Respiration and circulation affected by gas leakage into the abdominal cavity during endoscopic esophageal submucosal dissection after gastrostomy: a case report

Abstract Background Pneumoperitoneum is a common complication of percutaneous endoscopic gastrostomy (PEG). We report a case of circulatory and respiratory depression due to pneumoperitoneum caused by PEG dislodgement during endoscopic submucosal dissection (ESD) surgery. Case presentation A 46-year-old man with PEG for dysphagia underwent ESD for esophageal cancer under general anesthesia. The patient developed a gradual increase in peak inspiratory pressure, followed by a decrease in peripheral oxygen saturation (SpO2) and blood pressure, as well as an increase in heart rate (HR) during endoscopic submucosal ESD for esophageal cancer. We suspected mediastinal emphysema due to esophageal perforation, but the surgery was successfully completed. Postoperative computed tomography (CT) revealed that the abdominal and gastric walls, which had been fixed by PEG, were detached, resulting in a large amount of intra-abdominal gas and mediastinal emphysema. Conclusions ESD in patients with PEG should be performed carefully because of the possibility of intraoperative PEG dislodgement and pneumoperitoneum caused by insufflation gas leakage.

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Closed laparoscopic and endoscopic cooperative surgery for early gastric cancer with difficulty in endoscopic submucosal dissection: a report of three cases

Surgical Case Reports ◽

10.1186/s40792-020-01015-4 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Hiroshi Saito ◽

Akihiro Nishimura ◽

Yusuke Sakimura ◽

Hiroki Tawara ◽

Kengo Hayashi ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Abdominal Cavity ◽

Tumor Resection ◽

Invasive Procedure ◽

Case Presentation ◽

Less Invasive ◽

Submucosal Dissection

Abstract Background Endoscopic submucosal dissection (ESD) is increasingly applied for early gastric cancer. ESD is a less invasive procedure and could be a radical treatment. However, in some cases, ESD cannot be completed owing to patient or technical factors. In such cases, which could have the potential for curative resection with ESD, standard gastrectomy is excessively invasive. Through closed laparoscopic and endoscopic cooperative surgery (LECS), gastric tumor can be precisely resected without exposing tumor cells to the abdominal cavity. Compared with standard gastrectomy, closed LECS is less invasive for the treatment of early gastric cancer. Case presentation We performed closed LECS for three cases of early gastric cancer after failed ESD. In all three cases, ESD was interrupted owing to technical and patient factors, including perforation, respiratory failure, and carbon dioxide narcosis. All three cases successfully underwent closed LECS with complete tumor resection and showed an uneventful postoperative course. All three patients remain alive and have experienced no complications or recurrence, with a median follow up of 30 (14–30) months. Conclusions Closed LECS is less invasive and useful procedure for the treatment of early gastric cancer, particularly in cases with difficulty in ESD.

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Extraperitoneal gas leakage causing pneumothorax after low rectal submucosal dissection

Minerva Anestesiologica ◽

10.23736/s0375-9393.19.13421-9 ◽

2019 ◽

Vol 85 (5) ◽

Author(s):

Arantxa Pavón-Benito ◽

Ana Casimiro-Erviti ◽

Leonor Veiga-Gil ◽

Elena Pérez-Bergara ◽

Miguel Salvador-Bravo

Keyword(s):

Gas Leakage ◽

Submucosal Dissection

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A case of pleuroperitoneal communication in which establishing a laparoscopic pneumoperitoneum was useful for the detection of a fistula

Surgical Case Reports ◽

10.1186/s40792-021-01147-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Takehiko Manabe ◽

Kenji Ono ◽

Soichi Oka ◽

Yuichiro Kawamura ◽

Toshihiro Osaki

Keyword(s):

Thoracic Surgery ◽

Surgical Repair ◽

Abdominal Cavity ◽

Case Presentation ◽

X Ray ◽

Video Assisted Thoracic Surgery ◽

Video Assisted ◽

Pleuroperitoneal Communication ◽

Small Pore ◽

Chest X Ray

Abstract Background Pleuroperitoneal communication (PPC) is rarely observed, accounting for 1.6% of all patients who undergo continuous ambulatory peritoneal dialysis (CAPD). Although there have been several reports concerning the management of this condition, we have encountered several cases in which control failed. We herein report a valuable case of PPC in which laparoscopic pneumoperitoneum with video-assisted thoracic surgery (VATS) was useful for supporting the diagnosis and treatment. Case presentation The patient was a 58-year-old woman with chronic renal failure due to chronic renal inflammation who was referred to a nephrologist in our hospital to undergo an operation for the induction of CAPD. Post-operatively, she had respiratory failure, and chest X-ray and computed tomography (CT) showed right-sided hydrothorax that decreased when the injection of peritoneal dialysate was interrupted. Therefore, PPC was suspected, and she was referred to our department for surgical repair. We planned surgical treatment via video-assisted thoracic surgery. During the surgery, we failed to detect any lesions with thoracoscopy alone; we therefore added a laparoscopic port at her right-sided abdomen near the navel and infused CO2 gas into the abdominal cavity. On thoracoscopy, bubbles were observed emanating from a small pore at the central tendon of the diaphragm, which was considered to be the lesion responsible for the PPC. We closed it by suturing directly. Conclusions VATS with laparoscopic pneumoperitoneum should be considered as an effective method for inspecting tiny pores of the diaphragm, especially when the lesions responsible for PPC are difficult to detect.

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Bowel incarceration within the vaginal tunic in a three-and-half-year-old bilaterally cryptorchid Lhasa Apso

Acta Veterinaria Scandinavica ◽

10.1186/s13028-021-00586-y ◽

2021 ◽

Vol 63 (1) ◽

Author(s):

Dorcas Oyueley Kodie ◽

Noah Segun Oyetayo ◽

Oladotun Solomon Awoyemi ◽

Cecelia Omowunmi Oguntoye ◽

Oghenemega David Eyarefe

Keyword(s):

Risk Factor ◽

Sertoli Cell ◽

Epidural Anaesthesia ◽

Spermatic Cord ◽

Abdominal Cavity ◽

Case Presentation ◽

Spermatic Cord Torsion ◽

Left Testicle ◽

History Of ◽

Sertoli Cell Tumours

Abstract Background Cryptorchidism in dogs is of clinical concern due to its association with development of Sertoli cell tumours, seminomas and spermatic cord torsion. A patent inguinal ring has been found as a risk factor for peritoneal content migration and inguinal hernias. This study reports a case of bowel migration through a patent inguinal ring in a bilaterally cryptorchid dog and incarceration within the vaginal tunic of the left testicle. Case presentation A three-and-a-half-year-old bilaterally cryptorchid Lhasa Apso with a history of anorexia, vomiting, stranguria and inability to defecate was diagnosed with bowel incarceration in the vaginal tunic of a retained left testicle. Surgery performed under epidural anaesthesia with acepromazine/butorphanol premedication revealed a loop of the colon entrapped in the vaginal tunic of the retained left testicle. The incarcerated bowel was thoroughly examined for viability and repositioned into the abdominal cavity. The inguinal ring was repaired and bilateral cryptorchidectomy performed. Conclusion Cryptorchidectomy in dogs is often considered when there is concern for neoplasm or torsion of retained testes. However, this report suggests that cryptorchidectomy should be considered also to preclude the possibility of bowel obstructive emergencies.

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PS02.146: LARYNX-PRESERVING SURGERY FOR CERVICAL ESOPHAGEAL CANCER USING INTRAOPERATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION: A CASE REPORT

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.146 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 162-162

Author(s):

Yoshiki Taniguchi ◽

Koji Tanaka ◽

Yasuhiro Miyazaki ◽

Tomoki Makino ◽

Tsuyoshi Takahashi ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Esophageal Cancer ◽

Endoscopic Submucosal Dissection ◽

Cell Carcinoma ◽

Squamous Cell ◽

Tumor Invasion ◽

Pathological Examination ◽

Submucosal Layer ◽

Cervical Esophageal Cancer ◽

Submucosal Dissection

Abstract Background We sometimes experience cases of cervical esophageal cancer which requires laryngectomy due to spread of cancer to larynx. We report a case of esophageal cancer resection with preservation of larynx using intraoperative endoscopic submucosal dissection. Methods The patient was a 59-year-old woman who had dysphagia. She had received total gastrectomy with Roux-en-Y reconstruction for gastric cancer in 2001, chemoradiation (61.2Gy) for esophageal cancer in 2008. Argon plasma coagulation (APC) was performed for the carcinoma in situ of cervical esophagus in 2016. This time superficial 0-IIc tumor was observed at the same site of the scar of APC, and a biopsy revealed squamous cell carcinoma. An endoscopic findings revealed two 0-IIc lesions at distance of 18–22 cm, and 32–34 cm from the incisors, and biopsy resulted in a diagnosis of squamous cell carcinoma. Since tumor was close to the esophageal orifice, the tumor invasion to the larynx was suspected. On the other hand, there were no obvious findings of the submucosal layer invasion, and the both tumor were thought to be limited to the epithelium or lamina propria mucosae (EP/LPM). We performed mediastinoscopic and thoracoscopic transhiatal esophagectomy, subcutaneous ileocolic reconstruction. Results After confirming the tumor invasion to the esophageal orifice by chromoendoscopy with 1% Lugol's iodine solution, we dissected the whole circumference of esophagus in submucosal layer just above the tumor by ESD, put an incision outside of esophageal wall, and resected the esophagus. We preserved short length of muscle layer and performed reconstruction with hypopharynx-ileum anastomosis. Pathological examination revealed squamous cell carcinoma, pT1a-EP, ly0, v0, pPM0, pDM0, pIM0, and curative resection was performed. The postoperative course was uneventful. Conclusion There were no reports of successful larynx-preserving surgery for cervical esophageal cancer using intraoperative ESD. When the tumor was limited in the mucosa, esophagectomy with intraoperative ESD may enable larynx preservation even if the tumor invaded to the esophageal orifice. Disclosure All authors have declared no conflicts of interest.

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Metastatic hypopharyngeal and esophageal cancer to a percutaneous endoscopic gastrostomy site

Esophagus ◽

10.1007/s10388-008-0160-1 ◽

2008 ◽

Vol 5 (3) ◽

pp. 155-156 ◽

Cited By ~ 1

Author(s):

Naruo Kawasaki ◽

Yutaka Suzuki ◽

Takakuni Kato ◽

Kazuto Tsuboi ◽

Akira Matsumoto ◽

...

Keyword(s):

Esophageal Cancer ◽

Percutaneous Endoscopic Gastrostomy ◽

Endoscopic Gastrostomy

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Transgastrostomic Endoscopy Assisted Endoscopic Submucosal Dissection for Gastric Tumors in Patients with Percutaneous Endoscopic Gastrostomy

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2007.03.250 ◽

2007 ◽

Vol 65 (5) ◽

pp. AB161

Author(s):

Shinji Nishiwaki ◽

Hiroshi Araki ◽

Junji Kawaguchi ◽

Naohumi Kawade ◽

Kiyoyuki Takenaka ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Percutaneous Endoscopic Gastrostomy ◽

Gastric Tumors ◽

Submucosal Dissection ◽

Endoscopic Gastrostomy

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Spontaneous pneumoperitoneum with duodenal diverticulosis in an elderly patient: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0769-4 ◽

2020 ◽

Vol 6 (1) ◽

Cited By ~ 2

Author(s):

Takeshi Ueda ◽

Tetsuya Tanaka ◽

Takashi Yokoyama ◽

Tomomi Sadamitsu ◽

Suzuka Harada ◽

...

Keyword(s):

Conservative Treatment ◽

Abdominal Cavity ◽

Vital Signs ◽

Rare Condition ◽

Exploratory Laparotomy ◽

Case Presentation ◽

Free Air ◽

Spontaneous Pneumoperitoneum ◽

Upper Abdominal ◽

Emergent Laparotomy

Abstract Background Pneumoperitoneum commonly occurs as a result of a viscus perforation and usually presents with peritoneal signs requiring emergent laparotomy. Spontaneous pneumoperitoneum is a rare condition characterized by intraperitoneal gas with no clear etiology. Case presentation We herein report a case in which conservative treatment was achieved for an 83-year-old male patient with spontaneous pneumoperitoneum that probably occurred due to duodenal diverticulosis. He had stable vital signs and slight epigastric discomfort without any other signs of peritonitis. A chest radiograph and computed tomography showed that a large amount of free gas extended into the upper abdominal cavity. Esophagogastroduodenoscopy showed duodenal diverticulosis but no perforation of the upper gastrointestinal tract. He was diagnosed with spontaneous pneumoperitoneum, and conservative treatment was selected. His medical course was uneventful, and pneumoperitoneum disappeared after 6 months. Conclusion In the management of spontaneous pneumoperitoneum, recognition of this rare condition and an accurate diagnosis based on symptoms and clinical imaging might contribute to reducing the performance of unnecessary laparotomy. However, in uncertain cases with peritoneal signs, spontaneous pneumoperitoneum is difficult to differentiate from free air resulting from gastrointestinal perforation and emergency exploratory laparotomy should be considered for these patients.

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