ABSTRACT
The traditional management of pancreatic pseudocyst (PP) is surgical drainage; however, there is significant morbidity associated with this approach. An endoscopic ultrasound (EUS)-guided transgastric endoscopic approach is preferred if there is favourable access to the PP. This case report describes a rare complication of an EUS-guided transgastric drainage of a PP secondary to a suboptimally positioned stent. Significant soiling of the peritoneal cavity by pancreatic juices and gastric contents occurred due to leakage around the stent puncture sites. A novel technique using an infant feeding tube is described to inflate the collapsed PP and facilitate definitive surgical cystogastrostomy. A literature review and discussion surrounding the safety of endoscopic decompression and the type of stent utilised is also presented.
Subject(s)
Abdomen/diagnostic imaging , Fecal Impaction/complications , Intestinal Obstruction/etiology , Abdomen/physiopathology , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Aged, 80 and over , Enema , Fecal Impaction/diagnostic imaging , Fecal Impaction/therapy , Female , Hematemesis/diagnosis , Hematemesis/etiology , Humans , Intestinal Obstruction/therapy , Tomography, X-Ray Computed/methods , Treatment OutcomeSubject(s)
Anastomotic Leak/surgery , Cholecystectomy, Laparoscopic/adverse effects , Common Bile Duct/injuries , Laparotomy/trends , Anastomotic Leak/etiology , Cholangiopancreatography, Endoscopic Retrograde/methods , Common Bile Duct/diagnostic imaging , Common Bile Duct/pathology , Female , Humans , Iatrogenic Disease , Laparotomy/methods , Middle Aged , Postoperative Complications/etiology , Reoperation/trends , Treatment OutcomeABSTRACT
Internal hernia postgastrectomy is an exceedingly rare complication especially in the laparoscopic cohort of patients. Different types of internal hernias have been described, of which, Petersen's and jejunojejunostomy mesenteric defect hernias are the most commonly encountered followed by oesophageal defect and transverse colon mesocolic defect hernias. As the early presentation is always non-specific, late diagnosis of internal hernia has significant implication on morbidity and mortality. Here, we present a rare case of a patient with previous laparoscopy-assisted total gastrectomy presented with features of impending bowel obstruction and bowel ischaemia secondary to dual incarcerated internal hernias. We also reviewed the literature focusing on clinical features of internal hernia, essential CT findings and preventive measures.
