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Acute gastric dilatation in two black and white colobus monkeys is described. The subfamily colobini have a ruminant-like stomach and a pregastric fermentation, of important for the observations described.
Initial examination and therapy, and the avoidance of maltreatment are emphasized. Gastric decompression is of prime importance, after which no compound should be administered via stomach tube. Where large amounts of high starch grains are fed, primary acute gastric dilatation must be differentiated from that secondary to small bowel dilatation, by immediate gastric intubation and irrigation of the cardia with lidocaine. If cessation of pain and improvement of peristalsis and general attitude follow, the former state may be assumed. If pain persists and peristalsis does not improve markedly, one should assume small bowel displacement. Rectal examination is helpful in initial evaluation: impactions, inguinal herniation and ileocaecal intussusception may be diagnosed and small bowel displacement suspected. Palpation of one or more distended loops of bowel in the ventral middle third of the abdomen indicates small bowel displacement or ileus and flaccid distension. Distinction by rectal palpation alone is difficult. Palpation of the gas-distended apex of the caecum in the middle third of the abdomen is virtually pathognomonic for 180 degrees rotation of the large bowel. Abdominal paracentesis yielding true sanguineous effusion indicates a necrotizing segment of the bowel. If negative, such a segment is absent, or there is an infarcted segment, not yet damaged to the point of leaching whole blood, or the necrotizing segment is outside the peritoneal cavity, i.e., in the thorax, intussuscepted into the caecum, or herniated into the inguinal canal. Recurrent colics frequently may be due to verminous arteritis but the relationship to diet should be investigated. Recurrent colics after grain ingestion with occult blood in the faeces may be due to ulcers; such cases respond well to grain withdrawal. The advantages and disadvantages of phenothiazine-derived tranquillizers are discussed. They are contra-indicated if there is any evidence of circulating volume insufficiency but are benefical in many instances through improved peripheral perfusion of organs provided circulating volume is adequate, i.e., early in acute abdominal disease prior to development of circulatory insufficiency. They should not be administered if immediate surgery is contemplated because of hypotensive effects. The administration of oral antibiotics (Neomycin) early in the course of the disease is encouraged. This is contra-indicated if the horse is already toxic, when it should receive parenteral antibiotics, preferably chloromycetin. Tetracyclines may predispose to the later development of salmonella diarrhoea. Absolute analgesia should be provided; our preference is the magnesium sulphate-chloral hydrate solutions. Administration of mineral oil is desirable in initiation of peristalsis, depression of Gram-negative overgrowth and softening of impactioning obstructions but nothing should be administered per os if the stomach has required decompression.
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Oral administration of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) to hamsters at a concentration of 50-83 μg/ml in the drinking water resulted in a high incidence of tumours in the glandular stomach. Short-term administration of MNNG for 4-6 months resulted in more adenocarcinomata in the glandular stomach than long-term administration for 7-8 months. One case of metastasis of an adenocarcinoma of the glandular stomach to the liver and 2 cases of metastasis to the regional lymph nodes were found. Spindle cell sarcomata in the glandular stomach and adenocarcinomata in the duodenum were also often produced.Oral administration of MNNG at the very high concentration of 500-2000 μg/ml induced a hepatic cell carcinoma, intrahepatic bile duct carcinomata, bile duct cystadenomata and cystic dilatation, and a haemangioma in the liver but no tumour in the glandular stomach.Sequential morphological studies on the glandular stomach of hamsters receiving 50 μg/ml of MNNG in the drinking water showed 3 stages of change of the mucosa. The mucosa became atrophic and eroded in the first 16 weeks. Irregular atypical glands developed at the margins of erosions and proliferation of spindle cells in the submucosa were found after 18 weeks. Spindle cell sarcomata developed in animals after 20 weeks. Adenocarcinomata developed between 25 and 32 weeks.
Percutaneous endoscopic gastrostomy is used for long-term nutritional support and can be performed with relatively few complications. We describe a patient in whom the internal bumper eroded into the stomach wall and was completely covered by gastric epithelium 11 months after gastrostomy tube placement. The gastrostomy tube itself was patent, and the end still protruded into the lumen of the stomach so that tube feeding was not impaired. Endoscopy, in combination with passage of Savary dilators over a guidewire, was safely used to remove the gastrostomy tube and buried bumper. We recommend this approach in patients with the "buried bumper" syndrome to prevent continued tube migration into the gastric and abdominal walls.
PURPOSE: A new method for internal drainage of malignant ascites is presented in 5 patients with symptomatic malignant ascites. MATERIAL AND METHODS: US-guided percutaneous gastrostomy and paracentesis were performed using the Seldinger technique. A 2.5-mm Cope-loop catheter was inserted in the fluid-filled stomach. In the lower abdomen the proximal part of a Denver peritoneo-venous shunt was introduced after dilation up to 4.8 mm. The pump chamber was sutured to the skin. The distal part of the Denver shunt was cut a few cm from the pump chamber and connected to the gastrostomy catheter. When pumping, ascites is shunted to the stomach lumen. RESULTS: The insertion presented no complications, and all shunt systems initially functioned well. However, the shunts had to be removed within the first 2 weeks because of mechanical problems such as clotting, leakage, and peritoneal septum formation. No infections were reported. CONCLUSION: The peritoneo-gastric shunt may present a therapeutic alternative in selected patients, but the mechanical problems have first to be solved.
UNLABELLED: The movement of the stomach after gastrectomy was studied by cine-fluoroscopic and photo-optical technique in patients undergoing pylorus preserving gastrectomy (pyloric canal being preserved approximately 1.5 cm in 8 cases; group A) or antrum preserving gastrectomy (pyloric antrum being preserved 3-5 cm in 16 cases; group B). All patients were operated on in our clinic for a benign lesion located near the angle of the stomach. RESULTS: 1) In the early postoperative period, the oral gastric remnants showed remarkable dilatation in group A. The dilatation was also observed in group B, but less prominent. 2) For the recovery from the gastric dilatation and reappearance of gastric motility, it took much more time in group A than in group B. 3) Co-ordinated movements across the anastomotic site were recognized about one month after operation in group B and about two months in group A. 4) Antiperistalsis at the preserved antrum during an early postoperative period was observed in 2 of 16 cases in group B. The antiperistalsis in the two cases turned into normo-peristalsis in about two months. 5) From the results obtained, the preserved antrum showed an excellent functional drainage effect and plays an important role for the transportation of the gastric content. 6) In conclusion, antrum preserving gastrectomy results in a good postoperative gastric motility and is an excellent operative method for the benign lesions located near the angle of the stomach.
Gastroplasty (GP) or gastric bypass with exclusion of 90% of the distal stomach (GBP) have largely replaced small bowel bypass in the surgical management of morbid obesity. Despite the theoretical advantages of GP over GBP, revision rates of up to 20% are reported with GP because of unsatisfactory weight loss resulting from staple line disruption, pouch dilatation, and/or stomal enlargement. This report describes four alternative surgical approaches to failed GP. "Complete" partitioning of the stomach accompanied by gastrogastrostomy or conversion to Roux-en-Y GBP is recommended. Because of intangible advantages associated with exclusion of the stomach and duodenum, conversion to GBP is favored over GP revision in such cases.
The camel's stomach consists of 3 compartments. The third one was subdivided according the external and internal appearance into 3 parts: initial dilated part, middle long narrow part and terminal dilated part with a thick wall. The mucosa in the first 2 parts contain simple tubular glands separated by a clearly visible Lamina propria mucosae, heavily infiltrated with lymphocytes which aggregates to form true lymph nodules especially in the retiform of the initial dilated part. It is concluded that these glands are cardiac glands.
OBJECTIVE: To determine long-term outcome associated with laparoscopic-assisted gastropexy in prevention of gastric dilatation-volvulus (GDV) in susceptible dogs and to evaluate use of laparoscopy to correct GDV. DESIGN: Prospective study. ANIMALS: 25 client-owned large-breed dogs. PROCEDURE: 23 dogs susceptible to GDV were referred as candidates for elective gastropexy. These dogs had a history of treatment for gastric dilatation, clinical signs of gastric dilatation, or family members with gastric dilatation. Laparoscopic-assisted gastropexy was performed. One year after surgery, abdominal ultrasonography was performed to evaluate the attachment of the stomach to the abdominal wall. Two dogs with GDV were also treated with laparoscopic-assisted derotation of the stomach and gastropexy. RESULTS: None of the dogs developed GDV during the year after gastropexy, and all 20 dogs examined ultrasonographically had an intact attachment. Another dog was euthanatized at 11.5 months for unrelated problems. Two dogs with GDV successfully underwent laparoscopic-assisted gastropexy after the stomach was repositioned. CONCLUSIONS AND CLINICAL RELEVANCE: Laparoscopic-assisted gastropexy resulted in a persisting attachment between the stomach and abdominal wall, an absence of GDV development, and few complications. Dogs with a high probability for development of GDV should be considered candidates for minimally invasive gastropexy. Carefully selected dogs with GDV can be treated laparoscopically.
During a 3.3-year period, gastric dilatation-volvulus was diagnosed in 134 dogs. Thirteen of them died or were euthanatized prior to treatment. In 33 dogs, decompression and emptying of the stomach was successfully performed via a gastric tube. Rate of recurrence was 75.8% (25/33) for these dogs. Eighty-eight dogs were treated surgically. In all but 1 surgically treated dog, a new technique for gastropexy was performed for prevention of relapse. For the 5-cm-long gastropexy, the pyloric antrum was incorporated in the cranial suture of the abdominal wall. Of the surgically treated group, 63 dogs (79.7%) were discharged from the clinic in good condition. Recurrence of gastric dilatation, without evidence of gastric volvulus, 2 (n = 3) and 6 (n = 1) months after surgery, was observed in 6.6% (4/61) of surgically treated dogs with gastric dilatation-volvulus. Four (6.6%) of the 61 dogs died or were euthanatized because of other causes, but had been without signs of gastric dilatation within a mean of 19 months after surgery. In the remaining 53 dogs (86.8%), relapse had not been observed by the end of the follow-up period. In dogs with surgical treatment of gastric dilatation-volvulus, recurrence rate (6.6%) was significantly (P < 0.0001) different from that in those with medical treatment (75.8%). This study indicated that recurrence of gastric dilatation-volvulus may be prevented with this simple and fast gastropexy technique.
PURPOSE: To determine whether ingestion of a tooth whitener containing 6% hydrogen peroxide as bleaching agent affected the gastric mucosa of adult, female laboratory rats. MATERIALS AND METHODS: Thirty-six fasting rats were intubated with a single bolus (5 g/kg body weight) of the tooth whitener Natural White which contains 6% hydrogen peroxide. Thirty-two control rats received deionized water. Rats were necropsied 15 minutes, 2 hours, 1 and 2 weeks after whitener ingestion. The gastric mucosa was examined histologically and blood hematocrit, glucose, BUN, and bilirubin measured. RESULTS: Six of the 36 rats died within 2 hours of receiving whitener. Within 15 minutes of whitener ingestion, stomachs were grossly bloated with gas. Histological observation showed that gastric mucosal cells were vacuolated and gastric glands dilated. After 2 hours, gastric epithelial and glandular cells had sloughed off into the gastric lumen. Mean blood glucose and hematocrit were significantly (P < 0.05) elevated (233 +/- 41 mg/ml and 50.5 +/- 0.9%) over mean control values (129 +/- 8 mg/ml and 42.8 +/- 2.4%). Within 1 week, the stomachs of experimental rats were no longer bloated, the gastric mucosa appeared normal histologically, but mean blood hematocrit was significantly (P < 0.05) decreased (38.0 +/- 1.5%) from mean control value (43.3 +/- 0.5%). There were no significant differences in mean blood values 2 weeks after whitener ingestion.
A 19-year-old primipara was referred to our center for a routine scan at 33 + 4 weeks' gestation. A visible but small stomach bubble (18 mm) was detected in the fetal abdomen, associated with a dilation of the esophagus with a tapering distal part. Direct visualization of filling and emptying of the proximal esophagus suggested the presence of obstruction. A cystic pouch in the region of the esophagus was observed to be full and empty in accordance with fetal swallowing. No other fetal anomalies were detected. Fetal biometric measurements were on the 10th percentile and polyhydramnios was detected. Esophageal atresia type I was suspected. Fetal karyotyping was declined by the parents, no therapy was given and the pregnancy continued until week 37 when a female baby was delivered following spontaneous labor. Esophageal atresia type I was radiographically confirmed. Bougienage was used for 8 weeks and esophageal anastomosis was successfully performed when the infant was 11 months old. No other anomalies were found and the child is currently in excellent health. The present case shows that the upper neck pouch sign may be a delayed manifestation present only in certain types of esophageal atresia. However, when it occurs it should prompt careful fetal examination as it is an important step in the diagnosis of esophageal atresia.
Sixty patients who underwent distal splenorenal shunt were followed up from one to ten years, with an average of 5.6 years. Postoperative portography through the superior mesenteric artery was carried out in 58 of these patients and the remaining two were studied at autopsy. The diameter of the portal vein was unchanged in 65 per cent of the patients within 30 postoperative days, but it decreased remarkably in size one year after the surgery in one third of the patients, and it was observed in about half of the patients at 5 years after the surgery. Numerous collaterals had developed around the pancreas and stomach in the majority of cases presenting narrowing of the portal vein. Enormously dilated pancreatic veins directed to non-isolated distal splenic vein were identified in the autopsied cases. These findings strongly suggest that pancreatic veins connecting to the distal vein may play a leading role in production of malcirculation of the portal system after distal splenorenal shunt.
BACKGROUND: Open and laparoscopic antireflux procedures may require reoperation for failures of the initial procedure in about 3% to 6% of cases. The purpose of this study is to describe our operative experiences, postoperative results, and patients' view of outcome following laparoscopic refundoplication. METHODS: Thirty patients (18 men, 12 women), mean age 56 years (range 37 to 77) underwent laparoscopic redo surgery. In 18 patients the initial surgery was done by the open technique, and 3 had surgery twice previously. Twelve patients had previous laparoscopic antireflux surgery. Indications for redo surgery were recurrent reflux (n = 17), dysphagia (n = 6), and the combination of both (n = 7). RESULTS: Twenty-eight patients were completed laparoscopically, 21 with a floppy Nissen and 7 with a Toupet fundoplication. Two patients were converted to the open procedure because of intraoperative technical problems. In 5 cases there was an injury to the stomach wall, successfully managed laparoscopically. Postoperatively 1 patient had dysphagia and required pneumatic dilatation, another had gas bloat. There was a significant increase in lower esophageal sphincter pressure at 3 months (12.4+/-4.8 mm Hg; n = 30) and 1 year (12.3+/-4.5 mm Hg; n = 30). Twenty-four hour pH monitoring showed a decrease of the DeMeester Score at 3 months after surgery from 14.7+/-10.6 (n = 30) and 1 year after surgery from 12.1+/-8.7 (n = 30). Gastrointestinal quality of life index increased from 87 points preoperatively to 121 at 3 months and 123 at 1 year, which is comparable with a healthy population (123 points). CONCLUSIONS: Laparoscopic refundoplication is a feasible and effective procedure with excellent postoperative results, independent of whether the primary procedure was done by the open or laparoscopic technique.
Children who develop end-stage renal disease (ESRD) as a result of obstructive uropathies require evaluation and treatment of associated bladder dysfunction to ensure a good outcome following renal transplantation. Bladder dynamics can often be optimized medically, although surgical intervention is occasionally necessary. For those patients who require bladder augmentation, the use of a dilated native ureter (ureterocystoplasty) is preferred to the more commonly used intestine or stomach (enterocystoplasty), which carry a higher risk of complications. Unfortunately, most patients do not have a suitable anatomy for ureterocystoplasty and, by necessity, intestine or stomach has to be utilized. Herein, we describe the successful application of ureterocystoplasty in the presence of ESRD and a solitary kidney prior to renal transplantation. We believe that owing to the many advantages of native urothelium, every effort should be made to use ureter and avoid the use of intestine.
The combination of duodenal atresia and esophageal atresia without tracheoesophageal fistula leads to a closed loop of bowel involving the distal esophagus, stomach, and duodenum. Prenatally, this association of anomalies is visualized as a characteristic dilated C-shaped fluid collection in the fetal abdomen. We report three cases of the association of duodenal and esophageal atresia without tracheoesophageal fistula, identified sonographically in the second trimester of pregnancy.
A mucocele is rarely observed after esophageal exclusion for corrosive burns. It may represent a contra-indication to esophageal conservation in case of a total gastric resection for necrosis and perforation of the stomach. To evaluate this risk, 15 patients, operated between January 1970 and december 1988, were reviewed: they underwent total gastric resection with esophageal exclusion, followed by a secondary colon transplant between the cervical esophagus and the duodenum. A plain chest film was performed for 13 patients and a CT scan for 11 patients. Mean follow-up was 5.7 years (2 months - 17 years). Four patients died, one of them after resection of a compressive esophageal mucocele. Six mucoceles were detected on 13 chest films and 7 were described on 11 CT scans. On the whole, 8 mucoceles were diagnosed on 15 patients; one of them was complicated by tracheal compression. The formation of a secondary esophageal mucocele is a late sign of incomplete destruction of the esophageal wall. It is a frequent complication of esophageal exclusion performed after total gastrectomy for corrosive burns of the stomach. It must be detected on a chest film which shows the largest dilatations or on a CT scan, which is a better investigation. When the diameter of the mucocele is equal of superior to 50 mm, it can be compressive and must be treated by resection of internal diversion.