Hernia diafragmática secundaria a trauma: presentación tardía / Complicated diaphragmatic hernia: late outcome of trauma

Resumen Introducción: La hernia diafragmática complicada de presentación tardía constituye una urgencia quirúrgica. Los objetivos del presente estudio son la descripción de las características del diagnóstico de las hernias diafragmáticas de presentación tardía, tratamiento, resultados y la identificación del punto de corte entre el inicio de los síntomas y el desarrollo de necrosis. Pacientes y Métodos: Estudio retrospectivo de una serie de casos constituida por todos los pacientes operados por hernia diafragmática complicada de presentación tardía entre los años 2006 y 2016. Se midieron variables categóricas y continuas que se presentan con estadística descriptiva. Se utilizaron curvas Receiver Operating Characteristics (ROC) a las 6 y 12 h desde el inicio de los síntomas, para determinar el punto de corte del tiempo de presentación clínica en pacientes sometidos a resección de algún órgano. Una vez establecido el punto de corte se calcularon la sensibilidad; especificidad; las razones de verosimilitud positiva y negativa; los valores predictivos positivo y negativo; y la prevalencia. Resultados: La presentación clínica, estudio, diagnóstico y tratamiento fue similar a lo descrito en la literatura quirúrgica. Se estableció el punto de corte a las 12 h con sensibilidad de 80% y especificidad de 83%. Conclusiones: El diagnóstico y tratamiento de estos pacientes debería ser llevado a cabo antes de las 6 h desde el inicio de los síntomas. Aun cuando el universo descrito es reducido, se sugiere que después de las 12 h desde el momento de la estrangulación, los órganos comprometidos se encontrarán necróticos requiriendo resección quirúrgica.

Introduction: Late presentation of traumatic diaphragmatic hernia constitutes a true surgical emergency. The purposes of this study were to describe the diagnostic characteristics, treatment and outcomes of late presentation diaphragmatic hernias and to identify a cutoff point from the onset of symptoms to necrosis development. Patients and Methods: A retrospective series of cases constituted by all patients subjected to emergency diaphragmatic hernia repair form 2006 to 2016 was studied. Categorical and continuous variables were measured and analyzed with descriptive statistics. Receiver Operating Characteristics (ROC) curves at 6 and 12 hours from the onset of symptoms were used to determine the cutoff point for organ resection. Once stablished the cutoff point, sensitivity, specificity, positive and negative predictive values and prevalence were calculated. Results: Clinical presentation, diagnostic study and surgical treatment were similar to what has been already described. The cutoff point was defined at 12 hours from the onset of symptoms with 80% sensitivity and 83% sensibility. Conclusions: The diagnosis and treatment of these cases should be carried on before the first 6 hours after the onset of symptoms. Even though the universe of this study was small, we may suggest that after 12 hours form the onset of symptoms, the implicated organs would be found necrotic requiring surgical resection.

Effects of large dose norepinephrine on the anastomotic healing after esophagectomy / 中国综合临床

Objective To explore the impact of using large dose norepinephrine on the anastomotic healing after esophagectomy.Methods Clinical data of data of 148 cases patients with esophageal cancer who were treated in Wuwei Tumor Hospital of Gansu Province with surgery from January 2014 to June 2016 were retrospectively analized.There were 7 patients who were used 25-67 mg ((32.6 ± 2.3) mg) norepinephrine because of the low blood pressure and other factors during the first 4 d postoperative as research group,and the other 141 patients who had not applied or applied the small dose were set as control group.The patients of two groups with postoperative anastomotic healing and fistula incidence were compared.Results There were 3 cases and 7 cases of postoperative patients appeared anastomotic fistula in the research group and the control group,the rate of anastomotic fistula were 42.86％ (3/7) and 4.96％ (7/141) respectively,the difference was significant (x2=9.78,P =0.001),and 2 cases appeared varying degrees residual gastric necrosis in the research group,all of them occurred in the patients with large dosage and long time.Conclusion There are great risk on the anastomotic fistula and residual stomach mecrosis if long time and large dose norepinephrine was used after esophagectomy,it should be caused enough attention for surgeons.

Acute Gastric Necrosis Due to Gastric Outlet Obstruction Accompanied with Gastric Cancer and Trichophytobezoar

Gastric necrosis due to gastric outlet obstruction is a very rare condition, but it might be fatal if missed or if diagnosis is delayed. Our patient was a 73-year-old male complaining of abdominal pain, distension and dyspnea for 1 day. In plain radiography and computed tomography, a markedly distended stomach and decreased enhancement at the gastric wall were noted. He underwent explo-laparotomy, and near-total gastric mucosal necrosis accompanied by sludge from the soaked laver was noted. A total gastrectomy with esophagojejunostomy was performed, and he recovered without sequelae. Final pathologic examination revealed advanced gastric cancer at the antrum with near-total gastric mucosal necrosis.

Gastric Necrosis after Gastric Dilatation in a Patient with Bulimia / 대한법의학회지

Acute gastric dilatation leading to gastric necrosis is rare but potentially fatal condition that can occur in patients with bulimia. It usually develops after a bulimic episode and it is not diagnosed with sufficient rapidity it may lead to gastric perforation followed by peritonitis, sepsis, shock, and death. Because of the rarity of this condition and the patients in whom it occurs, the clinician must maintain a high degree of suspicion when treating patients with eating disorders who present with abdominal pain after a binge. This case report describes a 24-year old woman with acute gastric dilatation due to binge eating, who had the gastrotomy and died of complications such as gastric necrosis and disseminated intravascular coagulation.

A Case of Gastric Wall Hematoma and Ischemic Necrosis After Endoscopic Biopsy / 영남의대학술지

Hematoma of gastric wall is very rare, and occasionally associated with coagulopathy, trauma, peptic ulcer disease, and therapeutic endoscopy. Ischemic gastric necrosis is also rare because of the abundant anastomotic supply to the stomach, and it is usually associated with surgery and disruption of the major vessels. Endoscopic submucosal injection of hypertonic saline-epinephrine (HS-E) is a safe, cost-effective, and widely used therapy for hemostasis but it may cause tissue necrosis and perforation. We describe a case of gastric wall hematoma with oozing bleeding after endoscopic gastric mucosa biopsy in 71-year old woman with chronic renal failure and angina pectoris undergoing anti-platelet medication. We injected a small dose of HS-E (7ml) for controlling oozing bleeding. Two days later, endoscopy showed huge ulcer with necrotic tissue at the site of previously hematoma. Therefore we should pay particular attention for hematoma and mucosal necrosis when performing endoscopic procedure in a patients with high bleeding and atherosclerotic risk.