Gastric adenocarcinoma with enteroblastic differentiation: an unexpected cause of upper gastrointestinal bleeding

A 78-year-old male with previous medical history of hypertension, dyslipidemia, benign prostatic hyperplasia and colectomy for colon adenocarcinoma 16 years earlier presented to emergency department with melena for approximately 2 weeks. He denied hematemesis or hematochezia. He also denied other symptoms including abdominal pain, nausea, vomiting, fever, anorexia or weight loss. Usual medications included silodosin, simvastatin, losartan, hydrochlorothiazide, pantoprazole and midazolam. He denied recent intake of iron supplements or non-steroidal anti-inflammatory drugs. Physical examination was unremarkable except for pale skin. Laboratory studies revealed the presence of anemia (hemoglobin level: 7.1 g/dL). Leukocyte and platelet counts, liver tests, renal function, electrolyte levels, C-reactive protein and coagulation studies were all normal. Upper digestive endoscopy revealed red blood and blood clots in gastric lumen and a polypoid lesion with a diameter of approximately 20 mm located at the greater curvature of the proximal body with active oozing hemorrhage (Figure 1). Bleeding was successfully controlled with injection of diluted epinephrine at the base of the polyp and the patient was admitted in intermediate care unit for close monitoring. During the following days,

Phyllanthus reticulatus Prevents Ethanol-Induced Gastric Ulcer via Downregulation of IL-8 and TNF-α Levels

The current study aimed to determine the protective effect of P. reticulatus on ethanol-induced gastric ulcer. For this purpose, thirty-six Sprague-Dawley rats were divided into six groups. The first group served as normal control, while, in other five groups, absolute ethanol was used to induce gastric ulcer. Group II served as a diseased group, while groups III, IV, and V were treated with methanol extract, ethyl acetate fraction, and n-hexane fraction, respectively, in a dose of 400 mg/kg bodyweight. Group VI was given omeprazole in a dose 20 mg/kg bodyweight. The stomachs were removed, ulcer score was evaluated, and histopathological examination of gastric lumen was conducted. Total acidity and pH values were determined in gastric juice. TNF-α and IL-8 mRNA expressions levels were determined using the reverse transcription real-time PCR method. The data indicated that P. reticulatus protected against gastric ulcer, which was evident by attenuation of ulcer score. The pretreatment with P. reticulatus raised the gastric pH and improved all evaluated histopathological parameters such as ulcer score, erosion score, hemorrhage score, fibrinoid necrosis score, inflammatory infiltrate score, and edema score. P. reticulatus significantly reduced mRNA expression levels of TNF-α and IL-8. In conclusion, P. reticulatus possess antiulcer property which might be attributed to downregulation of TNF-α and IL-8 expression levels.

H. pylori eradication therapy: impact of gastric mucosa atrophy on transport of amoxicillin to H. pylori colonization area

AIM: The aim was to assess systemic transport of amoxicillin, the most common antibiotic in H. pylori eradication regimens to the gastric in atrophic gastritis. MATERIALS AND METHODS: Systemic transport of amoxicillin to the gastric lumen of rats was evaluated in washes from the gastric mucosa in the model of atrophic gastritis after intravenous drug infusion. Transport of amoxicillin from bloodstream to the gastric lumen was also assessed in patients with atrophic and non-atrophic gastritis in aspirated via nasogastric probe gastric juice after oral drug administration. Amoxicillin concentration was measured in samples using liquid chromatography-mass spectrometry. RESULTS: In rats with induced atrophic gastritis, hyperemia and acute erosions of the gastric mucosa, as well as microscopic signs of non-active chronic body gastritis and non-active antral atrophic gastritis were found. Amoxicillin concentration in washes from the gastric mucosa was significantly (p 0.01) higher in rats of experimental group than in control group at all time points (30, 60, 120, 240 min after drug infusion). The lowest mean amoxicillin concentration in gastric juice was observed in patients with antral atrophy (p 0.01). The maximum amoxicillin concentration in gastric secretion was found at the 180th min of aspiration in patients with atrophy of gastric mucosa, while in patients of the group of comparison it was found at 30-120th min of aspiration. CONCLUSIONS: Acute gastric mucosa erosions enhance amoxicillin delivery to gastric lumen in rats. Atrophy of antral mucosa more than in the corpus is characterized by decreased amoxicillin transfer from systemic bloodstream to gastric lumen in patients after oral amoxicillin intake. The gastric mucosa atrophy should be taken into consideration while predicting the efficacy of H. pylori eradication therapy in patients with chronic gastritis.

Additional criterion for assessing the risk of gastric variceal bleeding according to multispiral computed tomography

Aim. To establish the parameters of gastric varices which determine a high risk of gastric bleeding according to the results of multispiral computed tomography.Material and methods. The results of studies of 39 patients with liver cirrhosis and gastric varices were retrospectively studied. Nine of them had signs of previous bleeding on endoscopic examination or the corresponding data in the medical history. In 3 patients gastric bleeding occurred 30-47 days after multispiral computed tomography.Results. According to the results of multispiral computed tomography with multiplanar reconstructions gastric bleeding was detected in 12 patients with protrusion of submucosal varicose veins into the gastric lumen by 5 mm or more with a vein diameter >7 mm.Conclusion. The results of multispiral computed tomography, complemented by the hydro-computed tomography technique, provide important additional information on predicting the development of gastric bleeding in the selection of patients for preventive minimally invasive interventions on the veins of the stomach.

Suicidal acid ingestion leading to gastric outlet obstruction treated by early definitive surgery—case report

Chemical ingestions can cause acute injury to the oesophagus, stomach, pylorus, duodenum and sometimes other organs after ingestion of corrosives, but it may be as late as 1 year after ingestion. A 30-year-old male patient presented to the emergency department with sudden epigastric abdominal pain after flash material ingestion. Computed tomography of abdomen showed signs of small bowel obstruction associated with segmental small bowel ischaemic changes. Postoperatively, patient developed an intolerance to oral intake with upper gastrointestinal scope showing sever stricture at the distal gastric lumen and pylorus. The patient was taken to the operation where gastrojejunostomy and brown procedure was done. Corrosive gastric injury treatment depends on the degree of gastric involvement, related oesophageal strictures and the patient’s general health. Early surgery offers very satisfactory and physiological results, whereas avoiding gastric resection or bypass provides very satisfactory and physiological outcomes.

Focus on the totally laparoscopic feeding gastrostomy tube placement operative technique

Laparoscopic feeding gastrostomy placement is a surgical operation that allows the feeding of malnourished patients through a tube that is placed in the gastric lumen. The benefits of an improved nutritional status in terms of improving clinical outcomes are well documented in the literature and consist in a reduction of the complication rates of the surgical patients, the length of hospital stay, the readmission rates, and a reduction of the cost of health services by reducing the morbidity or mortality. We present a totally laparoscopic technique of feeding tube placement.

Hair loss in an infant presenting with failure to thrive

An 11-month-old male child with a complex past medical history presented for admission due to failure to thrive. He had hair loss throughout his scalp, and his abdomen was distended. There was parental report of hair pulling and hair in his stool. An upper gastrointestinal (GI) radiograph with fluoroscopy was performed and showed a filling defect in the gastric lumen. On endoscopy, he was found to have a gastric bezoar consisting of hair, nail, and food material. The trichobezoar was removed, and he began to tolerate feeds and showed consistent weight gain. There were no recurrence of symptoms 8 months following removal. While inadequate caloric intake is a common reason for failure to thrive, mechanical obstruction from a trichobezoar as a cause is rare and to our knowledge has not been reported in a child this young.

Complicated gastric duplication cyst presenting as cystic intraperitoneal collection: a case report

Background Alimentary tract duplications are rare anomalies and any delay in the diagnosis may develop various complications. Infection, hemorrhage, or perforation of the duplication cyst may lead to an acute presentation. Occasionally, it may lead to a diagnostic and management dilemma. Herein, we report an unusual complication of gastric duplication cyst. Case presentation A 2.5-year-old girl presented with recurrent abdominal distension, fever, and abdominal pain. The imaging workup revealed a huge intraperitoneal collection. Intraoperatively, a huge pseudocyst was encountered communicating with the gastric duplication cyst. The gastric duplication cyst was sharing a common wall with the greater curvature of the stomach but was not communicating with the gastric lumen. Pseudocyst along with gastric duplication cyst was completely excised. The resultant seromuscular defect of the stomach was also closed. The postoperative period was uneventful. Conclusion Perforation of the gastric duplication cyst should be kept in differentials of intraperitoneal collection not amenable to multiple aspirations. Huge intraperitoneal collection secondary to perforation of gastric duplication is exceedingly rare and scarcely reported in the literature.

Hypertrophic gastropathy associated with gastric sarcoma in a dog

A 14-y-old spayed female Labrador Retriever was presented with an 8-mo history of chronic vomiting. Abdominal ultrasound and gastrointestinal endoscopy revealed a mass protruding into the gastric lumen, with cytologic features suggestive of sarcoma. A partial gastrectomy was performed; the gastric body and antrum were thickened, with a cerebriform appearance of the mucosal surface. Histologic examination revealed a submucosal neoplastic proliferation of fusiform cells variably arranged in irregular bundles and scattered whorls. Fusiform cells strongly reacted to antibodies against vimentin, S100, and neuron-specific enolase; glial fibrillary acidic protein was moderately and multifocally expressed. Pancytokeratin, KIT, α–smooth muscle actin, and desmin were nonreactive. Histologic and immunohistochemical findings suggested a diagnosis of gastric sarcoma with features referable to a non-GIST (gastrointestinal stromal tumor), non–smooth muscle NIMT (non-angiogenic, non-lymphogenic intestinal mesenchymal tumor). The overlying gastric mucosa was thickened by elongated and dilated gastric glands, predominantly lined by intensely periodic acid-Schiff–stained mucous cells. This altered mucosal architecture was suggestive of Ménétrier-like disease. Although this disease has been hypothesized to predispose to gastric adenocarcinoma in dogs, an association with gastric sarcoma has not been documented previously in the veterinary literature, to our knowledge.