scholarly journals Successful revision surgery for very late-onset stomal obstruction following Gomez gastroplasty: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yudai Hojo ◽  
Yasunori Kurahashi ◽  
Toshihiko Tomita ◽  
Tsutomu Kumamoto ◽  
Tatsuro Nakamura ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Preoperative Diagnosis ◽  
Late Onset ◽  
Staple Line ◽  
Weight Loss Surgery ◽  
Wedge Resection ◽  
Gastric Pouch ◽  
Sudden Onset ◽  
Gastric Body ◽  
Greater Curvature

Abstract Background Gomez gastroplasty, which was developed in the 1970s as one of the gastric restrictive surgeries for severe obesity, partitions the stomach using a stapler from the lesser towards the greater curvature at the upper gastric body, leaving a small channel. This procedure is no longer performed due to poor outcomes, but surgeons can encounter late-onset complications even decades after the surgery. Here, we report a case of very late-onset stomal obstruction following Gomez gastroplasty which was successfully treated by revision surgery. Case presentation A 58-year-old man was referred to our institution with sudden-onset nausea and vomiting. He underwent weight loss surgery in the USA in 1979, but the details of the surgery were unclear. Esophagogastroduodenoscopy demonstrated a stoma at the greater curvature of the upper gastric body, and fluoroscopy showed retention of contrast medium in the fundus and poor outflow through the stoma. Abdominal computed tomography revealed a staple line partitioning the stomach. Considering these preoperative investigation findings and the period during which the surgery was performed, the patient was diagnosed with very late-onset stomal obstruction following Gomez gastroplasty. Supporting the preoperative diagnosis, the surgical findings revealed a staple line extending from the lesser towards the greater curvature of the upper gastric body and a channel reinforced by a running seromuscular suture on the greater curvature. Moreover, gastric torsion caused by the enlarged proximal gastric pouch was found. Re-gastroplasty involving wedge resection of the original channel was performed followed by construction of a new channel. Postoperative course was uneventful, and the patient no longer had symptoms of stomal obstruction after revision surgery. Conclusions Re-gastroplasty was safe and feasible for very late-onset stomal obstruction following Gomez gastroplasty. Accurate preoperative diagnosis based on the patient’s interview and the investigation findings was important for surgical planning. A careful follow-up is required to prevent excessive weight regain after revision surgery.

scholarly journals Gastric Mucosal Changes Caused by Lugol's Iodine Solution Spray: Endoscopic Features of 64 Cases on Screening Esophagogastroduodenoscopy

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Daisuke Tsurumaru ◽  
Takashi Utsunomiya ◽  
Shuji Matsuura ◽  
Masahiro Komori ◽  
Satoshi Kawanami ◽  
...  
Keyword(s):  
Gastric Mucosa ◽  
Gastric Body ◽  
Gastric Disease ◽  
Iodine Solution ◽  
Lugol’S Iodine ◽  
Reticular Pattern ◽  
Before And After ◽  
Mucosal Changes ◽  
Greater Curvature ◽  
Gastric Mucosal Changes

Aim. To clarify the endoscopic mucosal change of the stomach caused by Lugol's iodine solution spray on screening esophagogastroduodenoscopy (EGD).Methods. Sixty-four consecutive patients who underwent EGD for esophageal squamous cell carcinoma screening were included in this study. The records for these patients included gastric mucosa findings before and after Lugol's iodine solution was sprayed. The endoscopic findings of the greater curvature of the gastric body were retrospectively analyzed based on the following findings: fold thickening, exudates, ulcers, and hemorrhage.Results. Mucosal changes occurred after Lugol's solution spray totally in 51 patients (80%). Fold thickening was observed in all 51 patients (80%), and a reticular pattern of white lines was found on the surface of the thickened gastric folds found in 28 of the patients (44%). Exudates were observed in 6 patients (9%).Conclusion. The gastric mucosa could be affected by Lugol's iodine; the most frequent endoscopic finding of this effect is gastric fold thickening, which should not be misdiagnosed as a severe gastric disease.

A Case of Late-Onset Psychosis: Integrating Neuropsychological and SPECT Data

1996 ◽  
Vol 9 (3) ◽  
pp. 146-153 ◽  
Author(s):  
Blaine S. Cloud ◽  
Tania Giovannetti Carew ◽  
Howard Rothenberg ◽  
Paul Malloy ◽  
David J. Libon
Keyword(s):  
Executive Control ◽  
Late Onset ◽  
Sudden Onset ◽  
Normal Range ◽  
Visuospatial Abilities ◽  
Normal Limits ◽  
Neuropsychological Evaluations ◽  
Psychotic Behavior ◽  
Spect Scan ◽  
Work Up

We report the case of a 67-year-old woman who experienced a sudden onset of psychotic illness (i.e., prominent delusions and hallucinations) that has endured for approximately 3 years. As part of her neurobehavioral work-up, a SPECT scan revealed right frontal and left anterior temporal-lobe hypoperfusion. Serial neuropsychological evaluations obtained 2 years apart demonstrated a steady decline on tests of executive control (monitoring, allocation of attention, perseveration) and visuospatial abilities, whereas performance in other areas of cognitive functioning have remained steady and in the normal range for the patient's age. Over this same period of time, serial EEG, MRI, and neurology examinations have been within normal limits. Thus, there was little evidence with which to diagnose dementia. It is suggested that concomitant impairment in executive control, coupled with a degraded capacity to process perceptual information, can give rise to enduring psychotic behavior.

scholarly journals Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up

2017 ◽  
Vol 80 (1) ◽  
Author(s):  
Claudio I. Perez ◽  
María J. Oportus ◽  
Felipe Mellado ◽  
Felipe Valenzuela ◽  
Cristián Cartes ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Late Onset ◽  
Long Term Follow Up

Contractions move contents by changing the configuration of the isolated cat stomach

1998 ◽  
Vol 274 (2) ◽  
pp. G359-G369 ◽  
Author(s):  
Konrad Schulze-Delrieu ◽  
Robert J. Herman ◽  
Siroos S. Shirazi ◽  
Bruce P. Brown
Keyword(s):  
Pressure Wave ◽  
Video Camera ◽  
Gastric Volume ◽  
Gastric Body ◽  
Proximal Stomach ◽  
Gastric Contents ◽  
Gastric Lumen ◽  
Remote Sites ◽  
Greater Curvature ◽  
Gastric Contractions

To understand how contractions move gastric contents, we measured, in isolated cat stomachs, the effects of contractions on gastric length, diameters, pressures, and emptying. Movements of the stomach and of gastric contents were monitored by video camera and ultrasound and were related to mechanical events. Based on pressures, we defined the following four phases of contractions: 1) Po, a steady pressure associated with tonic contraction of proximal stomach; 2) P′, a pressure wave during which the contraction indents the gastric body; 3) a pressure nadir while the contraction lifts the gastric sinus toward the incisura; and 4) a second pressure wave, P”, as the contraction advances through the antrum. In open preparations, liquid output and shortening of the greater curvature are large during Po, stop during P′, and resume with P”. Contractions generate higher pressures when gastric volume is held steady. Contractions increase wall thickness and decrease gastric diameters at sites they involve and have opposite effects at remote sites. Contractions move the incisura and hence redraw the borders between gastric segments and shift volumes back and forth within the gastric lumen. Contractions furthermore stir up, compress, and disperse particulate beans without moving them to the pylorus. We conclude that gastric contractions 1) reverse changes in gastric length that occur during gastric filling, 2) move gastric contents directly through local contact and indirectly by changing the configuration of the stomach, and 3) interact with structures such as the incisura in retaining and breaking up solid gastric contents.

Late-Presenting Congenital Diaphragmatic Hernia: A Potentially Life Threatening Case

2009 ◽  
Vol 16 (2) ◽  
pp. 102-105 ◽  
Author(s):  
HY Chan ◽  
CC Wong ◽  
F Ng
Keyword(s):  
Respiratory Distress ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Clinical Symptoms ◽  
Late Onset ◽  
Sudden Onset ◽  
Mediastinal Shift ◽  
Wide Range ◽  
Urgent Operation ◽  
Life Threatening

Congenital diaphragmatic hernia (CDH) generally presents with respiratory distress in the neonatal period. Late onset CDH is less common and is associated with a wide range of clinical symptoms. We report a case of a 4-year-old child presenting with sudden onset of dizziness, abdominal pain and vomiting after swimming. Radiological investigations showed a left CDH with mediastinal shift. She gradually developed respiratory distress after admission. Urgent operation showed that the contents of the hernia included stomach, spleen, small and large bowels. This case highlights the importance of suspicion of CDH, proper clinical examination and investigation of children with acute non-specific gastrointestinal complaints.

scholarly journals A Practical Strategy of Controlled Monopolar Cautery With/Without Oversewing for Staple Line Bleeding in Bariatric Surgery: A Single Center Experience

2021 ◽  
Author(s):  
Fang-Chin Hsu ◽  
Hai-Ning Hsu ◽  
Hsin-Mei Pan ◽  
Wan-Ting Hung ◽  
Guo-Shiou Liao ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Gastric Tube ◽  
Staple Line ◽  
Gastric Pouch ◽  
Laparoscopic Bariatric Surgery ◽  
Safe Method ◽  
Patient Demographics ◽  
Single Center Experience ◽  
Practical Strategy ◽  
Staple Line Leakage

Abstract Introduction In laparoscopic bariatric surgery, stapling devices are essential for creating a gastric tube or gastric pouch. Staple line bleeding (SLB) is an important issue, but the effect of monopolar cautery for SLB control is unclear. This study aimed to evaluate the outcomes of controlled monopolar cautery with/without oversewing for SLB control during bariatric surgery. Materials and Methods From January 2019 to May 2021, 66 patients underwent bariatric surgery with controlled monopolar cautery with/without oversewing for SLB control. Patient demographics and intraoperative and postoperative outcomes were analyzed. Results This study enrolled 35 women and 31 men (mean age: 38.1 years; mean body mass index: 39.8 kg/m2). All patients had varying degrees of SLB. Controlled monopolar cautery was applied to 63 patients with ≤6 bleeding sites. Only two patients needed further partial oversewing of the bleeding sites after controlled monopolar cautery failed to achieve hemostasis. Initially, three patients had more than six bleeding sites, and thus complete oversewing was performed to achieve successful hemostasis. There was no intraabdominal or gastrointestinal bleeding. There were one gastric stricture, one anastomotic leakage, and one staple line leakage. Conclusions The strategy of controlled monopolar cautery with/without oversewing is a simple, practical, inexpensive, and safe method for SLB control during bariatric surgery.

scholarly journals CDX2 Protein as a Surrogate Marker of Gastric Mucosal Atrophy

2021 ◽  
Vol 10 (3) ◽  
pp. 60-67
Author(s):  
M. N. Parygina ◽  
S. I. Mozgovoi ◽  
A. G. Shimanskaya ◽  
A. V. Kononov
Keyword(s):  
Logistic Regression ◽  
Gastric Mucosa ◽  
Chronic Gastritis ◽  
Regression Models ◽  
Surrogate Marker ◽  
Gastric Body ◽  
Quantitative Index ◽  
Diagnostic Quality ◽  
Logistic Regression Models ◽  
Greater Curvature

The aim of the study is to develop an approach to assess the severity of the gastric mucosa (GM) atrophy based on the immunohistochemical (IHC) technique to improve diagnostic quality of the stage of chronic gastritis (CG) and to implement predictive assessment of risk factors of gastric cancer development.Material and methods. The study included 155 cases of CG selected in accordance with Operational Link for Gastritis Assessment (OLGA)-system (2 samples of antral gastric mucosa (GM), 1 sample of angular GM and 2 samples of corpus GM). All biopsy samples were examined using histological and IHC (CDX2) techniques. An expression semi-quantitative index was developed to characterize CDX2. The results obtained were statistically processed using the Mann-Whitney and Kruskal-Wallis tests, the Spearman correlation coefficient, and the construction of logistic regression models.Results. It was found that the value of the CDX2 index assessed within the GM biopsy samples positively correlates with the gradation of atrophy (r=0.665 (p<0.001)). A positive correlation remains between the CDX2sum index, calculated by summing the CDX2 index values at each of the GM points, and the stage of chronic gastritis according to the OLGA classification (r=0.70 (p<0.01)). When assessing the contribution of changes at each point of biopsy sampling and retrospective correlation of the CDX2 index at two points of the GM and the stage of chronic gastritis, the greatest correlation was found for points 3 (stomach angle) and 5 (greater curvature of the gastric body), at three points – for points 1 (greater curvature antrum), 3 and 5 (r=0.592 (p<0.01)). Logistic regression models were built to predict the stage of chronic gastritis based on the CDX2 index in the specified combinations of points. The following model was chosen as the optimal one: to take biopsies at three points (1, 3, 5) and assess their CDX2 index, with sensitivity equal 80.4%, specificity equal 82.8% and diagnostic accuracy equal 83.9%.Conclusion. The CDX2 semi-quantitative index can be used to evaluate GM atrophy. The performed regression analysis demonstrates its predictive role. The constructed regression model based on the CDX2 semi-quantitative index calculation at two/three points of GM allows increasing predictive value of biopsy investigations and accuracy of stratified assessment of the gastric adenocarcinoma risk development in patients with CG.

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