Post-gastrectomy anastomosis site obstruction is a relatively rare complication after a subtotal gastrectomy.We present a case of a 75-year-old man who underwent a truncal vagotomy, omental patch, gastrojejunostomy, a...Post-gastrectomy anastomosis site obstruction is a relatively rare complication after a subtotal gastrectomy.We present a case of a 75-year-old man who underwent a truncal vagotomy, omental patch, gastrojejunostomy, and Braun anastomosis for duodenal ulcer perforation and a gastric outlet obstruction.Following the 10 th postoperative day, the patient complained of abdominal discomfort and vomiting.We diagnosed post-gastrectomy anastomosis site obstruction by an upper gastrointestinal series and an upper endoscopic examination.We inserted a self-expandable metallic stent(SEMS) at the anastomosis site.The stent was fully expanded after deployment.On the day following the stent insertion, the patient began to eat, and his abdominal discomfort was resolved.This paper describes the successful management of post-gastrectomy anastomosis site obstruction with temporary placement of a SEMS.展开更多
BACKGROUND The most common site of paragonimiasis is in the lungs.The migratory route passes through the duodenal wall,peritoneum,and diaphragm to the lungs;thus,the thoracic cavity and central nervous system,as well ...BACKGROUND The most common site of paragonimiasis is in the lungs.The migratory route passes through the duodenal wall,peritoneum,and diaphragm to the lungs;thus,the thoracic cavity and central nervous system,as well as the liver,intestine,and abdominal cavity may be involved.Here,we present a case of intraperitoneal paragonimiasis without other organ involvement,mimicking tuberculous peritonitis.CASE SUMMARY A 57-year-old man presented with recurrent abdominal pain for 4 wk.Physical examination revealed tenderness in the right lower quadrant.Laboratory findings showed complete blood counts within the normal range without eosinophilia.Multiple reactive lymph nodes and diffuse peritoneal infiltration were noted on abdominal computed tomography(CT).There were no abnormalities on chest CT or colonoscopy.Intraoperative findings of diagnostic laparoscopy for the differential diagnosis of tuberculous peritonitis and peritoneal carcinomatosis included multiple small whitish nodules and an abscess in the peritoneum.Pathological reports confirmed the presence of numerous eggs of Paragonimus westermani(P.westermani).A postoperative serum enzyme-linked immunosorbent assay revealed P.westermani positivity.Persistent and repetitive history-taking led him to retrospectively recall the consumption of freshwater crab.After 3 d of treatment with praziquantel(1800 mg;25 mg/kg),he recovered from all symptoms.CONCLUSION In patients who require diagnostic laparoscopy for the differential diagnosis of tuberculous peritonitis and peritoneal carcinomatosis,repetitive history-taking and preoperative serologic antibody tests against Paragonimus may be helpful in diagnosing intraperitoneal paragonimiasis without other organ involvement.展开更多
文摘Post-gastrectomy anastomosis site obstruction is a relatively rare complication after a subtotal gastrectomy.We present a case of a 75-year-old man who underwent a truncal vagotomy, omental patch, gastrojejunostomy, and Braun anastomosis for duodenal ulcer perforation and a gastric outlet obstruction.Following the 10 th postoperative day, the patient complained of abdominal discomfort and vomiting.We diagnosed post-gastrectomy anastomosis site obstruction by an upper gastrointestinal series and an upper endoscopic examination.We inserted a self-expandable metallic stent(SEMS) at the anastomosis site.The stent was fully expanded after deployment.On the day following the stent insertion, the patient began to eat, and his abdominal discomfort was resolved.This paper describes the successful management of post-gastrectomy anastomosis site obstruction with temporary placement of a SEMS.
文摘BACKGROUND The most common site of paragonimiasis is in the lungs.The migratory route passes through the duodenal wall,peritoneum,and diaphragm to the lungs;thus,the thoracic cavity and central nervous system,as well as the liver,intestine,and abdominal cavity may be involved.Here,we present a case of intraperitoneal paragonimiasis without other organ involvement,mimicking tuberculous peritonitis.CASE SUMMARY A 57-year-old man presented with recurrent abdominal pain for 4 wk.Physical examination revealed tenderness in the right lower quadrant.Laboratory findings showed complete blood counts within the normal range without eosinophilia.Multiple reactive lymph nodes and diffuse peritoneal infiltration were noted on abdominal computed tomography(CT).There were no abnormalities on chest CT or colonoscopy.Intraoperative findings of diagnostic laparoscopy for the differential diagnosis of tuberculous peritonitis and peritoneal carcinomatosis included multiple small whitish nodules and an abscess in the peritoneum.Pathological reports confirmed the presence of numerous eggs of Paragonimus westermani(P.westermani).A postoperative serum enzyme-linked immunosorbent assay revealed P.westermani positivity.Persistent and repetitive history-taking led him to retrospectively recall the consumption of freshwater crab.After 3 d of treatment with praziquantel(1800 mg;25 mg/kg),he recovered from all symptoms.CONCLUSION In patients who require diagnostic laparoscopy for the differential diagnosis of tuberculous peritonitis and peritoneal carcinomatosis,repetitive history-taking and preoperative serologic antibody tests against Paragonimus may be helpful in diagnosing intraperitoneal paragonimiasis without other organ involvement.
