BACKGROUND Esophagogastric leakage is one of the most severe postoperative complications.Partial disruption of the anastomosis,can be successfully treated with an endoscopic vacuum assisted closure(E-VAC).The advantag...BACKGROUND Esophagogastric leakage is one of the most severe postoperative complications.Partial disruption of the anastomosis,can be successfully treated with an endoscopic vacuum assisted closure(E-VAC).The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess.The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC.CASE SUMMARY Two male patients developed a potentially life threatening esophagogastric leakage.Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction.Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears.Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances,and treatment of sepsis with appropriate antibiotics.CONCLUSION Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy.Through individual approach it allows a more accurate assessment of healing.展开更多
BACKGROUND Pancreatic walled-off necrosis(WON)rarely causes critical gastric necrosis and perforation,which may develop when pancreatic WON squashes against the stomach.The Atlanta 2012 guidelines were introduced for ...BACKGROUND Pancreatic walled-off necrosis(WON)rarely causes critical gastric necrosis and perforation,which may develop when pancreatic WON squashes against the stomach.The Atlanta 2012 guidelines were introduced for acute pancreatitis and its related clinical entities.However,there are few reported cases describing the clinical course and resolution of pancreatic WON.CASE SUMMARY We report the case of a 45-year-old man who presented to the urgent emergency department with gastric perforation caused by a severe complication of pancreatic WON on computed tomography.The patient underwent an emergency distal pancreatectomy,splenectomy,and gastric wedge resection.Postoperative findings showed re-perforation of the gastric wall at a previously resected margin.Furthermore,endoscopic examination revealed an ulcerative area with a defect in the fundus.After diagnostic endoscopy,endoscopic vacuum-assisted closure was performed,and continuous suction was transferred over all tissues in contact with the sponge surface.The patient recovered without any further complications and was discharged in good condition at postoperative week 8.No recurrence occurred during the 6-mo follow-up period.CONCLUSION When managing a patient with serious gastric perforation complicated by pancreatic WON,a multidisciplinary treatment approach should be considered.展开更多
文摘BACKGROUND Esophagogastric leakage is one of the most severe postoperative complications.Partial disruption of the anastomosis,can be successfully treated with an endoscopic vacuum assisted closure(E-VAC).The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess.The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC.CASE SUMMARY Two male patients developed a potentially life threatening esophagogastric leakage.Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction.Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears.Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances,and treatment of sepsis with appropriate antibiotics.CONCLUSION Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy.Through individual approach it allows a more accurate assessment of healing.
基金the Clinical Research Grant from Pusan National University Hospital in 2023.
文摘BACKGROUND Pancreatic walled-off necrosis(WON)rarely causes critical gastric necrosis and perforation,which may develop when pancreatic WON squashes against the stomach.The Atlanta 2012 guidelines were introduced for acute pancreatitis and its related clinical entities.However,there are few reported cases describing the clinical course and resolution of pancreatic WON.CASE SUMMARY We report the case of a 45-year-old man who presented to the urgent emergency department with gastric perforation caused by a severe complication of pancreatic WON on computed tomography.The patient underwent an emergency distal pancreatectomy,splenectomy,and gastric wedge resection.Postoperative findings showed re-perforation of the gastric wall at a previously resected margin.Furthermore,endoscopic examination revealed an ulcerative area with a defect in the fundus.After diagnostic endoscopy,endoscopic vacuum-assisted closure was performed,and continuous suction was transferred over all tissues in contact with the sponge surface.The patient recovered without any further complications and was discharged in good condition at postoperative week 8.No recurrence occurred during the 6-mo follow-up period.CONCLUSION When managing a patient with serious gastric perforation complicated by pancreatic WON,a multidisciplinary treatment approach should be considered.
