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Cureus Apr 2023Marginal ulcers are a late complication of gastric bypass surgery. A marginal ulcer is a term for ulcers that develop at the margins of a gastrojejunostomy, primarily...
Marginal ulcers are a late complication of gastric bypass surgery. A marginal ulcer is a term for ulcers that develop at the margins of a gastrojejunostomy, primarily on the jejunal side. A perforated ulcer involves the entire thickness of an organ, creating an opening on both surfaces. We will present an intriguing case of a 59-year-old Caucasian female who arrived at the emergency department with diffused chest and abdominal pain that began in her left shoulder and went down to the right lower quadrant area. The patient was in visible pain with restlessness, and her abdomen was moderately distended. The computed tomography (CT) showed possible perforation in the gastric bypass surgery area, but the results were inconclusive. The patient had laparoscopic cholecystectomy ten days prior, and the pain began right after surgery. The patient underwent an open abdominal exploratory surgery, with the closure of the perforated marginal ulcer. The fact that the patient had undergone another surgery and had pain immediately afterward also obscured the diagnosis. This case shows the rare presentation of the patientäs diverse signs and symptoms and inconclusive reports that led to the open abdominal exploratory surgery that finally confirmed the diagnosis. This case highlights the importance of a thorough past medical history, including surgical history. The past surgical history led the team to zone in on the gastric bypass area, leading to an accurate differential diagnosis.
PubMed: 37252481
DOI: 10.7759/cureus.38127 -
International Journal of Surgery Case... Jun 2023Aortoenteric fistulas (AEF) are infrequent malignant complications of abdominal aortic aneurysms (AAA). We present a unique case of a patient with recurring AAA...
INTRODUCTION
Aortoenteric fistulas (AEF) are infrequent malignant complications of abdominal aortic aneurysms (AAA). We present a unique case of a patient with recurring AAA fistulisations.
PRESENTATION OF CASE
During oncologic treatment, a 63-year-old male was incidentally diagnosed with infrarenal AAA and assigned follow-up but was hospitalised with anaemia and elevated inflammation markers 14 months later. A CT-angiography scan detected an AAA enlargement, but no extravasation (negative FOBT). Another CTA-scan displayed a pseudoaneurysm and ruptured AAA 10 days later. During a total laparotomy, an enlarged pulsating inflammatory conglomerate without active leakage was detected, with a 2 cm duodenal defect (PAEF). The AAA was resected and replaced by a linear silver-coated Dacron graft. 3,5 years after PAEF, the patient was hospitalised with abdominal pain and haematemesis. He underwent gastroscopies, coloscopies, CT- and CTA-scans - all without significant findings. Only after the capsule-endoscopy detected a jejunal ulcer, the PET-scan visualized active regions in the jejunum and the aortic graft. A total laparotomy was performed; previous stapler-lined jejuno-jejunal anastomosis had adhered to the silver-coated Dacron graft (SAEF). The Dacron graft was removed and replaced with a linear xenograft from bovine pericardium.
DISCUSSION
No evidence-based recommendations prefer endovascular aneurysm repair (EVAR) over open repair, leaving the strategy dependent on local preferences. Whether EVAR or initial xenograft usage would have shown surpassing results, is speculative, as no graft material/type has proved long-term pre-eminence.
CONCLUSIONS
This case displays AEF's complex treatment and challenging diagnosis. Multimodal diagnostic and strategic approaches should be considered for best patient outcome.
PubMed: 37220677
DOI: 10.1016/j.ijscr.2023.108344 -
Revista Espanola de Enfermedades... May 2023A 61-year-old woman admitted for epigastric abdominal pain, three months of evolution, worsens after ingestion, associating abdominal distension and constipation....
A 61-year-old woman admitted for epigastric abdominal pain, three months of evolution, worsens after ingestion, associating abdominal distension and constipation. Physical examination: abdominal pain and distension in the mesogastric zone. Blood tests: slight increase in C-reactive protein; abdominal X-ray: the small bowel dilatation; computed tomography scan: small bowel obstruction due to intussusception. An exploratory laparotomy was performed, confirming a mechanical intestinal occlusion secondary to 5 centimeters jejunal intussusception (image 3); It was execute an intestinal resection with adequate margins and an anisoperistaltic mechanical side-to-side anastomosis. Correct postoperative evolution; hospital discharge on the sixth day. Pathology report: polypoid intussusception, 4.3x3.3 centimeters, superficial ulceration, edema, chronic inflammation; resection margins without alterations.
PubMed: 37204085
DOI: 10.17235/reed.2023.9698/2023 -
JPGN Reports Nov 2022The pseudomembranous inflammatory process is a process characterized by the formation of a white membrane-like exudate over colonic mucosa and is mainly caused by...
The pseudomembranous inflammatory process is a process characterized by the formation of a white membrane-like exudate over colonic mucosa and is mainly caused by toxin. The stool culture is considered to be the gold standard and is technically challenging and is not performed routinely. There are some reports of duodenitis and proximal jejunitis in horses attributed to infection. Hereby, we report a case of pseudomembranous duodenitis in a seven-year-old boy with a complaint of severe abdominal pain. Upper endoscopy revealed patchy ulceration and a white membrane in the duodenum. A biopsy was taken with the impression of a fungal infection. The histological study revealed crater-like ulceration with upward exudation of mucus consistent with the pseudomembranous inflammatory process. To the best of our knowledge, pseudomembranous duodenitis is not reported in the human as yet.
PubMed: 37168466
DOI: 10.1097/PG9.0000000000000260 -
Clinical Journal of Gastroenterology Aug 2023Although free-flap jejunal reconstruction is frequently performed after cervical esophagectomy for cervical esophageal cancer, the procedure after gastric surgery has...
Segmental cervical esophagectomy with free jejunal flap reconstruction for cervical esophageal cancer in patients with previous history of gastric surgery: a report of two cases.
Although free-flap jejunal reconstruction is frequently performed after cervical esophagectomy for cervical esophageal cancer, the procedure after gastric surgery has not been reported. We encountered two patients with esophageal cancer and previous gastric surgeries who eventually underwent segmental esophagectomy with free-flap jejunal reconstruction. Case one involved a 75-year-old man who underwent abdominal abscess and duodenal ulcer perforation surgeries (abdominal drainage and subsequent gastrojejunal bypass). A type 0-IIa tumor was located posterior to the cervical esophagus's right wall, 21 cm from the incisor, without lymph node swelling or distant metastasis. The left lobe of the thyroid gland was mobilized to ensure an oral resection margin. Severe abdominal adhesions required careful adhesiolysis to harvest the jejunum (20 cm long) 40 cm from the jejunojejunostomy. An end-to-side and side-to-end esophagojejunostomy were performed for the proximal and distal ends, respectively. Case two involved a 75-year-old male with a history of distal gastrectomy with Billroth I reconstruction for early gastric cancer. A submucosal tumor-like lesion was located on the cervical esophageal wall on the left side, 21 cm from the incisor. The distal esophagus required additional segmental resection because the anal resection line was close to the tumor. Jejunum (10 cm long) 30 cm from Ligament of Treitz was harvested. An end-to-side and end-to-end esophagojejunostomy for the proximal and distal ends, respectively, was performed. This surgery requires a thorough preoperative examination to ensure an adequate surgical margin and a careful free-flap harvest based on post-gastric surgery anatomy.
Topics: Male; Female; Humans; Aged; Esophagectomy; Jejunum; Plastic Surgery Procedures; Esophageal Neoplasms; Uterine Cervical Neoplasms
PubMed: 37165274
DOI: 10.1007/s12328-023-01804-y -
European Journal of Pediatric Surgery... Jan 2023Nonhypertrophic idiopathic pyloric stenosis (NHIPS) is a rare occurrence in children. It could be related to peptic ulcers, but a definitive cause is yet to be found....
Nonhypertrophic idiopathic pyloric stenosis (NHIPS) is a rare occurrence in children. It could be related to peptic ulcers, but a definitive cause is yet to be found. Treatment is a matter of debate, ranging from medical to surgical. We report the case of a 15-year-old boy suffering postprandial vomiting and weight loss in the previous 3 months. NHIPS was diagnosed and successfully treated with several sessions of endoscopic pyloric dilation and jejunal feeding. In association with a multidisciplinary approach, endoscopic dilation should be considered as a first-line treatment to avoid surgery.
PubMed: 37152680
DOI: 10.1055/s-0043-57040 -
Molecular Pharmaceutics Jun 2023The intestine is an organ responsible for the absorption and metabolism of orally administered drugs. To predict pharmacokinetics behavior in the small intestine, it is...
The intestine is an organ responsible for the absorption and metabolism of orally administered drugs. To predict pharmacokinetics behavior in the small intestine, it is necessary to examine the human intestinal expression profiles of the genes related to drug absorption, distribution, metabolism, and excretion (ADME). In this study, to obtain more accurate expression profiles in various regions of the human intestine, biopsy samples were collected from endoscopically noninflamed mucosa of the duodenum, jejunum, ileum, colon, and rectum from Japanese including Crohn's disease or ulcerative colitis patients, and both RNA-seq and quantitative proteomics analyses were performed. We also analyzed the expression of drug-metabolizing enzymes (cytochromes P450 (CYPs) and non-CYP enzymes), drug transporters, and nuclear receptors. Overall, the mRNA expression levels of these ADME-related genes correlated highly with the protein expression levels. The characteristics of the expression of ADME-related genes differed significantly between the small and large intestines, including the expression levels of CYP enzymes, which were higher and lower in the small and large intestines, respectively. Most CYPs were expressed dominantly in the small intestine, especially the jejunum, but were rarely expressed in the large intestine. On the other hand, non-CYP enzymes were expressed in the large intestine but at lower expression levels than in the small intestine. Moreover, the expression levels of drug metabolizing enzyme genes differed even between the proximal and distal small intestine. Transporters were expressed most highly in the ileum. The data in the present study will enhance understanding of the intestinal ADME of drug candidates and would be useful for drug discovery research.
Topics: Humans; Proteomics; Transcriptome; Intestines; Intestine, Small; Cytochrome P-450 Enzyme System; Membrane Transport Proteins; Intestinal Mucosa
PubMed: 37132462
DOI: 10.1021/acs.molpharmaceut.2c01002 -
Cureus Mar 2023With the growing obesity epidemic, surgeons are performing more bariatric surgeries, including Roux-en-Y gastric bypass (RYGB) reversals. Although studies have...
With the growing obesity epidemic, surgeons are performing more bariatric surgeries, including Roux-en-Y gastric bypass (RYGB) reversals. Although studies have identified indications for RYGB reversals, little information is available about the long-term effects of the procedure. We wish to highlight a case with long-term complications of RYGB reversal and subsequent management. We present a patient with multiple abdominal surgeries including an RYGB reversal that was complicated by a stenosed gastrogastric anastomosis that caused several gastrojejunostomy ulcerations and malnutrition secondary to intractable nausea and vomiting. A 51-year-old female with a complex surgical history including a simple RYGB reversal in 2019 presented to the ER with complaints of abdominal pain, uncontrolled diarrhea, and an inability to tolerate food for six months. Workup revealed multiple marginal ulcers at the remnant jejunum attached to the gastric pouch, and a stenosed gastrogastrostomy placed high along the cardia of the remnant stomach and pouch. This stenosis resulted in a nonfunctional, nondependent reversal that only drained when filled. Ultimately, a large gastrotomy was performed, and an endoscope was utilized to identify a small pinhole connection between the patient's pouch and the remnant stomach along the superomedial portion of the remnant stomach's fundus. The anvil of a 60 mm GIA black load stapler was guided through and fired twice to come across the stricture. After the stricture was completely crossed, the endoscope was passed through, confirming that it was widely patent. The postoperative course was uneventful, and the patient was discharged with total parenteral nutrition (TPN) on postoperative day 15 before being discontinued at her follow-up visit. She reported that she had been gaining weight and eating well. Long-term complications following RYGB reversal are not well-discussed in the literature. This case offers insight into such complications, discusses the surgical technique utilized to fix them, and calls for further research on the topic to better inform surgeons and patients alike.
PubMed: 37090345
DOI: 10.7759/cureus.36477 -
Obesity Surgery Jun 2023During the laparoscopic Roux-en-Y gastric bypass procedure, closing mesentery or not was still controversial according to preexisted studies. So, the current... (Meta-Analysis)
Meta-Analysis Review
During the laparoscopic Roux-en-Y gastric bypass procedure, closing mesentery or not was still controversial according to preexisted studies. So, the current meta-analysis aimed to compare the outcome of closure versus non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass. Fifteen studies were included, enrolling 53,488 patients. Based on the outcome of analysis, regarding internal hernia, Petersen space's IH, jejunal mesenteric's IH, hospital days, and reoperation, closure of the mesentery was better than non-closure. Besides, small bowel obstruction, anastomosis ulcer, stenosis, leakage, bleeding, gastrointestinal perforation, and postoperative BMI of patients show no difference between non-closure and closure.
Topics: Humans; Gastric Bypass; Obesity, Morbid; Postoperative Complications; Hernia, Abdominal; Laparoscopy; Mesentery; Retrospective Studies
PubMed: 37081253
DOI: 10.1007/s11695-023-06594-3 -
ACG Case Reports Journal Mar 2023
PubMed: 37021279
DOI: 10.14309/crj.0000000000000969