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Giant gastric trichobezoars are unusual form of foreign body found in stomach of mostly young adolescent females which may lead to morbidity and high mortality 30%, if goes unnoticed. These females have history of trichophagia or trichotillomania. This report is of a 12- year old young adolescent female presented with epigastric pain and mass. An exploratory laparotomy with anterior gastrotomy was performed and a giant trichobezoar with a very large tail of 2.5 ft was removed, weighing 2.52 kg. She recovered well and was discharged on 7th post-operative day. Patient was advised for psychiatric follow up.
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Objective To investigate the effect of sleeve gastrotomy (SG) and gastric plication (GP) on the short-term metabolism in type 2 diabetes mellitus (T2DM) Zucker fatty rats.Methods Thirty healthy male rats were randomly allocated into three groups:Sham,SG and GP groups,and devices like metabolic cage were applied to detect the metabolic changes in the third week after operation.Results The body weight of the SG and GP group decreased,but no statistical significance was found when compared with that of the Sham group.Less food consumption were found in SG (P＜0.05) and GP (P＜0.05) groups compared with that of the Sham group.In the daytime,the energy expenditure of SG group was higher than that of the sham group(P＜0.01),while in the night,the energy expenditure of both the SG (P＜0.001) and GP (P＜0.001) groups were higher than that of the Sham group.In the night,the activity level of SG (P＜0.05) and GP (P＜0.05) groups were lower than that of the Sham group,and activity level in the night was lower than that in the daytime for SG group(P＜0.05).In the daytime,the respiratory exchange rate (RER) of the SG (P＜0.001) and GP (P＜0.001) group were lower than that of the Sham group,and the night RER of GP group was higher than that in the daytime (P＜0.05).No statistical significance was found in terms of the average speed among the three groups.The average speed of the Sham (P＜0.05) and SG (P＜0.05) group in the night were faster that in the daytime.The fasting plasma glucose (FPG) of SG and GP group were improved compared with that of the Sham group.Conclusion SG and GP procedures can improve the metabolism of diabetic rats in the short term.
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Objective To explore the effects of different ways of nutritional support on organ functional recovery and prognosis in the elderly with multiple organ dysfunction syndromes (MODS).Methods 85 patients with MODS were randomized into enteral nutrition(EN) group (n=43 cases)and total parenteral nutrition(TPN) as control group (n=42 cases).EN group received nutritional support by nasogastric feeding tube or percutaneous endoscopic gastrotomy (PEG)/ percutaneous endoscopic jejunostomy (PEJ),and TPN group got nutrition by central vein for at least 2 months of therapeutic course.Body mass index (BMI),hemoglobin (HB),functions of liver and kidney,electrolytes,blood glucose and lipid,serum albumin(ALB),transferring(TRF),prealbumin (PA),immunoglobulin(IgA,IgG,IgM),leukomonocyte (CD3+,CD4+,CD4+/CD8+) were compared between two groups before and after treatment.Results The levels of Hb,BMI,ALB,TRF and PA after treatment for 1 and 2 months significantly improved (t1EN =2.672,2.440,2.209,3.331,5.025,t1TpN=2.720,2.337,2.179,3.418,2.221 and tEN2nd maonh=2.279,3.021,2.337,3.005,5.779,tTPN2nd month=2.118,2.956,3.018,3.310,2.119,all P＜0.05) in two groups as compared with before treatment,and there was remarkable difference in the level of PA between EN group and TPN group(t=2.336,P＜0.05).Hyperlipemia at 1 and 2 months after treatment occurred in TPN group (t1TPN =3.609,t2TPN =3.114,P＜0.05).The levels of IgG (t1st month=2.664,t2nd month =2.983,P＜0.05) and IgA (t1st month =2.437,t2nd month =3.005,P＜0.05) were higher after treatment for 1 and 2 months than before treatment.The levels of CD3+,CD4+ and CD4+/CD8+ cells improved (t2nd month =2.399,3.478,2.579,3.995,P ＜ 0.05 ) and IgM (t2nd month =3.886,P＜0.05) increased after treatment for 2 months in EN group.In EN group,aspiration pneumonia appeared in 34 cases and the occurrence rate decreaed (x2 =51.12,P ＜ 0.05 ) after PEG/PEJ operation (only 5 cases).Reflux esophagitis reduced and alleviated 2 months after PEG/PEJ operation (x2=13.53,P＜ 0.05).ConclusionsTimely sufficient EN support may improve nutritional and immunological status in elderly patients with MODS.PEG/PEJ can reduce the occurrence of aspiration pneumonia and reflux esophagitis caused by the nasogastric feeding tube.
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PURPOSE: The aim of this report was to describe a new reconstructive technique of pancreaticogastrostomy and to also discuss this procedure's effectiveness for reducing the incidence of postoperative complications. METHODS: We retrospectively analyzed early surgical outcomes in 21 consecutive patients who underwent this novel pancreaticogastrostomy after pancreaticoduodenectomy. Pancreaticogastrostomy was completed with 2 transpancreatic sutures with buttresses on both the upper and lower edges of the implanted pancreas through the retracted anterior gastrotomy. RESULTS: Operative mortality was zero and morbidity was 23.8%. A significant pancreatic fistula occurred in 1 patient (4.7%; grade B). CONCLUSION: This technique is very easy to perform, less traumatic to the pancreatic stump, can be performed through a mini-laparotomy due to good vision and straight sutures, and it is secure owing to anchoring of the invaginated pancreatic stump to the stomach's posterior wall with buttresses. The results of this pilot study indicate that the technique may provide a favorable outcome and could be an alternative method of pancreatoenteric anastomosis. However, to determine its superiority over the conventional procedures, this operative technique should be evaluated more comprehensively in a larger series.
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Humans , Incidence , Pancreas , Pancreatic Fistula , Pancreaticoduodenectomy , Pilot Projects , Retrospective Studies , Sutures , Vision, OcularABSTRACT
PURPOSE: The aim of this report was to describe a new reconstructive technique of pancreaticogastrostomy and to also discuss this procedure's effectiveness for reducing the incidence of postoperative complications. METHODS: We retrospectively analyzed early surgical outcomes in 21 consecutive patients who underwent this novel pancreaticogastrostomy after pancreaticoduodenectomy. Pancreaticogastrostomy was completed with 2 transpancreatic sutures with buttresses on both the upper and lower edges of the implanted pancreas through the retracted anterior gastrotomy. RESULTS: Operative mortality was zero and morbidity was 23.8%. A significant pancreatic fistula occurred in 1 patient (4.7%; grade B). CONCLUSION: This technique is very easy to perform, less traumatic to the pancreatic stump, can be performed through a mini-laparotomy due to good vision and straight sutures, and it is secure owing to anchoring of the invaginated pancreatic stump to the stomach's posterior wall with buttresses. The results of this pilot study indicate that the technique may provide a favorable outcome and could be an alternative method of pancreatoenteric anastomosis. However, to determine its superiority over the conventional procedures, this operative technique should be evaluated more comprehensively in a larger series.
Subject(s)
Humans , Incidence , Pancreas , Pancreatic Fistula , Pancreaticoduodenectomy , Pilot Projects , Retrospective Studies , Sutures , Vision, OcularABSTRACT
Objetivos- avaliar as gastrostomias endoscópicas percutâneas realizadas no serviço de endoscopia do Hospital e Maternidade São Camilo Pompeia/São Paulo, de 01 janeiro de 2008 até 31 junho de 2009, quanto sua indicação, efetividade e índice de complicações. Materiais e métodos- foram realizadas 35 gastrostomias endoscópicas percutâneas pela técnica de tração (pull technique), descrita em 1981 por Ponsky e Gauderer, com o aparelho de endoscopia Olympus Exera CLV 165 e kits de gastrostomia endoscópica percutânea fornecidos pela Wilson Cook e Boston. Todos pacientes receberam antibioticoprofilaxia com cefazolina. Resultados- 13 (37%) pacientes do sexo masculino e 22 (63%) do sexo feminino, com idade variando entre 15 e 95 anos (média de 45 anos). Acidente vascular encefálico foi a principal indicação do método, com 18 (51%) casos. A duração do procedimento variou entre 4 e 14 minutos (média de 7 minutos e 3 segundos). Ocorreu apenas uma complicação imediata. Verificou-se infecção local em 1 (3,5%) paciente, infecção local e em 4 extravasamento do conteúdo gástrico. Conclusões- a gastrostomia endoscópica percutânea é um procedimento de simples e rápida execução, seguro, sem necessitar de laparotomia, anestesia geral ou loco-regional, apresentando baixos índices de morbimortalidade, boa aceitabilidade estética e facilidade de manejo pelos familiares dos pacientes.
Objective- to describe, analyze and evaluate the percutaneous endoscopic gastrostomy at the endoscopic department of the Hospital São Camilo Pompeia / São Paulo from 01 January 2008 to 31 June 2009. Materials and methods- 31 percutaneous endoscopic gastrostomy were performed by pull technique, described in 1981 by Ponsky and Gauderer, using Olympus Evis Exera CLV 165 endoscope and Wilson Cook and Boston Access percutaneous endoscopic gastrostomy kits device. Antibiotic prophylaxis with cefazolina was administered in all patients. Results- 13 (37%) patients were men and 22 (63%) women. Mean age was 45 years old (15 to 95). Stroke was the most commom indication for the procedure, accounting for 18 (51%) patients. Average procedure length was 7 minutes and 3 seconds, ranging from 4 to 14 minutes. Immediate complications occur in 1 patient. Local infection occurred in 1 (3.5%) patient, local infection plus fluids drainage in 4. Conclusions- percutaneous endoscopic gastrostomy is a simple, short and safe procedure, with no need of laparotomy, no general or regional anesthesia, presenting low complications rate, low morbi-mortality, better cosmesis and simple handling for the patients family.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Gastrostomy , Gastrostomy/adverse effects , Gastrostomy/methods , Nutritional Support , EndoscopyABSTRACT
BACKGROUND: Endoscopic mucosal resection (EMR) is now in clinical use for the management of mucosal and submucosal tumors of the stomach (including early gastric cancer), but its use is limited by the size, depth, and the location of the tumor. METHODS: After the introduction of a new concept of laparoscopic intra-gastric surgery (L.I.G.S.) in which all trocars and surgical instruments are inserted directly into the gastric cavity to perform the resection of mucosal or submucosal lesions of the stomach by Dr. Ohashi, sixteen patients with a mucosal or a submucosal tumor in the posterior wall of the stomach have been successfully treated by L.I.G.S. in our hospital since 1995. RESULTS: 2 patients with early gastric cancer, 9 with a leiomyoma, and 5 with polyps. Twelve (87.5%) of the tumors were located in the antrum and 4 (12.5%) in the body. L.I.G.S. was successfully done on 14 patients (93%) with conversion to a minilaparotomy in 1 patient. The leiomyoma located in the lesser curvature was treated by L.I.G.S. through an anterior gastrotomy using hand suturing. The operationg time was about 100-160 minutes for the L.I.G.S., 120 minutes in the conversion case, and 180 minutes in the L.I.G.S. through an anterior gastrotomy. Postoperative pain was negligible in all cases, and the patients were discharged uneventfully six to seven days after surgery. The follow-up period was 1 to 37 months, and there were no recurrences. The important points of this approach are confirmation of the location of the tumor by both gastrofiberscopy and laparoscopy, excluding the determination of regional lymph node metastasis by endoscopic ultrasonography, and proper selection of the trocar sites. CONCLUSION: We conclude that L.I.G.S. is technically feasible, safe, and useful for a mucosal or a submucosal tumor in the posterior wall of the stomach and that it should be considered as a viable alternative to endoscopic mucosal resection and conventional gastric resection.