ABSTRACT
Bleeding as the most common complication of gastric cancer is a significant problem of modern surgery. Both oncologists and surgeons in ordinary hospitals deal with this adverse event. In addition to the well-known drugs for hemostasis, there are also generally recognized traditional methods of endoscopic hemostasis and transcatheter angiographic embolization. Surgical interventions do not lose their role too if previous hemostatic methods turned out to be ineffective. The reports devoted to radiotherapy for treatment and prevention of gastric bleeding following malignant process have been recently published. Such a wide choice of hemostatic methods prompted us to analyze the most significant recent studies regarding effectiveness of various methods and choice of the most optimal one.
Subject(s)
Embolization, Therapeutic , Hemostasis, Endoscopic , Hemostatics , Stomach Neoplasms , Embolization, Therapeutic/adverse effects , Embolization, Therapeutic/methods , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Hemostasis, Endoscopic/adverse effects , Humans , Stomach Neoplasms/complications , Stomach Neoplasms/diagnosis , Stomach Neoplasms/surgery , Treatment OutcomeABSTRACT
Bleeding as the most common complication of gastric cancer is a significant problem of modern surgery. Both oncologists and surgeons in ordinary hospitals deal with this adverse event. In addition to the well-known drugs for hemostasis, there are also generally recognized traditional methods of endoscopic hemostasis and transcatheter angiographic embolization. Surgical interventions do not lose their role too if previous hemostatic methods turned out to be ineffective. The reports devoted to radiotherapy for treatment and prevention of gastric bleeding following malignant process have been recently published. Such a wide choice of hemostatic methods prompted us to analyze the most significant recent studies regarding effectiveness of various methods and choice of the most optimal one.
Subject(s)
Embolization, Therapeutic , Hemostasis, Endoscopic , Stomach Neoplasms , Angiography , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Humans , Stomach Neoplasms/complications , Stomach Neoplasms/diagnosis , Stomach Neoplasms/surgerySubject(s)
Duodenal Obstruction , Duodenum , Gastrectomy/methods , Gastroenterostomy/methods , Pancreatitis, Chronic/complications , Plastic Surgery Procedures/methods , Chronic Disease , Duodenal Obstruction/diagnosis , Duodenal Obstruction/etiology , Duodenal Obstruction/physiopathology , Duodenal Obstruction/surgery , Duodenum/diagnostic imaging , Duodenum/surgery , Endoscopy, Digestive System/methods , Gastric Emptying , Humans , Laparotomy/methods , Male , Middle Aged , Treatment OutcomeABSTRACT
In the period from 1984 to 2010 operations were made on 41 patients aged from 36 to 76 years with chronic ischemia of digestive organs (CIDO), infarction of the small intestine was determined in 7 of them mainly due to atherosclerotic injury of the celiac trunk (CT) and/or superior mesenteric artery (SMA). In 41 patients antegrade (15) or retrograde (26) shunting of CT and/or SMA were fulfilled with synthetic prostheses in combination with resection of the small intestine in 7 patients, with lethal outcome in 2 of them only. No prosthesis infection was noted. Lethality in early terms was 17.1% mainly at the early stage of the work. Observations during the period from one month to 24 years were followed up in 26 (63.4%) patients. Their state remains satisfactory, the shunts are patent. In treatment of patients with CIDO the antegrade and retrograde shunting of CT and/or SMA are shown to be effective methods.
Subject(s)
Blood Vessel Prosthesis Implantation/methods , Celiac Artery/surgery , Intestine, Small/blood supply , Ischemia/surgery , Mesenteric Artery, Superior/surgery , Mesenteric Vascular Occlusion/surgery , Adult , Aged , Anastomosis, Surgical/methods , Angiography , Celiac Artery/diagnostic imaging , Female , Humans , Ischemia/diagnostic imaging , Ischemia/etiology , Male , Mesenteric Artery, Superior/diagnostic imaging , Mesenteric Vascular Occlusion/complications , Mesenteric Vascular Occlusion/diagnostic imaging , Middle Aged , Retrospective Studies , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Operations for compression stenosis of the celiac trunk (CSCT) were made on 97 patients aged 5.5-18 years (56 women and 41 men). Three basic clinical syndromes were observed: pain abdominal, dyspeptic and neurovegetative. The appearance or intensification of abdominal pains observed in 71.3% of the patients were connected with meal, in 59.69% of them it was simultaneous with physical exercise. The diagnosis of OSCT was based mainly on findings of ultrasonic duplex scanning. The indications to decompression of the celiac trunk were: clinical manifestations of CSCT, the stenosis degree at the maximal expiration more than 50%, peak systolic velocity of the blood flow more than 2 m/s and a gradient of arterial pressure more than 15 mm Hg. The decompression of the celiac trunk consisted in the dissection of a median arcuate ligament of the diaphragm, its interior crura and celiac ganglion fibers. Convalescence and recovery was stated in 87 of 97 patients in the nearest and long-term follow-up.
Subject(s)
Arterial Occlusive Diseases/surgery , Celiac Artery/surgery , Abdominal Pain/etiology , Adolescent , Arterial Occlusive Diseases/complications , Arterial Occlusive Diseases/diagnosis , Child , Child, Preschool , Chronic Disease , Constriction, Pathologic/complications , Constriction, Pathologic/surgery , Decompression, Surgical , Female , Follow-Up Studies , Humans , Male , Treatment OutcomeABSTRACT
Mycotoc aneurysms (MA)--a rare and extremely dangerous lesion of the aorta. CT, MRA and aortography were used to diagnose MA of the thoracoabdominal areas in 2 men of 64 and 67 years of age. The clinical picture included: fever with shivering with the temperature 38-39 degrees C and increasing pains in the inferiothoracic and lumbar areas of the spine. Hemoculture was positive in 1 patient only. The patients were operated on. Shunting of the aorta from the inferiothoracic to infrarenal segments was performed in one patient with the exclusion of the involved portion and resection of MA. Metalloosteosynthesis of the spine due to destruction of LI-LII and compression of the spine were performed in the second patient followed by analogous shunting of the aorta and visceral arteries with the resection of the aneurysm. To prevent infection of the prostheses the shunts were wrapped up with a piece of the greater omentum. One patient died two months later from recurrent sepsis. The other one is alive, within 28 months the shunts are patent, there are no signs of a reinfection.
Subject(s)
Aneurysm, Infected , Aortic Aneurysm, Abdominal , Aortic Aneurysm, Thoracic , Aged , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/surgery , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Aortography , Blood Vessel Prosthesis , Follow-Up Studies , Humans , Magnetic Resonance Angiography , Male , Middle Aged , Time Factors , Tomography, X-Ray ComputedABSTRACT
The ultrasound duplex scanning with colored pictures of blood flow in the celiac trunk and superior mesenteric artery with occlusive lesion of them by atherosclerosis or compression by the diaphragm is a highly sensitive and sufficiently accurate research method. It allows to detect disturbances in patency of these vessels, the state of blood flow in them and to assess the results of operative treatment. A comparison of the data of preoperative ultrasound duplex scanning and aortic-arteriography has shown coincidence of the localization and, in most cases, the degree of stenosis of the celiac trunk and superior mesenteric artery. The results of direct electromanometry proved to be similar to those of dopplerography in 88% of cases before the operation and in all the cases after decompression of the celiac trunk.
Subject(s)
Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/surgery , Celiac Artery/diagnostic imaging , Mesenteric Artery, Superior/diagnostic imaging , Ultrasonography, Doppler, Color , Adult , Angiography , Aortography , Arteriosclerosis/diagnostic imaging , Arteriosclerosis/surgery , Celiac Artery/pathology , Constriction, Pathologic , Female , Follow-Up Studies , Humans , Male , Manometry , Mesenteric Artery, Superior/pathology , Middle Aged , Time Factors , Vascular PatencyABSTRACT
An analysis of 72 reconstructive operations on the abdominal aorta (in 5 cases shunts of the celiac trunk and superior mesenteric arteries were performed) fulfilled by the authors has shown that in order to prevent the development of the aorto(prosthetic)-intestinal erosions and fistulas and possible extension of the inflammatory process to the synthetic prostheses from the adjacent organs it is necessary to use the corresponding technical means and the following methods of protection of anastomoses and vascular transplants: protection of the prosthesis by local tissues or greater omentum flaps, selection of the corresponding diameter and length of the prosthesis.