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Modified Heller´S Esophageal Myotomy Associated with Dor's
Crimson Publishers Research Article Wings to the Research Modified Heller´s Esophageal Myotomy Associated with Dor’s Fundoplication A Surgical Alternative for the Treatment of Dolico Megaesophagus Fernando Athayde Veloso Madureira*, Francisco Alberto Vela Cabrera, Vernaza ISSN: 2637-7632 Monsalve M, Moreno Cando J, Charuri Furtado L and Isis Wanderley De Sena Schramm Department of General Surgery, Brazil Abstracts The most performed surgery for the treatment of achalasia is Heller´s esophageal myotomy associated or no with anti-reflux fundoplication. We propose in cases of advanced megaesophagus, specifically in the dolico megaesophagus, a technical variation. The aim of this study was to describe Heller´s myotomy modified by Madureira associated with Dor´s fundoplication as an alternative for the treatment of dolico megaesophagus,Materials and methods: assessing its effectiveness at through dysphagia scores and quality of life questionnaires. *Corresponding author: proposes the dissection ofTechnical the esophagus Note describing intrathoracic, the withsurgical circumferential procedure and release presenting of it, in the the results most of three patients with advanced dolico megaesophagus, operated from 2014 to 2017. The technique A. V. Madureira F, MsC, Phd. Americas Medical City Department of General extensive possible by trans hiatal route. Then the esophagus is retracted and fixed circumferentially in the Surgery, Full Professor of General pillars of the diaphragm with six or seven point. The goal is at least on the third part of the esophagus, to achieveResults: its broad mobilization and rectification of it; then is added a traditional Heller myotomy. Submission:Surgery At UNIRIO and PUC- Rio, Brazil Published: The mean dysphagia score in pre-op was 10points and in the post- op was 1.3 points (maximum October 09, 2019 of 10 points being observed each between the pre and postoperative 8.67 points, 86.7%) The mean October 24, 2019 hospitalization time was one day. -
Dieulafoy's Lesion Associated with Megaesophagus
vv ISSN: 2455-2283 DOI: https://dx.doi.org/10.17352/acg CLINICAL GROUP Received: 21 September, 2020 Case Report Accepted: 06 October, 2020 Published: 07 October, 2020 *Corresponding author: Valdemir José Alegre Salles, Dieulafoy’s Lesion Associated Assistant Doctor Profesor, Department of Medicine, University of Taubaté, Brazil, Tel: +55-15-12-3681-3888; Fax: +55-15-12-3631-606; E-mail: with Megaesophagus Keywords: Dieulafoy’s lesion; Esophageal Valdemir José Alegre Salles1,2*, Rafael Borges Resende3, achalasia; Haematemesis; Endoscopic hemoclip; Gastrointestinal bleeding 3 2,4 Gustavo Seiji , and Rodrigo Correia Coaglio https://www.peertechz.com 1Assistant Doctor Profesor, Department of Medicine, University of Taubaté, Brazil 2General Surgeon at the Regional Hospital of Paraíba Valley, Taubaté, Brazil 3Endoscopist Physician at the Regional Hospital of Paraíba Valley, Taubaté, Brazil 4Assistant Profesor, Department of Medicine, University of Taubaté, Brazil A 31-years-old male patient, with no previous symptoms, admitted to the ER with massive hematemesis that started about 2 hours ago and already with hemodynamic repercussions. After initial care with clinical management for compensation, and airway protection (intubation) he underwent esophagogastroduodenoscopy (EGD), which was absolutely inconclusive due to the large amount of solid food remains and clots already in the proximal esophagus with increased esophageal gauge. After a 24 hours fasting, and 3 inconclusive EGD, since we don’t have the availability of an overtube, we decided to use a calibrated esophageal probe (Levine 22) and to maintain lavage and aspiration of the contents, until the probe returned clear. In this period, the patient presented several episodes of hematimetric decrease and melena, maintaining hemodynamic stability with intensive clinical support. -
Megaesophagus in Congenital Diaphragmatic Hernia
Megaesophagus in congenital diaphragmatic hernia M. Prakash, Z. Ninan1, V. Avirat1, N. Madhavan1, J. S. Mohammed1 Neonatal Intensive Care Unit, and 1Department of Paediatric Surgery, Royal Hospital, Muscat, Oman For correspondence: Dr. P. Manikoth, Neonatal Intensive Care Unit, Royal Hospital, Muscat, Oman. E-mail: [email protected] ABSTRACT A newborn with megaesophagus associated with a left sided congenital diaphragmatic hernia is reported. This is an under recognized condition associated with herniation of the stomach into the chest and results in chronic morbidity with impairment of growth due to severe gastro esophageal reflux and feed intolerance. The infant was treated successfully by repair of the diaphragmatic hernia and subsequently Case Report Case Report Case Report Case Report Case Report by fundoplication. The megaesophagus associated with diaphragmatic hernia may not require surgical correction in the absence of severe symptoms. Key words: Congenital diaphragmatic hernia, megaesophagus How to cite this article: Prakash M, Ninan Z, Avirat V, Madhavan N, Mohammed JS. Megaesophagus in congenital diaphragmatic hernia. Indian J Surg 2005;67:327-9. Congenital diaphragmatic hernia (CDH) com- neonate immediately intubated and ventilated. His monly occurs through the posterolateral de- vital signs improved dramatically with positive pres- fect of Bochdalek and left sided hernias are sure ventilation and he received antibiotics, sedation, more common than right. The incidence and muscle paralysis and inotropes to stabilize his gener- variety of associated malformations are high- al condition. A plain radiograph of the chest and ab- ly variable and may be related to the side of domen revealed a left sided diaphragmatic hernia herniation. The association of CDH with meg- with the stomach and intestines located in the left aesophagus has been described earlier and hemithorax (Figure 1). -
Peroral Endoscopic Myotomy for the Treatment of Achalasia: a Clinical Comparative Study of Endoscopic Full-Thickness and Circular Muscle Myotomy
Peroral Endoscopic Myotomy for the Treatment of Achalasia: A Clinical Comparative Study of Endoscopic Full-Thickness and Circular Muscle Myotomy Quan-Lin Li, MD, Wei-Feng Chen, MD, Ping-Hong Zhou, MD, PhD, Li-Qing Yao, MD, Mei-Dong Xu, MD, PhD, Jian-Wei Hu, MD, Ming-Yan Cai, MD, Yi-Qun Zhang, MD, PhD, Wen-Zheng Qin, MD, Zhong Ren, MD, PhD BACKGROUND: A circular muscle myotomy preserving the longitudinal outer esophageal muscular layer is often recommended during peroral endoscopic myotomy (POEM) for achalasia. However, because the longitudinal muscle fibers of the esophagus are extremely thin and fragile, and completeness of myotomy is the basis for the excellent results of conventional surgical myotomy, this modi- fication needs to be further debated. Here, we retrospectively analyzed our prospectively main- tained POEM database to compare the outcomes of endoscopic full-thickness and circular muscle myotomy. STUDY DESIGN: According to the myotomy depth, 103 patients with full-thickness myotomy were assigned to group A, while 131 patients with circular muscle myotomy were assigned to group B. Symptom relief, procedure-related parameters and adverse events, manometry outcomes, and reflux complications were compared between groups. RESULTS: The mean operation times were significantly shorter in group A compared with group B (p ¼ 0.02). There was no increase in any procedure-related adverse event after full-thickness myotomy (all p < 0.05). During follow-up, treatment success (Eckardt score 3) persisted for 96.0% (95 of 99) of patients in group A and for 95.0% (115 of 121) of patients in group B (p ¼ 0.75). -
Annular Pancreas Causing Gastric Outlet Obstruction in Adult: a Case Study
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 4 Ver. IX (Apr. 2016), PP 05-06 www.iosrjournals.org Annular Pancreas Causing Gastric Outlet Obstruction in Adult: A Case Study Dr Shyam Charan Baskey1, Dr Ramchandra Besra1,Dr Niranjan Mardi1, 2 2 Dr Shital Malua , Dr Pankaj Bodra 1Senior Resident,1Ex Senior Resident, 1Junior Resident1, 2Associate Professor Department of Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand India, Pin- 834009 Abstract: Annular pancreas is one of rare congenital anomalies that rarely manifest in adult. We hereby discuss our experiences with one of the presentation of annular pancreas. A 20 years male presented with pain abdomen symptom of gastric outlet obstruction, radiological investigation reported as chronic pancreatitis, on high level of suspicion exploratory laprotomy done with finding of annular pancreas. Bypass surgery done. Patients discharged uneventful. Key words: Annular pancreas, gastric outlet obstruction, CT scan, exploratory laprotomy. I. Introduction Annular pancreas is a congenital anomaly that consists of a ring of pancreatic tissue partially or completely obstructing second part of duodenum. It is formed due to failure of the ventral bud to rotate. Thus, it elongates and encircles the upper part of the duodenum, it can present in a wide range of clinical severities and can affect neonates to the elderly like peptic ulcer, pancreatitis, obstructive jaundice, gastric outlet obstruction etc, thereby making the diagnosis difficult, although diagnosis of annular pancreas can be made preoperatively by upper gastrointestinal endoscopy, CT scan, Endoscopic retrograde cholangiopancreatography (ERCP) and Magnetic resonance cholangiopancratography (MRCP). -
Peroral Endoscopic Myotomy: Techniques and Outcomes
11 Review Article Page 1 of 11 Peroral endoscopic myotomy: techniques and outcomes Roman V. Petrov1, Romulo A. Fajardo2, Charles T. Bakhos1, Abbas E. Abbas1 1Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; 2Department of General Surgery, Temple University Hospital. Philadelphia, PA, USA Contributions: (I) Conception and design: RA Fajardo, RV Petrov; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: RA Fajardo, RV Petrov; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Roman Petrov, MD, PhD, FACS. Assistant Professor, Department of Thoracic Medicine and Surgery. Lewis Katz School of Medicine at Temple University, 3401 N Broad St. C-501, Philadelphia, PA, USA. Email: [email protected]. Abstract: Achalasia is progressive neurodegenerative disorder of the esophagus, resulting in uncoordinated esophageal motility and failure of lower esophageal sphincter relaxation, leading to impaired swallowing. Surgical myotomy of the lower esophageal sphincter, either open or minimally invasive, has been a standard of care for the past several decades. Recently, new procedure—peroral endoscopic myotomy (POEM) has been introduced into clinical practice. This procedure accomplishes the same objective of controlled myotomy only via endoscopic approach. In the current chapter authors review the present state, clinical applications, outcomes and future directions of the POEM procedure. Keywords: Peroral endoscopic myotomy (POEM); minimally invasive esophageal surgery; gastric peroral endoscopic myotomy; achalasia; esophageal dysmotility Received: 17 November 2019; Accepted: 17 January 2020; Published: 10 April 2021. -
Updates in Clinical Gastroenterology of Dogs and Cats
2016 WINTER MEETING Saturday February 13, 2016 Burlington Hilton Hotel Todd R. Tams, DVM, DACVIM Chief Medical Officer, Veterinary Centers of America Los Angeles, CA [email protected] UPDATES IN CLINICAL GASTROENTEROLOGY OF DOGS AND CATS Generously sponsored by: HOLD THE DATES! VVMA SUMMER MEETING Small Animal Neurology: Alexander de Lahunta, DVM Friday, June 24, 2016 One Health: A Community Approach to Shared Bacteria Burlington Hilton Hotel – MRSA and Beyond: Meghan Davis, DVM, Ph.D., MPH 6 CE Credit Hours Large Animal: Bovine topic TBD VVMA SPAY/NEUTER MEETING AND WET LAB Stay tuned for more information. Saturday and Sunday October 8-9, 2016 Capital Plaza Hotel, Montpelier VT-CAN!, Middlesex Thanks for being a member! We are pleased to welcome the following members who joined since our 2015 Summer Meeting: Elizabeth Brock, Northwest Veterinary Assoc. Lisa Kiniry, BEVS Brandon Cain, Peak Veterinary Referral Ctr. Garrett Levin, BEVS Marie Casiere, Woodstock Animal Hospital Pam Levin, BEVS Dan Cole Kaitlin Manges, Ark Veterinary Hospital Emily Comstock, Vermont Large Animal Clinic Philip March, Peak Veterinary Referral Ctr. Kim Crowe, Vermont Technical College Thomas Olney, Rockingham Veterinary Clinic Anne Culp, BEVS Pamela Perry, Peak Veterinary Referral Ctr. Sabina Ernst Emily Picciotto, BEVS Allison Foster, Peak Veterinary Referral Ctr. Catarina Ruksznis, Large Animal Medical Associates Diane Gildersleeve, Newbury Veterinary Clinic Adrienne Snider, Petit Brook Veterinary Clinic Justin Goggin, Metropolitan Veterinary Radiology Kevin -
Dysphagia What Is Dysphagia? Dysphagia Is a General Term Used to Describe Difficulty Swallowing
Dysphagia What is Dysphagia? Dysphagia is a general term used to describe difficulty swallowing. While swallowing may seem very involuntary and basic, it’s actually a rather complex process involving many different muscles and nerves. Swallowing happens in 3 different phases: Insert Shutterstock ID: 119134822 1. During the first phase or oral phase the tongue moves food around in your mouth. Chewing breaks food down into smaller pieces, and saliva moistens food particles and starts to chemically break down our food. 2. During the pharyngeal phase your tongue pushes solids and liquids to the back of your mouth. This triggers a swallowing reflex that passes food through your throat (or pharynx). Your pharynx is the part of your throat behind your mouth and nasal cavity, it’s above your esophagus and larynx (or voice box). During this reflex, your larynx closes off so that food doesn’t get into your airways and lungs. 3. During the esophageal phase solids and liquids enter the esophagus, the muscular tube that carries food to your stomach via a series of wave-like muscular contractions called peristalsis. Insert Shutterstock ID: 1151090882 When the muscles and nerves that control swallowing don’t function properly or something is blocking your throat or esophagus, difficulty swallowing can occur. There are varying degrees of Dysphagia and not everyone will describe the same symptoms. Your symptoms will depend on your specific condition. Some people will experience difficulty swallowing only solids, or only dry solids like breads, while others will have problems swallowing both solids and liquids. Still others won’t be able to swallow anything at all. -
Issues in Endocrinology
VetEdPlus E-BOOK RESOURCES Issues in Endocrinology WHAT’S INSIDE The Diagnosis of Canine Hyperadrenocorticism Canine Hypothyroidism Feline Diabetes Mellitus Hypoadrenocorticism: Diagnosis and Treatment of Addison’s Disease Treatment of Pituitary-dependent A SUPPLEMENT TO Made possible by Hyperadrenocorticism an educational grant: Canine Diabetes Mellitus Chronic Pancreatitis in Felines E-BOOK PEER REVIEWED The Diagnosis of Canine Hyperadrenocorticism Audrey Cook, BVM&S, MSc VetEd, MRCVS, DACVIM-SAIM, DECVIM-CA, DABVP (Feline) Department of Small Animal Clinical Sciences, Texas A&M College of Veterinary Medicine and Biomedical Sciences College Station, Texas Hyperadrenocorticism (HAC or Cushing’s syndrome must have some (usually many) of the syndrome) describes the clinical manifestations classic signs (BOX 1). of chronic exposure to excessive glucocorticoids. Spontaneous HAC is often caused by More than 95% of dogs are polyuric/polydipsic; inappropriate secretion of adrenocorticotropic a normal water intake makes HAC less likely. hormone (ACTH) by a pituitary tumor (i.e., Additionally, most manifest dermatologic pituitary-dependent HAC [PDH]) or may reflect changes;2 in my experience, a good hair coat the autonomous production of cortisol by an adrenal tumor (AT).1 There are occasional reports of dogs with HAC BOX 1 Clinical Signs Commonly due to an aberrant response to a digestive hormone Associated With Canine HAC (i.e., food-dependent HAC) or from ectopic Polyuria and polydipsia ACTH secretion, but these are extremely rare. Polyphagia Panting CLINICAL PRESENTATION Abdominal distention Spontaneous HAC is usually diagnosed in older Hepatomegaly dogs, particularly Boston terriers, dachshunds, Muscle weakness 1 miniature poodles, and beagles. It is uncommon Dermatologic changes in dogs younger than 5 years of age. -
The Gastrointestinal Tract Frank A
91731_ch13 12/8/06 8:55 PM Page 549 13 The Gastrointestinal Tract Frank A. Mitros Emanuel Rubin THE ESOPHAGUS Bezoars Anatomy THE SMALL INTESTINE Congenital Disorders Anatomy Tracheoesophageal Fistula Congenital Disorders Rings and Webs Atresia and Stenosis Esophageal Diverticula Duplications (Enteric Cysts) Motor Disorders Meckel Diverticulum Achalasia Malrotation Scleroderma Meconium Ileus Hiatal Hernia Infections of the Small Intestine Esophagitis Bacterial Diarrhea Reflux Esophagitis Viral Gastroenteritis Barrett Esophagus Intestinal Tuberculosis Eosinophilic Esophagitis Intestinal Fungi Infective Esophagitis Parasites Chemical Esophagitis Vascular Diseases of the Small Intestine Esophagitis of Systemic Illness Acute Intestinal Ischemia Iatrogenic Cancer of Esophagitis Chronic Intestinal Ischemia Esophageal Varices Malabsorption Lacerations and Perforations Luminal-Phase Malabsorption Neoplasms of the Esophagus Intestinal-Phase Malabsorption Benign tumors Laboratory Evaluation Carcinoma Lactase Deficiency Adenocarcinoma Celiac Disease THE STOMACH Whipple Disease Anatomy AbetalipoproteinemiaHypogammaglobulinemia Congenital Disorders Congenital Lymphangiectasia Pyloric Stenosis Tropical Sprue Diaphragmatic Hernia Radiation Enteritis Rare Abnormalities Mechanical Obstruction Gastritis Neoplasms Acute Hemorrhagic Gastritis Benign Tumors Chronic Gastritis Malignant Tumors MénétrierDisease Pneumatosis Cystoides Intestinalis Peptic Ulcer Disease THE LARGE INTESTINE Benign Neoplasms Anatomy Stromal Tumors Congenital Disorders Epithelial Polyps -
Parasites in Liver & Biliary Tree
Parasites in Liver & Biliary tree Luis S. Marsano, MD Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Louisville & Louisville VAMC 2011 Parasites in Liver & Biliary Tree Hepatic Biliary Tree • Protozoa • Protozoa – E. histolytica – Cryptosporidiasis – Malaria – Microsporidiasis – Babesiosis – Isosporidiasis – African Trypanosomiasis – Protothecosis – S. American Trypanosomiasis • Trematodes – Visceral Leishmaniasis – Fascioliasis – Toxoplasmosis – Clonorchiasis • Cestodes – Opistorchiasis – Echynococcosis • Nematodes • Trematodes – Ascariasis – Schistosomiasis • Nematodes – Toxocariasis – Hepatic Capillariasis – Strongyloidiasis – Filariasis Parasites in the Liver Entamoeba histolytica • Organism: E. histolytica is a Protozoa Sarcodina that infects 1‐ 5% of world population and causes 100000 deaths/y. – (E. dispar & E. moshkovskii are morphologically identical but only commensal; PCR or ELISA in stool needed to differentiate). • Distribution: worldwide; more in tropics and areas with poor sanitation. • Location: colonic lumen; may invade crypts and capillaries. More in cecum, ascending, and sigmoid. • Forms: trophozoites (20 mcm) or cysts (10‐20 mcm). Erytrophagocytosis is diagnostic for E. histolytica trophozoite. • Virulence: may increase with immunosuppressant drugs, malnutrition, burns, pregnancy and puerperium. Entamoeba histolytica • Clinical forms: – I) asymptomatic; – II) symptomatic: • A. Intestinal: – a) Dysenteric, – b) Nondysenteric colitis. • B. Extraintestinal: – a) Hepatic: i) acute -
Gastrointestinal Pathology Esophagus and Stomach
Gastrointestinal Pathology Esophagus and Stomach Andras KISS M.D., D.Sc. 2nd Dept. of Pathology Budapest February 07. 2018 1 Esophagus • Anatomy • Congenital anomalies • Motor dysfunction • Esophageal varices • Inflammatory conditions • Neoplasms 2 Anatomy • between C6 and Th11-12 • Length: – 10 cm in the newborn – 25 cm in adults – by endoscopy: between 15 and 40 cm from the incisor teeth • Areas of luminal narrowing – at the cricoid cartilage – at the anterior crossing of the left main bronchus and left atrium – at the diaphragm 3 Anatomy Mucosa squamous epithelium Submucosa glands, vessels, lymphatic vessels and follicules , venes!!! Tunica musc propria Adventitia (No serosa) 4 ESOPHAGUS Esophagusatresia: not or only paritally developed esophagus in 90 % of cases simultaneous ösophagotracheale Fistule complication: Polyhydramnion (because of intrauterine defect of swallowing) Dysphagia lusoria: abnormally positioned aortic arch or arteria lusoria (atypical a. subcl.) Compression: stenosis of the esophagus Dysphagia: disturbed act of swallowing Physiology of swallowing Oral Phase Pharyngeal Phase Physiology of swallowing Pharyngeal and esophageale phase: Fiberoptical endoscopy investigation of disturbed act of swallowing Foreign body Congenital anomalies • Ectopic tissues: gastric, pancreatic • Congenital cysts: – duplication cysts in the lower esophagus • Diaphragmal hernia: – abdominal viscera in the thorax ( not to confuse with hiatal hernia → see later) • Atresia: – a segment of the esophagus is a thin cord, the proximal part communicates generally with the upper respiratory tract by a fistula- the distal pouch may also be connected to the trachea • Mucosal webs: – semicircumferential protrusion of the mucosa into the lumen of the upper esophagus • Mucosal rings: – mucosa, submucosa and sometimes hypertrophied muscle protruding into the lumen of the lower esophagus in a concentric fashion ( A ring, B or Schatzki ring) 10 Esophageal atresia and tracheoesophageal fistula 11 Motor dysfunction associated lesions I.