11/66. Bouveret's syndrome presenting as upper gastrointestinal hemorrhage without hematemesis.A 74-year-old woman with a recent diagnosis of peptic ulcer disease diagnosed by endoscopy after presentation with an episode of upper gastrointestinal bleeding returned 6 1/2 weeks later with a 5-day history of nausea and vomiting without associated symptoms. An ultrasound was nondiagnostic except for a large gallstone and a poorly visualized gallbladder. Repeat endoscopy revealed a hard mass that was presumed to have formed secondarily to an ulcer-induced stricture, and a 6-cm filling defect just proximal to the duodenal bulb was seen on a preoperative upper gastrointestinal series. At laparotomy the mass was actually a large gallstone and two smaller stones, which had eroded into and become impacted in the duodenal bulb creating a gastric outlet obstruction. The stones were extracted via a duodenotomy, and the remaining portion of the gallbladder was removed with repair of the cholecystoduodenal fistula. The patient was discharged home after an uncomplicated postoperative course. gastric outlet obstruction by a duodenal gallstone is a condition known as Bouveret's syndrome, which is a rare complication of gallstone disease. Upper gastrointestinal hemorrhage is an especially rare form of presentation.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
12/66. Morgagni hernia: case report.This is a case report of an elderly woman who presented with a history of epigastric pain and persistent vomiting diagnosed initially as a duodenal ulcer, later as a pyloric stenosis and at laparotomy was found to have an anterior diaphragmatic hernia with gastric volvulus. hernia of Morgagni occurs through a congenital defect in the diaphragm but usually presents in adulthood. It could be an incidental diagnosis or can present with obstructing symptoms of the herniated viscera. Treatment is surgical with reduction of hernia and repair of the diaphragmatic defect. If misdiagnosed, this can lead to considerable morbidity and occasionally mortality due to the obstructed/strangulated hernial contents.- - - - - - - - - - ranking = 0.090718657377676keywords = duct (Clic here for more details about this article) |
13/66. Reestablishing duodenal continuity after previous gastrectomy for peptic ulcer.Gastroduodenal anastomosis is not routine during reoperation for stomal ulcers after primary Billroth II gastrectomy. It nevertheless is a sure way to prevent an increased peptic potential which is brought about by a duodenal bypass. We have reviewed the published cases and added three more, bringing the total to 47. We analyzed the modalities, indications and results of this method. Gastroduodenal anastomosis can be accomplished more often than is thought, despite the often necessary large gastric resections. Separation of the duodenopancreatic block and liberation of the fundus allows suturing without traction. End-to-side anastomosis of the stomach on the anterior wall of the second portion of the duodenum avoids dissection of the duodenal stump. vagotomy is required when basal acidity is greater than 20 mEq/liter. Reestablishing a physiologic alimentary tract is particularly indicated in chronic obstruction due to stenosis associated with a proximal loop syndrome in young patients. Jejunal interposition becomes necessary when total gastrectomy is the result of repeated surgery. Such a method is the best solution for agastria. The excellent results obtained by gastroduodenal anastomosis after repeat gastrectomy should encourage wider use.- - - - - - - - - - ranking = 0.5keywords = obstruction (Clic here for more details about this article) |
14/66. Primary hyperparathyroidism with duodenal ulcer and H. pylori infection.A patient with duodenal ulcer and primary hyperparathyroidism was found to have an abnormally high intragastric pH. The pH level returned to normal after surgical removal of the parathyroid adenoma followed by normalization of parathyroid hormone (PTH) and serum calcium concentrations. The patient was positive for helicobacter pylon (H. pylori) infection. Although the exact mechanism by which chronic hypercalcemia or high PTH level inhibited gastric acid secretion in this case remains unclear, our findings suggest that hypercalcemia may play some role in H. pylori associated gastroduodenal diseases through induction of proinflammatory cytokines or by enhancing the attachment of H. pylori to gastric epithelial cells.- - - - - - - - - - ranking = 0.090718657377676keywords = duct (Clic here for more details about this article) |
15/66. fistula involving portal vein and duodenum at the site of a duodenal ulcer in a patient after previous extrahepatic bile duct resection and brachytherapy.Fistulas involving the portal venous system and gastrointestinal (GI) tract are rare. However, they can cause life-threatening GI hemorrhage. A case of a fistula between the main portal vein and the posterior wall of the duodenal bulb at the site of a duodenal ulcer in a patient who had previously undergone an extrahepatic bile duct resection and brachytherapy for mucinous cystadenocarcinoma is reported. Consideration should be given to this entity in the differential diagnosis of GI hemorrhage in patients with a history of previous major biliary surgery.- - - - - - - - - - ranking = 104.95566812846keywords = extrahepatic, bile duct, bile, duct (Clic here for more details about this article) |
16/66. Congenital causes of duodenal ulcers in adults.In seven cases of congenital anomalies in adults, duodenal obstruction and peptic ulcer disease developed. There were two cases of congenital duodenal web, two of hypertrophic pyloric stenosis, two of annular pancreas, and one of a preduodenal portal vein. The diagnosis is seldom made preoperatively. In the four patients who had preoperative gastric analysis, the acid secretions were increased. Those patients who underwent endoscopy had changes consistent with hypertrophic secretory gastrophy and duodenitis. We believe that treatment should be directed toward relief of the duodenal obstruction and the reduction of basal acid secretion by truncal vagotomy in all such cases.- - - - - - - - - - ranking = 1.0907186573777keywords = obstruction, duct (Clic here for more details about this article) |
17/66. Achalasia cardia and gastric outlet stenosis in a postmenopausal woman: case report.The orderly contractility of the oesophagus and the regulated ability of the pyloric sphincter allow the influx and efflux of gastric contents. When these physiological processes are impaired, gastric luminal transit is altered as expected in achalasia cardia and gastric outlet obstruction. movement across the inlet and outlet of the stomach is therefore altered. A case of a 58-year old woman diagnosed with simultaneous occurrence of achalasia cardia and gastric outlet stenosis resulting from chronic duodenal ulcer is presented. The diagnosis was based on clinical, radiological and intraoperative findings. This patient has remained well after a simultaneous anterior cardiomyotomy and H-M pyloroplasty. To my knowledge this is the first time that such an association causing gastric "inlet" and "outlet" obstruction has been reported.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
18/66. Extended surgery for the hepatic artery aneurysm involving duodenum and pancreas--a case report.hepatic artery aneurysms have been the most frequently reported splanchnic artery aneurysms in the past decade. Due to the complex anatomy and sensitivity of the liver to ischemic injury, a number of therapeutic alternatives exist in repairing aneurysmal hepatic arteries. Excision or obliteration of all hepatic artery aneurysms appears to be the management of choice. However, in managing aneurysms involving the proper hepatic artery and its extrahepatic branches, restoration of normal hepatic blood flow is most crucial. A 49-year-old man was found to have a huge extrahepatic artery aneurysm involving the area from the origin of the common hepatic artery to the distal proper hepatic artery. It ruptured into the duodenal bulb and firmly adhered to the surrounding structures including pancreas and common bile duct. Extended surgery with restoration of normal hepatic flow was performed safely. In cases with huge extrahepatic artery aneurysms, an aggressive approach to restore the hepatic arterial continuity seems appropriate for the prevention of ischemic damage to the liver.- - - - - - - - - - ranking = 58.923512073784keywords = extrahepatic, bile duct, bile, duct (Clic here for more details about this article) |
19/66. Resection for hepatocellular carcinoma with duodenal invasion: report of a case.A 73-year-old man was admitted to our hospital on emergency for severe anemia. Upper gastrointestinal endoscopic study revealed a hemorrhagic ulcer in the duodenal bulb. He underwent endoscopic hemostasis. Abdominal ultrasonography and computed tomography showed a huge mass in segment 4 of the liver, growing into the extrahepatic space with direct invasion to the duodenal bulb. Extended left lobectomy and partial gastroduodenectomy was performed, because the endoscopic management of hemostasis was incomplete. He was discharged on the 30th postoperative day. Histopathologically, the tumor cells were moderately differentiated hepatocellular carcinoma with direct invasion to the duodenal mucosa. This report demonstrated the first case with a hepatocellular carcinoma with duodenal invasion, for which hepatic resection was performed successfully.- - - - - - - - - - ranking = 18.966189224047keywords = extrahepatic (Clic here for more details about this article) |
20/66. Laparoscopic billroth II gastrectomy for completely stricturing duodenal ulcer: technical details.BACKGROUND: The authors report a series of three patients who underwent laparoscopic gastrectomy for gastric outlet obstruction due to stricturing duodenal ulcer. MATERIALS AND methods: In all cases an intracorporeal resection of the antrum and an antecolic end to side gastrojejunostomy (Billroth II) were performed. Technical details are discussed in the paper. RESULTS: Mean operative time was 260 minutes, mean blood loss was 43 millilitres. There were no postoperative complications and all patients were discharged on the fifth postoperative day. A follow up of three years shows that no patient had recurrence and post-gastrectomy syndromes. CONCLUSIONS: Laparoscopic Billroth II gastrectomy is a safe and feasible procedure with benefits such as quick hospital stay, decreased postoperative pain, good cosmesis and reduced morbidity.- - - - - - - - - - ranking = 0.5keywords = obstruction (Clic here for more details about this article) |
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