Spontaneous pneumothorax in two dogs undergoing combined laparoscopic ovariectomy and total laparoscopic gastropexy

Two dogs underwent a combined laparoscopic ovariectomy and total laparoscopic gastropexy. The intra-abdominal pressure and pulmonary compliance decreased, but the peak airway pressure increased at 20 min after the start of gastropexy with intracorporeal suturing. Right chest auscultation and percussion revealed reduced breath sounds and hyper-resonance. No abnormalities in the functioning of the instruments or diaphragmatic defects were detected. The tidal volume was reduced and a positive end-expiratory pressure of 5 cmH₂O was applied. The right chest of the two dogs was drained off: 950 mL (case 1) and 250 mL (case 2) of gas. After thoracentesis, the pulmonary compliance improved and surgery was completed successfully. The postoperative chest radiographs highlighted the residual right pneumothorax.

Chronic Gastric Volvulus as a Late Complication of Hepatectomy for Hepatoblastoma in a Child: A Case Report / 대한소아소화기영양학회지

Gastric volvulus (GV) is an uncommon pathology, with 10-20% of cases occurring in children, typically before one year of age. It often occurs in people with congenital diaphragmatic hernias, intestinal malrotation, eventration of the diaphragm, paraesophageal hernias, wandering spleens, asplenism, or intra-abdominal adhesions. We report a rare case of chronic GV after left hemihepatectomy for hepatoblastoma in a child. The patient was a 9-year-old boy who complained of upper abdominal pain and postprandial upper abdominal distension for one year. At the age of 4 months, he was diagnosed with hepatoblastoma and had undergone left hemihepatectomy. The upper gastrointestinal contrast study revealed chronic organoaxial gastric volvulus. After a surgical procedure involving adhesiolysis and an anterior wall gastropexy, the patient improved and the symptoms resolved. Although GV is a rare disease, it should be suspected in a patient with a previous abdominal surgical history who is complaining of abdominal distension and pain.

Idiopathic type-4 hiatal hernia in a middle-aged cat / 대한수의학회지

A 6-year-old female domestic short hair cat presented with acute onset of vomiting, anorexia, lethargy, and tachypnea. The cat was apparently healthy prior to presentation without history of trauma. On diagnostic imagings, the entire stomach and spleen were detected in the thoracic cavity. An emergent celiotomy was performed, and a type-4 hiatal hernia was confirmed; the stomach, spleen, pancreas, and duodenum were herniated through the esophageal hiatus. It was corrected using phrenicoplasty, esophagopexy, and left-sided gastropexy and there was no recurrence 16 months after surgery. This is the first case report of an idiopathic type-4 hiatal hernia in a cat.

Chronic Gastric Volvulus with Laparoscopic Gastropexy after Endoscopic Reduction: A Case Report

Gastric volvulus is an uncommon clinical entity. There are three types of gastric volvulus; organoaxial, mesenteroaxial and combined type. This condition can lead to a closed-loop obstruction or strangulation. Traditional surgical therapy for gastric volvulus is based on an open approach. Here we report a successful case of a patient with chronic gastric volvulus with a laparoscopic treatment. A 79-year-old woman came to the emergency department with epigastric pain accompanied by nausea for 2 weeks. Abdominal computed tomography revealed markedly distended stomach with transposition of gastroesophageal Junction and gastric antrum. Barium meal study revealed presence of the antrum was folded over 180 degrees that was located above gastroesophageal junction. We attempted an endoscopic reduction, but it was unsuccessful. The patient got laparoscopic anterior gastropexy. Based on our result, laparoscopic gastropexy can be considered as a good choice of the treatment for gastric volvulus.

A Case of Mesentero-axial Gastric Volvulus Presenting as Recurrent Vomiting of a Children

Acute gastric volvulus in children is a rare condition, but a potentially life-threatening cause of upper gastrointestinal obstruction requiring prompt diagnosis and treatment. However, the symptoms are ambiguous, so that it can be easily misdiagnosed. We report on the case of a 3-year-old boy patient with recurrent vomiting despite conservative therapy. Findings of a bedside ultrasonography and upper gastro-intestinal contrast study showed mesentero-axial gastric volvulus without adjacent organ abnormality. He was managed with endoscopic gastropexy and was discharged without complication.

Short-Term Complications of Percutaneous Endoscopic Gastrostomy according to the Type of Technique / 대한소아소화기영양학회지

PURPOSE: The method of percutaneous endoscopic gastrostomy (PEG) tube placement can be divided into the pull and introducer techniques. We compared short-term complications and prognosis between patients who underwent the pull technique and two other types of introducer techniques, the trocar introducer technique and T-fastener gastropexy technique. METHODS: Twenty-six patients who underwent PEG were enrolled in this study. We retrospectively investigated the age, sex, body weight, weight-for-age Z-score, underlying diseases, PEG indications, complications, duration of NPO (nil per os), pain control frequency, and duration of antibiotic therapy. The patients were classified into three groups according to the PEG technique. The occurrence of complications was monitored for 10 weeks after the procedure. RESULTS: The age, sex, body weight, and weight-for-age Z-score were not significantly between the three groups. Most patients had cerebral palsy and seizure disorders. Dysphagia was the most common indication for PEG. Major complications occurred in 5 (50%), 4 (66.7%), and 0 (0%) patients in group I, II, and III, respectively (p=0.005). Further, peristomal infection requiring systemic antibiotic therapy occurred in 2 (20%), 3 (50%), and 0 (0%) patients in group I, II, and III, respectively (p=0.04). There was no significant difference between the groups with respect to minor complications, duration of NPO, pain control frequency, and duration of antibiotic therapy. CONCLUSION: The results indicate that the T-fastener gastropexy technique was associated with the lowest rate of major complications.

T-Fastener Migration after Percutaneous Gastropexy for Transgastric Enteral Tube Insertion

BACKGROUND/AIMS: To determine the prevalence and time-course of t-fastener migration after gastropexy deployment. METHODS: We reviewed our procedural database for all percutaneous gastrostomy and gastrojejunostomy tube insertions performed over a 14-month period using a widely accepted t-fastener kit for gastropexy (Kimberly-Clark). Of 201 patients, 71 (41 males, 30 females; mean age, 56 years) underwent subsequent abdominal computed tomography (CT) imaging. The location and associated findings of each t-fastener were retrospectively recorded for each CT scan performed after the tube insertion. RESULTS: A total of 153 t-fasteners were deployed during 71 procedures with subsequent CT follow-up. In the short term (within 4 weeks after deployment), 5.1% of the t-fasteners had detached and were no longer present; 59.5% were intraluminal or within the gastric wall; and 35.5% were within the anterior abdominal wall musculature or subcutaneous. In the long term (>3 months), 48.6% of the t-fasteners had detached and were no longer present, 25.0% were intraluminal or within the gastric wall, and 26.4% were within the anterior abdominal wall musculature or subcutaneous. No t-fastener-related complications, such as abscesses, fluid collections, or fistulae, were identified. CONCLUSIONS: Following gastropexy for percutaneous transgastric feeding tube placement, t-fastener migration into the abdominal wall frequently occurred soon after the tube insertion. Therefore, recent t-fastener deployment does not guarantee an intact gastropexy.

New "introducer" PEG-gastropexy with T fasteners: a pilot study / Gastrostomia endoscópica percutânea pela técnica de introdução com gastropexia com T-tags: um estudo piloto

CONTEXT: Enteral feeding is indicated for patients unable to maintain appropriate oral intake, and percutaneous endoscopic gastrostomy (PEG) is the most adequate long-term enteral access. Peristomal infections are the most common complications of PEG, occurring in up to 8 percent of patients, despite the use of prophylactic antibiotics. The "introducer" PEG-gastropexy technique avoids PEG tube passage through the oral cavity, preventing microorganisms' dislodgment to the peristomal site. OBJECTIVES: To compare the incidence of peristomal wound infection at 7-day post-procedure after conventional "pull" technique versus a new "introducer" PEG-gastropexy kit. Secondary outcomes included success rates, procedure time, and other complications. METHODS: Eighteen patients referred for PEG placement between June and December 2010 were randomly assigned to "pull" PEG with antibiotics or "introducer" PEG-gastropexy technique without antibiotics. RESULTS: Overall success rate for both methods was 100 percent, although mean procedure duration was higher in the "introducer" PEG-gastropexy group (12.6 versus 6.4 minutes, P = 0.0166). Infection scores were slightly higher in patients who underwent "pull" PEG with antibiotics compared with "introducer" PEG-gastropexy without antibiotics (1.33 ± 0.83 versus 0.75 ± 0.67, P = 0.29). CONCLUSION: Although procedure duration was longer in the "introducer" PEG-gastropexy, infection scores were marginally higher in the "pull" PEG technique.

CONTEXTO: A nutrição enteral está indicada para pacientes incapazes de manter aporte voluntário adequado e a gastrostomia endoscópica percutânea (GEP) é a via preferencial para acesso enteral de longa duração. As infecções periostomais são as principais complicações da GEP, ocorrendo em até 8 por cento dos pacientes, a despeito do uso de antibiótico profilático. A GEP pela técnica de introdução com gastropexia evita a passagem da sonda de gastrostomia pela cavidade oral, prevenindo contra o deslocamento de microorganismos ali presentes até o sítio da ostomia. OBJETIVO: Comparar a incidência de infecção periostomal no 7º dia após GEP por técnica de tração versus GEP pela técnica de introdução com gastropexia. Objetivos secundários incluíram: taxa de sucesso, tempo de procedimento e outras complicações. MÉTODOS: Dezoito pacientes encaminhados ao setor de endoscopia do Hospital Albert Einstein, São Paulo, SP, para realização de GEP entre junho e dezembro de 2010, foram randomizados para realização de gastrostomia pela técnica de tração com antibioticoterapia profilática ou pela técnica de introdução com gastropexia sem antibiótico profilaxia. RESULTADOS: A taxa de sucesso para ambos os métodos foi de 100 por cento, apesar do tempo do procedimento ter sido mais longo no grupo da técnica de introdução (12,6 versus 6,4 min, P = 0,0166). Os índices de infecção foram discretamente superiores no grupo de GEP por tração, com antibioticoterapia profilática, em comparação ao grupo GEP por introdução com gastropexia (1,33 ± 0,83 versus 0,75 ± 0,67, P = 0,29). CONCLUSÃO: Apesar da duração do procedimento ter sido mais longa no grupo GEP por introdução com gastropexia, a taxa de infecção foi discretamente mais elevada no grupo GEP por tração.

Laparoscopic gastropexy for the treatment of gastric volvulus / Gastropexia laparoscópica para o tratamento do volvo gástrico

Context - gastric volvulus is an acquired, life-threatening condition in which the stomach rotates upon itself. Objective - to describe the application of laparoscopic gastropexy in the case of severe gastric volvulus presentedby an elderly female. Method - a 69 year old woman presenting severe abdominal pain with, retching and the incapacity to vomit, small dysphagia and sensation of post-prandial fullness was admitted to Hospital São Lucas de Governador Valadares, Brazil. Following clinical examination, the patient was submitted to plain and contrast x-rays of the abdomen and chest, computed tomography of the abdomen and upper gastrointestinal endoscopy. Laparoscopic gastropexy was performed in which the diaphragmatic hernia was reduced, the hiatus sutured, and anti-adhesive polypropylene mesh applied for fixation of the stomach. Results - the clinical, radiological and imaging features were typical of gastric volvulus. Rotation of the stomach was successfully corrected by laparoscopy and the patient was discharged from hospital three days after surgery. One month later, the patient was totally asymptomatic with respect to the igestive tract. Conclusions - an adult female patient suffering from acute gastric volvulus was successfully treated using a laparoscopic approach applied ten days after admission to hospital. Early diagnosis and the prompt surgical correction of such cases are crucial in reducing mortality in gastric volvulus.

Contexto- volvo gástrico é uma condição adquirida, com risco de vida, na qual o estômago sofre um deslocamento em torno de seu eixo. Objetivo- relatar a aplicação de gastropexia laparoscópica numa paciente idosa, apresentando volvo gástrico grave. Método- uma mulher de 69 anos de idade, apresentando dor abdominal severa, náusea e incapacidade de vomitar, pequena disfagia e sensação de plenitude pós-prandial foi admitida no Hospital São Lucas de Governador Valadares, Brasil. Após o exame clínico, foram realizadas radiografias do abdômen e peito (simples e de contraste), juntamente com tomografia de endoscopia superior. Após o diagnóstico, a paciente foi submetida à laparoscopia. A hérnia do diafragma foi reduzida junto com sutura hiatal, além da aplicação de uma tela de polipropileno anti-aderente para fixação do estômago. Resultados- as características clínicas, radiológicas e de imagem revelaram um volvulus gástrico típico. A rotação do estômago foi corrigida com sucesso através de laparoscopia e a paciente foi liberada do hospital após três dias da operação. Um mês após a cirurgia, a paciente encontrava-se totalmente assintomática no que diz respeito ao trato digestivo. Conclusões- uma paciente adulta, sofrendo de volvo gástrico agudo, foi tratada com sucesso através de procedimento laparoscópico realizado dez dias após a internação hospitalar. O diagnóstico precoce e a correção cirúrgica breve são essenciais para a redução da mortalidade em casos de volvo gástrico.

Updates on Percutaneous Radiologic Gastrostomy/Gastrojejunostomy and Jejunostomy

Gastrostomy placement for nutritional support for patients with inadequate oral intake has been attempted using surgical, endoscopic, and, more recently, percutaneous radiologically guided methods. Surgical gastrostomy has been superseded by both endoscopic and radiologic gastrostomy. We describe herein the indications, contraindications, patient preparations, techniques, complications, and aftercare with regard to radiologic gastrostomy. In addition, we discuss the available tube types and their perceived advantages. There remain some controversies regarding gastropexy performance and primary percutaneous gastrojejunostomy. Percutaneous jejunostomy is indicated for patients whose stomach is inaccessible for gastrostomy placement or for those who have had a previous gastrectomy.

Percutaneous Radiologic Gastrostomy: A 12-Year Series

BACKGROUND/AIMS: Interventional radiologists have played a main role in the technical evolution of gastrostomy, from the first surgical/endoscopical approaches to percutaneous interventional procedures. This study evaluated the results obtained in a 12-year series. METHODS: During the period December 1996 to December 2008, 254 new consecutive gastrostomies and 275 replacement procedures were performed in selected patients. All of the cases were treated by a T-fastener gastropexy and tube placement. The procedures were assessed by analyzing indications, patient selection, duration of the procedures, and mortality. RESULTS: All 254 first gastrostomies were successful; replacement procedures were also successfully performed. One (0.2%) patient with severe neurologic disorders died after the procedure without signs of procedure-related complications, and seven (1.3%) major complications occurred (four duodenal lesions with peritoneal leakage, two gastric bleedings, and one gastric lesion). Minor complications were easily managed; three tube ruptures were resolved. CONCLUSIONS: This long-term series and follow-up showed that a group of interventional radiologist can effectively provide gastrostomy placement and long-term tube management. Percutaneous gastrostomy is less invasive than other approaches and it satisfies the needs even of high-risk patients.

Obstructive Jaundice after Bilioenteric Anastomosis: Transhepatic and Direct Percutaneous Enteral Stent Insertion for Afferent Loop Occlusion

Recurrent tumour after radical pancreaticoduodenectomy may cause obstruction of the small bowel loop draining the liver. Roux-loop obstruction presents a particular therapeutic challenge, since the postsurgical anatomy usually prevents endoscopic access. Careful multidisciplinary discussion and multimodality preprocedure imaging are essential to accurately demonstrate the cause and anatomical location of the obstruction. Transhepatic or direct percutaneous stent placement should be possible in most cases, thereby avoiding long-term external biliary drainage. Gastropexy T-fasteners will secure the percutaneous access and reduce the risk of bile leakage. The static bile is invariably contaminated by gut bacteria, and systemic sepsis is to be expected. Enteral stents are preferable to biliary stents, and compound covered stents in a sandwich construction are likely to give the best long-term results. Transhepatic and direct percutaneous enteral stent insertion after jejunopexy is illustrated and the literature reviewed.

Acute Gastric Volvulus due to Diaphragmatic Eventration

We present the case report of a 72-year-old female in whom diaphragmatic eventration and secondary gastric volvulus developed 10 years after a left partial pneumonectomy for a bronchiectasis. Eventration of the diaphragm is defined as an abnormal elevation of an intact diaphragm. The abnormally wide subdiaphragmatic space provides the potential for a gastric volvulus, which results from the strong negative intrathoracic pulling force created by the potential subphrenic space and paradoxical movement of the diaphragm. Unless this strong negative force is first eliminated, gastropexy alone will lead to recurrence. Obliteration of the subphrenic space by colonic displacement is a simple and effective way of abolishing this negative subdiaphragmatic pulling force. Treatment of gastric volvulus requires immediate surgical repair to prevent subsequent necrosis and perforation, with surgical correction of the underlying anatomic abnormality being the treatment of choice for gastric volvulus. We experienced a case of gastric volvulus due to diaphragmatic eventration who was treated with colonic displacement.

An Evaluation of the Fluoroscopy-guided Percutaneous Gastrostomy with the Pull Technique

PURPOSE: To evaluate the safety and usefulness of the fluoroscopy-guided percutaneous gastrostomy (FPG) using a large profile gastrostomy tube accompanied with the pull technique, and without the use of an endoscopy or a gastropexy. MATERIALS AND METHODS: From March 2005 to February 2007, 25 patients underwent an FPG using a large profile gastrostomy tube accompanied by the pull technique, in which a 24F pull-type tube was inserted into a patient's mouth and was pulled to the upper abdominal puncture site using a snare, under fluoroscopy. The 18 patients with difficulty swallowing due to muscular atrophic lateral sclerosis or transitional myodystrophy included 5 cases of quadriplegia, 1 case of Parkinson's disease, and 1 metastatic mediastinal tumor. The technical success rate, occurrence of complications, and clinical outcomes were examined. RESULTS: The technical success rate was found to be 100%. In addition, the retention periods for the indwelling tube ranged from 1 to 24 months (mean: 6.5 months), with all tubes retained at a normal position with normal function. No procedure-related mortality occurred. One patient (4%) did however develop a complication in the form of ascites and ascitic fluid leakage around the tube, which was of hepatic origin and was ultimately resolved after the drainage of ascites. CONCLUSION: As a result of this study the FPG, accompanied with the pull technique using a 24F tube, should be considered as a safe and effective method for examining patients. It was found to have a high success rate and a low complication rate.

A Case of Mesenteroaxial Gastric Volvulus Diagnosed Using Endoscopic Procedure / 대한소화기내시경학회지

Gastric volvulus is characterized by an abnormal rotation of the stomach typically 180degrees left to right around a line joining the relatively fixed pylorus and the esophagus. Gastric volvulus can be classified anatomically as organoaxial, mesenteroaxial or combined, and symptomatically as acute or chronic. Acute gastric volvulus is an extremely rare emergency surgical condition. The classical triad of gastric volvulus are severe nausea with a paradoxical inability to vomit, localized epigastric pain and an inability to pass a nasogastric tube. Gastric volvulus may be suspected on a plain radiological examination of the abdomen as well as by its symptoms. It is confirmed by the specific findings on the esophagogastroduodenoscopy. We report a case of acute mesenteroaxial gastric volvulus, that was treated using laparoscopic reduction and anterior gastropexy.

A case of mesenteroaxial type of acute gastric volvulus associated with diaphragmatic eventration / 대한내과학회지

Acute gastric volvulus is extremely rare emergency surgical condition by abnormal rotation of stomach. It presents a puzzling picture which makes early diagnosis difficult, yet surgical interference must be accomplished early if life is to be saved. Gastric volvulus can be classified anatomically as organoaxial or mesenteroaxial. The symptoms triad of gastric volvulus are severe nausea with a paradoxical inability to vomiting, localized epigastric pain and impossibility of introducing a gastric tube. The diagnosis of it may be suspected on plain radiographic examination of the abdomen and symptoms, it is confirmed by specific findings on the upper gastrointestinal series. We experienced a case of mesenteroaxial type of acute gastric volvulus associated with diaphragmatic eventration. We treated this patient with reduction of volvulus, repair of diaphragmatic eventration, gastrojejunostomy and gastropexy. The authors report this case with a brief review of recent literatures.

A Case of Gastric Volvulus

Gastric volvulus is a rare surgical disorder in the pediatric population. We experienced a case of gastric volvulus. A 2-year-old boy was admitted to hospital with abdominal distension. An upper gastrointestinal series showed reversal of the greater and lesser curvatures. Surgical exploration revealed an organoaxial volvulus of the stomach, and anterior gastropexy was performed.