scholarly journals Zollinger-Ellison syndrome. Case report

Case reports ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. 28-35
Author(s):  
Juan Felipe Rivillas-Reyes ◽  
Juan Leonel Castro-Avendaño ◽  
Héctor Fabián Martínez-Muñoz
Keyword(s):  
Peptic Ulcer ◽  
Epigastric Pain ◽  
Perforated Peptic Ulcer ◽  
Whipple Procedure ◽  
Ulcer Disease ◽  
Zollinger Ellison Syndrome ◽  
Standard Management ◽  
Effective Option ◽  
Low Incidence ◽  
Emergency Surgical Intervention

Introduction: The Zollinger-Ellison syndrome (ZES) is a pathology caused by a neuroendocrine tumor, usually located in the pancreas or the duodenum, which is characterized by elevated levels of gastrin, resulting in an excessive production of gastric acid.Case presentation: A 42-year-old female patient with a history of longstanding peptic ulcer disease, who consulted due to persistent epigastric pain, melena and signs of peritoneal irritation.  Perforated peptic ulcer was suspected, requiring emergency surgical intervention. Subsequently, a tumor lesion in the head of the pancreas was documented and managed with Whipple procedure. The pathology results reported a tumor suggestive of neuroendocrine neoplasm.Discussion: The Zollinger-Ellison syndrome occurs in 0.1 to 3 people per 1 000 000 inhabitants worldwide and is predominant in women between 20 and 50 years of age. It usually appears as a refractory acid-peptic disease or as a complication of gastric acid hypersecretion. Medical therapy is the standard management, being proton pump inhibitors (PPI) the most effective option. Surgery is recommended for sporadic ZES.Conclusions: ZES has a low incidence rate. It is rarely considered in the differential diagnosis of chronic epigastric pain and high clinical suspicion is required to achieve adequate management. This article is highly relevant as it presents a confirmed clinical case of ZES in Colombia, highlighting the importance of producing local scientific literature to improve the diagnosis and treatment of this pathology.

Perforated Peptic Ulcer of the Duodenum After the Laparoscopic Roux-en-Y Gastric Bypass

2021 ◽  
pp. 000313482110505
Author(s):  
Robert B. Laverty ◽  
Brian S. Yoon ◽  
Kyle K. Sokol ◽  
Brian K. Sparkman
Keyword(s):  
Gastric Bypass ◽  
Peptic Ulcer ◽  
Epigastric Pain ◽  
Rare Complication ◽  
Vital Signs ◽  
Perforated Peptic Ulcer ◽  
Care Physician ◽  
Anterior Portion ◽  
Omental Patch ◽  
Ulcer Disease

Perforated ulcers of the gastric remnant and duodenum seem to be a rare complication after a Roux-en-Y gastric bypass. Diagnosis of this complication can be difficult given a vague presentation, however, early intervention is critical to prevent further morbidity. We present the case of a 38-year-old male with a perforated duodenal ulcer nearly a year after Roux-en-Y gastric bypass. Upon presentation, he complained of 8 hours of epigastric pain. His medical history was significant for chronic peptic ulcer disease and a negative history of H. pylori. Recently, he had been prescribed naproxen by his primary care physician for knee pain. His vital signs were normal with the exception of his systolic blood pressure which was 190 mmHg. He was diaphoretic and peritonitic on exam. He was taken emergently for a diagnostic laparoscopy and found to have a perforation of ∼5 mm of the anterior portion of his duodenum. This was repaired laparoscopically with an omental patch and the patient recovered without any further intervention required. While this is a rare complication reported in the literature, this or similar complications of the remnant stomach may be underrepresented in publications. The surgical intervention of this disease will either be resection of the remnant or an omental patch. However, controversy remains as to the proper post-operative medical treatment. For our patient, the inciting agent was likely the naproxen he was given and this was stopped immediately. Patient education and ownership should remain a cornerstone for patients that have undergone a Roux-en-y gastric bypass.

scholarly journals Small Intestine Obstruction in Patients due to Phytobezoar: Case Report of Four Patients

2016 ◽  
Vol 02 (01) ◽  
pp. 040-043
Author(s):  
V Kumar ◽  
Anupama Pujar ◽  
Ashwini Kudari ◽  
Kush Luthra
Keyword(s):  
Peptic Ulcer ◽  
Case Report ◽  
Perforated Peptic Ulcer ◽  
Definitive Treatment ◽  
Ulcer Disease ◽  
High Fiber ◽  
Fiber Diet ◽  
Barium Examination ◽  
Carcinoma Esophagus ◽  
High Fiber Diet

ABSTRACT Introduction: Bezoars are rare cause of small-bowel obstruction and lead to intraluminal obstruction. The other causes are foreign bodies, gall stones, and enteroliths. Phytobezoars are collection of non-digestible materials, usually of vegetable origin, and are most commonly found in patients with impaired gastric emptying, on high-fiber diet and with abnormal food habits.We present a case report of four patients who presented with acute intestinal obstruction, and the etiology in all these four cases was found to be a phytobezoar. The complaints of diffuse pain abdomen, vomiting, and constipation were common in all four cases. One patient had undergone a gastric pull-up surgery for carcinoma esophagus and one female had undergone bilroth1 for peptic ulcer disease. One patient was a known case of diabetes mellitus and had undergone surgery for perforated peptic ulcer few years back. Conclusion: Diagnosis of bezoars is usually confirmed by barium examination or endoscopy, and definitive treatment is surgery in case of obstruction with the removal of bezoar.

FEASIBILITY OF ERAS (ENHANCED RECOVERY AFTER SURGERY) PROTOCOL IN PATIENTS UNDERGOING EMERGENCY REPAIR FOR PERFORATED PEPTIC ULCER DISEASE IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 41-43
Author(s):  
Chayan Rui ◽  
Chandan Roy Choudhury ◽  
Puspak Ghosh
Keyword(s):  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Tertiary Care ◽  
Perforated Peptic Ulcer ◽  
Patch Repair ◽  
Care Hospital ◽  
Ulcer Disease ◽  
Emergency Repair

Introduction: The surgical treatment of perforated peptic ulcer disease has evolved in parallel to advances in medical treatment of Peptic Ulcer Disease. Objective: To investigate the feasibility of ERAS (Enhanced Recovery after Surgery) Pathways in patients undergoing emergency repair for Perforated peptic ulcer disease. Materials and methods: Institutional based prospective analytical study. Indoor patients in Dept. of General Surgery in Medical College and Hospital Kolkata. January 2019 to June 2020. Study was conducted for 18 months.14 months was provided for data collection. Next 2 months for statistical analysis and another 2 months for thesis writing and submission. Conclusion: ERAS pathway (with some modications) seems to be safe and feasible in a highly selected subset of patients undergoing emergency Omental grahams patch repair of Perforated Peptic Ulcer Disease

Peptic Ulcer Disease

2021 ◽  
pp. 46-67
Author(s):  
Albatool Abumunaser
Keyword(s):  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Epigastric Pain ◽  
Healing Process ◽  
Nutrition Therapy ◽  
Nutrition Intervention ◽  
Ulcer Disease ◽  
Behavioral Choices ◽  
Mucosal Thickness ◽  
Tract Disease

This chapter will discuss a peptic ulcer disease (PUD) case. PUD is a common gastrointestinal tract disease (GIT) that affects the stomach and duodenum. It is characterized by deep lesions into the mucosal thickness. Various dietary and behavioral choices could aggravate the epigastric pain associated with PUD and interfere with the healing process leading to complications. Management of PUD includes medical treatment with medications along with behavioral and nutritional changes. This case presents a complication of PUD, and choices exacerbating the condition. It will also discuss the role of medical nutrition therapy in minimizing the symptoms and promoting ulcer healing. Additionally, it will allow the dietetic professional to methodically assess the elements in the case that are relevant for planning the nutrition intervention; in addition to, educating the patient about dietary modifications to improve the patient's quality of life.

Article Commentary: Zollinger–Ellison Syndrome: A Personal Perspective

2008 ◽  
Vol 74 (7) ◽  
pp. 563-571 ◽  
Author(s):  
E. Christopher Ellison
Keyword(s):  
Peptic Ulcer ◽  
Total Gastrectomy ◽  
Malignant Potential ◽  
Personal Perspective ◽  
Surgical Removal ◽  
Tumor Removal ◽  
Ulcer Disease ◽  
Zollinger Ellison Syndrome ◽  
Biochemical Cure ◽  
The Impact

The odyssey of Zollinger-Ellison Syndrome is one of the most interesting in surgery. From the initial recognition of two patients with severe peptic ulcer disease in 1955 sprung an international dialogue on this unique disease culminating in discovery that gastrin was the hormone secreted by these pancreatic and duodenal tumors. The impact was the birth of a new area of science, “gastrointestinal endocrinology.” Initially, surgeons were challenged by the complexity of the patients and the need to perform total gastrectomy to prevent death from complications of the severe ulcer disease. Later, after the discovery of proton pump inhibitors, total gastrectomy was no longer needed and the surgeon could focus treatment on tumor removal added by radioimmunoassay for gastrin and new imaging modalities. Today, we recognize that all gastrinomas have malignant potential; early surgical removal can reduce the incidence of metastases and improve survival, independent of biochemical cure, in both sporadic and familial forms of the disease.

scholarly journals Association of Helicobacter Pylori with Peptic Ulcer Perforation

2019 ◽  
Vol 2 (1) ◽  
pp. 4-10
Author(s):  
Sunit Agrawal ◽  
D Thakur ◽  
P Kafle ◽  
A Koirala ◽  
R K Sanjana ◽  
...  
Keyword(s):  
Risk Factors ◽  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Perforated Peptic Ulcer ◽  
Patch Repair ◽  
Peptic Ulcer Perforation ◽  
Ulcer Disease ◽  
Ulcer Perforation ◽  
H Pylori

Background: Helicobacter pylori is found in more than 90% cases of peptic ulcer. This study examines the possibility of association of Helicobacter pylori in perforated peptic ulcer disease and its relation to persisting ulcer as well as the influence of other risk factors; namely: smoking, alcohol, current non-steroidal anti inflammatory drugs (NSAIDs) and steroid use. Materials and Methods: In this prospective study, total of 50 cases of peptic ulcer perforation admitted in College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal were selected on the basis of the non-probability (purposive) sampling method. All patients who presented with suspected peptic ulcer perforation were included in the study and the perforations were repaired by Modified Graham’s Patch and were given triple therapy postoperatively. The age, sex, incidence, mode of presentation, precipitating factors, association with the risk factors and postoperative complications were all evaluated and compared. Results: Of 50 patients studied, the age ranged from 17 to 75 years, mean age being 40.1 years with the peak incidence in the 3rd and 5th decades of life showing a male dominance (92%). H. pylori was seen in ulcer edge biopsy in 29 patients (58%). Most common clinical presentation was pain abdomen, the most common signs of perforation were tenderness, rebound tenderness and absent bowel sounds. The mean duration of stay in hospital in H. pylori positive patients was 12.07±8.15 days as compared with 11.1±5.12 days in H. pylori negative patients. The incidence of peptic ulcer perforation was higher in the patients consuming alcohol (64%) than smokers (48%), followed by NSAIDs user(22%). 20% of the patients with delayed presentation developed complications postoperatively. Perforated peptic ulcer was repaired by Modified Graham’s Patch Repair, followed by anti H. pylori therapy in all of them. Conclusion: Peptic ulcer perforation is quite common among the patients with peptic ulcer disease with history of chronic smoking, alcoholism and analgesic intake, more commonly in males. There is association of H. pylori in 58% of patients with peptic ulcer perforation.

scholarly journals Non-perforated peptic ulcer disease: multidetector CT findings, complications, and differential diagnosis

2017 ◽  
Vol 8 (5) ◽  
pp. 455-469 ◽  
Author(s):  
Massimo Tonolini ◽  
Anna Maria Ierardi ◽  
Elena Bracchi ◽  
Paolo Magistrelli ◽  
Adriana Vella ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Multidetector Ct ◽  
Perforated Peptic Ulcer ◽  
Ulcer Disease ◽  
Ct Findings

Role of Empiric Anti-Fungal Therapy in the Treatment of Perforated Peptic Ulcer Disease: Review of the Evidence and Future Directions

2019 ◽  
Vol 20 (8) ◽  
pp. 593-600
Author(s):  
Jared M. Huston ◽  
Laura Kreiner ◽  
Vanessa P. Ho ◽  
James M. Sanders ◽  
Therese M. Duane
Keyword(s):  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Perforated Peptic Ulcer ◽  
Future Directions ◽  
Ulcer Disease ◽  
Anti Fungal

scholarly journals Laparoscopic Repair for Perforated Duodenal Ulcer

2015 ◽  
Vol 20 (3) ◽  
pp. 168-172
Author(s):  
Cotirleţ A. ◽  
Tincu E. ◽  
Coşa Raluca ◽  
Popa E. ◽  
Gavril Laura ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Laparoscopic Repair ◽  
Perforated Peptic Ulcer ◽  
Gastric Surgery ◽  
High Morbidity ◽  
Ulcer Disease ◽  
Surgical Emergencies ◽  
Abdominal Disease ◽  
Laparoscopic Closure ◽  
Prolonged Surgery

Abstract Perforated peptic ulcer (PPU), despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Perforated peptic ulcer is a common abdominal disease that is treated by surgery. The development of laparoscopic surgery has changed the way to treat such abdominal surgical emergencies but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense. However we can say that laparoscopic repair is a viable and safe surgical option for patients with perforated peptic ulcer disease and should be considered with the necessary expertise available.

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