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Endoscopy Dec 2024
Topics: Humans; Hepatectomy; Endoscopy; Duodenal Diseases; Drainage; Fistula
PubMed: 38467352
DOI: 10.1055/a-2268-5793 -
Narra J Dec 2023Ingestion of corrosive substances is most common in children, while in adults causes more severe damages. Massive ingestion of corrosive substances results in severe...
Ingestion of corrosive substances is most common in children, while in adults causes more severe damages. Massive ingestion of corrosive substances results in severe damage to the gastrointestinal tract and oropharynx if not treated properly. Corrosive substances with pH<2 or >12 can result in severe esophageal damage with either colliquative (alkaline) or coagulative (acidic) necrosis and, at the same time various gastrointestinal injuries could lead to late post-corrosive complications. The aim of the case study was to report the gastrointestinal mucosal damages due to hydrochloric acid (HCl) and sodium hydroxide (NaOH) ingestion. A 55-year-old male patient was presented to the emergency room with a chief complaint of vomiting an hour before admission. Continuous vomiting with a volume of approximately 10-20 cc per vomit. The vomit was initially bluish and turned in to blackish brown over time. Other complaints included nausea, rapid breathing, heartburn, and burning mouth and throat, and had weakness and dizziness. The patient accidentally drank floor cleaning liquid containing HCl. The patient was diagnosed with hematemesis due to ulceration of esophageal, gastric, and duodenal mucosa induced by HCl. Tracheoesophageal fistula developed later in the patient as a long-term complication. Another a 22-year-old male patient was presented to the emergency room with chief complaints of nausea and vomiting an hour before admission. Headache and slight tightness were also experienced. The patient mouth felt burned pain in the solar plexus and frothy saliva. An hour earlier, the patient attempted suicide by drinking two bottles of floor cleaning liquid due to economic problems. The patient was diagnosed with erosive mucosal esophagogastroduodenum induced by NaOH. These cases highlight that intoxication with corrosive substances can complicate damage to the gastrointestinal mucosal and damage features depend on the type of substance concentration and quantity of the corrosive substance.
PubMed: 38450338
DOI: 10.52225/narra.v3i3.259 -
Radiology Case Reports May 2024Duodenal stump insufficiency is an infrequent but potentially devastating complication of upper gastrointestinal surgery. In the era of image-guided interventions,...
Duodenal stump insufficiency is an infrequent but potentially devastating complication of upper gastrointestinal surgery. In the era of image-guided interventions, duodenal stump insufficiency is usually treated rather conservatively or with percutaneous interventions than with surgery. Herein, we present a case of a postsurgical duodenal stump fistula successfully treated in a step-by-step manner with percutaneous drainage of a periduodenal abscess-fistula complex, percutaneous transcholecystic biliary drainage for partial biliary diversion and percutaneous transcatheter fistula embolization via the duodenum with n-butyl-cyanoacrylate.
PubMed: 38449489
DOI: 10.1016/j.radcr.2024.02.022 -
The American Journal of Case Reports Mar 2024BACKGROUND Endoscopic biliary stent implantation is a recognized and effective method for the treatment of benign and malignant diseases of the bile duct and pancreas,...
BACKGROUND Endoscopic biliary stent implantation is a recognized and effective method for the treatment of benign and malignant diseases of the bile duct and pancreas, ensuring smooth bile drainage. Currently, stent migration is considered a long-term and complex process, and in most cases, stents are removed through endoscopy or expelled from the body through the intestinal cavity. In rare cases, stents lead to formation of duodenocolic fistulas. CASE REPORT We report a case of duodenal colon fistula caused by a biliary stent penetrating the duodenum and entering the ascending colon. We removed the stent through endoscopy and clamped the fistulas of the colon and duodenum separately with titanium clips. Due to the presence of large common bile duct stones, nasobiliary drainage was performed again. Later, laparoscopic choledocholithotomy was performed, and the patient was discharged after rehabilitation. CONCLUSIONS ERCP endoscopy must consider the possibility of stent displacement in patients with biliary stents. In the case of CBD biliary stent dislocation in the patient, continuous abdominal plain films and physical examinations are required until spontaneous discharge is confirmed. In addition, for patients with benign bile duct stenosis undergoing biliary drainage, doctors should urge them to return to the hospital on time to remove the stent. For patients with postoperative abdominal pain or peritonitis symptoms, abdominal CT scan confirmation is required and early intervention should be considered.
Topics: Humans; Intestinal Fistula; Drainage; Bile Ducts; Laparoscopy; Stents
PubMed: 38446721
DOI: 10.12659/AJCR.943020 -
Journal of Surgical Case Reports Feb 2024Since the early 1990's, laparoscopic cholecystectomy has become the gold standard for the treatment of symptomatic gallbladder disease. Although the incidence of...
Since the early 1990's, laparoscopic cholecystectomy has become the gold standard for the treatment of symptomatic gallbladder disease. Although the incidence of postoperative complications is generally lower with this approach, gallbladder perforation represents a serious risk that is among the most common complications of laparoscopic cholecystectomy. The sequalae that can follow iatrogenic perforation have not been well documented and only a few case reports exist in the current literature. In this paper we discuss two case reports of delayed perihepatic abscesses following prior laparoscopic cholecystectomy, ultimately resulting in fistulous tracts. The course of the disease is discussed along with the diagnostic workup and eventual successful management of the aforementioned complications. Treating enteric fistulae requires a systematic approach and is carried out in phases. Enteric fistula formation following laparoscopic cholecystectomy is a rare complication of retained gallstones that can present months to years following the index operation. Significant care should be taken to avoid perforation and all efforts should be made to retrieve stones if spillage occurs.
PubMed: 38434254
DOI: 10.1093/jscr/rjae071 -
Updates in Surgery Apr 2024The surgical treatment of acute necrotizing pancreatitis has significantly evolved in recent years with the advent of enhanced imaging techniques and minimally invasive...
The surgical treatment of acute necrotizing pancreatitis has significantly evolved in recent years with the advent of enhanced imaging techniques and minimally invasive surgery. Various minimally invasive techniques, such as video-assisted retroperitoneal debridement (VARD) and endoscopic transmural necrosectomy (ETN), have been employed in the management of acute necrotizing pancreatitis and are often part of step-up approaches. However, almost all reported step-up approaches only employ a fixed minimally invasive technique prior to open surgery. In contrast, we implemented different minimally invasive techniques during the treatment of acute pancreatitis based on the extent of pancreatic necrosis. For acute necrotizing pancreatitis of the pancreatic bed with or without extension into the left retroperitoneum, we performed mesocolon-preserving laparoscopic necrosectomy for debridment. The quantitative indication for pancreatic debridment in our institute has been described previously. For acute necrotizing pancreatitis of the pancreatic bed with or without extension into the left retroperitoneum, mesocolon-preserving laparoscopic necrosectomy was performed for debridment. To safeguard the mesocolon, the pancreatic bed was entered via the gastrocolic ligament, and the left retroperitoneum was accessed via the lateral peritoneal attachments of the descending colon. Of the 77 patients requiring pancreatic debridment, 41 patients were deemed suitable for mesocolon-preserving laparoscopic necrosectomy by multiple disciplinary team and informed consent was acquired. Of these 41 patients, 27 underwent percutaneous drainage, 10 underwent transluminal drainage, and 2 underwent transluminal necrosectomy prior to laparoscopic necrosectomy. Two patients (4.88%) died of sepsis, three patients (7.32%) required further laparotomic necrosectomy, and five patients (12.20%) required additional percutaneous drainage for residual infection. Three patients (7.32%) experienced duodenal fistula, all of which were cured through non-surgical treatments. Nineteen patients (46.34%) developed pancreatic fistula that persisted for over 3 weeks, with 17 being successfully treated non-surgically. The remaining two patients had pancreatic fistulas that lasted over 3 months; an internal drainage procedure has been planned for them. No patient developed colonic fistula. Mesocolon-preserving laparoscopic necrosectomy proved to be safe and effective in selected patients. It can serve as a supplementary procedure for step-up approaches or as an alternative to other debridment procedures such as VARD, ETN, and laparotomic necrosectomy.
Topics: Humans; Pancreatitis, Acute Necrotizing; Mesocolon; Acute Disease; Laparoscopy; Minimally Invasive Surgical Procedures; Pancreatic Fistula; Drainage; Debridement; Treatment Outcome
PubMed: 38429596
DOI: 10.1007/s13304-024-01773-y -
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 -
Journal of Laparoendoscopic & Advanced... Mar 2024To introduce laparoscopic neo-pancreaticogastrostomy (neo-PG) and investigate its application potential in total laparoscopic pancreaticoduodenectomy (TLPD). We... (Clinical Trial)
Clinical Trial
To introduce laparoscopic neo-pancreaticogastrostomy (neo-PG) and investigate its application potential in total laparoscopic pancreaticoduodenectomy (TLPD). We performed a single-center prospective single-arm trial to evaluate the feasibility and safety of neo-PG for its initial application in TLPD. The first 50 patients who were operated by a single surgeon and who underwent TLPD with neo-PG at our institution were recruited. The pre/intra/postoperation data were collected and analyzed. Twenty-nine male patients and 21 female patients from May 2022 to March 2023 were included. The mean operation time was 272.60 ± 47.30 minutes. The median PG time was 16 (15, 23) minutes. Six patients had delayed gastric emptying (DGE), and all underwent standard LPD. None of the patients had Grade B/C postoperative pancreatic fistula (POPF) or postoperative hemorrhage, or underwent reoperation. The median length of post-LPD hospital stay was 6 (6, 8) days. None of the patients died within 90 days after surgery. Nineteen cases were pathologically classified as pancreatic lesion, 6 cases as bile duct lesion, 18 cases as duodenal lesion, and 7 cases as ampullary lesion. The laparoscopic neo-PG is a simple, safe, and feasible pancreatic anastomosis that can be applied in TLPD. Pylorus-preserving LPD may decrease DGE rate. Further studies involving more surgeons are warranted to prove that our new technique may terminate POPF in TLPD.
Topics: Female; Humans; Male; Anastomosis, Surgical; Laparoscopy; Pancreatic Fistula; Pancreatic Neoplasms; Pancreaticoduodenectomy; Postoperative Complications; Prospective Studies; Retrospective Studies
PubMed: 38386987
DOI: 10.1089/lap.2023.0360 -
BMJ Case Reports Feb 2024
Topics: Humans; Gastric Fistula; Peptic Ulcer; Gastric Outlet Obstruction; Pyloric Stenosis; Duodenum
PubMed: 38383119
DOI: 10.1136/bcr-2023-259395 -
BMJ Case Reports Feb 2024A man in his 60s attended emergency for acute-onset abdominal pain and haematemesis. Requiring resuscitation, a CT abdomen/pelvis revealed a primary aortoenteric fistula...
A man in his 60s attended emergency for acute-onset abdominal pain and haematemesis. Requiring resuscitation, a CT abdomen/pelvis revealed a primary aortoenteric fistula actively bleeding into the duodenum. His background included a previous severe Q-fever infection and a heavy smoking history. Despite attempts at resuscitation and an emergent surgical attempt at haemostasis, the patient did not survive the massive gastrointestinal haemorrhage.Even in less severe cases, management of aortoenteric fistulas is tricky. Blood cultures and angiographic imaging are important investigations in guiding surgical approach. The pathology tends to have a significant rate of mortality even at tertiary-level vascular surgical centres.
Topics: Male; Humans; Vascular Fistula; Intestinal Fistula; Aortic Diseases; Tomography, X-Ray Computed; Gastrointestinal Hemorrhage
PubMed: 38378584
DOI: 10.1136/bcr-2023-258320