DOCSLIB.ORG

Gastric and Intestinal Dysmotility Syndromes

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Gastric and Intestinal Dysmotility Syndromes HIGHLIGHTS FROM MEDICAL GRAND ROUNDS EDY E. SOFFER, MD Dr. Soffer is a member of the Department of Gastroenterology at the Cleveland Clinic. His major clinical and research interests are in the Gastric and intestinal area of motor dysfunction of the stomach, small bowel, and colon dysmotility syndromes isorders of motility of the stomach and Causes of gastroparesis small intestine are common, and Gastroparesis can be a feature of many disor- patients often present with a variety of ders and syndromes, such as collagen vascular nonspecific symptoms, including nau- diseases and metabolic and endocrine disor- sea, abdominal pain, bloating, and ders, and an effect of medications such as anti- Dvomiting. The challenge for the internist is cholinergics or narcotics. However, most cases determine the nature and extent of motility encountered in clinical practice arc caused by dysfunction. vagotomy, diabetes, or unknown factors. Vagotomy. Postsurgical gastroparesis GASTRIC DYSMOTILITY occurs less frequently now that antibiotic Rule out treatment for Helicobacter pylori infection and mechanical Gastric motor dysfunction comprises two main potent acid-suppressing medicines have obstruction disorders: accelerated and delayed gastric emp- replaced surgery for treating peptic ulcer. Most before tying. patients who undergo a vagotomy and a Accelerated gastric emptying is seen pyloroplasty or gastroenterostomy experience considering a almost without exception after gastric surgery, little alteration in gastric emptying of solids, diagnosis of specifically vagotomy and drainage procedures although the initial phase of liquid emptying gastroparesis that result in dumping. Typical symptoms can be accelerated, resulting in dumping. occur after meals and include nausea, bloating, Fewer than 3% of postgastrectomy patients pain, diarrhea, and vasomotor symptoms such experience clinically significant gastroparesis. as syncope, flushing, and palpitations. Diabetic gastroparesis. Altered gastroin- Most office-based internists are more like- testinal function is common among patients ly to encounter delayed gastric emptying (also with longstanding type 1 diabetes mellitus, par- known as gastroparesis). Typical symptoms of ticularly those with complications such as gastroparesis include early satiety, nausea and retinopathy, peripheral neuropathy, or vomiting (mostly postprandial), abdominal nephropathy. Delayed emptying of solids is pain, and weight loss. Individually, none of common in diabetic patients and is frequently these symptoms indicates delayed gastric emp- asymptomatic. tying, but when they occur together, the like- Among symptomatic patients, gastroparesis lihood of gastroparesis is strong. frequently runs a fluctuating course, with However, before one considers a diagnosis episodes of pronounced symptoms interspersed of gastroparesis, mechanical obstruction must with relatively symptom-free intervals. be ruled out. Benign or malignant pancreatic Detecting gastroparesis is especially important disease or mesenteric ischemia should be sus- in patients with diabetes because it interferes pected if weight loss and pain are the predom- with nutrient delivery to the small intestine and inant symptoms. can result in fluctuating blood glucose levels. CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 64 • NUMBER 2 FEBRUARY 1997 6 9 Downloaded from www.ccjm.org on October 2, 2021. For personal use only. All other uses require permission. HIGHLIGHTS FROM MEDICAL GRAND ROUNDS n Gastric motor abnormalities in diabetes nondigestable food from emptying, and can include loss or disruption of antral migrating result in bezoar formation. motor complex (MMC) activity, fasting and postprandial antral hypomotility, and abnor- Pharmacologic therapy malities of the proximal small intestine. The Available agents that stimulate gastric empty- etiology of gut dysmotility in diabetes is not ing are not ideal, because they have an incon- clear, but evidence exists for autonomic ner- sistent effect on the motor function of the vous system and enteric nervous system dys- stomach. The ideal prokinetic agent for gas- function, in addition to the metabolic effects troparesis would target the defined pathophys- of hyperglycemia. iology, enhance stomach function (rather than Idiopathic gastroparesis. Many patients contractions), and cause few side effects. with gastroparesis have no primary abnormali- Cisapride is the most commonly used pro- ty. Most are young women. Some of these kinetic agent because of its good safety profile. patients report having a viral-like illness It is usually given at 10 mg four times a day at before the onset of gastric symptoms. Specific least 30 minutes before meals and at bedtime. viral infections, such as cytomegalovirus and Cisapride has a very good safety profile and herpes simplex, are known to cause gastropare- minimal side effects. sis in immunocompromised patients; the gas- Metoclopramide, a dopamine agonist, has troparesis resolves quickly following antiviral efficacy equal to that of cisapride. However, up therapy. to 20% of patients have side effects, the most troubling of which are related to extrapyrami- Diagnosis dal manifestations and mood changes. The most important diagnostic step for a Erythromycin is not particularly effective Gastroparesis in patient who presents with nausea, vomiting, as a prokinetic agent when given in oral form. diabetic patients bloating, or postprandial abdominal pain is to Cholinergic agents are rarely used because interferes with rule out mechanical obstruction, either of the of their high incidence of side effects. nutrient delivery stomach or the small intestine. After mechan- If tolerance develops to one of these pro- and can result in ical obstruction has been ruled out, gastric kinetic agents, I would increase the dose or add motor function is best evaluated by a another prokinetic agent. fluctuating radioscintigraphic solid-emptying study. This blood glucose test, in which the patient consumes a meal Surgical therapy levels that contains a radioisotope, allows for a sim- If dietary and pharmacologic methods fail in ple, sensitive, quantitative, noninvasive mea- patients with medical causes of gastroparesis, a sure of solid-phase emptying. feeding jejunostomy may be attempted. Subtotal gastrectomy and Roux-en-Y gas- TREATMENT OF GASTRIC DYSMOTILITY trojejunostomy can be helpful in severe post- surgical cases of gastroparesis, but are not effec- Dietary changes tive in cases caused by medical diseases. If radioscintigraphy reveals delayed gastric Gastric pacing, which requires the place- emptying, the initial phase of treatment ment of stimulating electrodes on the stom- should be directed toward dietary changes. ach, is experimental and its value has yet to be Small, frequent meals, preferably in liq- established. uid form, are encouraged because gastric emp- tying is volume-dependent, and liquids empty • INTESTINAL DYSMOTILITY faster than solids. A low-fat diet is helpful because fat is the Small-bowel motor activity and its control most potent inhibitor of gastric emptying. mechanisms are quite similar to those of the A low'residue diet is also important antrum of the stomach. Normal small bowel because the disturbed motor activity prevents motility serves to mix nutrients with digestive 70 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 64 • NUMBER 2 FEBRUARY 1997 Downloaded from www.ccjm.org on October 2, 2021. For personal use only. All other uses require permission. enzymes, allows sufficient time for absorption, general, prokinetic agents are less effective in and propels undigestible parts of the chyme treating intestinal dysmotility than in gastro- distally to the colon. Symptoms of intestinal paresis. dysmotility can be quite similar to those of gas- In refractory or severe, intermittent troparesis, though abdominal distention and intestinal dysmotility, a venting jejunostomy is changes in bowel habits indicate small-bowel helpful. Every attempt should be made to use disease. The disease is typically chronic. the small bowel by infusion of liquid formulas including elemental preparations. Total par- Diagnosis enteral nutrition may be required with bowel There is no adequate functional study of the failure. Intestinal transplantation and pacing small bowel that is analogous to solid phase are still experimental. • gastric emptying studies of the stomach. A diagnosis of intestinal dysmotility must rely on • SUGGESTED READING symptoms, plain abdominal radiographs, bari- um studies, and intestinal manometry. As in Anuras S. Intestinal pseudoobstruction syndrome. Annu Rev Med 1988; 39:1-15. gastric dysmotility, mechanical obstruction should be ruled out in the evaluation of Chaudhuri TK, Fink S. Update: pharmaceuticals and gastric emptying. Am J Gastroenterol 1980; 85:223-230. patients with symptoms of intestinal dysmotil- ity- Janssens J, PeetersTL, Vantrappen G, et al. Improvement ol gastric emp- Flat abdominal radiographs are not sensi- tying in diabetic gastroparesis by erythromycin. N Engl J Med 1990; 322:1028-1031. tive enough to distinguish obstruction from pseudo-obstruction, and contrast studies may Malagelada JR, Rees WDW, Mazzotta LJ, Go VLW. Gastric motor abnor- be needed to exclude mechanical obstruction. malities in diabetic and postvagotomy gastroparesis: Effect ol meioclo- pramide and bethanechol. Gastroenterology 1980; 78:286-293. If pseudo-obstruction is suspected, I would pro- ceed to manometry. Malmud LS, Fisher RS, Knight LC, Rock E. Scinit¡graphic evaluation ol Manometry.
Load more

Recommended publications
  • Association Between Gastric Myoelectric Activity Disturbances and Dyspeptic T Symptoms in Gastrointestinal Cancer Patients ⁎ Aneta L
    Advances in Medical Sciences 64 (2019) 44–53 Contents lists available at ScienceDirect Advances in Medical Sciences journal homepage: www.elsevier.com/locate/advms Original research article Association between gastric myoelectric activity disturbances and dyspeptic T symptoms in gastrointestinal cancer patients ⁎ Aneta L. Zygulskaa, , Agata Furgalab, Krzysztof Krzemienieckia,c,1, Beata Wlodarczykb, Piotr Thorb a Department of Oncology, University Hospital in Cracow, Cracow, Poland b Department of Pathophysiology, Jagiellonian University Medical College, Cracow, Poland c Department of Oncology, Jagiellonian University Medical College, Cracow, Poland ARTICLE INFO ABSTRACT Keywords: Purpose: Dyspeptic symptoms present a severe problem in gastrointestinal (GI) cancer patients. The aim of the Gastrointestinal carcinoma study was to analyze an association between gastric myoelectric activity changes and dyspeptic symptoms in Gastric motility gastrointestinal cancer patients. Gastric myoelectric activity Material and Methods: The study included 80 patients (37 men and 43 women, mean age 61.2 ± 7.8 years) Electrogastrography diagnosed with GI tract malignancies: colon (group A), rectal (group B) and gastric cancers (group C). Gastric Dyspeptic symptoms myoelectric activity in a preprandial and postprandial state was determined by means of a 4-channel electro- gastrography. Autonomic nervous system was studied based on heart rate variability analysis. The results were compared with the data from healthy asymptomatic controls. Results: In a fasted state, GI cancer patients presented with lesser percentages of normogastria time (A:44.23 vs. B:46.5 vs. C:47.10 vs. Control:78.2%) and average percentage slow wave coupling (ACSWC) (A:47.1 vs. B:50.8 vs. C:47.2 vs. Control:74.9%), and with higher values of dominant power (A:12.8 vs.
    [Show full text]
  • Gastroenterostomy and Vagotomy for Chronic Duodenal Ulcer
    Gut, 1969, 10, 366-374 Gut: first published as 10.1136/gut.10.5.366 on 1 May 1969. Downloaded from Gastroenterostomy and vagotomy for chronic duodenal ulcer A. W. DELLIPIANI, I. B. MACLEOD1, J. W. W. THOMSON, AND A. A. SHIVAS From the Departments of Therapeutics, Clinical Surgery, and Pathology, The University ofEdinburgh The number of operative procedures currently in Kingdom answered a postal questionnaire. Eight had vogue in the management of chronic duodenal ulcer died since operation, and three could not be traced. The indicates that none has yet achieved definitive status. patients were questioned particularly with regard to Until recent years, partial gastrectomy was the eating capacity, dumping symptoms, vomiting, ulcer-type dyspepsia, diarrhoea or other change in bowel habit, and favoured operation, but an increasing awareness of a clinical assessment was made based on a modified its significant operative mortality and its metabolic Visick scale. The mean time since operation was 6-9 consequences, along with Dragstedt and Owen's years. demonstration of the effectiveness of vagotomy in Thirty-five patients from this group were admitted to reducing acid secretion (1943), has resulted in the hospital for a full investigation of gastrointestinal and widespread use of vagotomy and gastric drainage. related function two to seven years following their The success of duodenal ulcer surgery cannot be operation. Most were volunteers, but some were selected judged only on low stomal (or recurrent) ulceration because of definite complaints. There were more females rates; the other sequelae of gastric operations must than males (21 females and 14 males). The following be considered.
    [Show full text]
  • Association of Oral Anticoagulants and Proton Pump Inhibitor Cotherapy with Hospitalization for Upper Gastrointestinal Tract Bleeding
    Supplementary Online Content Ray WA, Chung CP, Murray KT, et al. Association of oral anticoagulants and proton pump inhibitor cotherapy with hospitalization for upper gastrointestinal tract bleeding. JAMA. doi:10.1001/jama.2018.17242 eAppendix. PPI Co-therapy and Anticoagulant-Related UGI Bleeds This supplementary material has been provided by the authors to give readers additional information about their work. Downloaded From: https://jamanetwork.com/ on 10/02/2021 Appendix: PPI Co-therapy and Anticoagulant-Related UGI Bleeds Table 1A Exclusions: end-stage renal disease Diagnosis or procedure code for dialysis or end-stage renal disease outside of the hospital 28521 – anemia in ckd 5855 – Stage V , ckd 5856 – end stage renal disease V451 – Renal dialysis status V560 – Extracorporeal dialysis V561 – fitting & adjustment of extracorporeal dialysis catheter 99673 – complications due to renal dialysis CPT-4 Procedure Codes 36825 arteriovenous fistula autogenous gr 36830 creation of arteriovenous fistula; 36831 thrombectomy, arteriovenous fistula without revision, autogenous or 36832 revision of an arteriovenous fistula, with or without thrombectomy, 36833 revision, arteriovenous fistula; with thrombectomy, autogenous or nonaut 36834 plastic repair of arteriovenous aneurysm (separate procedure) 36835 insertion of thomas shunt 36838 distal revascularization & interval ligation, upper extremity 36840 insertion mandril 36845 anastomosis mandril 36860 cannula declotting; 36861 cannula declotting; 36870 thrombectomy, percutaneous, arteriovenous
    [Show full text]
  • 374 Part 876—Gastroenterology
    § 874.5550 21 CFR Ch. I (4–1–08 Edition) Drug Administration on or before July subpart E of part 807 of this chapter 13, 1999 for any tongs antichoke device subject to § 874.9. that was in commercial distribution [51 FR 40389, Nov. 6, 1986, as amended at 65 before May 28, 1976, or that has, on or FR 2316, Jan. 14, 2000] before July 13, 1999, been found to be substantially equivalent to a tongs antichoke device that was in commer- PART 876—GASTROENTEROLOGY- cial distribution before May 28, 1976. UROLOGY DEVICES Any other tongs antichoke device shall have an approved PMA or declared Subpart A—General Provisions completed PDP in effect before being Sec. placed in commercial distribution. 876.1 Scope. 876.3 Effective dates of requirement for pre- [51 FR 40389, Nov. 6, 1986, as amended at 64 market approval. FR 18329, Apr. 14, 1999] 876.9 Limitations of exemptions from sec- tion 510(k) of the Federal Food, Drug, § 874.5550 Powered nasal irrigator. and Cosmetic Act (the act). (a) Identification. A powered nasal irrigator is an AC-powered device in- Subpart B—Diagnostic Devices tended to wash the nasal cavity by 876.1075 Gastroenterology-urology biopsy means of a pressure-controlled pul- instrument. sating stream of water. The device con- 876.1300 Ingestible telemetric gastro- sists of a control unit and pump con- intestinal capsule imaging system. nected to a spray tube and nozzle. 876.1400 Stomach pH electrode. (b) Classification. Class I (general con- 876.1500 Endoscope and accessories. trols). The device is exempt from the 876.1620 Urodynamics measurement system.
    [Show full text]
  • Definitions of Bariatric Surgery CPT-4 Codes Description 43770
    Appendix A: Definitions of Bariatric Surgery CPT-4 Description Codes 43770 Laparoscopy, surgical, gastric restrictive procedure: placement of adjustable gastric band 43644 Laparoscopy, surgical, gastric restrictive procedure with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) 43645 Laparoscopy, surgical, gastric restrictive with gastric bypass and small intestine reconstruction to limit absorption 43842 Gastric restrictive procedure, without gastric bypass, for morbid obesity, vertical banded gastroplasty 43843 Other gastric restrictive procedures, without gastric bypass, and other than Vertical Banded Gastroplasty 43844 Laparoscopic gastric restrictive procedure with gastric bypass and Roux en Y gastroenterostomy 43845 Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileolieostomy to limit absorption (BPD) 43846 Gastric restrictive procedure, with gastric bypass, for morbid obesity; with short limb (less than 100 cm) Roux-en-Y gastroenterostomy 43847 Gastric restrictive procedure, with small intestine reconstruction to limit absorption; with long limb (>150 cm) Roux-en-Y 43659 Gastrectomy, total; with Roux-en-Y reconstruction; Mini -gastric bypass S2082 Laparoscopy, surgical; gastric restrictive procedure, adjustable gastric band includes placement of subcutaneous port S2085 Laparoscopic gastric bypass ICD-9 Description Codes 44.68 Laparoscopic gastroplasty Banding Silastic vertical banding Vertical banded gastroplasty (VBG) Code also any synchronous laparoscopic
    [Show full text]
  • GASTROENTEROSTOMY AFTER THREE to FIVE YEARS by B
    Postgrad Med J: first published as 10.1136/pgmj.31.360.511 on 1 October 1955. Downloaded from 5"I THE RESULT OF VAGOTOMY AND GASTROENTEROSTOMY AFTER THREE TO FIVE YEARS By B. V. McEvEDY, F.R.C.S. Senior Registrar, University College Hospital, London and G. K. KIRKLAND, M.B., Ch.B., D.P.H. Assistant Surgeon, Oldham Royal Infirmary and Ancoats Hospital It is only iI years since Lester Dragstedt re- personally; while questionnaire follow-up has introduced vagal section in the treatment of peptic been criticized as inaccurate, it is of interest that ulcers, yet in this short period, after attaining a no case seen was worse than the questionnaire had popularity almost equal to that of partial gas- implied while several were better. The series con- trectomy, the operation has fallen into disrepute sisted of I75 duodenal ulcer and nine jejunal ulcer and is now rarely performed. Despite the many patients. Protected by copyright. failures large numbers of patients have been cured Of the I84 cases operated upon two died in the by vagotomy although the different factors pro- immediate post-operative period, both from in- ducing success or failu"re have not been adequately testinal obstruction. One was a case of malrotation elucidated. In the three years prior to I948 it was of the gut and death was from massive volvulus, shown that vagotomy was contra-indicated for while in the second case the obstruction was due -gastric ulcers and that for duodenal ulcers a to old tuberculous adhesion4 around the terminal gastroenterostomy must also be performed to ileum.
    [Show full text]
  • 414 Part 876—Gastroenterology- Urology
    Pt. 876 21 CFR Ch. I (4–1–16 Edition) (b) Classification. Class II (special 876.9 Limitations of exemptions from sec- controls). The special controls for this tion 510(k) of the Federal Food, Drug, device are: and Cosmetic Act (the act). (1) The patient contacting compo- Subpart B—Diagnostic Devices nents must be demonstrated to be bio- compatible. 876.1075 Gastroenterology-urology biopsy (2) Non-clinical performance testing instrument. must demonstrate that the device per- 876.1300 Ingestible telemetric gastro- forms as intended under anticipated intestinal capsule imaging system. 876.1330 Colon capsule endoscopy system. conditions of use. The following per- 876.1400 Stomach pH electrode. formance characteristics must be dem- 876.1500 Endoscope and accessories. onstrated: 876.1620 Urodynamics measurement system. (i) Mechanical integrity testing (e.g., 876.1725 Gastrointestinal motility moni- tensile strength testing, fatigue test- toring system. ing) and 876.1735 Electrogastrography system. (ii) Shelf life testing. 876.1800 Urine flow or volume measuring (3) The technical specifications must system. include pressure measurement accu- Subpart C—Monitoring Devices racy to characterize device perform- ance. 876.2040 Enuresis alarm. (4) Clinical performance testing must 876.2050 Prostate lesion documentation sys- document any adverse events observed tem. during clinical use, and demonstrate Subpart D—Prosthetic Devices that the device performs as intended under anticipated conditions of use. 876.3350 Penile inflatable implant. (5) Labeling must include the fol- 876.3630 Penile rigidity implant. lowing: 876.3750 Testicular prosthesis. (i) Appropriate warnings and pre- Subpart E—Surgical Devices cautions, (ii) A detailed summary of the clin- 876.4020 Fiberoptic light ureteral catheter.
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • Evaluation Tool for a Gastroenterostomy Simulated Training1
    ORIGINAL ARTICLE Technical Skill Evaluation tool for a gastroenterostomy simulated training1 I II III Márcio Alencar Barreira , Delano Gurgel Siveira , Hermano Alexandre Lima Rocha , Luiz Gonzaga de Moura JuniorIV, Charles Jean Gomes de MesquitaV, Gleydson Cesar de Oliveira BorgesVI IMD, Surgical Oncologist, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza- CE, Brazil. Conception and design of the study; technical procedures; acquisition, interpretation and analysis of data; manuscript preparation and writing. IIMD, General Surgeon, Hospital Universitário Walter Cantídio, UFC, Fortaleza-CE, Brazil. Technical procedures, critical revision. IIIPhD, Assistant Professor, Professional Master’s Degree Program in Minimally Invasive Technology and Simulation in Health, Centro Universitário Christus (UNICHRISTUS), Fortaleza-CE, Brazil. Conception and design of the study, statistical analysis, interpretation of data, critical revision. IVPhD, Hospital Geral Dr. César Cals, Professional Master’s Degree Program in Minimally Invasive Technology and Simulation in Health, UNICHRISTUS, Fortaleza-CE, Brazil. Conception and design of the study, critical revision. VPhD, Professional Master’s Degree Program in Minimally Invasive Technology and Simulation in Health, UNICHRISTUS, Fortaleza-CE, Brazil. Conception and design of the study, interpretation and analysis of data, critical revision, final approval. VIMD, Holy House of Mercy of Fortaleza, Professional Master’s Degree Program in Minimally Invasive Technology and Simulation in Health, UNICHRISTUS, Fortaleza-CE, Brazil. Conception and design of the study, interpretation and analysis of data, critical revision, final approval. Abstract Purpose: To create a checklist to evaluate the performance and systematize the gastroenterostomy simulated training. Methods: Experimental longitudinal study of a quantitative character. The sample consisted of twelve general surgery residents. The training was divided into 5 sessions and consisted of participation in 20 gastroenterostomys in synthetic organs.
    [Show full text]
  • Gastrojejunocolic Fistula After Gastroenterostomy with Billroth II Reconstruction for Duodenal Ulcer: Report of a Case
    Scientific Research and Essays Vol. 6(21), pp. 4634-4638, 30 September, 2011 Available online at http://www.academicjournals.org/SRE DOI: 10.5897/SRE11.996 ISSN 1992-2248 ©2011 Academic Journals Full Length Research Paper Gastrojejunocolic fistula after gastroenterostomy with Billroth II reconstruction for duodenal ulcer: Report of a case Yin-Lu Ding*, Yong Zhou and Jian-Liang Zhang Department of General Surgery, The Second Hospital of Shandong University, Beiyuan Road, Jinan , 250033, Shandong Province, China. Accepted 24 August, 2011 Gastrojejunocolic fistula is a late, rare and severe complication of gastroenterostomy with Billroth II reconstruction for peptic ulcer and is associated with inadequate gastric resection and incomplete vagotomy. The fistula is thought to be due to perforation of a marginal ulcer into the transverse colon. In the past, attempted primary repair had high mortality and staged operations were normally performed. We herein report the case of a 60 year-old man with gastrojejunocolic fistula who was admitted to our hospital with a symptom triad of faecal vomiting/breath, chronic diarrhea and weight loss. His history included a distal gastric resection and Billroth II reconstruction for a duodenal ulcer 15 years previously. The laboratory data on admission revealed hypoproteinemia and hypoalbuminemia. Both barium-enema and colonoscopy examination showed the existence of the gastrojejunocolic fistula. After improving his state of malnutrition, a one-stage repair was performed. The postoperative course was uneventful and the patient was discharged on the 22th postoperative day. In this case, improved nutritional support allowed successful one-stage surgical repair to be performed. Key words: Gastrojejunocolic fistula, gastrectomy, stomal ulcer.
    [Show full text]
  • Small Bowel Transplant
    Ontario Health Technology Assessment Series 2003; Vol. 3, No. 1 Small Bowel Transplant An Evidence-Based Analysis April 2003 Medical Advisory Secretariat Ministry of Health and Long-Term Care Suggested Citation This report should be cited as follows: Medical Advisory Secretariat. Small bowel transplant: an evidence-based analysis. Ontario Health Technology Assessment Series 2003; 3(1) Permission Requests All inquiries regarding permission to reproduce any content in the Ontario Health Technology Assessment Series should be directed to [email protected]. How to Obtain Issues in the Ontario Health Technology Assessment Series All reports in the Ontario Health Technology Assessment Series are freely available in PDF format at the following URL: www.health.gov.on.ca/ohtas. Print copies can be obtained by contacting [email protected]. Conflict of Interest Statement All analyses in the Ontario Health Technology Assessment Series are impartial and subject to a systematic evidence-based assessment process. There are no competing interests or conflicts of interest to declare. Peer Review All Medical Advisory Secretariat analyses are subject to external expert peer review. Additionally, the public consultation process is also available to individuals wishing to comment on an analysis prior to finalization. For more information, please visit http://www.health.gov.on.ca/english/providers/program/ohtac/public_engage_overview.html. Contact Information The Medical Advisory Secretariat Ministry of Health and Long-Term Care 20 Dundas Street West, 10th floor Toronto, Ontario CANADA M5G 2N6 Email: [email protected] Telephone: 416-314-1092 ISSN 1915-7398 (Online) ISBN 978-1-4249-7267-8 (PDF) Small Bowel Transplant - Ontario Health Technology Assessment Series 2003; Vol.
    [Show full text]
  • BY BYRON B. DAVS, MD Wilensky, Speaking of the Current Operations for Ulcer, Says
    COMPARATIVE RESULTS OF PYLOROPLASTY AND OF GASTRO- ENTEROSTOMY IN STOMACH SURGERY* BY BYRON B. DAVS, M.D. or Ommu, NEB. FOR a long time the leading internists have been criticising the results in gastric surgery. So many complaints from such a source should not be ignored. To be sure, we may very fairly come back with the retort that after medical treatment has failed, where surgery relieves 6o to 70 per cent. of these cases, the medical man has little ground for criticism. In a recent article by Bastedo, of Columbia University, he mnakes the startling statement that " in our own practice ulcer cases that have had one or more operations come for treatment almost as frequently as ulcer cases that have not been operated." This seems to be an extreme assertion, but when we ask almost any internist of his experiences he voices the same sentiment. Smithies, out of 226 cases of gastroenteros- tomy operations for gastric and duodenal ulcers traced, reports only fifty- seven, 20.9 per cent., were clinically free of complaints. It leads one to ask if the operative results in this field are good enough to satisfy the com- posite surgical conscience. As the results now stand, from I5 to 40 per cent. of the operations done for gastric ulcers are failures. At least they do not restore the patient to sound health. There has been a tendency to explain the imperfect results on the ground that the operation was ill advised and the technic faulty. Moynihan asserts that many of the poor results following gastroenteros- tomy have been due to: (i) Operation done in the absence of any organic lesions justifying it; (2) in cases of chronic extragastric lesions that have been overlooked; (3) incomplete operation, the ulcer not hav- ing been dealt with; and (4) various defects in technic.
    [Show full text]