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Collagenous gastritis in a Korean child: a case report.
Collagenous gastritis, a counterpart of collagenous colitis, is an extremely rare disorder. The first case of collagenous gastritis in a Korean boy in his pre-teens who had been receiving treatment for refractory iron deficiency anemia has been reported. The patient had been suffering from intermittent abdominal pain, recurrent blood-tinged vomiting and poor oral intake. The gastric endoscopy revealed diffuse cobblestone appearance of the mucosa with easy touch bleeding throughout the stomach but no abnormalities in the esophagus, duodenum, and colon. Pathologic examination of the gastric biopsies from the antrum, body and cardia showed a subepithelial collagen deposition with entrapped dilated capillaries, moderate infiltrates of lympho-plasma cells and eosinophils of the lamina propria, and marked hypertrophy of the muscularis mucosa. The collagen deposition appeared as discontinuous bands with focally irregular extension into the deeper part of the antral mucosa. It measured up to 150 microm. Helicobacter pylori infection was not detected. The biopsies from the duodenum, esophagus and colon revealed no pathologic abnormalities.
Adenocarcinoma arising in association with gastric heterotopic pancreas: A case report and review of the literature.
We report a case of adenocarcinoma arising in a focus of heterotopic pancreas, occurring in the stomach of a 52-year-old man. The patient presented with gastric outlet obstruction. Radiographic studies revealed thickening of the gastric wall, but endoscopy failed to reveal a mucosal abnormality. A 50% distal gastrectomy was performed, along with vagotomy. Microscopic examination revealed extensive involvement of the muscularis propria of the distal stomach by heterotopic pancreas. The ectopic pancreas had a microscopic appearance consistent with Heinrich's class III, in which the majority of the heterotopic pancreas was characterized by cystically dilated duct structures. Occasional islets were present. Intimately associated with the cystically dilated ducts was a prominent number of small infiltrating ducts lined by columnar or cuboidal cells with enlarged hyperchromatic nuclei containing prominent nucleoli. These were consistent with a well-differentiated invasive adenocarcinoma. Despite multiple sectioning, no connection between the adenocarcinoma and the overlying gastric mucosa was seen. Adenocarcinoma arising within ectopic pancreas is a rare occurrence with fewer than 30 well-documented cases reported in the world literature to our knowledge.
Repair of a full-thickness gastric rupture in a horse.
A 14-year-old Thoroughbred broodmare was evaluated for signs of mild to moderate abdominal pain of 5 hours' duration. Exploratory celiotomy revealed a 20 x 8-cm subserosal hematoma associated with a focal serosal perforation overlying a muscular tear along the parietal surface of the stomach. The odor of intestinal tract gas was detected, but gross contamination of the abdomen was not evident. Concurrent partial volvulus of the small intestine was evident. Removal of the large colon from the abdomen appeared to coincide with propagation of the serosal perforation to a full-thickness gastric rent. The tear was repaired by use of a 2-layer inverting closure. The horse had evidence of an acute gastrointestinal tract hemorrhage 10 days after surgery, but responded to treatment. At a 2-year follow-up evaluation, the mare had foaled once and had not experienced recurrent signs of abdominal disease.
Role of gastric distention in cholecystokinin's satiety effect in golden hamsters.
Cholecystokinin (CCK) inhibits gastric emptying in a number of species. Since gastric distention is facilitated by reduced gastric emptying, and since gastric distention is a long-known satiety stimulus, it is possible that CCK suppresses feeding by facilitating gastric distention satiety mechanisms. In the first experiment peripheral injections of CCK-octapeptide (CCK-8) inhibited gastric emptying in hamsters. The effective dose range corresponded to the dose range previously shown to be effective at inhibiting feeding in hungry hamsters. In a second experiment the sham-feeding paradigm, in which orally ingested liquid diet passes out of a gastric fistula (thereby eliminating gastric distention), was used to determine whether CCK-8 would reduce hamster feeding in the absence of gastric distention. An intraperitoneal dose of CCK-8 produced a slight and statistically unreliable suppression of sham-feeding. In contrast, the same dose produced a robust and reliable inhibition of feeding during a real-feeding trial (the gastric fistula was closed and the stomach was thus able to distend). These data therefore suggest that enhanced gastric distention may contribute to or magnify the satiety effect of peripherally administered CCK in this species. A third experiment examined the mechanism of CCK action on gastric emptying and feeding. Since (in other species) CCK appears to reduce the rate of gastric emptying primarily by constricting the pyloric sphincter, it was predicted that destroying pyloric control of gastric emptying by pyloroplasty would attenuate CCK's effect on both gastric clearance and feeding. However, pyloroplasty did not alter the normal inhibition of gastric emptying nor the usual feeding inhibitory response after a given dose of CCK-8.(ABSTRACT TRUNCATED AT 250 WORDS)
An improved method for retaining retrieval line in children undergoing repeated esophageal dilatation.
Children undergoing repeated retrograde esophageal dilatation using gastrostomy introduced Tucker dilators must retain a retrieval line between dilations. Generally, the line is tied into a loop coursing through the esophageal lumen and exits at the gastrostomy and nose. This technique, while effective in maintaining the line in situ, is fraught with hazards of chronic erosion at both exits sites, with significant cosmetic deformity, necessitated by the taped external line and, in the pediatric age group, with frequent harassment by peers and siblings pulling the exposed line. We have modified this technique, leaving the line looped around the nasal septum with both ends extending down the esophagus into the stomach where they are tied to the tip of the gastrostomy catheter. This results in an almost completely internalized line that is protected, well tolerated, and easily retrieved for subsequent use with the dilators.
101 oesophageal cancers: a surgeon uses radiotherapy.
One hundred and one consecutive patients with oesophageal cancer, cancer of the cardia and gastric cancer extending upwards from the stomach to the oesophagus were treated from 1979 to 1985 with a policy that included radiotherapy treatment for 58. This heterogeneous group, which was considered together as oesophageal cancer, was subdivided according to anatomical location, histology and pretreatment staging. Those patients who could be treated surgically by a resection and anastomosis performed below the diaphragm were excluded. Thirty-five had surgery which was either an oesophagogastrectomy or oesophagojejunostomy with an intrathoracic anastomosis, except for two who were nonresectable. Eight patients were to ill or refused treatment. The role of radiotherapy was assessed in three groups: i. Operable squamous cell carcinoma of the oesophagus was treated by radical radiotherapy (22) with a 46% 1-year and 14% 5-year survival. ii. Inoperable squamous cell carcinoma of the oesophagus was given radical or palliative radiotherapy (25) with a 16% 1-year and 4% 5-year survival. iii. Non-resectable adenocarcinoma of the stomach or oesophagus was treated palliatively by radiotherapy to debulk the intraluminal tumour (11), all of whom had symptomatic relief of dysphagia. The results of radical radiotherapy for operable squamous cell carcinoma of the oesophagus were similar to the best results achieved by surgical resection in other series in which there is comparable staging. Radiotherapy should be included in the treatment options for oesophageal cancer.
Changes in gastrointestinal lymph and blood vessels in patients with cirrhotic portal hypertension.
BACKGROUND: The aim of this study was to characterize the lymph vessels in different parts of the gastrointestinal tract and also to evaluate morphometric changes in these vessels during cirrhotic portal hypertension. METHODS: Sixteen patients with cirrhotic portal hypertension and 18 control subjects without portal hypertension were enrolled in the study. Tissue specimens were collected at autopsy or surgery, and were stained enzyme histochemically, using 5'-nucleotidase and alkaline phosphatase to distinguish lymph vessels and blood vessels, respectively. The numbers of vessels and their luminal areas were estimated using computer graphics software (National Institutes of Health [NIH] image program). RESULTS: The numbers and luminal areas of the lymph vessels varied considerably among the different organs of the gastrointestinal tract, both in controls and in the patients with cirrhotic portal hypertension. There was no significant difference in the numbers of lymph vessels between controls and patients with cirrhotic portal hypertension. However, the luminal area of the lymph vessels in the esophagus and stomach was significantly greater in the patients with cirrhotic portal hypertension than in the controls. These differences in lymph vessels were not seen in the small intestine and colon. CONCLUSIONS: These data indicate that dilatation of lymph vessels may be related to the absorption of excess interstitial fluid, resulting from congestion, in cirrhotic portal hypertension.
[Cystic lymphangioma of the stomach. Report of a new case].
Cystic lymphangioma are rare benign tumours which are manifested as unilocular o multilocular masses containing chylous or serous material. Its origin is generally accepted to be a congenital lymphatic inflammation. It is difficult to make a preoperative diagnosis. Occasionally, when these lesions are suspected, they may be diagnosed by lymphography. We describe one case which underwent subtotal gastrectomy. At the microscopic examination dilated lymphatic channels were present with some lymphatic inflammation.
[Decompensated acute gastric dilatation caused by a bulimic attack in anorexia nervosa].
HISTORY AND CLINICAL FINDINGS: Abdominal pain developed after a bulimic binge in a 19-year-old girl with anorexia nervosa. She had unsuccessfully tried to induce vomiting. Physical examination showed no clinical sign of peritonitis, although there was diffuse abdominal tenderness on pressure. INVESTIGATIONS: There was leukopenia (2200 G/l) and a raised serum lactate level (58 mg/dl). No free air was seen on a plain film of the abdomen. Abdominal sonography revealed little free fluid subhepatically. TREATMENT AND COURSE: Acute respiratory impairment during investigations required emergency intubation. As bronchoscopy revealed aspiration a bronchial lavage was performed. Under gastroscopic control gastric emptying was achieved through a large gastric tube. After early improvement the patient developed the full picture of sepsis. Ultrasonography and needle puncture having revealed purulent intraabdominal fluid, a laparotomy was performed, which showed necrosis of the anterior and posterior walls of the stomach with free perforation. The greater curvature was resected. The patient slowly recovered but a relaparotomy for a subphrenic abscess became necessary on the 10th postoperative day. A year later there was free food passage, but the anorexia nervosa was unchanged. CONCLUSION: A bulimic binge can become life-threatening if the stomach does not empty spontaneously. Surgical intervention is required, if the patient's condition does not improve despite gastric emptying.
[Clinical significance of CT in evaluation of the gastrocolic trunk and its tributaries].
The gastrocolic trunk (GT), consists of the veins from stomach, duodenum, pancreas and colon, passes transversely in front of the head of the pancreas and drains to the superior mesenteric vein at the lebel of the uncus. Pancreatic and/or portal venous pathology may cause dilatation or occlusion of the GT. The purpose of this study is to clarify the usefulness of X-ray computed tomography (CT) for evaluation of the GT and its tributaries in the diagnosis of pancreatic disease. The CT examinations of 176 patients (97 with pancreatic disease, 79 without pancreatic or liver disease for comparison) were reviewed retrospectively. In the comparison group, a normal GT was identified in 81% of CT scans with 5mm thick sections. Abnormal findings of the GT and its tributaries were seen in 30 cases with the involvement(occlusion or stenosis) of the portal venous system in the group of pancreatic diseases. The GTs were occluded in 17 cases with involvement of GT or SMV and dilated in 5 cases with involvement of the portal vein, SMV, or splenic vein by pancreatic diseases. In 3 cases, GTs were minimally dilated without abnormality of the portal venous system. The right gastroepiploic veins were dilated in 15 cases with splenic vein obstruction (5 patients), GT obstruction (6), SMV stenosis (3), stenosis of main portal vein (1). Assessment of the GT and its tributaries on CT would be useful for evaluation of the extension of the pancreatic disease.
Pediatric upper gastrointestinal endoscopy: a 13-year experience.
This report describes a series of 553 flexible upper gastrointestinal (GI) endoscopies performed on 382 children in two surgical centers between 1975 and 1987. Indications included abdominal pain (180), reassessment of known disease (149), upper GI bleeding (99), foreign body ingestion (77), vomiting (14), dysphagia (10), and miscellaneous (24). Findings were chronic peptic ulcer (47), gastritis/duodenitis (63), healing disease (92), nonhealing disease (22), recurrent disease (32), foreign body impaction (22), stricture (9), esophagitis (7), varices (7), mass (6 [3 polyp, 1 lymphoma, 1 fungus ball, 1 inflammation]), normal (209), and miscellaneous (37). Endoscopic diagnosis was uniformly correct except on two occasions, when the presence of recurrent tracheoesophageal fistula in small infants was missed due to use of an inadequate instrument. A pathologic lesion is likely to be identifiable in GI bleeding (84.8%). Endoscopic surveillance for progress of known disease was found to be valuable, particularly in peptic ulcer management, as both incomplete healing after standard therapy as well as recurrence are frequent. The recent practice of routine antral biopsy in children with severe "nonspecific abdominable pain" enabled four cases of Campylobacter pylori colonization in the stomach to be diagnosed, thus allowing appropriate treatment. Endoscopy was therapeutic on 61 occasions: injection sclerotherapy (32), foreign body removal (20), polypectomy (3), and stricture dilatation (6). Endoscopy-guided bougienage, in particular, represents a recent major advance. There was no morbidity or mortality in the entire series. It is concluded that pediatric upper GI endoscopy performed by experienced surgeons is safe and effective. As a result of better understanding and technological advances, a changing trend of wider and more rational applications of the procedure is now evident.
Dislocated Atkinson tubes: removal and repositioning with a balloon catheter.
Atkinson tubes are inserted endoscopically for palliation of obstructing esophageal carcinoma. A technique was developed to reposition or remove dislocated tubes that involves the use of a dilation balloon catheter. The technique was successful in treating three partially dislocated tubes and one of two completely dislocated tubes (tubes completely dislodged into the stomach). The only complication occurred in two patients who coughed up a small amount of blood.
Intestinal pseudo-obstruction (Ogilvie's syndrome) in theophylline overdose.
Intestinal pseudo-obstruction (Ogilvie's syndrome) has previously been reported in 2 patients with theophylline toxicity treated with activated charcoal (AC), mechanical ventilation and opioid induced sedation. We report a case of Ogilvie's syndrome in a theophylline toxic patient treated with AC. A 45-y-old male with severe chronic obstructive pulmonary disease presented with vomiting and multifocal atrial tachycardia after an intentional theophylline overdose. His initial potassium concentration was 2.7 mEq/L and his theophylline was 191 mg/L (1060 mumol/L). The patient was hemodialyzed and given a total of 1,000 g of AC without cathartics during the first hospital day. He also received iv potassium replacement. On the second hospital day he required mechanical ventilation for respiratory acidosis. Clindamycin was given for purulent sputum and fever. Haloperidol was given to treat agitation. No other anticholinergic agents or opioids were given. The patient's potassium rose to 6.5 mEq/L and he was given kayexalate. During the third hospital day the patient developed abdominal distention, tenderness and leukocytosis. Abdominal radiographs revealed a distended cecum. In the operating room the cecum was found dilated to 16 cm with no distal obstruction. A cecostomy tube drained AC and pill fragments. A 6 cm charcoal bezoar was found in the stomach. The patient recovered uneventfully.
Heterotopic pancreas in the stomach: CT findings.
PURPOSE: To describe the computed tomographic (CT) findings of heterotopic pancreas in the stomach. MATERIALS AND METHODS: CT findings in 12 patients with heterotopic pancreas in the stomach were reviewed. Surgical resection (n = 11) or endoscopic excision (n = 1) was performed in cases of symptomatic heterotopic pancreas (n = 4), suspected submucosal tumors (n = 7), and gastric carcinoma (n = 1). Seven patients underwent helical CT with water as an oral contrast agent; five underwent nonhelical CT with water-soluble contrast material. RESULTS: Nine heterotopic pancreata were in the antrum and one each was in the body, fundus, and perigastric fat. Seven lesions were on the greater curvature aspect; five, on the lesser curvature aspect. Common CT findings were well-defined oval or round masses with smooth or serrated margins in the gastric antral wall. Four of the seven lesions in which helical CT was performed enhanced similarly to normal pancreas. Preoperatively, CT depicted 11 of the 12 lesions, but CT findings were interpreted correctly as heterotopic pancreas in only two; the remaining 10 were misinterpreted as other lesions. Atypical findings were cystic dilatation of heterotopic pancreatic duct in two, unusual location in the fundus or perigastric fat in two, and malignant transformation in one. CONCLUSION: CT findings of heterotopic pancreas in the stomach appear to be nonspecific for diagnosis, except for location.
[Hematobezoar in a female patient with varicose dilatation of esophageal veins].
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Atony and gastro-esophageal dilation during amyotrophic lateral sclerosis.
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[Esophageal dilatation by Savary-Guillard bougies in children].
Dilatations are considered the election treatment for esophageal stenosis of different etiologies. Different methods of dilatation have been used through the years. Security and effectiveness are the main subjects when we choose a dilatation method. We present the results of the last 3 years that Savary-Guilliard have been used, with a guide wire probe, under endoscopic control. Six patients with postsurgical stenosis and 10 with post lye ingestion stenosis were treated with the above mentioned method. The site of stenosis is localized under flexible endoscopy, and a special guide wire probe is introduced to the stomach. Once the wire is in place, different diameter bougies are introduced until a firm resistance is felt or the desired diameter is reach. In complicated cases the progression of the wire was controlled by X-rays. A total of 208 dilatations have done in 16 patients over the last three years. Six patients with postsurgical stenosis needed from two to six dilatations for their cure. Of the 10 patients who ingest lye, none of them had needed a gastrostomy. Three of them have no dysphagia after 9, 13 and 13 dilatations. The other 7 are under dilatations every 6 weeks in 6 cases and every 4 weeks in one case, been all of them in the second year of treatment. All the dilatations have been performed under general anesthesia, as outpatients. We have not had any complication under this treatment. We have found that the Savary-Guilliard method is adequate for esophageal dilatations in pediatric population. Security and effectiveness are the main points of this procedure, there is no need for a gastrostomy, and the child will have a better quality of life. This procedure is less aggressive, and this will give a shorter postop period, with no complications and the child will have a longer period of normal life between dilatations.