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World Journal of Gastroenterology Jan 2014To examine the effect of intra-gastric triacetin on both upper gastrointestinal motility and proximal gastric tone in conscious dogs.
AIM
To examine the effect of intra-gastric triacetin on both upper gastrointestinal motility and proximal gastric tone in conscious dogs.
METHODS
Three beagle dogs under sedation were surgically implanted with gastrocutaneous fistula in the gastric body and force transducers in the gastric antrum and duodenum. Beginning at week-2 after insertion, the animals were either fasted for 24 h or fed a liquid meal 2-3 h before the experiment. With the animals fully conscious, a polyethylene bag was inserted into the proximal stomach through the gastrocutaneous fistula, followed by 15 min of air inflation (minimal distending pressure of +2 mmHg) and then 20 mL of a low-, mid- or high-concentration triacetin solution (0.5%, 1.0% and 2.0%) or warm water (vehicle control). The proximal stomach receptive volume and gastric antral and duodenal contractions were measured over 10 min. The experiment was repeated twice per week over several months, with each animal receiving at least one infusion of the various triacetin solutions and the vehicle at different times. Intergroup differences were assessed by ANOVA and Bonferroni-Dunn post-hoc testing.
RESULTS
Intra-gastric infusion of mid- and high-concentration triacetin induced an increase in the proximal stomach receptive volume, and the average increase induced by the high-concentration at 0-4 min after infusion was significantly greater than that induced by the vehicle control (62.4 ± 9.8 vs 18.4 ± 4.7, P < 0.01). The mid- and high-concentration triacetin also produced a temporary inhibition of the gastric antral contractions at 2 min after infusions; however, only the fasted group showed triacetin-induced antral contractile inhibition that was significantly greater than that in the vehicle control group (P < 0.05). In addition, only the fasted group showed a high-concentration triacetin-induced increase in duodenal contractions at 9-10 min that was significantly different from that in the vehicle control group (P < 0.05).
CONCLUSION
Intra-gastric infusion of 1.0%-2.0% triacetin delays gastric emptying by increasing proximal stomach receptive volume, temporarily inhibiting gastric antral contractions and facilitating duodenal contractions.
Topics: Animals; Consciousness; Dogs; Dose-Response Relationship, Drug; Duodenum; Female; Gastric Emptying; Gastrointestinal Motility; Gastrointestinal Transit; Pyloric Antrum; Time Factors; Triacetin
PubMed: 24574778
DOI: 10.3748/wjg.v20.i4.1054 -
Asian Journal of Surgery May 2022
Topics: Duodenal Diseases; Humans; Intestinal Fistula
PubMed: 35341681
DOI: 10.1016/j.asjsur.2022.01.100 -
BMJ Case Reports Jan 2021Intraductal papillary mucinous neoplasms (IPMNs) are mucin-secreting cystic neoplasm of pancreas. They have a malignant potential. They are usually localised to the...
Intraductal papillary mucinous neoplasms (IPMNs) are mucin-secreting cystic neoplasm of pancreas. They have a malignant potential. They are usually localised to the pancreas but occasionally can involve surrounding structures (1.9%-6.6%), like bile duct and duodenum, and are labelled as IPMN with invasion. Jaundice as a manifestation of IPMN is not common (4.5%). It can present as jaundice as a result of invasion of common bile duct (CBD) resulting in stricture formation or uncommonly as a result of fistulising to CBD with resultant obstruction of CBD by thick mucin secreted by this tumour. As only few cases (around 23) of mucin-filled CBD are reported in the literature. We are presenting our experience in dealing a rare case of obstructive jaundice caused by IPMN fistulising into CBD, highlighting the difficulties faced in managing such case, especially with regards to biliary drainage and what can be the optimum management in such cases.
Topics: Adenocarcinoma, Mucinous; Anti-Bacterial Agents; Biliary Fistula; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Common Bile Duct; Drainage; Female; Humans; Jaundice, Obstructive; Middle Aged; Mucins; Neoplasm Invasiveness; Pancreas; Pancreatic Fistula; Pancreatic Neoplasms; Stents; Treatment Outcome
PubMed: 33431462
DOI: 10.1136/bcr-2020-238363 -
Journal of Physiology and Pharmacology... Feb 2024Using duodenocolic fistula in rats, this study attempts to highlight the particular cytoprotection aspects of the healing of fistulas and therapy potential of the stable...
Using duodenocolic fistula in rats, this study attempts to highlight the particular cytoprotection aspects of the healing of fistulas and therapy potential of the stable gastric pentadecapeptide BPC 157, a cytoprotection mediator (i.e. upgrading minor vessels to induce healing at both fistula's sides). Upon duodenocolic fistula creation (two 'perforated' lesions put together) (assessed at 3, 6, 9, 12, and 15 min), BPC 157, given locally at the fistula, or intragastrically (10 μg/kg, 10 ng/kg), rapidly induces vessel 'recruitment', 'running' toward the defect, simultaneously at duodenum and colon, providing numerous collaterals and branching. The mRNA expression studies done at that time provided strongly elevated (nitric oxide synthase 2) and decreased (cyclooxygenase-2, vascular endothelial growth factor A, nitric oxide synthase (NOS)-1, NOS-3, nuclear factor-kappa-B-activating protein) gene expression. As therapy, rats with duodenocolic fistulas, received BPC 157 10 μg/kg, 10 ng/kg, per-orally, in drinking water till sacrifice, or alternatively, intraperitoneally, first application at 30 min after surgery, last at 24 h before sacrifice, at day 1, 3, 7, 14, 21, and 28. Controls exhibited both defects persisting, continuous fistula leakage, diarrhea, continuous weight loss, advanced adhesion formation and intestinal obstruction. Contrary, all BPC 157-treated rats have closed both defects, duodenal and colonic, no fistula leakage (finally, maximal instilled volume corresponds to healthy rats), no cachexia, the same weight as before surgery, no diarrhea, markedly less adhesion formation and intestinal passage obstruction. Thus, BPC 157 regimens resolve the duodenal/colon lesions and duodenocolic fistulas in rats, and rapid vessels recovery appears as the essential point in the implementation of the cytoprotection concept in the fistula therapy.
Topics: Rats; Animals; Rats, Wistar; Vascular Endothelial Growth Factor A; Cytoprotection; Fistula; Peptide Fragments; Nitric Oxide Synthase; Anti-Ulcer Agents; Proteins
PubMed: 38583442
DOI: 10.26402/jpp.2024.1.09 -
Journal of Medical Case Reports Jul 2020A retroperitoneal abscess caused by duodenal perforation is a relatively rare disease clinically. We report the case of a patient with a local high-density shadow at the... (Review)
Review
INTRODUCTION
A retroperitoneal abscess caused by duodenal perforation is a relatively rare disease clinically. We report the case of a patient with a local high-density shadow at the head of the retroperitoneal pancreas.
CASE PRESENTATION
A 28-year-old Chinese man presented with fever and abdominal pain after overeating and heavy drinking. On physical examination, he had mild tenderness in his upper abdomen. Laboratory examination results showed a white blood cell count of 24.06 10/L and a neutrophil absolute value of 18.81 10/L, and a computed tomography scan showed an irregular soft tissue mass with uneven enhancement of the cystic wall in the retroperitoneal space. Gastroscopy showed that there was a fistula in the anterior wall of the duodenal bulb. Endoscopic anastomosis clip system (over-the-scope clip) of the duodenal fistula was performed successfully. After the operation, nasal feeding was provided with a nutrition tube, and empiric anti-infection, acid-inhibiting, and stomach-protecting treatments were administered. Our patient's body temperature gradually returned to normal, and his abdominal pain decreased.
CONCLUSIONS
A retroperitoneal abscess caused by duodenal perforation can be diagnosed by clinical symptoms and abdominal computed tomography imaging. The choice of treatment should be based on accurate and timely clinical and imaging data.
Topics: Abdomen; Abdominal Abscess; Abscess; Adult; Duodenal Diseases; Duodenum; Humans; Male
PubMed: 32678002
DOI: 10.1186/s13256-020-02393-x -
Revista Espanola de Enfermedades... May 2020We present the case of a 80 years-old male patient who underwent a CT angiogram due to hematemesis and hypovolemic shock. An upper gastrointestinal endoscopy revealed a...
We present the case of a 80 years-old male patient who underwent a CT angiogram due to hematemesis and hypovolemic shock. An upper gastrointestinal endoscopy revealed a large clot that closed the antrum and abundant red blood in the pyloric-antrum region. Sclerosis was performed blindly and the bleeding origin was not identified and the success of the sclerosis could not be evaluated. A primary aorta-duodenal fistula was observed by CT angiography, which was treated with an endograft and femoro-femoral bypass. The patient was discharged 14 days after admission.
Topics: Aged, 80 and over; Aortic Diseases; Duodenal Diseases; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Male; Vascular Fistula
PubMed: 32338019
DOI: 10.17235/reed.2020.6427/2019 -
Digestion 2007
Topics: Aged; Biliary Fistula; Cholelithiasis; Duodenal Obstruction; Female; Gastric Outlet Obstruction; Gastroscopy; Humans; Syndrome
PubMed: 17630474
DOI: 10.1159/000104975 -
World Journal of Gastroenterology Dec 2015This paper reports our experience with a new over-the-scope clip in the setting of recurrent bleeding and oesophageal fistula. We treated five patients with the...
This paper reports our experience with a new over-the-scope clip in the setting of recurrent bleeding and oesophageal fistula. We treated five patients with the over-the-scope Padlock Clip™. It is a nitinol ring, with six inner needles preassembled on an applicator cap, thumb press displaced by the Lock-It™ delivery system. The trigger wire is located alongside the shaft of the endoscope, and does not require the working channel. Three patients had recurrent bleeding lesions (bleeding rectal ulcer, post polypectomy delayed bleeding and duodenal Dieulafoy's lesion) and two patients had a persistent respiratory-esophageal fistula. In all patients a previous endoscopic attempt with standard techniques had been useless. All procedures were conducted under conscious sedation but for one patient that required general anaesthesia due to multiple comorbidities. We used one Padlock Clip™ for each patient in a single session. Simple suction was enough in all of our patients to obtain tissue adhesion to the instrument tip. A remarkably short application time was recorded for all cases (mean duration of the procedure: 8 min). We obtained technical and immediate clinical success for every patient. No major immediate, early or late (within 24 h, 7 d or 4 wk) adverse events were observed, over follow-up durations lasting a mean of 109.4 d. One patient, treated for duodenal bulb bleeding from a Dieulafoy's lesion, developed signs of mild pancreatitis 24 h after the procedure. The new over-the-scope Padlock Clip™ seems to be simple to use and effective in different clinical settings, particularly in "difficult" scenarios, like recurrent bleeding and respiratory-oesophageal fistulas.
Topics: Aged; Aged, 80 and over; Alloys; Equipment Design; Esophageal Fistula; Esophagoscopes; Esophagoscopy; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Operative Time; Postoperative Complications; Surgical Instruments; Time Factors; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26730172
DOI: 10.3748/wjg.v21.i48.13587 -
Surgery Dec 2020Necrotizing pancreatitis survivors develop complications beyond infected necrosis that often require invasive intervention. Remarkably few data have cataloged these late... (Observational Study)
Observational Study
BACKGROUND
Necrotizing pancreatitis survivors develop complications beyond infected necrosis that often require invasive intervention. Remarkably few data have cataloged these late complications after acute necrotizing pancreatitis resolution. We sought to identify the types and incidence of complications after necrotizing pancreatitis.
DESIGN
An observational study was performed evaluating 647 patients with necrotizing pancreatitis captured in a single-institution database between 2005 and 2017 at a tertiary care hospital. Retrospective review and analysis of newly diagnosed conditions attributable to necrotizing pancreatitis was performed. Exclusion criteria included the following: death before disease resolution (n = 57, 9%) and patients lost to follow-up (n = 12, 2%).
RESULTS
A total of 578 patients were followed for a median of 46 months (range, 8 months to 15 y) after necrotizing pancreatitis. In 489 (85%) patients 1 or more complications developed and included symptomatic disconnected pancreatic duct syndrome (285 of 578, 49%), splanchnic vein thrombosis (257 of 572, 45%), new endocrine insufficiency (195 of 549, 35%), new exocrine insufficiency (108 of 571, 19%), symptomatic chronic pancreatitis (93 of 571, 16%), incisional hernia (89 of 420, 21%), biliary stricture (90 of 576, 16%), chronic pain (44 of 575, 8%), gastrointestinal fistula (44 of 578, 8%), pancreatic duct stricture (30 of 578, 5%), and duodenal stricture (28 of 578, 5%). During the follow-up period, a total of 340 (59%) patients required an invasive intervention after necrotizing pancreatitis resolution. Invasive pancreatobiliary intervention was required in 230 (40%) patients.
CONCLUSION
Late complications are common in necrotizing pancreatitis survivors. A broad variety of problems manifest themselves after resolution of the acute disease process and often require invasive intervention. Necrotizing pancreatitis patients should be followed lifelong by experienced clinicians.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chronic Pain; Constriction, Pathologic; Drainage; Exocrine Pancreatic Insufficiency; Female; Follow-Up Studies; Gastric Fistula; Humans; Incidence; Intestinal Fistula; Islets of Langerhans; Male; Middle Aged; Pancreatectomy; Pancreatitis, Acute Necrotizing; Pancreatitis, Chronic; Retrospective Studies; Splanchnic Circulation; Survivors; Venous Thrombosis; Young Adult
PubMed: 32843212
DOI: 10.1016/j.surg.2020.07.004 -
BMC Gastroenterology Jul 2018Laparoscopic pancreaticoduodenectomy (LPD) remains to be established as a safe and effective alternative to open pancreaticoduodenectomy (OPD) for pancreatic-head and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Laparoscopic pancreaticoduodenectomy (LPD) remains to be established as a safe and effective alternative to open pancreaticoduodenectomy (OPD) for pancreatic-head and periampullary malignancy. The purpose of this meta-analysis was to compare LPD with OPD for these malignancies regarding short-term surgical and long-term survival outcomes.
METHODS
A literature search was conducted before March 2018 to identify comparative studies in regard to outcomes of both LPD and OPD for the treatment of pancreatic-head and periampullary malignancies. Morbidity, postoperative pancreatic fistula (POPF), mortality, operative time, estimated blood loss, hospitalization, retrieved lymph nodes, and survival outcomes were compared.
RESULTS
Among eleven identified studies, 1196 underwent LPD, and 8247 were operated through OPD. The pooled data showed that LPD was associated with less morbidity (OR = 0.57, 95%CI: 0.41~ 0.78, P < 0.01), less blood loss (WMD = - 372.96 ml, 95% CI, - 507.83~ - 238.09 ml, P < 0.01), shorter hospital stays (WMD = - 197.49 ml, 95% CI, - 304.62~ - 90.37 ml, P < 0.01), and comparable POPF (OR = 0.85, 95%CI: 0.59~ 1.24, P = 0.40), and overall survival (HR = 1.03, 95%CI: 0.93~ 1.14, P = 0.54) compared to OPD. Operative time was longer in LPD (WMD = 87.68 min; 95%CI: 27.05~ 148.32, P < 0.01), whereas R0 rate tended to be higher in LPD (OR = 1.17; 95%CI: 1.00~ 1.37, P = 0.05) and there tended to be more retrieved lymph nodes in LPD (WMD = 1.15, 95%CI: -0.16~ 2.47, P = 0.08), but these differences failed to reach statistical significance.
CONCLUSIONS
LPD can be performed as safe and effective as OPD for pancreatic-head and periampullary malignancy with respect to both surgical and oncological outcomes. LPD is associated with less intraoperative blood loss and postoperative morbidity and may serve as a promising alternative to OPD in selected individuals in the future.
Topics: Adenocarcinoma; Ampulla of Vater; Blood Loss, Surgical; Common Bile Duct Neoplasms; Humans; Laparoscopy; Length of Stay; Lymphatic Metastasis; Operative Time; Pancreatic Fistula; Pancreatic Neoplasms; Pancreaticoduodenectomy; Postoperative Complications; Survival Analysis
PubMed: 29969999
DOI: 10.1186/s12876-018-0830-y