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Canadian Journal of Surgery. Journal... Dec 2007
Topics: Adult; Foreign Bodies; Gastric Outlet Obstruction; Humans; Male; Stomach
PubMed: 18067699
DOI: No ID Found -
Annals of the Royal College of Surgeons... Nov 2021Inguinoscrotal hernias are the commonest form of abdominal wall hernia, but for them to contain stomach is extremely rare. The management of these hernias can be very...
INTRODUCTION
Inguinoscrotal hernias are the commonest form of abdominal wall hernia, but for them to contain stomach is extremely rare. The management of these hernias can be very challenging owing to their acute nature of presentation and distortion of anatomy. Our aim was to systematically review the literature for all reported cases of inguinoscrotal hernias containing stomach. In turn we analysed patient demographics, site of hernia, presentation and treatment. Outcomes were reviewed where available.
METHOD
We conducted a systematic search of the PUBMED, Embase and Medline databases with a combination of keywords: . An author's own case has also been included.
RESULTS
There were 20 case reports included in the review, plus the author's own case. They ranged in publication date from 1942 to 2020. Mean age at presentation was 71 years (range 49 to 87). All cases were male. In total, 62% ( = 13) of cases presented with combined symptoms of abdominal pain and vomiting, 48% ( = 10) presented with gastric outlet obstruction (GOO) and 48% ( = 10) presented with gastric perforation. All successfully treated cases with gastric perforation required a midline laparotomy approach, whereas 56% ( = 5) of patients in the GOO group were successfully treated conservatively. There were three deaths reported in this review, all in the gastric perforation group.
CONCLUSION
Stomach as a content of inguinoscrotal hernias is extremely rare. These hernias predominantly present acutely in the form of GOO or gastric perforation. All patients with gastric perforation will require a midline laparotomy. Patients with GOO can be successfully managed either surgically or in selective cases with conservative management.
Topics: Aged; Aged, 80 and over; Emergencies; Hernia, Inguinal; Humans; Male; Middle Aged; Risk Factors; Scrotum; Stomach; Stomach Diseases
PubMed: 34432531
DOI: 10.1308/rcsann.2021.0040 -
Annals of Surgery Open : Perspectives... Sep 2022In the early era of therapeutic laparotomy, surgeons developed operations where the extirpation of pathology only required simple ligation of blood supply, detachment of...
In the early era of therapeutic laparotomy, surgeons developed operations where the extirpation of pathology only required simple ligation of blood supply, detachment of diseased organs or drainage of infection. In 1881, when sutured anastomosis was in its infancy, a surgeon at Billroth's clinic in Vienna, Anton Wolfler, performed the first successful gastrojejunostomy to treat gastric outlet obstruction. The patient was a 38-year-old male who presented weak and emaciated with an obstructing stomach cancer. After Dr Wolfler's sutured gastrojejunostomy, the patient recovered without complication and was able to eat by mouth. Over the next 40 years, surgeons around the world explored variations in the technique of this operation until it was used in common practice for the management of gastric outlet obstruction. During that same era, gastrojejunostomy severed as a testing ground for sutured anastomosis, which became the accepted method of enteric anastomosis. This article will review the early history of gastrojejunostomy, its origination and the European and American innovators who created modifications of this life-saving operation. The importance that gastrojejunostomy had in the evolution of sutured enteric anastomosis will be highlighted.
PubMed: 37601146
DOI: 10.1097/AS9.0000000000000200 -
Journal of Gastrointestinal Surgery :... Nov 2023Esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation with...
Peroral Endoscopic Myotomy (POEM) and Laparoscopic Heller Myotomy with Dor Fundoplication for Esophagogastric Junction Outflow Obstruction (EGJOO): a Comparison of Outcomes and Impact on Physiology.
INTRODUCTION
Esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation with preserved peristalsis. Studies have shown that Heller myotomy with Dor fundoplication (HMD) and per oral endoscopic myotomy (POEM) are effective treatments for EGJOO. However, there is paucity of data comparing the efficacy and impact of these two procedures. Therefore, the aim of this study was to compare outcomes and impact on esophageal physiology in patients undergoing HMD or POEM for primary EGJOO.
METHODS
This was a retrospective review of patients who underwent either HMD or POEM for primary EGJOO at our institution between 2013 and 2021. Favorable outcome was defined as an Eckardt score ≤ 3 at 1 year after surgery. GERD-HRQL questionnaire, endoscopy, pH monitoring, and high-resolution manometry (HRM) results at baseline and 1 year after surgery were compared pre- and post-surgery and between groups. Objective GERD was defined as DeMeester score > 14.7 or LA grade C/D esophagitis.
RESULTS
The final study population consisted of 52 patients who underwent HMD (n = 35) or POEM (n = 17) for EGJOO. At a mean (SD) follow-up of 24.6 (15.3) months, favorable outcome was achieved by 30 (85.7%) patients after HMD and 14 (82.4%) after POEM (p = 0.753). After HMD, there was a decrease GERD-HRQL total score (31 (22-45) to 4 (0-19); p < 0.001), and objective reflux (54.2 to 25.9%; p = 0.033). On manometry, there was a decrease in LES resting pressure (48 (34-59) to 13 (8-17); p < 0.001) and IRP (22 (17-28) to 8 (3-11); p < 0.001), but esophageal body characteristics did not change (p > 0.05). Incomplete bolus clearance improved (70% (10-90) to 10% (0-40); p = 0.010). After POEM, there was no change in the GERD-HRQL total score (p = 0.854), but objective reflux significantly increased (0 to 62%; p < 0.001). On manometry, there was a decrease in LES resting pressure (43 (30-68) to 31 (5-34); p = 0.042) and IRP (23 (18-33) to 12 (10-32); p = 0.048), DCI (1920 (1600-5500) to 0 (0-814); p = 0.035), with increased failed swallows (0% (0-30) to 100% (10-100); p = 0.032). Bolus clearance did not improve (p = 0.539). Compared to HMD, POEM had a longer esophageal myotomy length (11 (7-15)-vs-5 (5-6); p = 0.001), more objective reflux (p = 0.041), lower DCI (0 (0-814)-vs-1695 (929-3101); p = 0.004), and intact swallows (90 (70-100)-vs-0 (0-40); p = 0.006), but more failed swallows (100 (10-100); p = 0.018) and incomplete bolus clearance (90 (90-100)-vs-10 (0-40); p = 0.004).
CONCLUSION
Peroral endoscopic myotomy and Heller myotomy with Dor fundoplication are equally effective at relieving EGJOO symptoms. However, POEM causes worse reflux and near complete loss of esophageal body function.
Topics: Humans; Esophageal Achalasia; Fundoplication; Heller Myotomy; Esophageal Motility Disorders; Esophageal Sphincter, Lower; Gastroesophageal Reflux; Manometry; Treatment Outcome; Stomach Diseases; Natural Orifice Endoscopic Surgery; Esophagogastric Junction
PubMed: 37848686
DOI: 10.1007/s11605-023-05844-0 -
Current Opinion in Gastroenterology Jul 2017To review recent advances in achalasia diagnostics and therapeutics. (Review)
Review
PURPOSE OF REVIEW
To review recent advances in achalasia diagnostics and therapeutics.
RECENT FINDINGS
The cardinal feature of achalasia, impaired lower esophageal sphincter (LES) relaxation, can occur in association with varied patterns of esophageal contractility. The Chicago Classification distinguishes among these as follows: without contractility (type I), with panesophageal pressurization (type II), with premature (spastic) distal esophageal contractions (type III), or even with preserved peristalsis [esophagogastric junction (EGJ) outlet obstruction]. Physiological testing also reveals achalasia-like syndromes that also benefit from achalasia therapies. Coincident with this has been the development of peroral endoscopic myotomy (POEM), an endoscopic technique for performing an esophageal myotomy. Hence, the option now exists to either selectively ablate the LES (pneumatic dilation, laparoscopic Heller myotomy, or POEM) or to ablate the sphincter and create a myotomy along some or the entire adjacent smooth muscle esophagus (POEM). Each achalasia syndrome has unique treatment considerations; type II achalasia responds well to all therapies, whereas type III responds best to POEM.
SUMMARY
Emerging data support the concept that optimal management of achalasia is phenotype-specific, guided by high-resolution manometry, and, in some instance, functional luminal imaging probe studies. This opinion article reviews the varied characteristic and treatment considerations of achalasia syndromes as currently understood.
Topics: Esophageal Achalasia; Esophageal Sphincter, Lower; Humans; Manometry; Natural Orifice Endoscopic Surgery; Peristalsis; Treatment Outcome
PubMed: 28426463
DOI: 10.1097/MOG.0000000000000365 -
Medicine Apr 2023Gastric trichobezoars are a rare form of bezoar formed from swallowed human hair as well as hair from dolls or animals, blankets, and carpets. They usually develop in... (Review)
Review
RATIONALE
Gastric trichobezoars are a rare form of bezoar formed from swallowed human hair as well as hair from dolls or animals, blankets, and carpets. They usually develop in young women who are emotionally disturbed, depressed, or mentally retarded, with trichotillomania and trichophagia. They can lead to abdominal pain, gastric ulceration, bleeding, obstruction, and perforation.
PATIENT CONCERNS
A 13-year-old girl was admitted to our institution with complaints of nausea, vomiting, and epigastric pain for 2 days. She underwent laparoscopic removal of a large gastric trichobezoar at our institution 5 years ago. A 12-year-old girl presented at our institution due to epigastric pain, dizziness, and melena for 2 days.
DIAGNOSIS
They were diagnosed with gastric trichobezoar by abdominal computed tomography scan and upper gastrointestinal endoscopy.
INTERVENTIONS
Large gastric trichobezoars were removed via a mini-laparotomy.
OUTCOMES
They recovered well postoperatively without complication.
LESSONS
Although the recurrence of gastric trichobezoar after surgery is rare, few recurrent cases were reported in the literature. Therefore, psychiatric consultation and regular follow-up after treatment should be considered in the children and their parents to prevent the recurrence of gastric trichobezoar.
Topics: Child; Female; Humans; Adolescent; Bezoars; Stomach; Hair; Trichotillomania; Abdominal Pain
PubMed: 37083802
DOI: 10.1097/MD.0000000000033589 -
Current Opinion in Gastroenterology Jul 2012The Chicago Classification for esophageal motility disorders was developed to complement the enhanced characterization of esophageal motility provided by high-resolution... (Review)
Review
PURPOSE OF REVIEW
The Chicago Classification for esophageal motility disorders was developed to complement the enhanced characterization of esophageal motility provided by high-resolution esophageal pressure topography (HREPT) as this new technology has emerged within clinical practice. This review aims to summarize the evidence supporting the evolution of the classification scheme since its inception.
RECENT FINDINGS
Studies examining the specific esophageal motility disorders in regards to HREPT metrics, clinical characteristics, and responses to treatments have facilitated updates of the diagnostic scheme and criteria. These studies have demonstrated variation in treatment responses associated with subclassification of achalasia, the use of distal latency in the diagnosis of distal esophageal spasm, and the development of diagnoses including esophagogastric junction outflow obstruction and hypercontractile esophagus.
SUMMARY
The diagnostic criteria described in the Chicago Classification have evolved to demonstrate a greater focus on distinct clinical phenotypes. Future evaluation of the natural history and treatment outcomes will assist in further refinement of this diagnostic scheme and management of esophageal motility disorders.
Topics: Algorithms; Esophageal Achalasia; Esophageal Motility Disorders; Esophagogastric Junction; Humans; Manometry; Muscle Relaxation
PubMed: 22476158
DOI: 10.1097/MOG.0b013e3283530f62 -
The Korean Journal of Gastroenterology... Jul 2020Gastric heterotopic pancreas is a relatively uncommon incidental finding. On the other hand, the presentation of gastric adenocarcinoma arising from a heterotopic...
Gastric heterotopic pancreas is a relatively uncommon incidental finding. On the other hand, the presentation of gastric adenocarcinoma arising from a heterotopic pancreas is rare. This paper reports a case of gastric adenocarcinoma arising from a heterotopic pancreas that presented as a gastric outlet obstruction 10 years after the initial diagnosis of a suspicious submucosal tumor. Endoscopy revealed a pyloric stricture with prepyloric wall thickening and a complete gastric outlet obstruction. Abdominal and pelvic computed tomography exposed a severely distended gastric lumen at the antrum with heterogeneously enhancing circumferential wall thickening in the prepyloric antrum and pylorus. Because conservative treatment was ineffective and a malignancy could not be excluded, laparoscopic subtotal gastrectomy with a gastrojejunostomy was performed for histological confirmation and treatment. The histopathology diagnosis was advanced gastric carcinoma arising from heterotopic pancreatic tissue.
Topics: Adenocarcinoma; Aged; Choristoma; Diagnosis, Differential; Endoscopy, Gastrointestinal; Endosonography; Gastric Outlet Obstruction; Humans; Male; Pancreas; Pyloric Antrum; Stomach Neoplasms; Tomography, X-Ray Computed
PubMed: 32703918
DOI: 10.4166/kjg.2020.76.1.37 -
CRSLS : MIS Case Reports From SLS 2022Gastric outlet obstruction secondary to foregut gastrointestinal malignancies can be managed with a variety of medical, endoscopic, and surgical options. Laparoscopic...
BACKGROUND
Gastric outlet obstruction secondary to foregut gastrointestinal malignancies can be managed with a variety of medical, endoscopic, and surgical options. Laparoscopic gastrojejunostomy is an option for those patients who are able to tolerate an operation as a long-term palliative option. This operation may be associated with some significant postoperative technical and nontechnical complications, including delayed gastric emptying. This paper describes an incision-less, endoscopic option that we propose can be used to salvage a functionally obstructed gastrojejunostomy.
CASE DESCRIPTION
A 57-year old male patient had a history of pancreatic adenocarcinoma causing gastric outlet obstruction and underwent a previously created surgical gastrojejunostomy at an outside hospital. His procedure was complicated by anastomotic leak and essentially persistent obstructive symptoms secondary to delayed gastric emptying. Though his anastomosis was demonstrably patent, these symptoms were thought to be secondary to a functional obstruction at the gastrojejunostomy. After repeated workups and many failed attempts to treat these symptoms, he ultimately underwent endoscopic placement of an uncovered colonic stent into the efferent limb of his gastrojejunostomy. This allowed for preferential drainage of gastric contents down the efferent limb, and improvement of his delayed gastric emptying.
CONCLUSIONS
In a select group of patients with advanced foregut malignancy, and with high re-operative risks, salvage endoscopic stenting may be useful in the palliation of symptoms from a functionally obstructed gastrojejunostomy.
Topics: Adenocarcinoma; Gastric Bypass; Gastric Outlet Obstruction; Gastroparesis; Humans; Male; Middle Aged; Pancreatic Neoplasms
PubMed: 36016812
DOI: 10.4293/CRSLS.2021.00094 -
Human Pathology May 2012Schwannoma is a rare gastrointestinal mesenchymal tumor, as the vast majority of gastric mesenchymal tumors are gastrointestinal stromal tumors. In this study, we... (Review)
Review
Schwannoma is a rare gastrointestinal mesenchymal tumor, as the vast majority of gastric mesenchymal tumors are gastrointestinal stromal tumors. In this study, we analyzed clinicopathologically 51 gastric schwannomas. These tumors predominantly occurred in older adults with a marked female predominance (40 women and 11 men; median and mean ages, 60 and 58 years). They variably presented with gastric discomfort, bleeding, or rarely gastric outlet obstruction; and many were incidental findings during other medical procedures. The tumors ranged from 1 to 10.5 cm (median, 4.5 cm). The typical histologic features included spindle cells usually with microtrabecular architecture and focal nuclear atypia, and peritumoral lymphoid cuff, whereas features of soft tissue schwannomas, such as encapsulation, nuclear palisading, vascular hyalinization, and dilatation, were absent or infrequent. Median mitotic count was 2/50 high-power fields, with the highest count being 13/50 high-power fields. No malignant variants were recognized, and long-term follow-up did not reveal recurrences or metastases. Immunohistochemically, all examined tumors were S100 protein positive and most were also GFAP positive, whereas CD34 and NF68 were encountered rarely and all tumors were negative for HMB45, KIT, DOG1/Ano 1, smooth muscle actin, desmin, and synaptophysin. None of the 9 tumors studied contained gastrointestinal stromal tumor-specific KIT or PDGFRA mutations. Fluorescence in situ hybridization studies revealed multiple signals with BCR probe (chromosome 22) and centromeric probes for chromosomes 2 and 18 suggesting polyploidy. These findings indicate that gastric schwannoma is a distinctive form of peripheral nerve sheath tumor that in many ways differs from soft tissue schwannoma. It should be distinguished from gastrointestinal stromal tumor and other mesenchymal tumors of the gastrointestinal tract, such as the S100 protein-positive gastrointestinal clear cell sarcoma and metastatic melanoma.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Female; Gastric Mucosa; Humans; Male; Middle Aged; Neurilemmoma; Proto-Oncogene Proteins c-kit; S100 Proteins; Sex Factors; Stomach; Stomach Neoplasms
PubMed: 22137423
DOI: 10.1016/j.humpath.2011.07.006