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A 31-year-old woman developed combined interstitial gastric and duodenal emphysema associated with acute dilatation of the stomach and duodenum following an asthmatic attack. The literature is reviewed.
Fusarenon-X (FX) 1.5 mg/kg was administered intraperitoneally (i.p.) to 6-week-old male Wistar rats for examination of pathologic effects on the glandular stomach. Rats ip-treated with sterilized physiological saline were used as control. FX-administered rats showed dilatation of the stomach with increased fluid contents after 1-4 hr. Light microscopically, a few apoptotic karyopyknosis were seen in chief cells in the basal region at 1 hr postadministration (PA) and mitotic inhibition was evident after 2 hr PA. Marked apoptosis of nuclear pyknosis and cytoplasmic inclusions in both zymogenic and oxyntic cells developed from basal to middle regions of the gastric mucous membrane at 2-4 hr PA with a peak at 3 hr. Apoptotic changes of differentiating neck cells and surface epithelia were less evident. Electron microscopy revealed that the chief cells were the main target of FX-induced apoptotosis. The parietal cells were secondarily involved because they phagocytosed chief cell-derived apoptotic bodies. In situ detection of DNA breaks by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) reaction revealed the positive nuclei after 1 hr PA, which increased with time and reached a peak at 3 hr PA, in accordance with apoptotic changes in histological study. Agarose gel electrophoresis of DNA isolated from the gastric mucosae of FX-administered rats showed ladder pattern of DNA fragments after 1.5 hr PA with the maximum distinctness at 3 hr PA.
OBJECTIVE: The purpose of this study was to describe the prenatal sonographic features and natural course of congenital jejunal and ileal atresia and correlate the findings with neonatal outcomes. METHODS: We identified all neonates with surgically confirmed jejunal or ileal atresia that had prenatal sonography and neonatal surgery in our center from January 1, 1995, to April 1, 2005. Sonography reports and images were reviewed, without knowledge of neonatal outcomes, for features of intestinal obstruction. Obstetric and neonatal outcomes were evaluated. RESULTS: Fifteen (60%) of 25 offspring with atresias (10 jejunal, 4 ileal, and 1 jejunoileal) had sonography, of which 13 (86.6%) had features of atresia. Findings, number of affected fetuses, and gestational age at recognition included fetal echogenic bowel (n = 8), mean +/- SD, 21.3 +/- 3.8 weeks (range, 17.7-28.4 weeks); enlarged stomach (n = 5), 27.5 +/- 5.0 weeks (range, 22.0-34.3 weeks); dilated bowel (n = 13), 27.8 +/- 5.8 weeks (range, 18.3-35.9 weeks); and polyhydramnios (n = 6), 33.3 +/- 1.7 weeks (range, 31.0-35.6 weeks). No fetus with ileal atresia had an enlarged stomach or polyhydramnios. Delivery occurred at a mean of 34.7 +/- 3.6 weeks, with 9 (60%) cesarean deliveries. Neonatal outcomes of age at surgery, neonatal intensive care unit days, hospital days, total parenteral nutrition days, and death were similar whether or not fetal echogenic bowel, enlarged stomach, dilated bowel, or polyhydramnios was present. Likewise, these outcomes did not vary by type of atresia or time of diagnosis (prenatal or neonatal). CONCLUSIONS: Jejunal and ileal atresia have specific sonographic patterns allowing specific prenatal diagnoses in most affected fetuses. Prenatal sonographic findings and time of diagnosis did not affect neonatal outcome.
Interposition of a jejunal pouch after proximal gastrectomy is a popular reconstruction method in Japan, because it produces a good quality of life soon after surgery. Many reports have described its usefulness. However, there are few reports describing its complications. We report here for the first time a case of pouch stasis needing surgery. A 23-year-old man underwent proximal gastrectomy with interposed jejunal pouch for traumatic strangulated diaphragmatic hernia. Three years later, he complained of persistent vomiting. Since surgery, he had eaten as much as other young people. An upper gastrointestinal series showed dilatation of the jejunal pouch and stasis of contrast medium. Since conservative therapy was not effective, surgery was performed. In the operative findings, the jejunal pouch was extremely dilated, the remaining stomach had become atrophic, and moreover, the anastomosis was severely distorted. It was considered that frequent excessive ingestion caused irreversible dilatation of the jejunal pouch, resulting in pouch stasis. Even though the jejunal pouch is interposed for reconstruction, it is very important to give nutritional guidance to patients, especially young patients, to prevent pouch stasis caused by excessive food ingestion.
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The endoscopic passage of a guidewire to facilitate the placement of a pneumatic dilator is not widely practiced. We describe a patient with achalasia in whom marked "sigmoid" deformity of the distal esophagus prevented the placement of a dilator by the standard technique. Correct positioning was easily achieved by using a fiberoptic endoscope to pass a guidewire into the stomach. The pneumatic dilator with internal stiffener was attached to the guidewire and positioned fluoroscopically at the gastroesophageal junction. A clinically successful dilatation was then achieved.
INTRODUCTION: The prognosis of anorexia nervosa (AN) is severe (death in 2 to 5% of cases). AN is closely linked to episodes of bulimia. OBSERVATION: A 25 year-old woman suffering from anorexia nervosa was hospitalised for an occlusive syndrome with vomiting, presence of abdominal cramps, absence of hydroaeric sounds and suspension of stools and gas. The biological examinations were normal. The abdominal scan revealed voluminous gastric dilatation. The diagnosis of functional occlusive syndrome was retained. With medical treatment and follow-up in intensive care the gastric dilatation progressively regressed. DISCUSSION: The periods of restricted nourishment during NA are interspaced by episodes of bulimia and at the origin of sometimes severe digestive complications. The abnormalities in gastric motility can lead to major dilatation of the stomach with the risk of perforation. The onset of abdominal pain in the context of AN during an episode of bulimia must evoke the diagnosis of acute gastric dilatation with major risk of perforation.
1. Calcitonin gene-related peptide (CGRP) potently enhances mucosal blood flow in the rat stomach. The aim of this study was to examine whether CGRP also dilates extramural arteries supplying the stomach and whether the vasodilator action of CGRP involves nitric oxide (NO). 2. Rat CGRP-alpha (0.03-1 nmol kg-1, i.v.) produced a dose-dependent increase in blood flow through the left gastric artery (LGA) as determined by an ultrasonic transit time technique in urethane-anaesthetized rats. Blockade of NO synthesis by NG-nitro-L-arginine methyl ester (L-NAME, 20 and 60 mumol kg-1, i.v.) significantly reduced basal blood flow (BF) in the LGA and attenuated the hyperaemic activity of CGRP by a factor of 2.8-4. D-NAME tended to enhance basal BF in the LGA but had no influence on the dilator activity of CGRP. The ability of vasoactive intestinal polypeptide to increase left gastric arterial blood flow remained unaltered by L-NAME. 3. L-NAME (20 and 60 mumol kg-1, i.v.) evoked a prompt and sustained rise of mean arterial blood pressure (MAP) and caused a slight decrease in the hypotensive activity of CGRP. In contrast, D-NAME induced a delayed and moderate increase in MAP and did not influence the hypotensive activity of CGRP. 4. Rat CGRP-alpha dilated the isolated perfused bed of the rat LGA precontracted with methoxamine and was 3 times more potent in this respect than rat CGRP-beta. The dilator action of rat CGRP-alpha in this preparation was not affected by L-NAME or D-NAME (40 microM). 5. L-NAME (60 micromol kg-1, i.v.) reduced gastric mucosal blood flow as assessed by laser Doppler flowmetry and diminished the hyperaemic activity of rat CGRP-alpha in the gastric mucosa by a factor of 4.5, whereas D-NAME was without effect.6. These data show that CGRP is a potent dilator of mucosal and extramural resistance vessels in the rat stomach. Its dilator action involves both NO-dependent and NO-independent mechanisms.
A 45 years old woman, hemodialysed since 1981, with an history of Staphylococcal septicemia in may 1983, is admitted in emergency room in may 1984 for massive gastro intestinal bleeding. After oesogastro fibroscopy suspecting duodenal ulcer, because continuous and recurrent bleeding, a laparotomy find only symptoms of portal hypertension (ascites, venous dilatation on abdominal oesophagus and stomach). The ligation of this venous dilatations stop temporarily the gastro intestinal bleeding. But recurrence of this bleeding conduct to a celiac angiography discovering a splenic aneurysm with arterio venous fistula. The surgical treatment of this aneurysm can stop the gastro intestinal bleeding. Histopathologic observation of this aneurysm can suspect an infectious origin.
In 10 cats anaesthetized using chloralose and with muscular relaxation by gallamine and continuous artificial ventilation in acute experiments photically evoked potentials (PEP) were recorded from the visual area of the cortex under different intragastric pressures and varying tidal volumes. It was the aim of this study to examine whether an exteroceptive stimulus (light flash) in the visual analyzer, which is influenced by an interoceptive stimulation (gastric pressure), may also be modified by different tidal volumes. Times, amplitudes and slope parameters, blood pressure and heart rate of the animals were studied. The PEP of the visual cortex was modified under the influence of the interoceptive stimuli. It could, however, be shown that already hypo- and hyperventilation alone may cause alterations in the latency period of the PEP. They arise in a different manner in individual parts of the measured parameters of the PEP and do not change these values in a typical manner. Additional dilatation of the stomach may suppress the phenomena caused by alterations in the tidal volume. Thus, attention should be paid to both blood gases and acid base balance in animals in studies on viscero-cerebral interrelationships as well as to interactions between different analyses using the method of evoked potentials.
An internal hernia of the stomach through a gastro-splenic defect is presented. This exceptional condition, that we can include between abdominal internal hernias, induced an high bowel occlusion that needed of emergency surgical treatment. The dilatation of the stomach, the weakness of anchorage structures, its ability to rotation and the emptying kinetic activity posterior actually favoured the incarceration of a part of the posterior wall in a gastro-splenic defect. Detension, hernial reduction and suture of gastro-splenic defect resolved the case: no post-operative complications, the patient was discharged in eight post-operative day.
BACKGROUND: Gastric cardia intestinal metaplasia (CIM), denoted by goblet cells is common. The frequency of persistent CIM is unknown. METHODS: 85 patients with CIM and follow-up endoscopies were prospectively identified during the time period of 10/6/94-12/21/97. The presence of goblet cells was the defining feature of CIM, other metaplastic cell types were not evaluated. AU 85 patients initially had biopsies that straddled the squamocolumnar junction (SCJ) showed CIM, an otherwise normal proximal stomach, lower esophagus, and squamocolumnar junction. The SCJ lay within the 2 cm of mucosa immediately proximal to the uppermost gastric fold and overlaid the junction of the tubular esophagus and the saccular dilatation of the stomach in all patients. The patients underwent endoscopy for many reasons. They were randomly identified based on the absence of a hiatal hernia and the presence of CIM. RESULTS: Ten of the 85 patients had CIM on repeat biopsy. Among patients with no CIM in the first repeat endoscopy, the degree of cardia inflammation decreased between the initial and first repeat endoscopy, whereas there was no change in the amount of inflammation among patients who had CIM in the first repeat endoscopy. The changes in mean inflammation score was significantly different between the two groups (P = .024). Twenty-two patients underwent a second repeat endoscopy and five had a third repeat endoscopy. Including all follow-up biopsies, six of the 85 patients (7%) had CIM. Four patients who did not have CIM on initial repeat endoscopy had CIM on their second repeat endoscopy, probably reflecting sampling issues. None of the biopsies had dysplasia. CONCLUSIONS: Cardia inflammation is a stimulus for cardia intestinal metaplasia, and a reduction in inflammation may allow the metaplastic mucosa to revert to normal.
In recent years we have treated two patients with gastric infarction as a complication of anorexia nervosa and bulimia. We found only three other cases reported in the literature. Surgical intervention was delayed in all five patients either because the diagnosis was missed by the physician or because the patient failed to seek medical attention. Physicians should be alerted to the possibility of acute gastric dilatation if a young woman, who may be undernourished and anorexic, complains of abdominal pain after ingestion of a large meal. Often this condition can be treated conservatively before irreversible damage to the gastric wall has taken place. If the gastric dilatation progresses, the stomach loses its contractility, resulting in venous occlusion, infarction, and gastric perforation. An extensive operation is required, and the patient undergoes an often complicated and prolonged hospital course.
A case report is presented of a 54-year old female patient with a history of acute-onset sharp retrosternal chest pain. Clinical examination was unremarkable, but the 12-lead ECG showed anterior T-wave inversion and the chest x-ray film showed gaseous dilatation of the stomach. The patient's symptoms and electrocardiographic abnormalities resolved immediately after gastric decompression. Further investigations revealed no evidence of coronary artery disease. This case report documents marked T-wave changes and atypical chest pain with gastric dilatation. The possible causes of the ECG changes and chest pain are discussed.
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