DOCSLIB.ORG

A Giant Gastric Bezoar in Billroth II Stomach: a Case Report On

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Giant Gastric Bezoar in Billroth II Stomach: a Case Report On Gastroenterology Insights 2016; volume 7:6808 A giant gastric bezoar in patients with delaying gastric emptying (such as those with diabetic gastroparesis, mixed Correspondence: Jin Yu Chieng, Department of Billroth II stomach: connective tissue disease, or hypothyroidism.2- Medicine, Faculty of Medicine and Health a case report on successful 4 Other predisposing conditions are inade- Science, Putra University of Malaysia, 43400 endoscopic removal via quate fluid intake leading to dehydration, and Serdang UPM, Selangor, Malaysia anatomic abnormalities such as diverticula or Tel.: +60.006.016.8580155. repeated fragmentation gastric outlet obstruction.1,2 E-mail: [email protected] and dissolution technique Most of the patients are fairly asymptomatic Key words: Anemia; Bezoar; Oesophago-gastro- initially. Abdominal pain (70%), nausea and negating the need for surgical duodenoscopy; OGDS; Ulcer. vomiting (64%), and early satiety are the main intervention 1,2,4,5 clinical symptoms. Gastric bezoars may Contributions: the authors contribute equally. result in peptic ulcer disease from pressure Jin Yu Chieng,1 Shiaw Hooi Ho,2 necrosis,6 and subsequent gastrointestinal 2 Conflict of interest: the authors declare no poten- Khean Lee Goh bleeding as well as gastric outlet obstruction.7,8 tial conflict of interest. 1Department of Medicine, Faculty A wide variety of therapeutic options have of Medicine and Health Science, Putra been reported. Medical treatment includes dis- Received for publication: 29 July 2016. University of Malaysia, Selangor; solution with ingestion of cellulose, papain, or Accepted for publication: 12 August 2016. 2 N-acetylcysteine.1,2,5,9-13 Ingestion of carbonat- Department of Medicine, University This work is licensed under a Creative Commons ed beverage Coca-Cola has been successfully of Malaya, Kuala Lumpur, Malaysia Attribution NonCommercial 4.0 License (CC BY- 4,14-16 used to dissolve bezoars. Endoscopic NC 4.0). management includes mechanical fragmenta- tion of the bezoar using water jet with subse- ©Copyright J. Yu Chieng et al., 2016 Abstract quent extraction, a drill device, tripod forceps, Licensee PAGEPress, Italy polypectomy snare plus diathermy, mechanical Gastroenterology Insights 2016; 7:6808 lithotripter, or Dormia basket.2,3,17 Surgical doi:10.4081/gi.2016.6808 A 76-year-old gentleman presented with intervention would be indicated if endoscopic only anemia. He had a history of perforated duode- removal fails. nal ulcer six years ago, with Billroth II repair We report a male patient with a history of 2 performed. A large gastric bezoar (8×6 cm ) gastric surgery presented with peptic ulcer dis- as outpatient. with a clean base ulcer at the anastomotic ease secondary to a giant gastric bezoar.use During the first OGDS attempt, we found junction was found during the initial oesopha- that the bezoar was too hard to be segmented go-gastro-duodenoscopy (OGDS). Rapid ure- by using biopsy forcep/baskets/polypectomy ase test was negative. He presented with mele- snare/tripod forceps/Argon plasma coagulation na during the subsequent follow up (OGDS Case Report alone. Only superficial pieces were removed. showed a Forrest Ib prepylori ulcer). We have After review the literature, decision had successfully removed the gastric bezoar with A 76-year-old gentleman was referred from been made to try to remove the gastric bezoar dissolution therapy initially (injection of coke- Healthcare Clinic for iron deficiency anemia by endoscopic fragmentation techniques and cola into the bezoar, followed by drinking 325 with positive fecal occult blood test. The dissolution therapy. In total, 5 sections of TM mL Coca-Cola twice daily), followed by four patient had a history of perforated duodenal OGDSs had been performed to remove the attempts of OGDS with endoscopic fragmenta- ulcer six years ago, with laparotomy repair bezoar under sedation (intravenous midazo- tion. Histopathology reported as degenerated (Billroth II) performed. He had mild epigastric lam/fentanyl). vegetable matter, acellular debris mixed with commercialdiscomfort. His bowel habits had never During the second OGDS attempt, we inject- scattered fungal and bacterial colonies, which changed. He did not report any loss of weight ed, via variceal needle, inside the bezoar 200 was compatible with bezoar. Follow-up OGDS or appetite. He denied of taking any traditional mL of Coca-Cola. The patient was instructed to showed complete clearance of the bezoar. or herbal medicine, nor the analgesic or drink at least one 325ml can of Coca-Cola twice TM Coca-Cola ingestion should be considered as steroid abuse. He denied of smoking. He did daily. initial treatment as it is non-invasive,Non and it not have any history of malaenic stool or During the third review, the patient claimed enables further successful endoscopic frag- hematemesis initially. He was clinically mild he had passing out malaenic stool. mentation. pallor. Laboratory data showed iron deficiency Hemoglobin level was 9.2 g/dL. OGDS reviewed anemia (hemoglobin level 9.1 g/L with low a bleeding anastomotic junction ulcer (Forrest mean cell volume and low mean cell hemoglo- class Ib), with the gastric bezoar. The bleeding bin, together with low serum iron, ferritin and had been successful secured by combination of Introduction transferrin saturation level). adrenaline injection and heater probe applica- A large gastric bezoar (about 8×6 cm2, of tion. He was warded for blood transfusion A bezoar is an indigestible mass of material, hard consistency) with an anastomotic junc- together with infusion proton pump inhibitor. such as hair, food, seeds, that other ingested tion ulcer (Forrest class III, with clean base) He was discharged well three days later. substances found in the gastrointestinal tract.1 was diagnosed during the oesophago-gastro- During the subsequent OGDSs, the anasto- Gastric bezoars are rare with estimated inci- duodenoscopy (OGDS) (Figure 1). Rapid ure- motic junction ulcer was found to be healed. dence about 0.4% on upper endoscopy.2 ase test was negative. Biopsies of the ulcer We noticed that the bezoar had become much Gastric bezoars usually result from inges- were taken, and reported as chronic active gas- softer, and easier to be segmented into small tion of indigestible material in patients with tritis with intestinal metaplasia histopatholog- pieces by using hot polypectomy snare. The impairment in the gastric motility or digestion, ically. At the time of diagnosis, no attempt was bezoar had been completely removed by using which could be due to previous gastric surgery made to remove or mechanically disrupt the a therapeutic scope with a roth net during the (such as Billroth I or II gastrectomy) or in the bezoar. Proton pump inhibitor was prescribed fourth OGDS attempt (Figure 2). [Gastroenterology Insights 2016; 7:6808] [page 43] Case Report Histopathology reported as mainly degenerat- ed vegetable matter, acellular debris mixed with scattered fungal and bacterial colonies, which was compatible with bezoar. Follow-up OGDS showed complete clearance of the bezoar (Figure 3). Subsequent hemoglo- bin levels were stable then. The interval of time from the initiation of treatment to endoscopic confirmation of bezoar clearance was 12 weeks. Discussion Figure 1. An endoscopic view of the gastric bezoar in the patient, with a prepyloric ulcer (Forrest class III with clean base). This patient had previous history of Billroth II surgery, which was a factor for formation of gastric bezoar. He presented to us with iron deficiency anemia, and the diagnostic OGDS shown peptic ulcer disease, which developed bleeding later on. This could be due to pres- sure ulcer as the Rapid urease test was nega- tive. Lee and colleagues had published a series with 17 patients, which shown combination only treatment with dissolution therapy and endo- scopic fragmentation technique were able to dissolve nearly all bezoars (16/17), while disso- lution therapy alone was successful in only 25% of the cases.18 In our case, we successes use to soften the gastric bezoar by ingestion of Coca-Cola, and to segment the bezoar into smaller pieces using hot polypectomy snare, followed by removal with roth net. Coca-Cola ingestion is a cheap, easy-to-per- form and safe procedure that can be accom- plished at any endoscopy unit. The mechanism of bezoar dissolution by Coca-Cola has not been thoroughly explained. It is believed that Figure 2. The fragments of the gastric bezoar removed from the stomach. the sodium bicarbonate in Coca-Cola has a mucolytic effect, and the carbon dioxide bub- commercial bles may penetrate into the bezoar, leading to digestion of the fibers. Coca-Cola’s low pH level (close to normal gastric secretions’ pH level) is important for the digestion of the fiber by acidifying the gastric content. Coca-ColaNon diminishes the size and softens the hard con- sistency of the bezoar, thus facilitating the dis- solution by hot polypectomy snare. Conclusions This study shows a successful removal of a large gastric bezoar with dissolution therapy using Coca-cola, followed by endoscopic frag- mentation techniques. Coca-cola ingestion should be considered as initial treatment as it is non-invasive, and it enables further success- ful endoscopic fragmentation. Figure 3. After treatment, there was complete resolution of the gastric bezoar. [page 44] [Gastroenterology Insights 2016; 7:6808] Case Report obstruction. Aust N Z J Surg 1994;64:187- er. Pharmacotherapy 2007;27:299-302. References 9. 14. Kato H, Nakamura M, Orito E, et al. The 8. Leung E, Barnes R, Wong L. Bezoar in gas- first report of successful nasogastric coca- 1. Walker-Renald P. Update on the medicinal tro-jejunostomy presenting with symptoms cola lavage treatment for bitter persimmon management of phytobezoars. Am J of gastric outlet obstruction: a case report phytobezoars in Japan. Am J Gastroenterol Gastroenterol 1993;88:1663-6. and review of the literature. J Med Case 2003;98:1662-3. 2. Andrus CH, Ponsky JL. Bezoars: classifica- Rep 2008;2:323 15.
Load more

Recommended publications
  • Management of Afferent Loop Obstruction: Reoperation Or Endoscopic and Percutaneous Interventions
    See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/282163026 Management of afferent loop obstruction: Reoperation or endoscopic and percutaneous interventions Article in World Journal of Gastrointestinal Surgery · September 2015 DOI: 10.4240/wjgs.v7.i9.190 CITATIONS READS 32 427 2 authors, including: Konstantinos Tsalis Aristotle University of Thessaloniki 115 PUBLICATIONS 976 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Laparoscopic liver resection using ICG green visualization of hepatic structures View project Laparoscopic liver resection using ICG green visualization of hepatic structures View project All content following this page was uploaded by Konstantinos Tsalis on 26 May 2017. The user has requested enhancement of the downloaded file. Submit a Manuscript: http://www.wjgnet.com/esps/ World J Gastrointest Surg 2015 September 27; 7(9): 190-195 Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx ISSN 1948-9366 (online) DOI: 10.4240/wjgs.v7.i9.190 © 2015 Baishideng Publishing Group Inc. All rights reserved. MINIREVIEWS Management of afferent loop obstruction: Reoperation or endoscopic and percutaneous interventions? Konstantinos Blouhos, Konstantinos Andreas Boulas, Konstantinos Tsalis, Anestis Hatzigeorgiadis Konstantinos Blouhos, Konstantinos Andreas Boulas, Anestis Abstract Hatzigeorgiadis, Department of General Surgery, General Hospital of Drama, 66100 Drama, Greece Afferent loop obstruction is a purely mechanical comp- lication that infrequently occurs following construction Konstantinos Tsalis, D’ Surgical Department, “G. Papanikolaou” of a gastrojejunostomy. The operations most commonly Hospital, Medical School, Aristotle University of Thessaloniki, associated with this complication are gastrectomy 54645 Thessaloniki, Greece with Billroth Ⅱ or Roux-en-Y reconstruction, and pancreaticoduodenectomy with conventional loop or Author contributions: Blouhos K designed the research; Boulas Roux-en-Y reconstruction.
    [Show full text]
  • Rapid Urease Test (RUT) for Evaluation of Urease Activity in Oral Bacteria In
    Dahlén et al. BMC Oral Health (2018) 18:89 https://doi.org/10.1186/s12903-018-0541-3 RESEARCH ARTICLE Open Access Rapid urease test (RUT) for evaluation of urease activity in oral bacteria in vitro and in supragingival dental plaque ex vivo Gunnar Dahlén*, Haidar Hassan, Susanne Blomqvist and Anette Carlén Abstract Background: Urease is an enzyme produced by plaque bacteria hydrolysing urea from saliva and gingival exudate into ammonia in order to regulate the pH in the dental biofilm. The aim of this study was to assess the urease activity among oral bacterial species by using the rapid urease test (RUT) in a micro-plate format and to examine whether this test could be used for measuring the urease activity in site-specific supragingival dental plaque samples ex vivo. Methods: The RUT test is based on 2% urea in peptone broth solution and with phenol red at pH 6.0. Oral bacterial species were tested for their urease activity using 100 μl of RUT test solution in the well of a micro-plate to which a 1 μl amount of cells collected after growth on blood agar plates or in broth, were added. The color change was determined after 15, 30 min, and 1 and 2 h. The reaction was graded in a 4-graded scale (none, weak, medium, strong). Ex vivo evaluation of dental plaque urease activity was tested in supragingival 1 μl plaque samples collected from 4 interproximal sites of front teeth and molars in 18 adult volunteers. The color reaction was read after 1 h in room temperature and scored as in the in vitro test.
    [Show full text]
  • Study of the Effect of Post-Operative Medical Management on Peptic Ulcer in Patients of Perforated Peptic Ulcer Disease
    International Surgery Journal Deshmukh SB et al. Int Surg J. 2016 Aug;3(3):1267-1272 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 DOI: http://dx.doi.org/10.18203/2349-2902.isj20161459 Research Article Study of the effect of post-operative medical management on peptic ulcer in patients of perforated peptic ulcer disease Sudhir B. Deshmukh1, Koushal U. Kondawar2, Satish Gireboinwd3, Meghraj J. Chawada4* 1Professor and HOD, 2PG Student, 3Assistant Professor, 4Associate Professor, Department of General Surgery, S. R. T. R. Government Medical College, Ambejogai, Maharashtra, India Received: 11 May 2016 Accepted: 14 May 2016 *Correspondence: Dr. Meghraj J. Chawada E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Peptic ulcer disease remains one of the most prevalent diseases of the gastrointestinal tract with annual incidence 1 ranging from 0.1% to 0.3% in India. Cases of peptic ulcer perforation are commonly encountered in our institute. The objective was to study the effect of post-operative medical management on peptic ulcer in patients of perforated peptic ulcer disease. Methods: A prospective non randomized study was conducted among all diagnosed cases of peptic ulcer perforation patients admitted through emergency or OPD in surgery ward in our hospital. Patient’s case record was evaluated to collect following data: personal information, past history of peptic ulcer disease, use of non-steroidal anti- inflammatory drugs for heart disease or osteoarthritis was taken.
    [Show full text]
  • The Puzzle of Coccoid Forms of Helicobacter Pylori: Beyond Basic Science
    antibiotics Review The Puzzle of Coccoid Forms of Helicobacter pylori: Beyond Basic Science 1, , 1,2, 1 1 3 Enzo Ierardi * y , Giuseppe Losurdo y , Alessia Mileti , Rosa Paolillo , Floriana Giorgio , Mariabeatrice Principi 1 and Alfredo Di Leo 1 1 Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; [email protected] (G.L.); [email protected] (A.M.); [email protected] (R.P.); [email protected] (M.P.); [email protected] (A.D.L.) 2 Ph.D. Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy 3 THD S.p.A., 42015 Correggio (RE), Italy; fl[email protected] * Correspondence: [email protected]; Tel.: +39-08-05-593-452; Fax: +39-08-0559-3088 G.L. and E.I. contributed equally and are co-first Authors. y Academic Editor: Nicholas Dixon Received: 20 April 2020; Accepted: 29 May 2020; Published: 31 May 2020 Abstract: Helicobacter pylori (H. pylori) may enter a non-replicative, non-culturable, low metabolically active state, the so-called coccoid form, to survive in extreme environmental conditions. Since coccoid forms are not susceptible to antibiotics, they could represent a cause of therapy failure even in the absence of antibiotic resistance, i.e., relapse within one year. Furthermore, coccoid forms may colonize and infect the gastric mucosa in animal models and induce specific antibodies in animals and humans. Their detection is hard, since they are not culturable. Techniques, such as electron microscopy, polymerase chain reaction, loop-mediated isothermal amplification, flow cytometry and metagenomics, are promising even if current evidence is limited.
    [Show full text]
  • Seer Program Code Manual
    THE SEER PROGRAM CODE MANUAL Revised Edition June 1992 CANCER STATISTICS BRANCH SURVEILLANCE PROGRAM DIVISION OF CANCER PREVENTION AND CONTROL NATIONAL CANCER INSTITUTE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE NATIONAL INSTITUTES OF HEALTH Effective Date: Cases Diagnosed January 1, 1992 The SEER Program Code Manual Revised Edition June 1992 Editors Jack Cunningham Lynn Ries Benjamin Hankey Jennifer Seiffert Barbara Lyles Evelyn Shambaugh Constance Percy Valerie Van Holten Acknowledgements The editors wish to acknowledge the assistance of Terry Swenson, Maureen Troublefield, Diane Licitra, and Jerome Felix of Information Management Services, Inc., in the preparation of the SEER Program Code Manual. The editors also wish to acknowledge the assistance of Dr. John Berg in preparation of the section on multiple primary determination for lymphatic and hematopoietic diseases. TABLE OF CONTENTS PREFACE TO THE REVISED EDITION ....................................... vii COMPUTER RECORD FORMAT ............................................ 1 INTRODUCTION AND GENERAL INSTRUCTIONS .............................. 5 REFERENCES .......................................................... 37 SEER CODE SUMMARY .................................................. 39 I BASIC RECORD IDENTIFICATION ...................................... 57 1.01 SEER Participant ........................................... 58 1.02 Case Number .............................................. 59 1.03 Record Number ............................................ 60
    [Show full text]
  • Helicobacter Pylori Infections: Culture from Stomach Biopsy, Rapid Urease Test (Cutest®), and Histologic Examination of Gastric Biopsy
    Available online at www.annclinlabsci.org 148 Annals of Clinical & Laboratory Science, vol. 45, no. 2, 2015 An Efficiency Comparison between Three Invasive Methods for the Diagnosis of Helicobacter pylori Infections: Culture from Stomach Biopsy, Rapid Urease Test (CUTest®), and Histologic Examination of Gastric Biopsy Avi Peretz1, Avi On 2, Anna Koifman1, Diana Brodsky1, Natlya Isakovich1, Tatyana Glyatman1, and Maya Paritsky3 1Clinical Microbiology Laboratory, 2Pediatric Gastrointestinal Unit, and 3Gastrointestinal Unit, Baruch Padeh Medical Center, Poria, affiliated to the Faculty of Medicine, Bar Ilan University, Galille, Israel Abstract. Background. Helicobacter pylori is one of the most prevalent pathogenic bacteria in the world, and humans are its principal reservoir. There are several available methods to diagnose H. pylori infection. Disagreement exists as to the best and most efficient method for diagnosis. Methods. In this paper, we report the results of a comparison between three invasive methods for H. pylori diagnosis among 193 pa- tients: culture, biopsy for histologic examination, and rapid urease test (CUTest®). Results. We found that all three methods have a high sensitivity and specificity for the diagnosis of infections caused by H. pylori. However, the culture method, which is not used routinely, also showed high sensitivity, probably due to biopsies’ seeding within 30 minutes, using warm culture media, non-selective media, and longer incuba- tion. Conclusions. Although not a routine test, culture from biopsy can be meaningful in identification of antibiotic-resistant strains of H. pylori and should therefore be considered a useful diagnostic tool. Keywords: Helicobacter pylor, Culture, Urease test, Gastric biopsy. Introduction Helicobacter pylori is one of the most prevalent Recently, a close association was found between H.
    [Show full text]
  • Do Perforated Gastric Ulcers Require Routine
    DO PERFORATED GASTRIC ULCERS REQUIRE ROUTINE INTRA-OPERATIVE BIOPSY? Meryl Dache Oyomno A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the requirements for the degree of Master of Medicine (General Surgery). Johannesburg, 2018 i DECLARATION I, Meryl Dache Oyomno, declare that this research report is my own work. It is being submitted for the degree of Master of Medicine (General Surgery) at the University of the Witwatersrand, Johannesburg. It has not been submitted before either whole or in part for any degree or examination at this or in any other university. ………………………………. On the ……. day of………. 2017 ii DEDICATION To my parents, Violet and Gordon Oyomno. iii ACKNOWLEDGEMENTS I owe a great debt of gratitude to Dr. Martin Brand, a remarkable supervisor! He was an enormous help in the formulation of the research question and protocol and read multiple drafts of the written report. I appreciate the quick responses and helpful feedback, the guidance and expert advice. In the same breath, I would like to thank Professor Damon Bizos for not only helping me come up with the research topic but for his constant guidance and support. I would also like thank the Wits postgraduate Hub statistical consultation team and Dr. Petra Gaylard of Data management and statistical analysis DMSA for their assistance in the data analysis and statistics. iv PRESENTATIONS ARISING FROM RESEARCH REPORT Oral Presentation 1. Do perforated gastric ulcers require routine intra-operative biopsy? A study in three Gauteng public hospitals. Bert Myburgh Research Forum 2015 v ABSTRACT Background.
    [Show full text]
  • Safe, Simple & Efficient Totally Laparoscopic Billroth II Gastrectomy
    China Gastric Cancer Research Highlight Safe, simple & efficient totally laparoscopic Billroth II gastrectomy by only stapling devices Kirubakaran Malapan1, Chih-Kun Huang1,2 1Department of Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Kaohsiung City, 82445, Taiwan; 2The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China Corresponding to: Chih-Kun Huang, M.D., Director. Department of Bariatric and Metabolic International Surgery Centre, E-da Hospital, No 1, E-Da Rd., Yan-chau District, Kaohsiung City, Taiwan, 82445. Email: [email protected]. Submitted May 08, 2013. Accepted for publication May 28, 2013. doi: 10.3978/j.issn.2224-4778.2013.05.28 Scan to your mobile device or view this article at: http://www.amepc.org/tgc/article/view/2081/2870 Gastric cancer is the fourth most common cancer diagnosis combination of both. Du J et al. reported their experience worldwide in men with an expected incidence of 640,000 of intracorporeal gastrojejunal anastomosis using a two cases and the fifth most common in women with an expected layer hand-sewn technique (9), whereas Ruiz et al. described incidence of 350,000 cases in 2011 (1). Approximately, 8% a 4-layer closure using continuous absorbable sutures (10). of total cases and 10% of annual cancer deaths worldwide Hand-sewn anastomosis requires advanced laparoscopic are attributed to this dreaded disease. Surgical resection skills and is considered to be time-consuming, but has offers the only durable cure from gastric cancer (2). Since the advantage of avoiding the risk of wound infection and the introduction of Billroth’s procedure of gastrectomy and hernias, which occur as a result of manipulation by a circular reconstruction in 1881, surgical techniques in gastric surgery stapler.
    [Show full text]
  • Postoperative Care and Functional Recovery After Laparoscopic Sleeve Gastrectomy Vs
    OBES SURG (2018) 28:1031–1039 https://doi.org/10.1007/s11695-017-2964-3 ORIGINAL CONTRIBUTIONS Postoperative Care and Functional Recovery After Laparoscopic Sleeve Gastrectomy vs. Laparoscopic Roux-en-Y Gastric Bypass Among Patients Under ERAS Protocol Piotr Major1,2 & Tomasz Stefura 3 & Piotr Małczak1,2 & Michał Wysocki 2,3 & Jan Witowski2,3 & Jan Kulawik1 & Mateusz Wierdak1,2 & Magdalena Pisarska1,2 & Michał Pędziwiatr 1,2 & Andrzej Budzyński1,2 Published online: 23 October 2017 # The Author(s) 2017. This article is an open access publication Abstract Results The rate of postoperative nausea and vomiting and Background The most commonly performed bariatric pro- incidence of intravenous fluid administration during the oper- cedures are laparoscopic sleeve gastrectomy (LSG) and ation was higher in LSG group. LRYGB patients were able to laparoscopic Roux-en-Y gastric bypass (LRYGB). There tolerate higher oral fluid intake volumes during the first and are major differences between LSG and LRYGB during the second postoperative day. Mean diuresis during the second postoperative period. Optimization of the postoperative and the third postoperative day was significantly higher in care may be achieved by using enhanced recovery after LRYGB group. Administration of diuretics and painkillers surgery (ERAS) protocol, which allows earlier functional was comparable between groups, while the risk of fever after recovery. the operation was higher in LRYGB group. Mean length of stay Purpose The aim was to assess differences in the course of was higher in LSG group (LRYGB vs. LSG, 3.46 days ± 1.58 postoperative care conducted in accordance with ERAS pro- vs. 3.64 days ± 4.41, p =0.039).
    [Show full text]
  • Electrohydraulic Lithotripsy of an Impacted Enterolith Causing Acute Afferent Loop Syndrome
    CASE REPORT Print ISSN 2234-2400 / On-line ISSN 2234-2443 Clin Endosc 2014;47:367-370 http://dx.doi.org/10.5946/ce.2014.47.4.367 Open Access Electrohydraulic Lithotripsy of an Impacted Enterolith Causing Acute Afferent Loop Syndrome Young Sin Cho, Tae Hoon Lee, Soon Oh Hwang, Sunhyo Lee, Yunho Jung, Il-Kwun Chung, Sang-Heum Park and Sun-Joo Kim Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea Afferent loop syndrome caused by an impacted enterolith is very rare, and endoscopic removal of the enterolith may be difficult if a stricture is present or the normal anatomy has been altered. Electrohydraulic lithotripsy is commonly used for endoscopic fragmenta- tion of biliary and pancreatic duct stones. A 64-year-old man who had undergone subtotal gastrectomy and gastrojejunostomy presented with acute, severe abdominal pain for a duration of 2 hours. Initially, he was diagnosed with acute pancreatitis because of an elevated amy- lase level and pain, but was finally diagnosed with acute afferent loop syndrome when an impacted enterolith was identified by comput- ed tomography. We successfully removed the enterolith using direct electrohydraulic lithotripsy conducted using a transparent cap-fitted endoscope without complications. We found that this procedure was therapeutically beneficial. Key Words: Afferent loop syndrome; Enterolith; Electrohydraulic lithotripsy INTRODUCTION cutaneous enterostomy has been considered as a palliative method. However, maturation of the percutaneous tract can Afferent loop syndrome (ALS) is characterized by the ac- occur very slowly prior to the procedure, and may cause dis- cumulation of bile acid and pancreatic juice, and distention comfort and pain.
    [Show full text]
  • Coders' Desk Reference for ICD-10-PCS Procedures
    2 0 2 DESK REFERENCE 1 ICD-10-PCS Procedures ICD-10-PCS for DeskCoders’ Reference Coders’ Desk Reference for ICD-10-PCS Procedures Clinical descriptions with answers to your toughest ICD-10-PCS coding questions Sample 2021 optum360coding.com Contents Illustrations ..................................................................................................................................... xi Introduction .....................................................................................................................................1 ICD-10-PCS Overview ...........................................................................................................................................................1 How to Use Coders’ Desk Reference for ICD-10-PCS Procedures ...................................................................................2 Format ......................................................................................................................................................................................3 ICD-10-PCS Official Guidelines for Coding and Reporting 2020 .........................................................7 Conventions ...........................................................................................................................................................................7 Medical and Surgical Section Guidelines (section 0) ....................................................................................................8 Obstetric Section Guidelines (section
    [Show full text]
  • Subtotal Gastrectomy, Antrectomy, Billroth II and Roux-En-Y
    Subtotal Gastrectomy, Antrectomy, Billroth II and Roux-en-Y Reconstruction and Local Excision in Complicated Gastric Ulcers Joachim Ruh, Enrique Moreno Gonzalez, Christoph Busch Subtotal Gastrectomy Introduction In subtotal gastrectomy, 75% of the stomach is resected. The passage is reconstructed using the proximal jejunum either as an omega loop or as a Roux-en-Y reconstruction. Indications and Contraindications Indications ■ Gastric carcinoma of the intestinal type in the distal part of the stomach ■ Complicated ulcers of the distal part of the stomach and the duodenum Preoperative Investigations/Preparation for the Procedure ■ In gastric carcinoma, the carcinoma should be clearly identified as an intestinal type in histopathological work-up. ■ The location of the carcinoma/ulcerative lesion should be clearly identified by means of endoscopy. 144 SECTION 2 Esophagus, Stomach and Duodenum Procedure STEP 1 Abdominal incision and mobilization of the stomach For laparotomy, a transverse epigastric incision should be chosen. In case of inadequate exposure, this incision should be extended with a midline incision. This approach provides adequate exposure up to the gastroesophageal junction. Alternatively, a midline laparotomy is adequate. Following the exploration of the whole abdomen for metastatic disease in case of gastric cancer, the gastric lesion should be located. The greater omentum of the stomach is dissected from the transverse colon, exposing the posterior wall of the stomach and opening the lesser sac (A). A Subtotal Gastrectomy, Antrectomy, Billroth II and Roux-en-Y Reconstruction and Local Excision in Complicated Gastric Ulcers 145 STEP 1 (continued) Abdominal incision and mobilization of the stomach The pylorus is freed from adjacent connective tissue (B), and the omentum minus is opened along the minor curvature.
    [Show full text]