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Case Reports in Gastroenterology 2021Heyde's syndrome, which is caused by aortic stenosis and subsequent acquired von Willebrand factor deficiency, is a gastrointestinal bleeding disease. Gastrointestinal...
Long Survival after Gastrointestinal Bleeding in a New-Onset Heyde's Syndrome Patient Treated with Multiple Endoscopic Hemostatic Procedures and Repeated Transfusions after Aortic Valve Replacement.
Heyde's syndrome, which is caused by aortic stenosis and subsequent acquired von Willebrand factor deficiency, is a gastrointestinal bleeding disease. Gastrointestinal bleeding develops in patients with Heyde's syndrome, which may have a different prognosis from general gastrointestinal bleeding; thus, it is important to understand the clinical course. We report a 76-year-old Japanese female who underwent aortic mechanical valve replacement 1 year ago and presented with recurrent gastrointestinal bleeding in angiodysplasia of the sigmoid colon. Endoscopic interventions achieved hemostasis. However, 6 rebleeding events occurred due to a sigmoid colon ulcer and gastric and jejunal angiodysplasia 7 years after first hemostasis. The patient underwent multiple endoscopic hemostatic procedures (upper, lower, and balloon-assisted endoscopy) and repeated transfusions (total of 394 units of red blood cells). The intensive treatment contributed to the survival time of 10 years. In addition, we performed a literature review of the prognosis of patients with Heyde's syndrome.
PubMed: 34720829
DOI: 10.1159/000519004 -
Case Reports in Gastroenterology 2021A 77-year-old man presented to our hospital with epigastric pain. He had previously undergone hepatic left lateral segmentectomy, cholangiojejunostomy, and Roux-en-Y...
A 77-year-old man presented to our hospital with epigastric pain. He had previously undergone hepatic left lateral segmentectomy, cholangiojejunostomy, and Roux-en-Y reconstruction at 42 years of age for intrahepatic stones and liver abscesses. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed bile duct stones and intrahepatic bile duct dilation of the caudate lobe. Bile duct drainage for the caudate lobe was necessary; however, the volume of his caudate lobe was very small, making percutaneous transhepatic biliary drainage (PTBD) or endoscopic ultrasound-guided biliary drainage (EUS-BD) difficult. Therefore, we attempted laparotomy-assisted endoscopic biliary drainage. Under general anesthesia, an incision was made on the jejunum approximately 15 cm from the Y-leg anastomosis. An esophagogastroduodenoscope was directly inserted into the common hepatic duct anastomosed with the jejunum. The caudate lobe branch had severe stenosis, and the area upstream of the stenosis was filled with stones, sludge, and pus. The biliary stenosis was dilated using a balloon, and the stones were completely removed using a basket and a balloon catheter. There are various methods of biliary and pancreatic surgery and gastrointestinal reconstruction, and there are cases in which PTBD, EUS-BD, and endoscopic retrograde cholangiopancreatography (ERCP) with an enteroscope are difficult. In such cases, ERCP under laparotomy could be a good treatment option.
PubMed: 34720826
DOI: 10.1159/000515371 -
Cirugia Y Cirujanos 2021Cholecystectomy is one of the most performed abdominal surgical procedures, with approximately 1.5 million procedures performed annually in the United States of america....
BACKGROUND
Cholecystectomy is one of the most performed abdominal surgical procedures, with approximately 1.5 million procedures performed annually in the United States of america. Most of the biliary duct injuries during laparoscopic cholecystectomy are due to a wrong perception of the anatomy. Two thirds of postsurgical stenosis develop within two and three years after repairing and the other third in the following ten years.
OBJECTIVE
To show the adequacy for postoperative endoscopic access in Roux-in-Y biliodigestive diversions.
METHOD
The best technique to repair biliary duct injuries is the Roux-in-Y hepaticojejunostomy or choledochojejunostomy, from this procedure we propose a surgical technique that consists to perform a perpendicular anastomosis between the defunctionalized jejunum loop and the duodenum for later endoscopic access of the Roux-en-Y biliodigestive diversion.
RESULTS
The duodenal-jejunal perpendicular anastomosis procedure was performed in four patients with Roux-Y biliodigestive diversion.
CONCLUSIONS
With the technique that is proposed, we have that advantage of keeping the anastomosis permanently open due to its rhomboidal design and because of the pylorus is kept intact alkaline reflux would not be a problem.
Topics: Anastomosis, Roux-en-Y; Anastomosis, Surgical; Duodenum; Humans; Jejunum; Laparoscopy
PubMed: 34665179
DOI: 10.24875/CIRU.20000924 -
The Journal of International Medical... Sep 2021Duodenal cavernous haemangiomas are rare, benign disorders, and massive gastrointestinal (GI) bleeding is a rare clinical condition. The present case report describes a...
Duodenal cavernous haemangiomas are rare, benign disorders, and massive gastrointestinal (GI) bleeding is a rare clinical condition. The present case report describes a 50-year-old male patient who presented with severe, ongoing haematochezia. A peripheral blood smear at the time of admission showed significant anaemia, and haemoglobin level was 52 g/l (normal range, 120-175 g/l). Albumin level was also low at 28 g/l (normal range, 40-55 g/l). Standard computed tomography (CT) showed mural thickening and relative lumen stenosis in the ascending (fourth) portion of the duodenum. Contrast-enhanced CT using hypotonic solution revealed the lesions to be hypervascular haemangiomas. Laparotomy and segmental duodenum resection were performed, and the first jejunal limb was anastomosed using a side-to-end technique. Histopathological examination confirmed the diagnosis of cavernous haemangioma. The patient showed marked improvement during follow-up. The present case findings emphasize that duodenal haemangioma is possible without a history of chronic anaemia, and should remain a consideration in differential diagnosis for patients presenting with massive GI bleeding. CT is useful for preoperative diagnosis of massive bleeding, and surgery with segmental resection is usually curative.
Topics: Anemia; Diagnosis, Differential; Duodenum; Gastrointestinal Hemorrhage; Hemangioma, Cavernous; Humans; Male; Middle Aged
PubMed: 34590919
DOI: 10.1177/03000605211010091 -
Journal of Pediatric Surgery Sep 2022No study has evaluated complication rates of the combined operations needed for temporary Enterostomy compared to primary anastomosis in the treatment of Jejunoileal...
PURPOSE
No study has evaluated complication rates of the combined operations needed for temporary Enterostomy compared to primary anastomosis in the treatment of Jejunoileal Atresia. Therefore the aim of this study is: 1) to compare the occurrence of severe postoperative complications (defined as Clavien-Dindo ≥III within 30 days) and 2) to compare the occurrence of different short- and long-term complications following treatment for Jejunoileal atresia either by primary anastomosis or the combined Enterostomy procedures.
METHODS
All consecutive neonates treated for Jejunoileal Atresias between January 1998 and February 2021 at our tertiary academic centres were retrospectively included. Perioperative characteristics and severity of postoperative complications (Clavien-Dindo) were extracted and evaluated, using chi-squared statistics, following each operation per treatment.
RESULTS
Eighty patients were included of whom 48 (60%) received a primary anastomosis and 32 (40%) an Enterostomy. Perioperative baseline characteristics were comparable, apart from significantly more patients with a gastroschisis and significantly less patients with jejunum atresia in the Enterostomy group. Our results showed that 1) significantly (p ≤ 0.01) more CD ≥III occur following treatment by Enterostomy. 2) Both short-term (surgical site infection, wound dehiscence) and long-term (short bowel syndrome, adhesive bowel obstruction) complications occurred significantly more in those treated by Enterostomy. We showed no significant difference in anastomotic leakage/stenosis and mortality rates between both treatment strategies.
CONCLUSION
Although perioperative factors might necessitate an Enterostomy, we advise a low threshold for performing a primary anastomosis when in doubt, taking into account the double risk of major complications found in patients treated with a temporary Enterostomy.
Topics: Anastomosis, Surgical; Enterostomy; Humans; Infant, Newborn; Intestinal Atresia; Postoperative Complications; Retrospective Studies; Short Bowel Syndrome
PubMed: 34429189
DOI: 10.1016/j.jpedsurg.2021.07.021 -
The Journal of International Medical... Jul 2021Bilioenteric anastomotic stricture is a serious complication following choledochojejunostomy. Some patients develop intrahepatic lithiasis and biliary tract infection...
OBJECTIVE
Bilioenteric anastomotic stricture is a serious complication following choledochojejunostomy. Some patients develop intrahepatic lithiasis and biliary tract infection without dilation of the intrahepatic bile duct. The present study was performed to investigate the safety and efficacy of laparoscopy combined with choledochoscopy in patients with bilioenteric anastomotic stricture with access via the jejunal loops.
METHODS
The data of 10 patients (7 men and 3 women; mean age, 60.8 ± 9.7 years; age range, 51-76 years) with potential bilioenteric anastomotic stricture without dilation of the intrahepatic bile duct from January 2015 to December 2019 were retrospectively reviewed.
RESULTS
All 10 patients underwent surgery, and their clinical parameters were recorded. The mean surgery time was 181.5 ± 35.4 minutes, and the mean estimated blood loss was 32.0 ± 15.5 mL. No patients developed serious complications during the perioperative period. The short-term outcome analysis at 12 months indicated that the stenosis had been effectively dilated and that the liver function had improved.
CONCLUSIONS
The results of the present study demonstrated that laparoscopy combined with choledochoscopy with access via the jejunal loops is feasible in the treatment of bilioenteric anastomotic stricture and intrahepatic lithiasis.
Topics: Aged; Bile Ducts, Intrahepatic; Biliary Tract Surgical Procedures; Constriction, Pathologic; Female; Humans; Laparoscopy; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 34325568
DOI: 10.1177/03000605211034542 -
Parasite (Paris, France) 2021Hilar biliary duct stricture may occur in hepatic cystic echinococcosis (CE) patients after endocystectomy. This study aimed to explore diagnosis and treatment...
AIM
Hilar biliary duct stricture may occur in hepatic cystic echinococcosis (CE) patients after endocystectomy. This study aimed to explore diagnosis and treatment modalities.
METHODS
Clinical data of 26 hepatic CE patients undergoing endocystectomy who developed postoperative hilar biliary duct stricture were retrospectively analyzed and were classified into three types: type A, type B, and type C. Postoperative complications and survival time were successfully followed up.
RESULTS
Imaging showed biliary duct stenosis, atrophy of ipsilateral hepatic lobe, reactive hyperplasia, hepatic hilum calcification, and dilation or discontinuity of intrahepatic biliary duct. All patients received partial hepatectomy to resect residual cyst cavity and atrophic liver tissue, and anastomosis of hepatic duct with jejunum or common bile duct exploration was applied to handle hilar biliary duct stricture. Twenty-five patients were successfully followed up. Among type A patients, one patient died of organ failure, and upper gastrointestinal bleeding and liver abscess occurred in one patient. Moreover, calculus of intrahepatic duct was found in one type B and type C patient.
CONCLUSION
Long-term biliary fistula, infection of residual cavity or obstructive jaundice in hepatic CE patients after endocystectomy are possible indicators of hilar bile duct stricture. Individualized and comprehensive treatment measures, especially effective treatment of residual cavity and biliary fistula, are optimal to avoid serious hilar bile duct stricture.
Topics: Biliary Tract Surgical Procedures; Constriction, Pathologic; Echinococcosis; Humans; Liver; Retrospective Studies
PubMed: 34142953
DOI: 10.1051/parasite/2021051 -
Jornal Vascular Brasileiro Mar 2021The purpose of this article is to report the case of a 53-year-old black man, with no previous comorbidities, who presented 48 days after a confirmed diagnosis of...
The purpose of this article is to report the case of a 53-year-old black man, with no previous comorbidities, who presented 48 days after a confirmed diagnosis of COVID-19, complaining of an initially insidious epigastric pain that had progressed to severe pain radiating to the interscapular vertebral region, with hyporexia and episodes of projectile vomiting, with no nausea or fever. Laboratory tests revealed no signs of acute infection or pancreatic injury. Abdominal computed tomography showed dilated, fluid-filled small bowel loops with thickened walls. After clinical treatment, the patient developed persistent abdominal pain. An exploratory laparotomy was performed, finding two sites of small bowel stenosis, with no extrinsic cause, and signs of local ischemia and considerable distension of jejunal and ileal loops. After enterectomy and side-to-side enteroanastomosis, the patient recovered satisfactorily and was discharged with a prescription for oral anticoagulants for outpatient use.
PubMed: 34093678
DOI: 10.1590/1677-5449.200105 -
International Journal of Surgery Case... Jun 2021In patients who underwent pancreatoduodenectomy for management of Chronic pancreatitis, early and late anastomotic failure can occur [1]. Nevertheless, taking into...
INTRODUCTION
In patients who underwent pancreatoduodenectomy for management of Chronic pancreatitis, early and late anastomotic failure can occur [1]. Nevertheless, taking into consideration that most pancreatic head resections are performed for malignant disease with poor prognosis, long term pancreatico-jejunal anastomotic durability has not been well examined; similarly, the management of its stenosis has not been well assessed [1].
CASE
Here we present a case of a 69 years old male patient with history of chronic alcoholic pancreatitis and ampullary fibrosis managed by pancreatico-duodenectomy presenting for 10 years delayed onset of recurrent acute pancreatitis with signs of pancreatico-jejunal anastomotic stenosis, managed surgically with revision of pancreatico-jejunal anastomosis.
CONCLUSION
Our case report might hold strongly for bringing up a purposeful approach, and be an insight to take into consideration in approaching pancreatic anastomosis, especially when pancreatic resections are utilized for treating benign pathologies.
PubMed: 34090188
DOI: 10.1016/j.ijscr.2021.106001 -
Medicine May 2021Syncope often occurs in patients with advanced head and neck cancers due to the stimulation of the autonomic nervous system by the tumor. Here, we describe a case of...
RATIONALE
Syncope often occurs in patients with advanced head and neck cancers due to the stimulation of the autonomic nervous system by the tumor. Here, we describe a case of frequent syncopal episodes after laryngopharyngectomy for hypopharyngeal cancer. As all syncopal episodes were observed during the forenoon, we also evaluated the heart rate variability using ambulatory electrocardiography to determine why the syncopal episodes occurred during a specified period of the day.
PATIENT CONCERNS
A 73-year-old Japanese man who underwent laryngopharyngectomy for recurrent hypopharyngeal cancer started experiencing frequent episodes of loss of consciousness that occurred during the same time period (10:00-12:00). He had never experienced syncopal episodes before the operation. From 23 to 41 days postoperatively, he experienced 9 syncopal episodes that occurred regardless of his posture.
DIAGNOSES
Pharyngo-esophagoscopy revealed an anastomotic stricture between the free jejunum graft and the upper esophagus. Swallowing videofluoroscopy confirmed the dilatation of the jejunal autograft and a foreign body stuck on the oral side of the anastomosis. Contrast-enhanced computed tomography revealed that the carotid artery was slightly compressed by the edematous free jejunum. The patient was diagnosed with carotid sinus syndrome (CSS) as the free jejunum was dilated when consuming breakfast, which may have caused carotid sinus hypersensitivity and induced a medullary reflex.
INTERVENTIONS
Administration of disopyramide was effective in preventing syncope. Heart rate variability analysis using ambulatory electrocardiography showed that parasympathetic dominancy shifted to sympathetic dominancy during 10:00 to 12:00. The significant time regularity of the syncopal episodes may have been affected by modified diurnal variation in autonomic tone activity.
OUTCOMES
After the surgical release and re-anastomosis of the pharyngoesophageal stenosis via an open-neck approach, no recurrent episodes of syncope were reported.
LESSONS
We reported a case of frequent syncopal episodes limited to the forenoon due to CSS after surgery for hypopharyngeal carcinoma. The patient was treated with anticholinergics followed by the release and re-anastomosis of the pharyngoesophageal stenosis. When syncope occurs after surgery for head and neck lesions, CSS due to postoperative structural changes should be considered as a differential diagnosis of syncope.
Topics: Aged; Anastomosis, Surgical; Breakfast; Carotid Sinus; Deglutition; Disopyramide; Electrocardiography; Esophageal Stenosis; Esophagus; Humans; Hypopharyngeal Neoplasms; Laryngectomy; Male; Pharyngectomy; Pharynx; Syncope; Syndrome
PubMed: 34011078
DOI: 10.1097/MD.0000000000025959