1/15. When is a pneumothorax not a pneumothorax?The authors report on a 13-year-old boy who, after exercise, had respiratory distress and left upper quadrant abdominal pain. Initially, a mistaken diagnosis of pneumothorax was made, and a chest tube was inserted. A nasogastric tube was then visualized on chest x-ray in the left hemithorax. He underwent a laparotomy and had herniation of spleen, stomach, and large and small bowel in the left pleural space passing through a traumatic defect in the hemidiaphragm. The laparoscopic Nissen fundoplication 3 years prior was felt to have contributed. A timely and correct diagnosis is essential to avoid the sequelae associated with these injuries and with inappropriate tube thoracostomy.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
2/15. Endoscopic management of intragastric migration of an Angelchik prosthesis.The Angelchik prosthesis was devised as a simple surgical solution for reflux oesophagitis. Since 1983 there have been increasing reports of complications attributed to the prosthesis, the more serious being transmural erosion through the oesophageal or gastric wall. The majority of these have required repeat surgery, which is not without risks. A case report of an Angelchik prosthesis incompletely eroding into the stomach is presented. The prosthesis was tethered by a 1 cm-thick mucosal bridge which precluded simple extraction. Using an endoscopic sphincterotome, the bridge was divided and the prosthesis removed. Endoscopic methods of extracting intragastric Angelchik prostheses should be considered before surgery is undertaken for this complication.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
3/15. Benign peptic ulcers penetrating pericardium and heart: clinicopathological features and factors favoring survival.Penetration of the pericardium and heart by benign peptic ulcers is rare. Before 1965 it was almost invariably fatal, but about 20% of recently reported cases have survived. We report 4 representative cases and review 91 additional cases from the literature. The ulcers arose in esophagus, hiatus hernias, abdominal stomach, and near anastomoses, and the predominant predisposing factor was previous surgery to the esophagogastric region. Whereas penetrating esophageal ulcers had a slightly better prognosis than gastric lesions, the principal determinant of clinical presentation, findings, and prognosis was the site of cardiac involvement. The clinicopathological features of pericardial, atrial, and ventricular involvement are distinct. We evaluate the different implications of these features for diagnosis, management, and prognosis and make some tentative recommendations regarding diagnostic procedures and treatment. early diagnosis and prompt surgical intervention are critical to successful treatment of this entity, which may present with predominantly cardiac or gastrointestinal symptomatology.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
4/15. Focal lymphoid hyperplasia (pseudolymphoma) of the esophagus.Focal lymphoid hyperplasia is an uncommon but ubiquitous lesion. It occurs most commonly in the gastrointestinal tract in association with chronic peptic ulcer disease of the stomach. We describe the hitherto unrecognized association of lymphoid hyperplasia in the esophagus with chronic stenosing ulcerating esophagitis and Barrett's mucosa. This association is considered to be analogous to the more prevalent coexistence of lymphoid hyperplasia and chronic peptic ulcer disease in the stomach.- - - - - - - - - - ranking = 2keywords = stomach (Clic here for more details about this article) |
5/15. Obstructive complications of the Nissen fundoplication.The obstructive complications of the Nissen fundoplication can be devastating. They are much more easily prevented than treated. The technical considerations in avoiding these complications are conceptually simple. The fundoplication should be done over a large intraesophageal stent. A no. 50 or 60 French dilator is appropriate and, in addition, the fundoplication should be left loose. If the fundoplication is to be left in the chest, the hiatus must be widely enlarged so that there is not the slightest hint of obstruction at the level of the diagphragm. Care must be taken in this case to approximate stomach to diaphragm. The Nissen fundoplication should be carried out using heavy sutures with generous bites of the stomach on both sides as well as bites of the esophageal wall and perhaps also the proximal stomach. If careful attention is paid to these technical details, the obstructive complications of the Nissen fundoplication should be eliminated.- - - - - - - - - - ranking = 3keywords = stomach (Clic here for more details about this article) |
6/15. Antireflux procedure after previous esophagogastrectomy.We have described a modified "inkwell" antireflux procedure that was particularly useful after esophagogastrectomy in a patient who lacked sufficient stomach tissue for the traditional wrap.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
7/15. Danger of fundoplication after selective vagotomy and antrectomy.Antireflux procedures are required in some patients at the same time or later after operations for chronic duodenal ulcer. The consequences to gastric blood supply are different between the three vagotomies usually performed to treat duodenal ulcer. A serious ischemic complication, incurred when a patient underwent fundoplication several years after a selective vagotomy and antrectomy, is reported to emphasize that the stomach relies on greater curvature arterial blood supply after this operation. Additional arteries ligated during fundoplication may surpass the capacity of remaining gastric arterial collaterals and produce ischemia. The same danger exists with fundoplication after proximal gastric vagotomy, if antrectomy has been added to treat recurrent ulcer. The technical differences of these two vagotomies from truncal vagotomy and the potential danger of fundoplication in these clinical situations must be recognized by the general surgeon.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
8/15. Gastric and esophageal dysfunction after ingestion of acid.Esophageal and gastric function was measured in a patient who swallowed a household acid solution. Dysphagia, transient ulceration of the esophagus with luminal narrowing, and complete loss of peristalsis without loss of lower esophageal sphincter function were noted. Gastric dysfunction appeared 2 weeks after ingestion with complete obstruction, necessitating antral resection. The proximal stomach was relatively spared.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
9/15. Postprandial hypoglycemia after Nissen fundoplication for reflux esophagitis.The motility of the stomach is modulated by the complex interplay of muscular, humoral, and neuronal factors. Rapid gastric emptying has been described after gastrectomy, gastrojejunostomy, vagotomy with pyloroplasty, and with active peptic ulcer disease. Rapid emptying may result in "dumping" syndrome and in postprandial hypoglycemia. We report a patient who developed postprandial hypoglycemia after a Nissen fundoplication for reflux esophagitis. This is the first report of this complication after this surgical procedure. The hypoglycemia was secondary to a combination of rapid gastric emptying, rapid absorption of glucose causing hyperglycemia, and excessive insulin secretion. This syndrome should be considered in patients who develop hypoglycemic symptoms after fundoplication. Treatment with a low carbohydrate diet and anticholinergic agents may offer symptomatic relief.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
10/15. Complications of intrathoracic Nissen fundoplication.This report details our experience with 30 patients who had Nissen fundoplication. Six underwent transabdominal Nissen fundoplication, and 10 had transthoracic Collis-Nissen with the gastric wrap in a subdiaphragmatic position. Ten patients had a transthoracic Nissen with the wrap in a supradiaphragmatic position. Four patients had a transthoracic Thal-Nissen procedure. In 1 of 4 patients with a Thal-Nissen procedure, intrathoracic rupture of the stomach with gastro-bronchial fistula developed and necessitated left lower lobectomy. Four of 10 patient in whom the gastric wrap was left in the chest experienced severe complications: in 1 patient a lesser curvature ulcer developed and required hemigastrectomy; 1 patient had herniation of the fundoplication with gastric outlet obstruction and required operation for its correction; 2 patients had intrathoracic rupture of the gastric wrap and ultimately died. The 6 patients with transabdominal Nissen and the 10 with transthoracic Collis-Nissen with wrap placed in the abdomen did well This experience severely condemns the practice of leaving the fundoplication above the diaphragm.- - - - - - - - - - ranking = 1keywords = stomach (Clic here for more details about this article) |
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