1/46. Double pylorus.We report a 55-year-old man presenting with postprandial epigastric pain and vomiting. barium meal study suggested two openings from the stomach to the duodenum. endoscopy revealed double pylorus with chronic duodenal ulcer, suggesting the second opening as an acquired one.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
2/46. Unusual gastrointestinal features in a child with pernicious anemia.Pernicious anemia in childhood is a rare disease. The radiologic demonstration of gastric mucosal atrophy led directly to this diagnosis in an 11-year-old girl. In addition, there was deformity of the pyloric antrum and superficial ulceration in the stomach and duodenum. endoscopy and biopsy confirmed these findings.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
3/46. Spontaneous esophageal perforation related to a duodenal ulcer with pyloric stenosis: report of a case.This report describes a case of spontaneous esophageal perforation that was considered to be etiologically related to a duodenal ulcer with pyloric stenosis. The patient was a 54-year-old Japanese man who presented following the sudden onset of severe abdominal pain and dyspnea after an episode of vomiting. He had a history of duodenal ulcer. Computed tomography revealed an extremely dilated stomach containing abundant food residue, intraabdominal effusion, bilateral pleural effusion, and mediastinal emphysema, findings that strongly suggested esophageal perforation. esophagoscopy confirmed perforation of the lower esophagus. laparotomy revealed marked contamination, including food residue in the abdominal cavity, and a severely dilated stomach attributed to pyloric stenosis caused by a duodenal ulcer. A 2-cm longitudinal perforation was found on the right side of the lower esophagus. Because the patient's general condition was too poor to tolerate a one-stage operation (primary closure of the perforation, gastrectomy, and reconstruction), we initially performed decompression gastrostomy and control of the esophageal leakage with T-tube placement. Following the T-tube was removed 1 month later, distal gastrectomy and reconstruction of the gastrojejunostomy (Billroth II method) could be safely performed.- - - - - - - - - - ranking = 2keywords = stomach (Clic here for more details about this article) |
4/46. Gastric endocrine pancreatic heterotopia.Heterotopic pancreas is a relatively infrequent lesion most often found in the stomach. Four histologic types are recognized: total, canalicular, exocrine, and endocrine heterotopia. To our knowledge, only 2 cases of purely endocrine heterotopic pancreas have been reported in detail. We describe the case of a patient with gastric and duodenal ulcers and gastric endocrine heterotopia. The lack of mass formation, histomorphology, and immunohistochemical features simulating islets of langerhans supported the diagnosis. We conclude that purely endocrine heterotopic pancreas is a very rare entity that, when present, can simulate a primary or metastatic neuroendocrine tumor. Adequate sampling of the specimen, histomorphologic pattern, and immunohistochemistry are important for the purpose of distinguishing between a neuroendocrine tumor and purely endocrine pancreatic heterotopia.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
5/46. Reestablishing duodenal continuity after previous gastrectomy for peptic ulcer.Gastroduodenal anastomosis is not routine during reoperation for stomal ulcers after primary Billroth II gastrectomy. It nevertheless is a sure way to prevent an increased peptic potential which is brought about by a duodenal bypass. We have reviewed the published cases and added three more, bringing the total to 47. We analyzed the modalities, indications and results of this method. Gastroduodenal anastomosis can be accomplished more often than is thought, despite the often necessary large gastric resections. Separation of the duodenopancreatic block and liberation of the fundus allows suturing without traction. End-to-side anastomosis of the stomach on the anterior wall of the second portion of the duodenum avoids dissection of the duodenal stump. vagotomy is required when basal acidity is greater than 20 mEq/liter. Reestablishing a physiologic alimentary tract is particularly indicated in chronic obstruction due to stenosis associated with a proximal loop syndrome in young patients. Jejunal interposition becomes necessary when total gastrectomy is the result of repeated surgery. Such a method is the best solution for agastria. The excellent results obtained by gastroduodenal anastomosis after repeat gastrectomy should encourage wider use.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
6/46. Gastrojejunocolic fistula after gastrectomy with Billroth II reconstruction: report of a case.We herein report the case of a 65-year old man with gastrojejunocolic fistula. The patient was admitted to our hospital because of edema of the lower limbs, diarrhea, and weight loss. His history included a distal gastric resection and Billroth II reconstruction for a duodenal ulcer 20 years previously. The laboratory data on admission revealed hypoproteinemia and hypoalbuminemia. An upper gastrointestinal X-ray series revealed a fistula between the transverse colon and upper jejunum. After improving his state of malnutrition, a partial resection of the remnant stomach, transverse colon, and jejunum, which were involved in the fistula, was performed. The postoperative course was uneventful and the patient was discharged on the 26th postoperative day. Gastrojejunocolic fistula is one of the severe complications of a stomal ulcer after a gastric resection with Billroth II reconstruction, which is considered to be induced by an inadequate resection of the stomach. As a result of the recent development of improved agents for the treatment of peptic ulcers, the occurrence of gastrojejunocolic fistula has decreased remarkably. However, gastrojejunocolic fistula should be recognized as one of the late severe complications observed after a gastrectomy with Billroth II reconstruction, since this disease may occur even 20 years after the first operation for peptic ulcer.- - - - - - - - - - ranking = 2keywords = stomach (Clic here for more details about this article) |
7/46. Perforated duodenal ulcer associated with an incarcerated hiatal hernia: report of a case.We report the case of a perforated duodenal ulcer and diffuse peritonitis associated with an incarcerated hiatal hernia. A 77-year-old woman with a 17-year history of rheumatoid arthritis treated with nonsteroidal anti-inflammatory drugs, who had also been receiving treatment for non-Hodgkin's lymphoma over 4 years, was referred to us for investigation of nausea and vomiting. An abdominal compute tomography (CT) scan showed an incarcerated hiatal hernia and free air in the hernia sac. Emergency laparotomy revealed an incarcerated hiatal hernia involving the stomach, transverse colon, and omentum. A perforated ulcer was also found in the posterior wall of the first portion of the duodenum. The combination of these disorders is thought to be rare in patients with a hiatal hernia and free air in its sac. As the reported mortality of perforated gastric ulcer associated with a hiatal hernia is high, early elective surgery should be performed in patients with a duodenal ulcer associated with a hiatal hernia.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
8/46. Achalasia cardia and gastric outlet stenosis in a postmenopausal woman: case report.The orderly contractility of the oesophagus and the regulated ability of the pyloric sphincter allow the influx and efflux of gastric contents. When these physiological processes are impaired, gastric luminal transit is altered as expected in achalasia cardia and gastric outlet obstruction. movement across the inlet and outlet of the stomach is therefore altered. A case of a 58-year old woman diagnosed with simultaneous occurrence of achalasia cardia and gastric outlet stenosis resulting from chronic duodenal ulcer is presented. The diagnosis was based on clinical, radiological and intraoperative findings. This patient has remained well after a simultaneous anterior cardiomyotomy and H-M pyloroplasty. To my knowledge this is the first time that such an association causing gastric "inlet" and "outlet" obstruction has been reported.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
9/46. Double pylorus.Double pylorus (DP) or duplication of the pylorus is an uncommon condition that is either congenital or acquired. Acquired double pylorus (DP) results from a peptic ulcer eroding through and creating a fistula between the duodenal bulb and the distal stomach. We report a case of an acquired double pylorus in an adult gentleman that resulted from the erosion of a duodenal and prepyloric ulcer.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
10/46. Severe hyperreninemic hypertension associated with spontaneous renal cholesterol crystal embolization.A 70-year-old man was admitted because of severe hypertension and renal insufficiency. Marked elevation in plasma renin activity (PRA; 34.2 ng/ml per h) was noted. Five days later, the patient developed hemorrhagic duodenal ulcers and panperitonitis, went into shock, and died. An autopsy revealed severe atherosclerosis with marked ulceration in the abdominal aorta. Renal histology showed multiple cholesterol crystal embolization (CCE) associated with infarction. cholesterol crystals were also detected in the vessels of the gastrointestinal system, including the liver, stomach, colon, and pancreas. Although not common, spontaneous CCE should be considered in elderly patients who present with abrupt onset of severe hypertension associated with renal insufficiency. The most important finding in this patient was severe hyperreninemia. Although potentiation of the renin-angiotensin-aldosterone system is the suggested mechanism for the hypertension in renal CCE, we could not find any reported case of renal CCE with hyperreninemia. It is reasonable to consider that severe hyperreninemia might be overlooked in renal CCE. PRA should be measured in patients with renal CCE, because it may give important information for selecting antihypertensive agents and improving the prognosis. To clarify this possibility, an accumulation of similar cases is necessary.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
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