Cases reported "Stomach Ulcer"

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1/58. Double pylorus: a complication of chronic gastric ulcer?

    A case of double pylorus with a chronic ulcer in one of the two channels is described. The patient, a middle-aged man with active rheumatoid arthritis, required partial gastrectomy to allow continued treatment of the arthritis with anti-inflammatory drugs. Detailed histological examination of the surgical specimen revealed features consistent with intramural penetration of an ulcer across the pyloric ring, resulting in a gastro-duodenal fistula. The findings provide further support for the hypothesis that the double pylorus is an acquired lesion, which occurs as an uncommon complication of chronic peptic ulcer.
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ranking = 1
keywords = fistula
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2/58. Gastropleural fistula originating from the lesser curve: a recognised complication, an uncommon pathway of communication.

    Fistulous communications between the abdominal and the pleural cavity are rare; they implicate intra-abdominal sepsis. We present a rare case of subphrenic abscess following gastric perforation, which resulted in thoracic empyema. This report emphasises that gastropleural fistulas, although uncommon, should be considered in differential diagnoses of thoracic empyema, especially when there is a longstanding history of peptic ulceration.
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ranking = 5
keywords = fistula
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3/58. Gastrocolic fistula complicating benign unoperated gastric ulcer. Report of four cases and review of the literature.

    Of 957 patients undergoing operation for benign gastric ulcer and its complications from 1965 through June 1975, 90 had perforated ulcers. Among these were four patients in whom a gastrocolic fistula had formed. Although two of the four patients had symptoms due to peptic ulcer dating back 12 and 68 months, symptoms of a gastrocolic fistula were the initial presentation of ulcer disease in the other two. All four patients had watery diarrhea and weight loss, and barium enema examination was diagnostic in each case. The perforating ulcers were located in the distal stomach on the greater curvature in all four patients. Although enterostasis was not present in these cases, regurgitation of colonic contents probably results in bacterial overgrowth in the small intestine, causing structural and functional damage to the mucosal cells by bacterial products, manifested clinically by diarrhea in 75% of the patients. Surgery should be advised in all cases after adequate preparation of the patient; bowel preparation with cathartics, enemas, and oral antibiotics is mandatory. The preferred operation is one-stage enbloc hemigastrectomy and resection of the involved segment of colon along with the fistulous tract. The present series brings to 43 the total number of cases of gastrocolic fistulas complicating benign, previously unoperated gastric or duodenal ulcers. There is an appreciable mortality associated with this condition - 7 of these 43 patients (16%) died as a direct consequence of their fistula.
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ranking = 8
keywords = fistula
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4/58. Gastrocolic fistulae as a consequence of benign gastric ulcer disease.

    Gastrocolic fistulae are a rare entity, occurring most commonly in the context of a malignant process or less frequently as a complication of a benign gastric ulcer. Presenting symptoms tend to be nonspecific, but the diagnosis can be confirmed with near certainty by barium enema examination or an upper gastrointestinal series. Although the management of gastrocolic fistulae has historically been surgical, medical management has recently been recommended as the first line of treatment when an underlying malignancy can be excluded.
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ranking = 6
keywords = fistula
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5/58. Spontaneous choledochoduodenal fistula secondary to long-standing ulcer disease.

    There are several varieties of bilioenteric fistulae. They are usually incidental findings, but once detected, various modalities can then be employed to further delineate the fistula. The fistulae usually arise as a complication of chronic duodenal ulcer disease, cholelithiasis or previous instrumentation to the biliary system. The presence of a fistula per se does not immediately equate to necessity for surgery. The treatment is dependent on its aetiology.
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ranking = 8
keywords = fistula
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6/58. 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.
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ranking = 1
keywords = fistula
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7/58. Spontaneous biliopneumothorax (thoracobilia) following gastropleural fistula due to stomach perforation by nasogastric tube.

    Gastropleural fistula may occur after pulmonary resection, perforated paraesophageal hernia, perforated malignant gastric ulcer at the fundus, or gastric bypass surgery for morbid obesity. We describe a case of gastropleural fistula after stomach perforation by a nasogastric tube in a patient who underwent Billroth II gastric resection for adenocarcinoma. Left biliopneumothorax occurred and was treated by thoracic drainage with -20 cm H2O aspiration. As gastropleural fistula persisted, laparotomy was repeated and gastric and diaphragmatic perforations were sutured. Gastropleural fistula is rare and, to our knowledge, this is the first reported case of gastropleural fistula and biliopneumothorax caused by gastric and diaphragmatic perforation by a nasogastric tube.
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ranking = 9
keywords = fistula
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8/58. Successful treatment of gastric fistula following rhabdomyolysis after vertical banded gastroplasty.

    Vertical banded gastroplasty is a gastric restrictive operation which has been performed with very satisfactory results in our department. We present a 46 year-old male with BMI 48, who experienced rhabdomyolsis after a VBG operation, complicated by perforation of an upper pouch ulcer and subsequent gastric fistula. Cardiac and renal failure occurred, necessitating intensive therapy with catecholamines, diuretics and hemodialysis. The patient underwent multiple operations, drainage of a retroperitoneal abscess, suture of a perforated ulcer, and gastric decompression by a gastrostomy. Prolonged treatment including TPN, drainage, broad spectrum antibiotics, skin and would protection and jejunostomy feeding, were necessary to obtain an eventual successful outcome. This case demonstrates that unexpected surgical complications may occur in morbidly obese patients and how difficult and long the management of these may be. Rhabdomyolsis is a potentially life-threatening complication of bariatric surgery, and careful postoperative observation of the patient is mandatory.
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ranking = 5
keywords = fistula
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9/58. Case report: gastrocolic fistula mimicking zollinger-ellison syndrome.

    fasting serum gastrin levels greater than 1000 pg/ml are said to establish the diagnosis of gastrinoma in a patient with peptic ulcer disease. The authors observed a patient with recurrent peptic ulcer disease, diarrhea, and a fasting serum gastrin of 1044 pg/ml who had a gastrocolic fistula, not the zollinger-ellison syndrome. The provocative tests of gastrin secretion, including secretin infusion and standard meal test, were helpful in ruling out a gastrinoma. This is the first reported association of gastrocolic fistula and hypergastrinemia. The patient demonstrates that the differential diagnosis of markedly elevated serum gastrin should be expanded to include gastrocolic fistula.
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ranking = 7
keywords = fistula
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10/58. Gastropericardial fistula, purulent pericarditis, and cardiac tamponade after laparoscopic Nissen fundoplication.

    Gastropericardial fistula, purulent pericarditis, and cardiac tamponade developed 7 years after laparoscopic Nissen fundoplication. The patient was successfully managed through a thoracotomy by open drainage of the pericardium, excision and closure of the fistula, and an omentum flap.
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ranking = 6
keywords = fistula
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