BACKGROUND Gastric wall necrosis is a rare complication of endoscopic treatment for bleeding gastric ulcer,which may exacerbate the patient’s condition once it occurs and may even require surgical intervention for tr...BACKGROUND Gastric wall necrosis is a rare complication of endoscopic treatment for bleeding gastric ulcer,which may exacerbate the patient’s condition once it occurs and may even require surgical intervention for treatment.CASE SUMMARY A 59-year-old man was admitted to our department with melena.Endoscopy revealed a giant ulcer in the gastric antrum with a visible vessel in its center,which was treated with sclerosants and tissue glue injection and resulted in necrosis of the gastric wall.CONCLUSION Injection of sclerosants and tissue glue may lead to gastric wall necrosis,which is a serious complication.Therefore,before administering this treatment to patients,we should consider other more effective methods of hemostasis to avoid gastric wall necrosis.展开更多
A 63-year-old woman was referred to our hospital for further examination because of an incidental finding of early gastric cancer.Endoscopic submucosal dissection(ESD)was successfully performed for complete resection ...A 63-year-old woman was referred to our hospital for further examination because of an incidental finding of early gastric cancer.Endoscopic submucosal dissection(ESD)was successfully performed for complete resection of the tumor.On the first post-ESD day,the patient suddenly complained of abdominal pain after an episode of vomiting.Abdominal computed tomography(CT)showed delayed perforation after ESD.The patient was conservatively treated with an intravenous proton pump inhibitor and antibiotics.On the fifth post-ESD day,CT revealed a gastric wall abscess in the gastric body.Gastroscopy revealed a gastric fistula at the edge of the post-ESD ulcer,and pus was found flowing into the stomach.An intradrainage stent and an extradrainage nasocystic catheter were successfully inserted into the abscess for endoscopic transgastric drainage.After the procedure,the clinical symptoms and laboratory test results improved quickly.Two months later,a follow-up CT scan showed no collection of pus.Consequently,the intradrainage stent was removed.Although the gastric wall abscess recurred 2 wk after stent removal,it recovered soon after endoscopic transgastric drainage.Finally,after stent removal and oral antibiotic treatment for 1 mo,no recurrence of the gastric wall abscess was found.展开更多
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 potential...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.展开更多
AIM： To substantiate the claims of Unani and Arabian traditional medicine practitioners on the gastroprotective potential effect of a popular spice anise, ＂Pimpinella anisum L.＂ on experimentally-induced gastric ul...AIM： To substantiate the claims of Unani and Arabian traditional medicine practitioners on the gastroprotective potential effect of a popular spice anise, ＂Pimpinella anisum L.＂ on experimentally-induced gastric ulceration and secretion in rats. METHODS： Acute gastric ulceration in rats was produced by various noxious chemicals including 80% ethanol, 0.2 mol/L NaOH, 25% NaCI and indomethacin. Anti-secretory studies were undertaken using pylorusligated Shay rat technique. Levels of gastric non-protein sulfhydryls （NP-SH） and wall mucus were estimated and gastric tissue was also examined histologically. Anise aqueous suspension was used in two doses （250 and 500 mg/kg body weight） in all experiments. RESULTS： Anise significantly inhibited gastric mu- cosal damage induced by necrotizing agents and indomethacin. The anti-ulcer effect was further confirmed histologically. In pylorus-ligated Shay rats, anise suspension significantly reduced the basal gastric acid secretion, acidity and completely inhibited the rumenal ulceration. On the other hand, the suspension significantly replenished ethanol-induced depleted levels of gastric mucosal NP-SH and gastric wall mucus concentration. CONCLUSION： Anise aqueous suspension possesses significant cytoprotective and anti-ulcer activities against experimentallynduced gastric lesions. The anti-ulcer effect of anise is possibly prostaglandin-mediated and/orthrough its anti-secretory and antioxidative properties.展开更多
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...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.展开更多
AIM: To determine the feasibility and safety of transgastric direct endoscopic necrosectomy(DEN) in patients with walled-off necrosis(WON) and gastric varices. METHODS: A single center retrospective study of consecuti...AIM: To determine the feasibility and safety of transgastric direct endoscopic necrosectomy(DEN) in patients with walled-off necrosis(WON) and gastric varices. METHODS: A single center retrospective study of consecutive DEN for WON was performed from 2012 to 2015. All DEN cases with gastric fundal varices noted on endoscopy, computed tomography(CT) or magnetic resonance imaging(MRI) during the admission for DEN were collected for analysis. In all cases, external urethral sphincter(EUS) with doppler was used to exclude the presence of intervening gastric varices or other vascular structures prior to 19 gauge fine-needle aspiration(FNA) needle access into the cavity. The tract was serially dilated to 20 mm and was entered with an endoscope for DEN. Pigtail stents were placed to facilitate drainage of the cavity. Procedure details were recorded. Comprehensive chart review was performed to evaluate for complications and WON recurrence. RESULTS: Fifteen patients who underwent DEN for WON had gastric varices at the time of their procedure. All patients had an INR < 1.5 and platelets > 50. Of these patients, 11 had splenic vein thrombosis and 2 had portal vein thrombosis. Two patients had isolated gastric varices, type 1 and the remaining 13 had > 5 mm gastric submucosal varices on imaging by CT, MRI or EUS. No procedures were terminated without completing the DEN for any reason. One patient had self-limited intraprocedural bleeding related to balloon dilation of the tract. Two patients experienced delayed bleeding at 2 and 5 d post-op respectively. One required no therapy or intervention and the other received 1unit transfusion and had an EGD which revealed no active bleeding. Resolution rate of WON was 100%(after up to 2 additional DEN in one patient) and no patients required interventional radiology or surgical interventions. CONCLUSION: In patients with WON and gastric varices, DEN using EUS and doppler guidance may be performed safely. Successful resolution of WON does not appear to be compromised by the presence of gastric varices, with similar rates of resolution and only minor bleeding events. Experienced centers should not consider gastric varices a contraindication to DEN.展开更多
基金Supported by Shenzhen Science and Technology Research and Development Fund,No.JSGG20210802153548040.
文摘BACKGROUND Gastric wall necrosis is a rare complication of endoscopic treatment for bleeding gastric ulcer,which may exacerbate the patient’s condition once it occurs and may even require surgical intervention for treatment.CASE SUMMARY A 59-year-old man was admitted to our department with melena.Endoscopy revealed a giant ulcer in the gastric antrum with a visible vessel in its center,which was treated with sclerosants and tissue glue injection and resulted in necrosis of the gastric wall.CONCLUSION Injection of sclerosants and tissue glue may lead to gastric wall necrosis,which is a serious complication.Therefore,before administering this treatment to patients,we should consider other more effective methods of hemostasis to avoid gastric wall necrosis.
文摘A 63-year-old woman was referred to our hospital for further examination because of an incidental finding of early gastric cancer.Endoscopic submucosal dissection(ESD)was successfully performed for complete resection of the tumor.On the first post-ESD day,the patient suddenly complained of abdominal pain after an episode of vomiting.Abdominal computed tomography(CT)showed delayed perforation after ESD.The patient was conservatively treated with an intravenous proton pump inhibitor and antibiotics.On the fifth post-ESD day,CT revealed a gastric wall abscess in the gastric body.Gastroscopy revealed a gastric fistula at the edge of the post-ESD ulcer,and pus was found flowing into the stomach.An intradrainage stent and an extradrainage nasocystic catheter were successfully inserted into the abscess for endoscopic transgastric drainage.After the procedure,the clinical symptoms and laboratory test results improved quickly.Two months later,a follow-up CT scan showed no collection of pus.Consequently,the intradrainage stent was removed.Although the gastric wall abscess recurred 2 wk after stent removal,it recovered soon after endoscopic transgastric drainage.Finally,after stent removal and oral antibiotic treatment for 1 mo,no recurrence of the gastric wall abscess was found.
文摘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.
基金Supported by King AbdulAziz City for Science and Technology, Riyadh, Saudi Arabia, Spices Project No. AR1637
文摘AIM： To substantiate the claims of Unani and Arabian traditional medicine practitioners on the gastroprotective potential effect of a popular spice anise, ＂Pimpinella anisum L.＂ on experimentally-induced gastric ulceration and secretion in rats. METHODS： Acute gastric ulceration in rats was produced by various noxious chemicals including 80% ethanol, 0.2 mol/L NaOH, 25% NaCI and indomethacin. Anti-secretory studies were undertaken using pylorusligated Shay rat technique. Levels of gastric non-protein sulfhydryls （NP-SH） and wall mucus were estimated and gastric tissue was also examined histologically. Anise aqueous suspension was used in two doses （250 and 500 mg/kg body weight） in all experiments. RESULTS： Anise significantly inhibited gastric mu- cosal damage induced by necrotizing agents and indomethacin. The anti-ulcer effect was further confirmed histologically. In pylorus-ligated Shay rats, anise suspension significantly reduced the basal gastric acid secretion, acidity and completely inhibited the rumenal ulceration. On the other hand, the suspension significantly replenished ethanol-induced depleted levels of gastric mucosal NP-SH and gastric wall mucus concentration. CONCLUSION： Anise aqueous suspension possesses significant cytoprotective and anti-ulcer activities against experimentallynduced gastric lesions. The anti-ulcer effect of anise is possibly prostaglandin-mediated and/orthrough its anti-secretory and antioxidative properties.
文摘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.
文摘AIM: To determine the feasibility and safety of transgastric direct endoscopic necrosectomy(DEN) in patients with walled-off necrosis(WON) and gastric varices. METHODS: A single center retrospective study of consecutive DEN for WON was performed from 2012 to 2015. All DEN cases with gastric fundal varices noted on endoscopy, computed tomography(CT) or magnetic resonance imaging(MRI) during the admission for DEN were collected for analysis. In all cases, external urethral sphincter(EUS) with doppler was used to exclude the presence of intervening gastric varices or other vascular structures prior to 19 gauge fine-needle aspiration(FNA) needle access into the cavity. The tract was serially dilated to 20 mm and was entered with an endoscope for DEN. Pigtail stents were placed to facilitate drainage of the cavity. Procedure details were recorded. Comprehensive chart review was performed to evaluate for complications and WON recurrence. RESULTS: Fifteen patients who underwent DEN for WON had gastric varices at the time of their procedure. All patients had an INR < 1.5 and platelets > 50. Of these patients, 11 had splenic vein thrombosis and 2 had portal vein thrombosis. Two patients had isolated gastric varices, type 1 and the remaining 13 had > 5 mm gastric submucosal varices on imaging by CT, MRI or EUS. No procedures were terminated without completing the DEN for any reason. One patient had self-limited intraprocedural bleeding related to balloon dilation of the tract. Two patients experienced delayed bleeding at 2 and 5 d post-op respectively. One required no therapy or intervention and the other received 1unit transfusion and had an EGD which revealed no active bleeding. Resolution rate of WON was 100%(after up to 2 additional DEN in one patient) and no patients required interventional radiology or surgical interventions. CONCLUSION: In patients with WON and gastric varices, DEN using EUS and doppler guidance may be performed safely. Successful resolution of WON does not appear to be compromised by the presence of gastric varices, with similar rates of resolution and only minor bleeding events. Experienced centers should not consider gastric varices a contraindication to DEN.
