designed and developed by us, for endoscopic gastrointestinal bypass anastomosis.
METHODS
Ten experimental pigs were used as model animals. The DSAMAR comprises 10 trapezoidal magnetic units, arranged in a straight line under the constraint of a guide wire. When the desired anastomosis site is reached under the guidance of an endoscope, the catheter pushes the magnetic unit along the guide wire. The linear DSAMAR can be assembled into a circular DSAMAR. Two DSAMARs were inserted, one at the end of the duodenum and the other into the stomach successively. They attracted each other and compressed the wall of the stomach and duodenum to establish gastrointestinal bypass anastomosis. The experimental pigs were euthanized 4 weeks after the operation, and the gastrointestinal bypass anastomosis specimens were obtained. The anastomosis formation was evaluated by the naked eye and histology.
RESULTS
Gastrointestinal bypass anastomosis with DSAMARs was successfully performed. The average operation time under an endoscope was 70.30 ± 19.05 min (range: 43-95 min). The DSAMARs were discharged through the anus 10-17 days after surgery. There were no complications such as gastrointestinal bleeding, perforation, anastomotic fistula, and gastrointestinal obstruction during and after the operation. Gastroscopy and gross specimen of the anastomosis showed a well-formed magnetic anastomosis. Histological observation showed good continuity of the serous membrane and the mucosa of magnetic anastomosis.
CONCLUSION
The DSAMAR is a safe and feasible device for fashioning gastrointestinal bypass anastomosis in this animal model.
Topics: Swine; Animals; Anastomosis, Surgical; Gastroscopy; Stomach; Duodenum; Magnetic Phenomena
PubMed: 38182996
DOI: 10.1186/s12876-024-03122-0 -
Archive of Clinical Cases 2023Pancreatic injury post blunt abdominal trauma is exceedingly rare. When complete major pancreatic duct (MPD) disruption occurs, a disconnection between the pancreas and...
Pancreatic injury post blunt abdominal trauma is exceedingly rare. When complete major pancreatic duct (MPD) disruption occurs, a disconnection between the pancreas and the duodenum can take place, ultimately leading to fistula formation. We describe a case of MPD disruption following blunt abdominal trauma, complicated by a fistula between the pancreas and an open abdomen (pancreatico-atmospheric fistula). Although the fistula was managed using standard methods for treating pancreatic fistulas, wound care was a significant challenge in this case where the fistula exteriorized into an open abdomen.
PubMed: 38098696
DOI: 10.22551/2023.41.1004.10270 -
International Journal of Surgery Case... Mar 2024Bouveret Syndrome, a rare form of gallstone ileus, involves the migration and impaction of a gallstone in the duodenum or stomach, causing gastric outlet obstruction....
INTRODUCTION AND IMPORTANCE
Bouveret Syndrome, a rare form of gallstone ileus, involves the migration and impaction of a gallstone in the duodenum or stomach, causing gastric outlet obstruction. Early intervention and a comprehensive care plan are essential for favorable outcomes.
CASE PRESENTATION
This article presents a case of an 82-year-old female with a history of coronary artery disease and untreated gallstones. The patient experienced nausea, vomiting, and abdominal pain for two weeks. Diagnostic procedures revealed a cholecystoduodenal fistula with a 4 cm stone lodged at the duodenojejunal angle. For our patient the gallstone was moved to the jejunum, followed by enterotomy and a latero_lateral gastroenteroanastomosis.
CLINICAL DISCUSSION
The rarity of Bouveret Syndrome and its nonspecific symptoms make diagnosis challenging, necessitating differentiation from other gastrointestinal disorders. Esophagogastroduodenoscopy (EGD) and imaging, such as computed tomography (CT), play crucial roles in diagnosis. In this case, the EGD did not show gallstones up to the second part of the duodenum. Management involves a multidisciplinary approach, with supportive care for stabilization and the primary goal of removing the impacted stone. Treatment options include endoscopic, surgical, or lithotripsy techniques. Bouveret Syndrome poses challenges due to its rarity, leading to delayed diagnosis. Prognosis varies based on factors such as stone size, location, and overall patient condition.
CONCLUSION
Through this case we emphasizes the importance of awareness, timely diagnosis, and appropriate management, with EGD and CT scan playing key roles in diagnosis. Surgical intervention remains a viable treatment option when endoscopic approaches are unavailable. The article highlights the controversial nature of fistula repair in Bouveret Syndrome.
PubMed: 38428049
DOI: 10.1016/j.ijscr.2024.109438 -
Medicine Oct 2023The Hem-o-lok clip, made from a nonabsorbable polymer, and its predecessor the metal ligation clip have been used widely for laparoscopic or robot-assisted surgery to...
RATIONALE
The Hem-o-lok clip, made from a nonabsorbable polymer, and its predecessor the metal ligation clip have been used widely for laparoscopic or robot-assisted surgery to ligate the cystic duct after a cholecystectomy, to ligate the appendix after an appendectomy, or control hemorrhage or on occasion to occlude a fistula or enterotomy. Displacement of these ligation clips to distant sites is an extremely rare complication in clinical practice.
PATIENT CONCERNS
The patient is a 67-year old female who sought medical attention for 3 days due to worsening intermittent upper abdominal pain and poor appetite. Gastroscopy showed both an ulcer and the presence of a foreign object embedded in the anterior wall of the duodenal bulb, consistent with what looked like a polymer-based ligation clip. After removal of the foreign body, which turned out to be a remnant of the polymer clip, no further pus was seen, but fresh granulomatous tissues were seen at the base.
DIAGNOSES
a polymer-based clip-induced duodenal bulb erosion with a local contained enterically draining abscess.
INTERVENTIONS
The patient recovered after removing foreign bodies under gastroscopy and receiving anti infection treatment.
OUTCOMES
The patient recovered after removing foreign bodies under gastroscopy and receiving anti infection treatment.
LESSONS
In laparoscopic cholecystectomy, attention should be paid to the correct surgical techniques, possibly by decreasing the number of such clips used or considering use of absorbable clips, ligature wires, ligation with absorbable suture material, or ultrasonic resection, all of which can be used for clipless cholecystectomy.
Topics: Female; Humans; Aged; Polymers; Abscess; Duodenum; Laparoscopy; Cholecystectomy, Laparoscopic; Foreign Bodies; Surgical Instruments
PubMed: 37904458
DOI: 10.1097/MD.0000000000035783 -
Journal of Clinical Medicine Jan 2024This case report underscores the importance of utilizing E-VAC (endoscopic vacuum-assisted closure) in the treatment of a perforated duodenal ulcer complicated by the...
This case report underscores the importance of utilizing E-VAC (endoscopic vacuum-assisted closure) in the treatment of a perforated duodenal ulcer complicated by the formation of a subphrenic abscess and septic shock. It showcases how E-VAC can effectively mitigate the risk of further complications, such as leakage, bleeding, or rupture, which are more commonly associated with traditional methods like stents, clips, or sutures. As a result, there is a significant reduction in mortality rates. A perforated duodenal ulcer accompanied by abscess formation represents a critical medical condition that demands prompt surgical intervention. The choice of the method for abscess drainage and perforation closure plays a pivotal role in determining the patient's chances of survival. Notably, in patients with a high ASA (American Association of Anesthesiologists) score of IV-V, the mortality rate following conventional surgical intervention is considerably elevated. The management of perforated duodenal ulcers has evolved from open abdominal surgical procedures, which were associated with high mortality rates and risk of suture repair leakage, to minimally invasive techniques like laparoscopy and ingestible robots. Previously, complications arising from peptic ulcers, such as perforations, leaks, and fistulas, were primarily addressed through surgical and conservative treatments. However, over the past two decades, the medical community has shifted towards employing endoscopic closure techniques, including stents, clips, and E-VAC. E-VAC, in particular, has shown promising outcomes by promoting rapid and consistent healing. This case report presents the clinical scenario of a patient diagnosed with septic shock due to a perforated duodenal ulcer with abscess formation. Following an exploratory laparotomy that confirmed the presence of a subphrenic abscess, three drainage tubes were utilized to evacuate it. Subsequently, E-VAC therapy was initiated, with the kit being replaced three times during the recovery period. The patient exhibited favorable progress, including weight gain, and was ultimately discharged as fully recovered. In the treatment of patients with duodenal perforated ulcers and associated abscess formation, the successful and comprehensive drainage of the abscess, coupled with the closure of the perforation, emerges as a pivotal factor influencing the patient's healing process. The positive outcomes observed in these patients underscore the efficacy of employing a negative pressure E-VAC kit, resulting in thorough drainage, rapid patient recovery, and low mortality rates.
PubMed: 38256604
DOI: 10.3390/jcm13020470 -
Asian Journal of Surgery Jan 2024
Topics: Humans; Abscess; Abdominal Abscess; Peritoneal Diseases; Retroperitoneal Space
PubMed: 37806884
DOI: 10.1016/j.asjsur.2023.09.176