Optimal resection of gastric bronchogenic cysts based on anatomical continuity with adherent gastric muscular layer: A case report

BACKGROUND Bronchogenic cysts are congenital lesions requiring radical resection because of malignant potential.However,a method for the optimal resection of these cysts has not been completely elucidated.CASE SUMMARY Herein,we presented three patients with bronchogenic cysts that were located adjacent to the gastric wall and resected laparoscopically.The cysts were detected incidentally with no symptoms and the preoperative diagnosis was challenging to obtain via radiological examinations.Based on laparoscopic findings,the cyst was attached firmly to the gastric wall and the boundary between the gastric and cyst walls was difficult to identify.Consequently,resection of cysts alone caused cystic wall injury in Patient 1.Meanwhile,the cyst was resected completely along with a part of the gastric wall in Patient 2.Histopathological examination revealed the final diagnosis of bronchogenic cyst and revealed that the cyst wall shared the muscular layer with the gastric wall in Patients 1 and 2.In Patient 3,the cyst was located adjacent to the gastric wall but histopathologically originated from diaphragm rather than stomach.All the patients were free from recurrence.CONCLUSION The findings of this study state that a safe and complete resection of bronchogenic cysts required the adherent gastric muscular layer or full-thickness dissection,if bronchogenic cysts are suspected via pre-and/or intraoperative findings.

Congenital intestinal malrotation with gastric wall defects causing extensive gut necrosis and short gut syndrome:A case report

BACKGROUND Congenital intestinal malrotation(CIM)is a common malformation in neonates.Early diagnosis and surgical intervention can improve the prognosis.CIM combined with congenital gastric wall defect is a potentially fatal condition.We present a severe case of CIM with gastric wall defect causing extensive gut necrosis and short gut syndrome.After three operations,the neonate survived and subsequently showed normal growth and development during infancy.CASE SUMMARY A male neonate(age:4 d)was hospitalized due to bloody stools and vomiting for 2 d,and abdominal distention for 1 d.Emergent exploratory laparotomy revealed black purplish discoloration of the bowel loops.Bowel alignment was abnormal with congestion and dilatation of the entire intestine,and clockwise mesentery volvulus(720°).The posterior wall of the gastric body near the greater curvature showed a defect in the muscularis layer(approximately 5.5 cm),and a circular perforation(approximately 3 cm diameter)at the center of this defect.Ladd’s procedure was performed and gastric wall defect was repaired.Third operation performed 53 d after birth revealed extensive adherence of small intestine and peritoneum,and adhesion angulated between many small intestinal loops.We performed intestinal adhesiolysis,resection of necrotic intestine,and small bowel anastomosis.CONCLUSION This case highlights that prolonged medical treatment may help improve intestinal salvage after surgical removal of necrotic intestines,and improve patient prognosis.

30例新生儿先天性胃壁肌层缺损致胃穿孔的诊疗分析

目的:探讨新生儿先天性胃壁肌层缺损致胃穿孔的临床特点及诊疗措施,为新生儿先天性胃壁肌层缺损致胃穿孔的临床诊治提供参考依据。方法:选取2021年4月—2023年4月贵阳市妇幼保健院收治的30例新生儿先天性胃壁肌层缺损致胃穿孔患儿为研究对象,分析其临床资料。结果:30例患儿均接受手术治疗,治愈率为63.33%(19/30)。术后病理检查均提示先天性胃壁肌层缺损。放弃治疗11例。结论:对于新生儿先天性胃壁肌层缺损致胃穿孔,需根据患儿临床表现、病史、体征等明确诊断,对于诊断确切并符合手术指征的患儿,应积极进行手术探查,尽早发现病灶,将修补胃壁切除,积极矫正消化道畸形,同时进行抗休克、抗感染治疗,可降低病死率,提高手术疗效,促进患儿早日康复。

新生儿先天性胃壁肌层缺损致胃穿孔诊疗分析

目的探讨新生儿先天性胃壁肌层缺损致胃穿孔的临床特点及诊疗措施。方法回顾性分析13例先天性胃壁肌层缺损致胃穿孔新生儿的临床资料。结果13例均行手术治疗,包括常规开腹手术及腹腔镜微创手术,并经病理证实符合临床诊断。其中8例存活,5例放弃,术后短期随访,患儿生长发育良好。结论针对新生儿先天性胃壁肌层缺损致胃穿孔,根据临床表现,结合病史、体征及腹部立位X片大部分不难诊断,诊断明确或有相应手术指征应尽早进行手术探查,彻底切除病变及探查发现并同时完成合并消化道畸形矫正,结合有效抗感染、抗休克及呼吸、循环、营养支持可降低该病死亡率,获得良好治疗效果。

先天性胃壁肌层缺损致胃穿孔8例的临床分析

目的结合回顾性调查分析,更加深入的了解先天性胃壁肌层缺损致胃穿孔患儿的临床特点,并掌握治疗预后,以期提高该类患儿的诊疗水平。方法对厦门大学附属第一医院小儿外科2010年3月-2019年3月来收治的先天性胃壁肌层缺损致胃穿孔8例患儿临床资料进行系统地回顾性调查分析。结果该组男6例,女2例。平均出生体重1.84 (1.05~3.15) kg;3例为顺产,5例为剖宫产;6例为早产儿伴低出生体重儿,2例为足月儿。为出生后1~4 d发现消化道穿孔。8例患儿存在哭闹、腹胀、呕吐及呼吸困难症状。1例患儿表现为消化道出血,7例患者出现肛门停止排便、排气或仅排少量肠液样粘液便。1例合并腹腔型隐睾,2例合并肠旋转不良。患者均进行病变组织切除+胃壁修补缝合+腹腔引流术。1例腹腔型隐睾行睾丸下降固定+疝囊高位结扎术,2例合并肠旋转不良患儿加行Ladd’s手术。1例合并有回肠闭锁,给予行回肠造口术,生后6个月二期行回肠还纳手术。8例患儿中,7例患儿存活,随访6~12个月, 1例患儿存在胃食管反流,通过有效的治疗,其症状得到了改善,饮食及排便基本正常。1例死亡,病死率为12.5%。死亡原因为DIC合并肺出血。结论对于新生儿来说,先天性胃壁肌层缺损对其影响较大,威胁患儿生命安全。因此临床必须尽早确诊,然后立刻进行手术探查,将病变组织切除,促进患儿身体康复。在此过程中,还需结合围手术期治疗,如抗感染、抗休克及营养支持等,保证患儿获得良好的预后。

腹腔镜早期诊治先天性胃壁肌层缺损

目的初步探讨先天性胃壁肌层缺损在未发生胃破裂之前的临床特点,以及腹腔镜在胃破裂之前早期诊治该病的应用价值。方法分析我院2018年经腹腔镜诊治的2例新生儿先天性胃壁肌层缺损患儿的病例资料。男、女各1例,男性患儿为足月儿,女性患儿为早产儿(胎龄分别为38+2周、34周),日龄分别为3 d、4 d,体重分别为2540g、1800g,2例患儿均以腹胀入院,均有自主排便,感染指标均在正常范围内,腹部X线片均表现出巨大胃泡影,胃肠减压无效,行上消化道造影均提示胃蠕动能力减弱,造影剂无法通过幽门。2例患儿均行腹腔镜探查术,术中均证实为先天性胃壁肌层缺损且未穿孔,2例均同时在腹腔镜下行胃壁修补术。结果2例患儿术后恢复良好,术后无任何感染征象,术后1周行上消化道造影无吻合口漏等相关并发症,胃壁形态及蠕动能力正常,逐步开奶后痊愈出院。检索中国知网(CNKI)、万方、维普、Pubmed、Clinicalkey、Google Scholar等数据库截至2018年12月,未检索到在未发生胃破裂之前,腹腔镜诊治先天性胃壁肌层缺损的相关报道。结论1.对呕吐、拒奶、上腹膨隆、有胃型、X线检查显示巨大胃泡影、胃肠减压后胃泡影变化不明显且上消化道造影提示胃蠕动能力减弱的新生儿,要高度怀疑先天性胃壁肌层缺损,可以考虑腹腔镜探查;2.腹腔镜在先天性胃壁肌层缺损尚未导致胃破裂之前进行早期诊断和治疗,可避免胃破裂后感染性休克、败血症等严重并发症的发生,且效果满意。