1/10. 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 = 1keywords = obstruction (Clic here for more details about this article) |
2/10. Retrograde jejunogastric intussusception: is endoscopic or surgical management more appropriate?Jejunogastric intussusception (JGI) is a rare complication which can develop after partial gastrectomy, gastroenteroanastomosis or enteroanastomosis. Although its management is usually surgical, an endoscopic reduction can alternatively be attempted. We present herein a case of acute JGI in which failure of endoscopic reduction required surgical resection and reconstruction. This is followed by a discussion based on the current available literature.- - - - - - - - - - ranking = 0.12862145736527keywords = duct (Clic here for more details about this article) |
3/10. Laparoscopic jejuno-jejunostomy for afferent loop stasis following truncal vagotomy with posterior gastro-jejunostomy for pyloric stenosis.A 47-year-old man presented with epigastric pain relieved by bilious vomiting since one month. He had undergone truncal vagotomy with posterior gastrojejunostomy for benign gastric outlet obstruction 2 years ago. endoscopy showed distension and stasis in the afferent loop, bile gastritis and esophagitis. Laparoscopic Braun jejunojejunostomy relieved his symptoms.- - - - - - - - - - ranking = 2.1403963159319keywords = bile, obstruction (Clic here for more details about this article) |
4/10. Three cases of afferent loop obstruction--the role of ultrasonography in the diagnosis.Three cases of obstruction of the afferent loop following a Billroth II type gastrectomy were preoperatively detected by ultrasonography. The obstructions in the 3 patients were caused by volvulus, internal herniation and recurrence of gastric cancer, respectively. The important US findings which helped diagnose this condition were a dilated intestinal loop without gas echo in the upper abdominal cavity and echo lucent swelling of the pancreas. ultrasonography is very useful for the early and easy detection of this life-threatening condition which requires immediate surgery.- - - - - - - - - - ranking = 6keywords = obstruction (Clic here for more details about this article) |
5/10. "Pseudogallbladder" appearance in partial afferent loop obstruction in a patient with cholecystectomy.We have described a patient who was admitted to the hospital for evaluation of RUQ abdominal pain 40 years after a Billroth II gastrectomy, as well as a cholecystectomy of which the patient was unaware. Gray-scale abdominal ultrasonography and Tc 99m-IDA hepatobiliary imaging were interpreted as revealing an enlarged gallbladder and cholelithiasis. An obstructed afferent loop of the Billroth II anastomosis had mimicked a gallbladder on ultrasonography and hepatobiliary imaging.- - - - - - - - - - ranking = 4keywords = obstruction (Clic here for more details about this article) |
6/10. carcinoma of the stomach after gastric operation.Seventeen cases of carcinoma of the stomach occurring late after previous gastric operation are presented. In all instances, patients had undergone gastroenterostomy, with or without gastric resection. Most patients had undergone the initial operation for peptic ulcer disease an average of 18 years before presenting with the tumor. Endoscopic biopsy of the gastroenterostomy and gastric cytologic evaluation offered a high degree of sensitivity and specificity in making the diagnosis. These tumors appeared to originate in the gastric mucosa near the stoma. survival was poor with both curative and palliative therapy. Alkaline bile reflux, achlorhydria and bacterial colonization are discussed as possible causes. patients who have undergone partial gastric resection are at increased risk for the development of carcinoma of the stomach remnant. We recommend that any patient in whom new upper gastrointestinal symptoms develop more than 10 hears after partial gastrectomy should undergo endoscopy with biopsy of the gastric mucosa adjacent to the anastomosis.- - - - - - - - - - ranking = 1.1403963159319keywords = bile (Clic here for more details about this article) |
7/10. Quantitative evaluation of bile diversion surgery utilizing 99mTc HIDA scintigraphy.This is a report of 21 patients presenting with epigastric pain, bilious vomiting, upper gastrointestinal bleeding, iron-deficiency anemia, and weight loss, who had undergone Billroth II gastrectomy from 3 to 35 yr earlier. Eighteen of 21 patients were found to have significant enterogastric reflux indices varying from 60% to 95% demonstrated by 99mTc HIDA scintigraphy. Thirteen patients had diversion antireflux surgery in the form of a Roux-en-Y procedure, and 1 patient had a Henley loop jejunal interposition. Postoperative 99mTc HIDA scintigraphic studies showed the enterogastric reflux indices to have decreased significantly to a range of 2%-26% (p less than 0.00001). There was marked improvement of symptoms, including correction of anemia and weight gain in those patients who had been anemic or who had sustained earlier weight loss. The enterogastric reflux indices of 10 asymptomatic control patients after Billroth II gastrectomy ranged from 4% to 45%. 99mTc HIDA scintigraphy is useful in evaluating patients before and after bile diversion surgery, and demonstrates the quantitative decrease in enterogastric reflux after such surgery.- - - - - - - - - - ranking = 5.7019815796594keywords = bile (Clic here for more details about this article) |
8/10. Endoscopic dilation of a gastric anastomotic stricture.A stricture developed in a patient two months after undergoind a Billroth I gastroduodenal anastomosis. His mechanical gastric obstruction was relieved by dilation up to 37 F caliber under direct vision using a fiberendoscope. The patient became, and has remained, symptom free. Visualization of the area two months after dilation showed an adequately patent anastomosis.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
9/10. afferent loop syndrome: a different picture.A patient who had a 50% gastrectomy with a Billroth II gastrojejunostomy one and a half years previously, complained of recent severe weakness as the only symptom was found to have an iron deficiency anemia with a periumbilical mass. A gastrointestinal series showed a soft tissue density in the epigastric area which, by ultrasonography, was found to be fluid-containing. laparotomy revealed obstruction of the afferent loop caused by a marginal ulcer.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
10/10. Delayed gastric emptying following gastrectomy.The characteristics of 46 patients unable to take a solid diet within two weeks of gastric resection and had no other post-operative complications are reviewed. The incidence of delayed gastric emptying was found to be 2 1/2 times greater in patients with vagotomy and hemigastrectomy than in those with subtotal gastrectomy. In addition, postoperative delay was often prolonged in the hemigastrectomy and vagotomy group. Mechanical factors were responsible for delay in only 10% of these patients. Possible explanations for these delays are made and it is suggested that localized starch peritonitis may explain many cases of "functional efferent limb ileus." Measures to evaluate the source of delay are recommended and suggest conservative management for the majority of patients. reoperation is reserved for those who require feeding or draining enterostomy tubes and those whose clinical course and evaluation suggest obstruction.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
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