Surgical treatment of sclerosing encapsulating peritonitis

We report a patient with end stage renal failure [ESRD] with chronic ambulatory peritoneal dialysis [CAPD] who suffered from chronic peritonitis due to repeat dialytic tube infection. She also had surgery for exploratory laparotomy because of gastric ulcer bleeding, and finally dialytic tube had removed. Abdominal cocoon formed one year later with severe adhesion of abdomen wall, peritoneum and intestine. Urgent surgical intervention secondary to intestinal obstruction was performed after failure of conservative treatment. To avoid the previous surgical adhesion, we performed the surgery with a horizontal incision, where ablation is most easily performed. With careful dissection and excision of the thick capsule, the patient is doing well without further incident at 12 months follow-up

Co-existing perforated duodenal ulcer and ruptured gastroduodenal artery aneurysm

Gastroduodenal artery [GDA] aneurysm is a rare and life threatening visceral artery aneurysms. We report a case of perforated duodenal ulcer accompanied with ruptured aneurysm of gastroduodenal artery. To our knowledge, this case is not yet reported in the literature with presentation of postoperative shock due to ruptured GDA aneurysm after perforated duodenal ulcer operation. Moreover, with awareness of ruptured GDA aneurysm and early treatment with transarterial embolization, the patient leads a good result after treatment

Using Multidetector-Row CT for the Diagnosis of Afferent Loop Syndrome Following Gastroenterostomy Reconstruction

PURPOSE: To assess the clinical manifestations and multidetector-row computed tomography (MDCT) findings of afferent loop syndrome (ALS) and to determine the role of MDCT on treatment decisions. MATERIALS AND METHODS: From January 2004 to December 2008, 1,100 patients had undergone gastroenterostomy reconstruction in our institution. Of these, 22 (2%) patients were diagnosed as ALS after surgery that included Roux-en-Y gastroenterotomy (n=9), Billroth-II gastrojejunostomy (n=7), and Whipple's operation (n=6). Clinical manifestations and MDCT features of these patients were recorded and statistically analyzed. The presumed etiologies of obstruction shown on the MDCT were correlated with clinical information and confirmed by surgery or endoscopic biopsy. RESULTS: The most common clinical symptom was acute abdominal pain, presenting in 18 patients (82%). We found that a fluid-filled C-shaped afferent loop in combination with valvulae conniventes projecting into the lumen was the most common MDCT features of ALS. Malignant causes of ALS, such as local recurrence and carcinomatosis, are the most common etiologies of obstruction. These etiologies and associated complications can be predicted 100% by MDCT. CONCLUSION: Our results suggest that MDCT is a reliable modality for assessing the etiologies of ALS and guiding treatment decisions.