Acute gastric dilatation: a transient cause of hepatic portal venous gas-case report and review of the literature.

Gastric pneumatosis (GP) and hepatic portal venous gas (HPVG) have typically been thought of as an ominous radiological sign associated with a grave prognosis, and the observation of HPVG on plain abdominal radiography, ultrasonography, or computed tomography is viewed as a significant finding. It is often associated with severe or potentially lethal conditions warranting urgent diagnosis and possible surgical intervention. Early studies of HPVG based on plain abdominal radiography found an associated mortality rate of 75% primarily due to ischemic bowel. However, modern abdominal computed tomography (CT) has resulted in the detection of HPVG in an increased proportion of nonfatal and benign conditions. We report a nonfatal case of HPVG in a patient with Noonan's syndrome due to acute gastric dilatation in the setting of gastric outlet obstruction caused by a congenital band that is extremely rare in adults.

Interatrial block - a novel risk factor for acute mesenteric ischemia.

Interatrial block (IAB; P-wave duration ≥110 milliseconds) denotes a conduction delay between the two atria. IAB has been shown to have a strong correlation with atrial arrhythmias, left atrial enlargement, left atrial electromechanical dysfunction and cerebral thromboembolism. Our study sought to determine whether there was an increased incidence of IAB in patients with acute occlusive mesenteric ischemia. Medical records of patients admitted with a diagnosis of acute mesenteric ischemia (AMeI) from January 2009 to March 2011 were reviewed retrospectively. One hundred seventy-two out of 342 patients reviewed, qualified after excluding mechanical surgical obstruction, suspected non-occlusive mesenteric ischemia due to shock/hypoperfusion, and mesenteric venous thrombosis. Of 99 patients who were in normal sinus rhythm without prior history of atrial arrhythmia, 88 (88.9 %) had IAB. This was more than twice the average prevalence of IAB of two general hospital populations (41 % and 47 % as demonstrated by two previous studies). IAB may thus represent a novel risk factor for AMeI as it does for embolic stroke.

Recurrent tense pneumoperitoneum due to air influx via abdominal wall stoma of a PEG tube.

A 70 years old male on ventilatory and circulatory support for sepsis and non ST segment elevation myocardial infarction developed abdominal distension 14 d after placement of a percutaneous endoscopic gastrostomy tube for enteral feeding. Radiography revealed free air in the abdomen and gastrograffin (G) study showed no extravasation into the peritoneum. The G tube was successfully repositioned with mechanical release of air. Imaging showed complete elimination of free air but the patient had a recurrence of pneumoperitoneum. Mechanical release of air with sealing of the abdominal wound was performed. Later, the patient was restarted on tube feeding with no complications. This case demonstrates a late complication of pneumoperitoneum with air leakage from the abdominal wall stoma.

Gastric electrical stimulation is safe and effective: a long-term study in patients with drug-refractory gastroparesis in three regional centers.

BACKGROUND: Drug-refractory gastroparesis has previously been without acceptable alternative therapies. Although gastric electrical stimulation has been used for over a decade, no long-term multicenter data exist. METHODS: We studied 214 consecutive drug-refractory patients with the symptoms of gastroparesis (146 idiopathic, 45 diabetic, 23 after surgery) who consented to participate in a variety of clinical research and clinical protocols at three centers from January 1992 through January 2005, resulting in 156 patients implanted with a gastric electrical stimulation device and the other 58 patients serving as controls. The patients were stratified into three groups: (1) consented but never permanently implanted; (2) implanted with permanent device, and (3) consented while awaiting a permanent device. The patients were followed over time for gastrointestinal symptoms, solid gastric emptying, health-related quality of life, survival, device retention, and complications. Demographics, descriptive statistics, and t tests were used for comparison between baseline and latest follow-up. RESULTS: At latest follow-up, median 4 years for 5,568 patient months, most patients implanted (135 of 156) were alive with intact devices, significantly reduced gastrointestinal symptoms, and improved health-related quality of life, with evidence of improved gastric emptying, and 90% of the patients had a response in at least 1 of 3 main symptoms. Most patients explanted, usually for pocket infections, were later reimplanted successfully. There were no deaths directly related to the device. CONCLUSION: Based on this sample of patients, implanted with gastric electrical stimulation devices at three centers and followed for up toward a decade, gastric electrical stimulation for drug-refractory gastroparesis is both safe and effective.