ABSTRACT
Gastric perforation is a rare complication after acute necrotizing pancreatitis. We describe endoscopic closure of a gastric perforation that appeared 4 days after surgical necrosectomy including splenectomy due to necrotizing pancreatitis, using the over-the-scope clip (OTSC) system (Ovesco Endoscopy GmbH, Tübingen, Germany). The clips, which are made of nitinol, are loaded onto an application cap which is mounted on the distal tip of the endoscope. The lesion was closed with two clips and the patient recovered well without reinterventions. The lesions showed normal healing on follow-up.
Subject(s)
Gastroscopy/methods , Pancreatitis, Acute Necrotizing/complications , Stomach Rupture/surgery , Adult , Endoscopy/methods , Follow-Up Studies , Gastroscopes , Humans , Male , Pancreatectomy/adverse effects , Pancreatectomy/methods , Pancreatitis, Acute Necrotizing/diagnosis , Pancreatitis, Acute Necrotizing/surgery , Postoperative Complications/surgery , Risk Assessment , Splenectomy/adverse effects , Splenectomy/methods , Stomach Rupture/etiology , Surgical Instruments , Treatment OutcomeABSTRACT
Neurotrophin 3 (NT3) and its receptors are expressed throughout the gastrointestinal tract, especially in the enteric nervous system. However, little is known about the effects of NT3 on gastrointestinal motility. To investigate the effects of NT3 on gastric or colonic motility under baseline conditions, after subdiaphragmatic vagotomy and in a model of postoperative ileus. Sprague-Dawley rats were equipped with strain gauge transducers on the gastric or colonic wall. Motility was recorded for 30 min, followed by i.v. administration of NT3 and motility-recording for another 60 min. Experiments were performed on three consecutive days and separately in a postoperative ileus model. To evaluate a vagal pathway, experiments were also performed on vagotomized rats. NT3 inhibited gastric motility. This inhibitory effect was reduced by subdiaphragmatic vagotomy. Preoperative treatment with NT3 prolonged the postoperative gastric ileus compared to vehicle treatment. Colonic motility in the intact animal was unchanged by NT3, but was increased postoperatively. NT3 treatment inhibited gastric but not colonic motility. This inhibition of gastric motility seems to be partly mediated by the vagus nerve. NT3 aggravates gastric postoperative ileus but attenuates colonic postoperative ileus, which corresponds to the observed positive effects of NT3 on constipated patients.
Subject(s)
Gastrointestinal Motility/drug effects , Neurotrophin 3/pharmacology , Animals , Consciousness , Defecation/drug effects , Disease Models, Animal , Eating/drug effects , Humans , Ileus/drug therapy , Intestines/drug effects , Intestines/innervation , Intestines/surgery , Male , Postoperative Complications/prevention & control , Rats , Rats, Sprague-Dawley , Recombinant Proteins/pharmacology , VagotomyABSTRACT
We report the case of a 72-year-old woman with a covered and perforated appendicitis and periappendicular abscess within the hernial sac (Amyand's hernia) of an incarcerated recurrent inguinal hernia after primary Shouldice repair. Initially, a preoperative CT-scan showed signs of an incarcerated femoral hernia. This would be the first reported case of an incarcerated recurrent Amyand's hernia, which is an extremely rare condition.
