Bouveret's syndrome, defined as gastric outlet obstruction due to a large gallstone, is still one of the most dramatic biliary gallstone complications. Although new radiological and endoscopic techniques have made...Bouveret's syndrome, defined as gastric outlet obstruction due to a large gallstone, is still one of the most dramatic biliary gallstone complications. Although new radiological and endoscopic techniques have made pre-surgical diagnosis possible in most cases and the death rate has dropped dramatically, "one-stage surgery" (biliary surgery carried out at the same time as the removal of the gut obstruction) should be still considered as the gold standard for the treatment of gallstone ileus.In this case, partial gastric outlet obstruction resulted in an atypical and insidious clinical presentation that allowed us to perform the conventional one-stage laparatomic procedure that completely solved the problem, thus avoiding any further complications.展开更多
A 72-year-old male gastric cancer patient with outlet obstruction underwent laparoscopic exploration. The examination disclosed intraperitoneal free cancer cells with no overt peritoneal, lymphatic, or hepatic metasta...A 72-year-old male gastric cancer patient with outlet obstruction underwent laparoscopic exploration. The examination disclosed intraperitoneal free cancer cells with no overt peritoneal, lymphatic, or hepatic metastasis. The patient underwent laparoscopy-assisted gastroje-junostomy (LAGJ) and started chemotherapy with S-1 plus cisplatin on postoperative day 13. Three course of the chemotherapy shrank the tumor markedly. Then, the patient underwent gastrectomy with a curative intent. Laparotomy revealed no intraperitoneal free cancer cells, and microscopically complete resection was achieved. The patient received S-1 chemotherapy as postoperative adjuvant treatment for 1 year, and is still alive with no evidence of peritoneal recurrence. LAGJ followed by S-1 plus cisplatin is one of the optional treatments that should be considered for patients with outlet obstruction as it may widen opportunities for potentially curative resection.展开更多
AIM:To determine the most effective intervention procedure by evaluation of mid and long-term therapeutic efficacy in patients of stricture of the gastrointestinal tract (GTT). METHODS:Different intervention procedure...AIM:To determine the most effective intervention procedure by evaluation of mid and long-term therapeutic efficacy in patients of stricture of the gastrointestinal tract (GTT). METHODS:Different intervention procedures were used to treat benign stricture of GIT in 180 patients including pneumatic dilation (group A,n=80),permanent (group B, n=25) and temporary (group C,n=75) placement of expandable metallic stents. RESULTS:The diameters of the strictured GIT were significantly greater after the treatment of all procedures employed (P<0.01).For the 80 patients in group A,160 dilations were performed (mean,2.0 times per patient). Complications in group A included chest pain (n=20),reflux (n=16),and bleeding (n=6).Dysphagia relapse occurred in 24(30%) and 48 (60%) patients respectively during 6-and- 12 momth follow-up periods in group A.In group B,25 uncovered or partially covered or antireflux covered expandable metallic stents were placed permantly, complications included chest pain (n=10),reflux (n=15), bleeding (n=3),and stent migration (n=4),and dysphagia relapse occurred in 5 (20%) and 3 patients (25%) during the 6-and-12 month follow-up periods,respectively.In group C,the partially covered expandable metallic stents were temporarily placed in 75 patients and removed after 3 to 7 days via gastroscope,complications including chest pain (n=30),reflux (n=9),and bleeding (n=12),and dysphagia relapse occurred in 9 (12%) and 8 patients (16%) during the 6-and-12 month follow-up periods,respectively.The placement and withdrawal of stents were all successfully performed.The follow-up of all patients lasted for 6 to 96 months (mean 45.3±18.6 months). CONCLUSION:The effective procedures for benign GIT stricture are pneumatic dilation and temporary placement of partially-covered expandable metallic stents.Temporary placement of partially-covered expandable metallic stents is one of the best methods for benign GIT strictures in mid and long-term therapeutic efficacy.展开更多
Bouveret's syndrome is an extremely rare type of gallstone-induced ileus with atypical clinical manifestations,such as abdominal distension and pain,nausea and vomiting,fever or even gastrointestinal bleeding,whic...Bouveret's syndrome is an extremely rare type of gallstone-induced ileus with atypical clinical manifestations,such as abdominal distension and pain,nausea and vomiting,fever or even gastrointestinal bleeding,which may easily be misdiagnosed. In the present case,a 55-year-old male was admitted to the hospital with upper gastrointestinal obstructive symptoms but without pain,fever,jaundice or melena. At first,gastrolithiasis and peptic ulcer combined with pyloric obstruction were suspected after gastroscopy revealed a large,hard stone in the duodenal bulb. A revised diagnosis of Bouveret's syndrome was made following abdominal computed tomography. Subsequently,the patient exhibited a good postoperative recovery after laparoscopic duodenotomy for gallstone removal and subtotal cholecystectomy. The condition of the patient remained stable after being followed up for 6 mo. The successful application of laparoscopic therapy to treat Bouveret's syndrome has seldom been reported. Laparoscopic enterolithotomy is safe and effective,with good patient tolerability,rapid postoperative recovery and few wound-related complications. The laparoscopic treatment of Bouveret's syndrome is worth exploring.展开更多
Early January 2023 saw U.S.media intensify condemnation of Iran for suspending talks in the Austrian capital,Vienna,aimed at reviving the 2015multilateral deal on its nuclear program.On the very first day of 2023,The ...Early January 2023 saw U.S.media intensify condemnation of Iran for suspending talks in the Austrian capital,Vienna,aimed at reviving the 2015multilateral deal on its nuclear program.On the very first day of 2023,The National Interest,a leading mainstream U.S.media outlet,carried an article titled In 2023,Washington Can’t Neglect Iran,which called for even tougher measures to prevent Iran from using its nuclear program to produce weapons.展开更多
文摘Bouveret's syndrome, defined as gastric outlet obstruction due to a large gallstone, is still one of the most dramatic biliary gallstone complications. Although new radiological and endoscopic techniques have made pre-surgical diagnosis possible in most cases and the death rate has dropped dramatically, "one-stage surgery" (biliary surgery carried out at the same time as the removal of the gut obstruction) should be still considered as the gold standard for the treatment of gallstone ileus.In this case, partial gastric outlet obstruction resulted in an atypical and insidious clinical presentation that allowed us to perform the conventional one-stage laparatomic procedure that completely solved the problem, thus avoiding any further complications.
文摘A 72-year-old male gastric cancer patient with outlet obstruction underwent laparoscopic exploration. The examination disclosed intraperitoneal free cancer cells with no overt peritoneal, lymphatic, or hepatic metastasis. The patient underwent laparoscopy-assisted gastroje-junostomy (LAGJ) and started chemotherapy with S-1 plus cisplatin on postoperative day 13. Three course of the chemotherapy shrank the tumor markedly. Then, the patient underwent gastrectomy with a curative intent. Laparotomy revealed no intraperitoneal free cancer cells, and microscopically complete resection was achieved. The patient received S-1 chemotherapy as postoperative adjuvant treatment for 1 year, and is still alive with no evidence of peritoneal recurrence. LAGJ followed by S-1 plus cisplatin is one of the optional treatments that should be considered for patients with outlet obstruction as it may widen opportunities for potentially curative resection.
基金Supported by the National Key Medical Research and Development Program of China during the 9~(th) Five-year Plan Period,No.96-907-03-04 Shanghai Nature Science Funds,No.02Zl314073 Shanghai Medical Development Funds,No.00419
文摘AIM:To determine the most effective intervention procedure by evaluation of mid and long-term therapeutic efficacy in patients of stricture of the gastrointestinal tract (GTT). METHODS:Different intervention procedures were used to treat benign stricture of GIT in 180 patients including pneumatic dilation (group A,n=80),permanent (group B, n=25) and temporary (group C,n=75) placement of expandable metallic stents. RESULTS:The diameters of the strictured GIT were significantly greater after the treatment of all procedures employed (P<0.01).For the 80 patients in group A,160 dilations were performed (mean,2.0 times per patient). Complications in group A included chest pain (n=20),reflux (n=16),and bleeding (n=6).Dysphagia relapse occurred in 24(30%) and 48 (60%) patients respectively during 6-and- 12 momth follow-up periods in group A.In group B,25 uncovered or partially covered or antireflux covered expandable metallic stents were placed permantly, complications included chest pain (n=10),reflux (n=15), bleeding (n=3),and stent migration (n=4),and dysphagia relapse occurred in 5 (20%) and 3 patients (25%) during the 6-and-12 month follow-up periods,respectively.In group C,the partially covered expandable metallic stents were temporarily placed in 75 patients and removed after 3 to 7 days via gastroscope,complications including chest pain (n=30),reflux (n=9),and bleeding (n=12),and dysphagia relapse occurred in 9 (12%) and 8 patients (16%) during the 6-and-12 month follow-up periods,respectively.The placement and withdrawal of stents were all successfully performed.The follow-up of all patients lasted for 6 to 96 months (mean 45.3±18.6 months). CONCLUSION:The effective procedures for benign GIT stricture are pneumatic dilation and temporary placement of partially-covered expandable metallic stents.Temporary placement of partially-covered expandable metallic stents is one of the best methods for benign GIT strictures in mid and long-term therapeutic efficacy.
文摘Bouveret's syndrome is an extremely rare type of gallstone-induced ileus with atypical clinical manifestations,such as abdominal distension and pain,nausea and vomiting,fever or even gastrointestinal bleeding,which may easily be misdiagnosed. In the present case,a 55-year-old male was admitted to the hospital with upper gastrointestinal obstructive symptoms but without pain,fever,jaundice or melena. At first,gastrolithiasis and peptic ulcer combined with pyloric obstruction were suspected after gastroscopy revealed a large,hard stone in the duodenal bulb. A revised diagnosis of Bouveret's syndrome was made following abdominal computed tomography. Subsequently,the patient exhibited a good postoperative recovery after laparoscopic duodenotomy for gallstone removal and subtotal cholecystectomy. The condition of the patient remained stable after being followed up for 6 mo. The successful application of laparoscopic therapy to treat Bouveret's syndrome has seldom been reported. Laparoscopic enterolithotomy is safe and effective,with good patient tolerability,rapid postoperative recovery and few wound-related complications. The laparoscopic treatment of Bouveret's syndrome is worth exploring.
文摘Early January 2023 saw U.S.media intensify condemnation of Iran for suspending talks in the Austrian capital,Vienna,aimed at reviving the 2015multilateral deal on its nuclear program.On the very first day of 2023,The National Interest,a leading mainstream U.S.media outlet,carried an article titled In 2023,Washington Can’t Neglect Iran,which called for even tougher measures to prevent Iran from using its nuclear program to produce weapons.
