Distensión gástrica aguda causada por síndrome de arteria mesentérica superior en una paciente bulímica

La dilatación gástrica aguda se fundamenta por dos teorías, la mecánica que es explicada por el síndrome de arteria mesentérica superior, y la atónica que es producto de una condición médica en la que el estómago progresivamente se vuelve hipotónico y se sobredistiende aún en ausencia de una causa mecánica obstructiva; con mayor frecuencia la dilatación gástrica aguda se presenta en pacientes con trastornos de la alimentación y puede conllevar a una complicación rara pero letal como la perforación gástrica. Presentamos el caso de una paciente de 18 años, quien acude al servicio de emergencia con dolor abdominal agudo, es intervenida quirúrgicamente, donde se encontró perforación de la pared gástrica anterior. Se le realizó una gastrectomía parcial proximal, y se envió el espécimen para estudio patológico. La histopatología mostró necrosis transmural predominantemente en fondo gástrico.

Acute gastric dilation is based on two theories, the mechanical one that is explained by the superior mesenteric artery syndrome and the atonic one, the latter is the product of a medical condition in which the stomach progressively becomes hypotonic and over-distended even in the absence of an obstructive mechanical cause; it most often occurs in patients with eating disorders; which can lead to a rare but fatal complication such as gastric perforation. We present the case of an 18 year old patient who comes to the emergency service of our hospital with acute abdominal pain, undergoes surgery, where there is perforation of the anterior gastric wall, and a proximal. Partial gastrectomy is performed, and a sends the specimen for pathology study. Histopathology shows transmural necrosis predominantly in the gastric fundus.

Risk factors of surgical incision infection in patients with gastrointestinal perforation / 中华全科医师杂志

The clinical data of 288 patients with gastrointestinal perforation undergoing surgical treatment from Jul 2014 to Jul 2017 were retrospectively analyzed,among whom the surgical incision infection occurred in 112 patients(38.9％).The risk factors of the incision infections were examined with logistic regression analysis.The univariate analysis showed that preoperative albumin level (≤30 g/L),body mass index (＞24.0 kg/m2),duration of abdominal pain(＞24 h),extension of incision,preoperative shock,colostomy,preoperative antibiotic use and the operation time were associated with incision infections(P＜0.05),while the gender,age,preoperative hemoglobin level,diabetes,incision length were not associated with the incision infections(P＞0.05).The multivariate logistic regression analysis showed that the body mass index(OR=1.61,P＜0.01),gastrointestinal perforation site(colon and rectum,OR=5.60,P＜0.01),extension of incision (OR=3.94,P＜0.01) and operation time(OR=1.04,P=0.02)were independent risk factors of theincision infection.The results suggest that the full preoperative preparation,intensive treatment of underlying diseases,avoiding incision extension and shortening operation time may be able to reduce the surgical incision infections for patients with the gastrointestinal perforation.

Advanced Gastric Cancer Perforation Mimicking Abdominal Wall Abscess

Surgeons occasionally encounter a patient with a gastric cancer invading an adjacent organ, such as the pancreas, liver, or transverse colon. Although there is no established guideline for treatment of invasive gastric cancer, combined resection with radical gastrectomy is conventionally performed for curative purposes. We recently treated a patient with a large gastric cancer invading the abdominal wall, which was initially diagnosed as a simple abdominal wall abscess. Computed tomography showed that an abscess had formed adjacent to the greater curvature of the stomach. During surgery, we made an incision on the abdominal wall to drain the abscess, and performed curative total gastrectomy with partial excision of the involved abdominal wall. The patient received intensive treatment and wound management postoperatively with no surgery-related adverse events. However, the patient could not receive adjuvant chemotherapy and expired on the 82nd postoperative day.

Comparison of gastric and other bowel perforations in preterm infants: a review of 20 years' experience in a single institution / 소아과

PURPOSE: In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations. METHODS: The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed. RESULTS: Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was 4.4+/-1.7 days of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed. CONCLUSION: Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants.

Comparison of the clinical effect of gastrectomy and simply repair in the treatment of acute gastric perforation / 中国基层医药

Objective To investigate the clinical efficacy of gastrectomy and simple repair in the treatment of acute gastric perforation.Methods 132 patients with acute gastric perforation were randomly divided into the control group and observation group by random number table,66 cases in each group.The control group received gastrectomy,the observation group was given simple repair treatment.The clinical efficacy,clinical indicators and ulcer recurrence Visick grading of patients in two groups were observed.Results The total effective rate of the observation group (87.9％) was significantly higher than that in the control group(71.3％) (x2 =5.634,P ＜ 0.05).The operative time,bed time,gastrointestinal function recovery time and hospitalization time in the observation group were (38.76 ± 6.23) min,(4.26 ± 1.67) d,(28.68 ± 4.74) h,(11.52 ± 2.32) d,those in the control group were (72.13 ± 10.78) min,(10.01 ± 2.21) d,(45.61 ± 5.69) h,(25.65 ± 3.95) d,there were statistically significant differences between the two groups(t =21.773,25.058,18.572,16.863,all P ＜ 0.01).The relapse rate in the observation group (4.6％) was significantly lower than that in the control group (15.2 ％) (x2 =4.181,P ＜ 0.05).Conclusion The simple repair in the treatment of acute gastric perforation has significant effect,it can effectively reduce the value of clinical parameters and the recurrence rate of patients,which has important clinical application value.

Ruptura gástrica por barotrauma / Barogenic rupture of the stomach

INTRODUÇÃO: A ruptura gástrica por barotrauma é uma causa rara de abdome agudo perfurativo, sendo geralmente tratada por laparotomia e rafia primária da lesão. Nas reanimações cardiopulmonares pode ocorrer 9 a 12 por cento de lesões de mucosa gástrica. RELATO DO CASO: Mulher no 5º dia de puerpério necessitou intubação orotraqueal devido à pneumonia hospitalar. Após procedimento evoluiu com distensão abdominal importante, associada a sinais de choque séptico. Após radiografia simples de abdome foi constado pneumoperitôneo. Submetida à laparotomia exploradora evidenciou-se ruptura de pequena curvatura gástrica de 7 cm. O tratamento da lesão foi com sutura primária. Recebeu alta no 14º do pós operatório após término do tratamento para pneumonia. CONCLUSÃO: Apesar de rara, a ruptura gástrica por barotrauma deve ser sempre aventada quando após reanimação cardiopulmonar houver distensão abdominal refratária à sondagem naso-gástrica.

BACKGROUND: Barogenic rupture of the stomach is a rare cause of acute perforated abdomen generally treated by laparotomy and primary wound suture. The lesion of gastric mucosa may occur during cardiopulmonary resuscitation in 9 to 12 percent of cases. CASE REPORT: Woman was intubated in the fifth day of delivery due to nosocomial pneumonia. She underwent to abdominal distension associated to septic shock signs after the procedure. The abdominal X-ray showed pneumoperitoneum. She was submitted to laparotomy and a 7 cm rupture in the gastric small curvature was found. The lesion was treated by primary suture. The patient was discharged 14 days after the surgery, in the ending of pneumonia treatment. CONCLUSION: Besides rare, barogenic gastric rupture must be inquired when after cardiopulmonary resuscitation the patient presents abdominal distension ovenproof to nasogastric tube.