Dehiscence following successful endoscopic closure of gastric perforation during endoscopic submucosal dissection

Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection(ESD).In terms of the treatment of such perforations,we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed conservatively.We now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic closure.In December 2006,we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis.A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc resection.Intensive conservative management was conducted following ESD,however,an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy.

Case of bronchoesophageal fistula with gastric perforation due to multidrug-resistant tuberculosis

Gastric perforation and tuberculous bronchoesophageal fistula(TBEF) are very rare complications of extrapulmonary tuberculosis(TB). We present a case of pulmonary TB with TBEF and gastric perforation caused by a multidrug-resistant tuberculosis strain in a nonacquired immune deficiency syndrome male patient.The patient underwent total gastrectomy with Rouxen-Y end-to-side esophagojejunostomy and feeding jejunostomy during intravenous treatment with anti-TB medication, and esophageal reconstruction with colonic interposition and jejunocolostomy were performed successfully after a full course of anti-TB medication.Though recent therapies for TBEF have favored medication, patients with severe stenosis or perforation require surgery and medication with anti-TB drugs basedupon adequate culture and drug susceptibility testing.

Subacute gastric perforation caused by a left ventricular assist device

This case report describes a rare complication of a left ventricular assist device (LVAD). A patient with ischemic cardiomyopathy had an LVAD placed due to intractable congestive heart failure following a large anterior myocardial infarction. The patient developed chronic bacteremia and multiple septic episodes. A gastric endoscopy revealed perforation of the anterior wall of the stomach by the LVAD. Gastric acid related erosions were present on the metallic surface suggesting prolonged exposure. This is the second case report of this rare complication and the first case report of a subacute course.

DIAGNOSIS, TREATMENT, AND RESEARCH OF ETIOLOGY OF SPONTANEOUS NEONATAL GASTRIC PERFORATION

SPONTANEOUS neonatal gastric perforation (SNGP) is a rare and life-threatening disease, which has a high mortality rate.This study retrospectively reported 23 cases of SNGP treated in the Department of Pediatric Surgery of Shengjing Hospital of China Medical University from January 1993 to December 2003, and briefly discussed the diagnosis, treatment, and possible etiology.

Gastric Perforation in a 28-Month-Old Child: Complicated by Peritonitis Admitted to the Surgical Emergency Room after a Case

We report the case of a 28-month-old male child with no particular history who was admitted to the emergency room for severe abdominal pain associated with vomiting, asthenia and fever at 39.1˚C that had progressed for 4 days. He was conscious, polypneic at 32 cycles/min on admission. On palpation the abdomen was distended, painful as a whole, more pronounced in the epigastrium. There was abdominal contracture, generalized defense, a cry with sudden decompression of the umbilicus. On abdominal auscultation, there was a disappearance of prehepatic dullness, a decrease in the dullness of the flanks and absence of hydro-aeric noises. On the digital rectal examination, Douglas’s cul de sac was bulging and sensitive. An unprepared X-ray of the abdomen revealed diffuse grayness, lateral gas crescent pneumoperitoneum under diaphragm. The preoperative resuscitation consisted of the placement of a nasogastric tube, a urinary catheter, a peripheral venous route and the fluid electrolyte rebalancing adapted according to the blood ionogram, early antibiotic therapy with broad aero and anaerobic spectrum. Surgical management under general anesthesia found at laparotomy a perforation of the anterior surface of the duodenal bulb which we estimate to be 1 cm in diameter with fibrin deposits. The gesture was the toilet of the peritoneal cavity;suture of the bank and the operative consequences were simple.

Gastric Perforation after Cesarean Delivery: An Unintended Consequence of the Opioid Epidemic

30 year old female now para 1 presented to the Emergency Department with nausea, vomiting, and abdominal pain 6 days after an uncomplicated primary cesarean delivery. She did not respond to conservative management and underwent exploratory laparotomy for worsening pain, pneumoperitoneum and intraabdominal fluid collections. Gastric perforations required repair via gastrojejunostomy. Postoperative course was unremarkable. The anti-opioid campaign has altered the approach to postoperative pain management in both positive and negative ways. It has sparked new interest in alternative approaches to postoperative pain management, which include an increased role for non-steroidal anti-inflammatory drugs (NSAIDs). We present a case of a woman who had a significant complication due to the reliance of non-opioid pain medications after cesarean delivery.

Surgical Management of Herniated Intrathoracic Gastric Perforation in Traumatic Diaphragmatic Rupture: An Unusual Two Rare Cases

Gastric perforation into the thoracic cavity through a diaphragmatic rupture is rare but, when it occurs, patients present in severe distress, with mortality approaching 50%. We present our experience of two rare and unusual cases of traumatic diaphragmatic rupture from penetrating chest injury associated with herniated intrathoracic gastric perforation over a five-year period from January 2015 to December 2020 at the cardiovascular and thoracic surgery department of the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Both patients underwent successful surgical repair through standard posterolateral thoracotomy with one having earlier negative exploratory laparotomy. The essence of the paper is to share and discuss the clinical presentation, diagnostic challenges, surgical management and the postoperative care of this very rare complication of traumatic diaphragmatic rupture.

Robust hydrogel adhesives for emergency rescue and gastric perforation repair

Development of biocompatible hydrogel adhesives with robust tissue adhesion to realize instant hemorrhage control and injury sealing,especially for emergency rescue and tissue repair,is still challenging.Herein,we report a potent hydrogel adhesive by free radical polymerization of N-acryloyl aspartic acid(AASP)in a facile and straightforward way.Through delicate adjustment of steric hindrance,the synergistic effect between interface interactions and cohesion energy can be achieved in PAASP hydrogel verified by X-ray photoelectron spectroscopy(XPS)analysis and simulation calculation compared to poly(N-acryloyl glutamic acid)(PAGLU)and poly(N-acryloyl amidomalonic acid)(PAAMI)hydrogels.The adhesion strength of the PAASP hydrogel could reach 120 kPa to firmly seal the broken organs to withstand the external force with persistent stability under physiological conditions,and rapid hemostasis in different hemorrhage models on mice is achieved using PAASP hydrogel as physical barrier.Furthermore,the paper-based Fe^(3+)transfer printing method is applied to construct PAASP-based Janus hydrogel patch with both adhesive and non-adhesive surfaces,by which simultaneous wound healing and postoperative anti-adhesion can be realized in gastric perforation model on mice.This advanced hydrogel may show vast potential as bio-adhesives for emergency rescue and tissue/organ repair.

An adhesive and resilient hydrogel for the sealing and treatment of gastric perforation

Adhesive hydrogels have been recently proposed as a potential option to seal and treat gastric perforation(GP)which causes high mortality despite advancements in surgical treatments.However,to be effective,the hydrogels must have sufficient tissue adhesiveness,tough mechanical property,tunable biodegradability and ideally are easy to apply and form.Herein,we report an adhesive and resilient hydrogel for the sealing and treatment of gastric perforation.The hydrogel consists of a bioactive,transglutaminase(TG)-crosslinked gelatin network and a dynamic,borate-crosslinked poly-N-[Tris(hydroxymethyl)methyl]acrylamide(PTH)network.The hydrogel can be formed in situ,facilitating easy delivery to the GP and allowing for precise sealing of the defects.In vivo experiments,using a perforated stomach mouse model,shows that the adhesive hydrogel plug effectively seals GP defects and promotes gastric mucosa regeneration.Overall,this hydrogel represents a promising biomaterial for GP treatment.

Acute phlegmonous gastritis complicated by delayed perforation

Here, we report on a case of acute phlegmonous gastritis (PG) complicated by delayed perforation. A 51-year-old woman presented with severe abdominal pain and septic shock symptoms. A computed tomography scan showed diffuse thickening of the gastric wall and distention with peritoneal fluid. Although we did not find definite evidence of free air on the computed tomography (CT) scan, the patient’s clinical condition suggested diffuse peritonitis requiring surgical intervention. Exploratory laparotomy revealed a thickened gastric wall with suppurative intraperitoneal fluid in which Streptococcus pyogenes grew. There was no evidence of gastric or duodenal perforation. No further operation was performed at that time. The patient was conservatively treated with antibiotics and proton pump inhibitor, and her condition improved. However, she experienced abdominal and flank pain again on postoperative day 10. CT and esophagogastroduodenoscopy showed a large gastric ulcer with perforation. Unfortunately, although the CT showed further improvement in the thickening of the stomach and the mucosal defect, the patient’s condition did not recover until a week later, and an esophagogastroduodenoscopy taken on postoperative day 30 showed suspected gastric submucosal dissection. We performed total gastrectomy as a second operation, and the patient recovered without major complications. A pathological examination revealed a multifocal ulceration and necrosis from the mucosa to the serosa with perforation.

Use of omental patch and endoscopic closure technique as an alternative to surgery after endoscopic full thickness resection of gastric intestinal stromal tumors: A series of cases

BACKGROUND Gastrointestinal stromal tumors(GISTs)originate from interstitial cells of Cajal.GISTs can occur anywhere along the gastrointestinal tract.Large lesions have traditionally been removed surgically.However,with recent innovations in advanced endoscopy,GISTs located within the stomach are now removed endoscopically.We describe a new innovative endoscopic technique to close large and hard to access defects after endoscopic full-thickness resection of gastric GISTs.CASE SUMMARY We present a series of three patients who were diagnosed with a gastric GIST.All patients underwent full-thickness endoscopic resection.In all cases,for closure of the surgical bed,conventional endoscopic techniques including hemoclips,endoloop and suturing were unsuccessful.We performed a new technique in which we pulled omental fat into the gastric lumen and completely closed the defect using endoscopic devices.All patients performed well post-procedure and computed tomography was carried out one day after the procedures which showed no extravasation of contrast.CONCLUSION The omental plug technique may be used as an alternative to surgery in selected cases of gastric perforation.