-
Cureus May 2024Corrosive poisoning is common in developing countries like India. It is mainly due to accidental consumption in children, whereas suicide is the usual intent in adults....
Corrosive poisoning is common in developing countries like India. It is mainly due to accidental consumption in children, whereas suicide is the usual intent in adults. It leads to devastating injuries, to the upper gastrointestinal tract such as necrosis and perforation. The long-term complications include stricture formation and gastric outlet obstruction. Here, we present the case of a 50-year-old male with an alleged history of corrosive acid ingestion. On contrast-enhanced computed tomography (CECT) of the abdomen, there was an absence of wall enhancement of the stomach and the first part of the duodenum, which was suggestive of necrosis or gangrenous changes with signs of impending perforation of the stomach and the first part of the duodenum. The patient was immediately taken up for surgery, and the intraoperative findings were consistent with the imaging findings.
PubMed: 38882952
DOI: 10.7759/cureus.60313 -
Endoscopy Dec 2024
Topics: Humans; Pylorus; Choristoma; Female; Male; Gastroscopy
PubMed: 38866057
DOI: 10.1055/a-2333-9480 -
Juntendo Iji Zasshi = Juntendo Medical... 2023Compared to distal gastrectomy (DG), pylorus-preserving gastrectomy (PPG), a peristaltic function-preserving surgery for early gastric cancer (EGC), is advantageous as...
BACKGROUND
Compared to distal gastrectomy (DG), pylorus-preserving gastrectomy (PPG), a peristaltic function-preserving surgery for early gastric cancer (EGC), is advantageous as it leads to a more improved nutritional status and quality of life (QOL) of patients. In recent years, total laparoscopic PPG (TLPPG), an anastomosis which is performed intracorporeally, has increasingly replaced laparoscopic-assisted PPG (LAPPG) due to its minimal invasiveness.
AIM
To evaluate the safety and feasibility of TLPPG in terms of perioperative efficacy.
PATIENTS
Three patients underwent TLPPG in the Affiliated Hospital of Changzhi Medical College from September 2021 to March 2022.
METHODS
Surgical safety analysis: Our three cases (TLPPG group) were compared to data from the CLASS-02 study, which collected data from multiple centers across China for the laparoscopic total gastrectomy (LTG group). The CLASS-02 study provides data from the most invasive type of gastric surgery, providing solid comparative data to our own.Postoperative short-term efficacy analysis: Patient questionnaire responses provided data on postoperative nutritional and QOL status. Results from our three cases were compared to the Japanese multicenter data PGSAS-37 (PGSAS group).
RESULTS
There were no complications or deaths occurred during or after operation in our cases. Compared to the PGSAS group, our cases scored lower for abdominal pain, dyspepsia, and weight loss.
CONCLUSION
Although more case information is needed, our findings demonstrate that TLPPG may be a possible and effective treatment for EGC in China, similar to that in Japan.
PubMed: 38855066
DOI: 10.14789/jmj.JMJ23-0018-OA -
Frontiers in Surgery 2024Gastric gastrointestinal stromal tumors in challenging anatomical locations are difficult to remove.
Robot-assisted laparoscopic combined with endoscopic partial gastrectomy (RALE-PG) for the treatment of gastric gastrointestinal stromal tumors in challenging anatomical locations: single-center experience.
BACKGROUND
Gastric gastrointestinal stromal tumors in challenging anatomical locations are difficult to remove.
METHODS
This study retrospectively analyzed the clinical data of 12 patients with gastric GISTs in challenging anatomical locations who underwent robot-assisted laparoscopic combined with endoscopic partial gastrectomy (RALE-PG) and manual suturing of the gastric wall.
RESULTS
This study included 12 patients with a mean age of 56.8 ± 9.8 years and a mean BMI of 23.9 ± 1.9 kg/m. Tumors were located in the GEJ ( = 3), lesser curvature ( = 3), posterior gastric wall ( = 3) and antrum ( = 3). The cardia and pylorus were successfully preserved in all patients regardless of the tumor location. The mean tumor size was 4.5 ± 1.4 cm. The mitotic-count/50 mm was less than 5 in all patients (100%). There was no intraoperative tumor rupture (0%) and no conversion to open surgery (0%). The median operation time was 122 (97-240) min, and the median blood loss volume was 10 (5-30) ml. The median postoperative VAS score was 2 (2-4). The median time to first flatus was 2 (2-3) days. The median time to first fluid intake was 2 (2-3) days. The median time to first ambulation after the operation was 3 (2-4) days. No cases of anastomotic stenosis or leakage were found. The median time to drain removal for 6 patients was 5 (4-7) days. The median time to nasogastric tube removal for all patients was 2 (1-5) days. The median postoperative hospital stay was 5 (4-8) days. One patient (female/41 year) developed moderate anemia (Clavien-Dindo grade II complication). There was no unplanned readmission within 30 days after the operation. The median distance from the tumor to the resection margin was 1 (1-2) cm. R0 resection was achieved in all patients. The median follow-up period was 19 (10-25) months, and all patients survived with no recurrence or metastasis.
CONCLUSIONS
RALE-PG is a safe, feasible and advantageous technique for treating GISTs in challenging anatomical locations. It can be used to accurately remove the tumor while preserving gastric function to the greatest extent, but long-term oncologic outcomes need to be evaluated in a study with a larger sample size and longer follow-up period.
PubMed: 38846924
DOI: 10.3389/fsurg.2024.1391387 -
Journal of Surgical Case Reports Jun 2024Ampulla of Vater (AOV) is typically located in the second part of the duodenum. There are few reported cases of ectopic AOV over the line extending from the pylorus of...
Ampulla of Vater (AOV) is typically located in the second part of the duodenum. There are few reported cases of ectopic AOV over the line extending from the pylorus of the stomach down to the distal part of the duodenum. However, to the best of our knowledge, there are only five cases reported in the English literature of an ectopic AOV in the fourth part of the duodenum, with only one of them having adenocarcinoma of the ampulla. Hereby, we report the first case of ectopic AOV in the fourth part of the duodenum, presenting with obstructive due to adenocarcinoma with focal squamous differentiation. This is the case a 42-year-old lady who had a sleeve gastrectomy for morbid obesity in the past. She presented with right upper quadrant pain for one month associated with subjective fever, unintentional weight loss, pale stool, and dark urine. The physical examination revealed a deeply jaundiced lady with an unremarkable abdominal exam. A computed tomography scan of the abdomen revealed intrahepatic and extrahepatic biliary dilation with ectopic insertion of the distal CBD into the fourth part of the duodenum with no evidence of biliary stones. She underwent pancreaticoduodenectomy after difficult biliary decompression. Histopathological diagnosis was moderately differentiated adenocarcinoma, pancreaticobiliary type with focal squamous differentiation. Ectopic AOV is a very rare entity, especially when it is associated with adenosquamous carcinoma changes.
PubMed: 38832061
DOI: 10.1093/jscr/rjae377 -
Journal of Surgical Case Reports May 2024A female in her 60s with vague abdominal symptoms was found to have a pancreatic mass in her CT scan. A core needle biopsy done endoscopically demonstrated a poorly...
A female in her 60s with vague abdominal symptoms was found to have a pancreatic mass in her CT scan. A core needle biopsy done endoscopically demonstrated a poorly differentiated adenocarcinoma. The patient completed nine cycles of neoadjuvant systemic mFOLFIRINOX. Repeat staging demonstrated a partial radiographic response. She underwent an open pylorus-preserving pancreatoduodenectomy with segmental superior mesenteric vein resection with primary reconstruction (ISGPS Type 3). The final pathology demonstrated a poorly differentiated adenosquamous carcinoma, R1 margin status. The case report demonstrates the effect of mFOLFIRINOX on pancreatic adenosquamous (PASC) carcinoma with a review of the microscopic pictures following the neoadjuvant therapy. It can be postulated that glandular component being the major component in a PASC has a good response to mFOLFIRINOX like that seen in pancreatic ductal adenocarcinoma with some presumed effect on the squamous component as well. From the above case report, we are proposing that mFOLFIRINOX can be an effective chemotherapy regime in the management of PASC.
PubMed: 38803839
DOI: 10.1093/jscr/rjae345 -
Scientific Reports May 2024Axolotls (Ambystoma mexicanum) are extensively studied for their relevance in human medical research. Despite being critically endangered in the wild, they have gained...
Axolotls (Ambystoma mexicanum) are extensively studied for their relevance in human medical research. Despite being critically endangered in the wild, they have gained popularity as household pets. Although they have been kept in captivity for over a century, detailed descriptions of their coelomic organ anatomy remain limited. Also, this species exhibits significant variations compared to other amphibians. Ultrasound is a non-invasive and painless medical imaging technique, ideally suited for investigating internal organs or structures. This study focused on describing the ultrasound appearance of the axolotl coelomic cavity. It details the identification, localization and parenchymal description of major organs in 28 neotenic axolotls using ultrasound frequencies ranging from 7 to 15 MHz. The accuracy of the results was validated by comparing ultrasound findings with necropsy results from one male and one female axolotl. The heart, lung surface, liver and reproductive tracts were visualized. Measurements, along with confidence intervals, were calculated for the spleen, kidneys, testicles, gastric wall, gallbladder, and pylorus. Occasional detection of hyperechoic millimetric particles in the gallbladder or ascites was noted. However, visualization of the pancreas and bladder was not possible. This research outcomes involve the development of a comprehensive atlas comprising images obtained throughout the study. Additionally, the experiment established a reproducible and readily accessible protocol for conducting anatomy-morphological assessments in axolotl medicine. This protocol stands as a crucial preliminary stage before advancing to lesion identification.
Topics: Animals; Ambystoma mexicanum; Pilot Projects; Ultrasonography; Male; Female
PubMed: 38782987
DOI: 10.1038/s41598-024-62264-z -
Heliyon May 2024Gastric liposarcoma (GL) is extremely rare and radical surgery has been the conventional treatment, even in small tumors. Laparoscopic wedge resection has been reported...
BACKGROUND
Gastric liposarcoma (GL) is extremely rare and radical surgery has been the conventional treatment, even in small tumors. Laparoscopic wedge resection has been reported worldwide for subepithelial tumors of the stomach.
CASE PRESENTATION
The patient was an asymptomatic 63-year-old man presenting with a subepithelial gastric tumor. The esophagogastroduodenoscopy showed a 3 cm ulcerated soft tumor located in the posterior wall of the antrum just above the pylorus. Two preoperative biopsies were performed with a negative result for malignant neoplasm. Dynamic computerized tomography revealed 35 × 35 mm well-defined pyloric mass with fat density. Despite the difficult location of the tumor, function-preserving surgery was performed. Surgery was initiated by a laparoscopic approach with four trocars. After the dissection of the greater omentum, the greater curvature and the posterior wall of the stomach were exposed. A gastrostomy was performed in the anterior wall of the antrum. Due to the difficulty in identifying the tumor location, a mini-laparotomy was conducted. After assessing the pylorus and section parameters, the tumor was extracted by gastrostomy and resected with a linear stapler. The patient was discharged after five days with no complications. The histological diagnosis was a well-differentiated liposarcoma. Resection margins were clear. The tumor cells tested negative for MDM2. No adjuvant therapy was indicated. The patient is alive without recurrence.
CONCLUSIONS
Despite its rarity, gastric liposarcoma should be respected for differential diagnosis in submucosal tumors. The main diagnostic method is histological, and surgery is the conventional treatment without yet having a consensus. Minimally invasive wedge resection might be a suitable treatment even if the location is close to the pylorus. Multicenter studies are required to obtain better results in the management of this pathology.
PubMed: 38774071
DOI: 10.1016/j.heliyon.2024.e30410 -
Trauma Case Reports Jun 2024We present a successful staged surgical repair of an adolescent who sustained a high grade combined pancreaticoduodenal injury following a high-speed motor vehicle...
BACKGROUND
We present a successful staged surgical repair of an adolescent who sustained a high grade combined pancreaticoduodenal injury following a high-speed motor vehicle collision.
METHODS
We discuss our case as well as provide a thorough literature review made on databases such as PubMed, Google Scholar, and Embase.
SUMMARY
A fifteen-year-old female presented after a motor vehicle collision with abdominal pain and imaging suggestive of pancreatic and duodenal injuries. Emergent exploratory laparotomy confirmed a transection of the pancreatic neck in addition to disruption of the second portion of the duodenum. She sustained other injuries including an injury to the portal vein and a right colonic perforation. A damage control strategy was employed, and the patient underwent duodenal repair, wide drainage of the pancreatic injury, primary portal vein repair, right hemicolectomy, and temporary abdominal closure using negative pressure wound dressing placement. She remained stable overnight in the ICU and was taken back to the operating room for a pylorus-preserving pancreaticoduodenectomy with a hepatobiliary surgeon the following afternoon. The patient required additional surgery for fixation of an unstable vertebral fracture but was discharged to inpatient rehab within two weeks of presentation. She did not require TPN, and the only long-term sequelae have been admissions for acute uncomplicated pancreatitis that have been treated medically.
CONCLUSION
Combined pancreatic and duodenal injury in the pediatric population is uncommon. We discuss our case of a patient requiring a pancreaticoduodenectomy. Despite postoperative pancreatitis and limited information in this field, we believe we provided the optimal surgical care, and this is a potential area for future investigation.
PubMed: 38770237
DOI: 10.1016/j.tcr.2024.101034 -
JPGN Reports May 2024Pyloric stenosis commonly affects infants and rarely causes gastric outlet obstruction in adolescents and older children. We present the case of an 11-year-old girl with...
Pyloric stenosis commonly affects infants and rarely causes gastric outlet obstruction in adolescents and older children. We present the case of an 11-year-old girl with a 2-month history of recurrent postprandial vomiting and weight loss. On physical examination, the patient presented with abdominal distension. Upper gastrointestinal endoscopy revealed a very small pyloric orifice through which the endoscope could not be advanced. Abdominal ultrasonography and a computed tomography confirmed pylorus thickening. She underwent Heineke-Mikulicz pyloroplasty with symptom resolution.
PubMed: 38756127
DOI: 10.1002/jpr3.12062