Acute Gastric Perforation Research Articles

Strangulated giant inguinal scrotal hernia with traction perforation at lesser curve of the stomach

A giant inguinoscrotal hernia is typically associated with a low risk of bowel obstruction or strangulation. When the hernia is complicated with acute gastric perforation, it is an exceedingly rare clinical entity. The operative strategy may be definitive at the index surgery or staged. The technical challenge is the severity of the peritoneal contamination contradicting mesh placement, coupled with the loss of domain. Herein we report a 58-year-old man with a long-standing right giant inguinoscrotal hernia, who presented with strangulation with a 1 day history. An urgent midline laparotomy access revealed a large tear over the lesser curvature of the stomach, attributable to choking at the hernia neck. Furthermore, there was severe contamination with total bowels herniation into the sac. We performed a complete reduction of hernia content, primary repair of stomach perforation, and primary closure of midline access and hernia neck repair with posterior wall reinforcement using prolene via an inguinal incision. The patient made an uneventful recovery and was discharged well. The perioperative clinical events and technical strategies are discussed in the current report.

Endoscopy Deliverable and Mushroom-Cap-Inspired Hyperboloid-Shaped Drug-Laden Bioadhesive Hydrogel for Stomach Perforation Repair.

Gastrointestinal tract perforation is a full-thickness injury that causes bleeding and fatal infection of the peritoneum. This condition worsens in an acidic gastric environment which interferes with the normal coagulation cascade. Current endoscopic clips to repair gastric perforations are ineffective, and metal or plastic occluders need secondary surgery to remove them. Herein, we report a self-expandable, endoscopy deliverable, adhesive hydrogel to block gastric perforation. We found the nanosilica coating significantly enhanced the adhesive strength even under a simulated strong acidic stomach environment. The developed device was disulfide cross-linked for the reducible degraded gel. By loading with vonoprazan fumarate (VF) and acidic fibroblast growth factor (AFGF), the hyperboloid-shaped device can have a sustained drug release to regulate intragastric pH and promote wound healing. The gel device can be compressed and then expanded like a mushroom when applied in an acute gastric perforation model in both rabbits and minipigs. By utilizing a stomach capsule robot for remotely monitoring the pH and by immunohistochemical analysis, we demonstrated that the compressible hyperboloid-shaped gel could stably block the perforation and promoted wound healing during the 28 days of observation. The real-time pH meter demonstrated that the gel could control intragastric pH above 4 for nearly 60 h to prevent bleeding.

Laparoscopic Management of Gastric Band Migration with Acute Gastric Perforation — a Video Vignette

Laparoscopic Management of Gastric Band Migration with Acute Gastric Perforation — a Video Vignette

S3172 Mixed Type Gastric Adenocarcinoma Presenting as Acute Gastric Perforation in a Young Adult: Can Crack Cocaine Cause Early Onset Perforation or Gastric Carcinoma Itself?

S3172 Mixed Type Gastric Adenocarcinoma Presenting as Acute Gastric Perforation in a Young Adult: Can Crack Cocaine Cause Early Onset Perforation or Gastric Carcinoma Itself?

Analysis of Curative Effect of Subtotal Gastrectomy and Simple Repair for Acute Gastric Perforation

Analysis of Curative Effect of Subtotal Gastrectomy and Simple Repair for Acute Gastric Perforation

Intragastric balloon outcomes in super-obesity: a 16-year city center hospital series

BackgroundIntragastric balloons represent an endoscopic therapy aimed at achieving weight loss by mechanical induction of satiety. Their exact role within the bariatric armamentarium remains uncertain. ObjectiveOur study aimed to evaluate the use of intragastric balloon therapy alone and before definitive bariatric surgery over a 16-year period. SettingA large city academic bariatric center for super-obese patients. MethodsBetween January 2000 and February 2016, 207 patients underwent ORBERA intragastric balloon placement at esophagogastroduodenoscopy. Four surgeons performed the procedures, and data were entered prospectively into a dedicated bariatric database. Patients’ weight loss data were measured through body mass index (BMI) and excess weight loss and recorded at each clinic review for up to 5 years (60 mo). Treatment arms included intragastric balloon alone with lifestyle therapy or intragastric balloon and definitive bariatric surgery: gastric banding, sleeve gastrectomy, or Roux-en-Y gastric bypass. An additional treatment arm of analysis included the overall results from intragastric balloon followed by stapled procedure. ResultsOne hundred twenty-nine female and 78 male patients had a mean age of 44.5 (±11.3) years and a mean BMI of 57.3 (±9.7) kg/m2. Fifty-eight percent of patients suffered from type 2 diabetes. Time from initial or first balloon insertion to definitive surgical therapy ranged between 9 and 13 months. Seventy-six patients had intragastric balloon alone, and 131 had intragastric balloon followed by definitive procedure. At 60 months postoperatively the intragastric balloon alone with lifestyle changes demonstrated an excess weight loss of 9.04% and BMI drop of 3.8; intragastric balloon with gastric banding demonstrated an excess weight loss of 32.9% and BMI drop of 8.9. Intragastric balloon and definitive stapled procedure demonstrated a BMI drop of 17.6 and an excess weight loss of 52.8%. Overall, there were 3 deaths (1.4%), 2 within 10 days due to acute gastric perforation secondary to vomiting and 1 cardiac arrest at 4 weeks postoperatively. ConclusionIntragastric balloons can offer effective weight loss in selected super-obese patients within a dedicated bariatric center offering multidisciplinary support. Balloon insertion alone offers only short-term weight loss; however, when combined with definitive bariatric surgical approaches, durable weight loss outcomes can be achieved. A strategy of early and continual vigilance for side effects and a low threshold for removal should be implemented. Surgeon and unit experience with intragastric balloons can contribute to “kick starting” successful weight loss as a bridge to definitive therapy in an established bariatric surgical pathway.

A primary study of endoscopic closure of acute gastric perforation using twin grasper combined with endoloops in a porcine survival model

Objective To evaluate the feasibility and efficacy of twin grasper combined with endoloops on closing acute stomach perforation. Methods Two experimental porcines of stomach perforation underwent endoscopic closure by twin grasper combined with endoloops. Survival conditions and closure of perforating were observed. Results Mild infection and abdominal adhesions were observed in one week after operation. The nylon rope fell off and an ulcer-like lesion was presented in the closed position. The methylene blue leak test was negative. Histologic examination revealed chronic inflammatory cells infiltration, granulation, fibroplasias, and regenerative mucous membrane crawling toward the center of perforation. Conclusion The technique of twin grasper combined with nylon ropes in closing the acute stomach perforation is feasible and effective. Key words: Gastric perforation; Animal experimentation; Twin grasper; Endoloop

Curative effect of laparoscopic surgery on acute gastric perforation

Objective: To investigate the postoperative inflammatory reaction, stress reaction and immune response of laparoscopic surgery and laparotomy for acute gastric perforation. Methods: Forty-four patients with acute gastric perforation receiving emergency surgery in our hospital from May 2012 to December 2015 were selected and retrospectively analyzed. Among these patients, there were 19 patients treated with laparoscopic surgery (LS group) and 25 patients treated with laparotomy (laparotomy group). At the first day after surgery, their serums were collected and the indexes of inflammatory reaction and stress reaction were detected. Mononuclear cells and red blood cells in peripheral blood were collected and detected for the immune function indexes. Results: At day 1 after surgery, the contents of serum interleukin-1β (IL-1β), IL-2, IL-6, IL-8, IL-10, cortisol, norepinephrine, epinephrine, renin and angiotensin-II of patients in the LS group were all significantly lower than those of the laparotomy group; fluorescence intensities of CD3, CD4, CD16 and CD56 of mononuclear cells in peripheral blood were all obviously higher than those of the laparotomy group; and the numbers of red blood cell C3bR and immune complex resette and the fluorescence intensities of complement receptor type 3, CD58 and CD59 were obviously higher than those of the laparotomy group. Conclusions: Emergency laparoscopic surgery used to treat acute gastric perforation shows slight postoperative inflammatory reaction and stress reaction and presents weak nonspecific immune response, specific immune response and erythrocyte immune response, which makes less trauma than laparotomy.

Comparison of the clinical effect of gastrectomy and simply repair in the treatment of acute gastric perforation

Objective To investigate the clinical efficacy of gastrectomy and simple repair in the treatment of acute gastric perforation.Methods 132 patients with acute gastric perforation were randomly divided into the control group and observation group by random number table,66 cases in each group.The control group received gastrectomy,the observation group was given simple repair treatment.The clinical efficacy,clinical indicators and ulcer recurrence Visick grading of patients in two groups were observed.Results The total effective rate of the observation group (87.9％) was significantly higher than that in the control group(71.3％) (x2 =5.634,P ＜ 0.05).The operative time,bed time,gastrointestinal function recovery time and hospitalization time in the observation group were (38.76 ± 6.23) min,(4.26 ± 1.67) d,(28.68 ± 4.74) h,(11.52 ± 2.32) d,those in the control group were (72.13 ± 10.78) min,(10.01 ± 2.21) d,(45.61 ± 5.69) h,(25.65 ± 3.95) d,there were statistically significant differences between the two groups(t =21.773,25.058,18.572,16.863,all P ＜ 0.01).The relapse rate in the observation group (4.6％) was significantly lower than that in the control group (15.2 ％) (x2 =4.181,P ＜ 0.05).Conclusion The simple repair in the treatment of acute gastric perforation has significant effect,it can effectively reduce the value of clinical parameters and the recurrence rate of patients,which has important clinical application value. Key words: Gastrectomy; Revision, surgical; Stomach rupture ; Case-control studies

Rescue endoscopic band ligation of iatrogenic gastric perforations following failed endoclip closure

Iatrogenic gastric perforation is one of the most serious complications during therapeutic endoscopy, despite significant advances in endoscopic techniques and devices. This case study evaluated the clinical efficacy and safety of the rescue endoscopic band ligation (EBL) technique in iatrogenic gastric wall perforation following the failure of primary endoclip closure. Five patients were enrolled in this study. These patients underwent emergency endoscopy following the onset of acute gastric wall perforation during endoscopic procedures. The outcome measurements were primary technical success and immediate or delayed procedure-related complications. Successful endoscopic closure using band ligation was reported in all patients, with no complication occurring. We conclude that EBL may be a feasible and safe alternate technique for the management of acute gastric perforation, especially in cases where closure is difficult with endoclips.

Massive Necrosis of the Upper Gastrointestinal Tract with Acute Gastric Perforation and Metabolic Acidosis after Hydrochloric Acid (HCl) Ingestion

Hydrochloric acid (HCl ; pH, 1) is a widespread product in households around the world, used as a toilet cleaner. As an easy available substance it becomes one of the main causes of the corrosive injuries of the gastrointestinal tract. While ingestion of alkali results primarily in esophageal damage, acids tend to spare the esophagus and produce necrosis of the stomach as in thermal burns. The mechanism of damage is also different ; alkalis produce liquefaction necrosis and acids coagulation necrosis. The extent and the severity of corrosive gastric injury is directly related to the concentration and amount of acidic substance as well as the period of time in the stomach, and to the amount of gastric content at the time of ingestion. We are reporting a case of massive necrosis of the upper GI tract with acute gastric perforation and metabolic acidosis due to suicidal acid ingestion.

Acute Gastric Perforation after Butane Ingestion

Acute Gastric Perforation after Butane Ingestion

Laparoscopic Total Gastric Vertical Plication in Morbid Obesity

The aim of this study was to introduce a new technique, total gastric vertical plication (TGVP), as a restrictive operation. It has the same result of weight loss as others with minimal risk of complication and very low cost, especially in developing countries. This technique was used by one surgeon in private hospitals during 3 years in Tehran, Iran. Patients were placed in the supine position with a 30-degree reverse Trendelenburg position. Trocars were inserted based on an ergonomic assessment (three 5 mm and one 10 mm). After the release of the greater curvature, continuous sutures were used with 00 nylon from the fondus to 3 cm of the pylorus. A vertical plication was performed in one or two layers. Distance between the stitch and lesser curvature was 2 cm in the anterior and posterior and between each stitch, all of them getting extra mucosal (far away from acid effect) owing to mild tension on the sutures that cut mucosa and put on a submucosa layer. TGVP was performed in 100 cases (mean age, 32; standard error of the mean = 2.1); mostly female (F/M = 76/24) and with average body mass index of 47 (36-58). The mean weight loss in our patients was 21.4% of excessive weight loss (EWL) 1 month after the operation, 54% after 6 months (72 cases), 61% after 12 months (56 cases), 60% after 24 months (50 cases), and 57% after 36 months (11 cases). The average time of follow-up was 18 months. The mean time of operation was 98 (70-152) minutes and all of the patients were discharged from the hospital after an average of 1.3 days (range, 1-4). The main postoperative complications were permanent vomiting, intracapsular liver hematoma, hypocalcemia at early postoperative period, hepatitis, leakage at the suture line, and acute gastric perforation. The volume of the stomach in this condition was 100 cc, but just one half of it was effective. If more than 50 cc was used, a painful condition would occur. The percentage of EWL in this technique is comparable to other restrictive methods, but EWL appears more rapidly. Early postoperative complications of this method are minimal, without any important late complications. This technique needs more expertise and is more time consuming. A long-term follow-up is advised.

Outcomes of Cocaine-Induced Gastric Perforations Repaired With an Omental Patch

Crack cocaine has been associated with acute gastric perforation. The appropriate surgical treatment and long-term outcomes remain unclear. A retrospective chart review of all gastroduodenal perforations associated with crack cocaine use was performed. Data abstracted included details of short- and long-term outcomes. Kaplan–Meier methods were used to evaluate surgical outcomes. Over the 14-year period ending December 2005, 16 cases of crack-induced gastric perforations were identified. Most (75%) were treated with an omental patch. The other patients underwent a formal antiulcer operation, including one vagotomy and pyloroplasty (V&P), one vagotomy and antrectomy, one subtotal gastrectomy, and one ulcer excision and V&P. All patients after antiulcer procedures were followed for a median of 63 months (range 27–120) with no recurrences. Follow-up data were available in 75% of the omental patch patients. Recurrence of disease was observed in 56% of these omental patch patients at a median of 20 months (range 11–39). Those without recurrence were followed for a median of 67 months (range 12–96). The recurrence rate was borderline lower in the antiulcer group (P = 0.072). Omental patch closure results in a recurrence rate over 50% compared with no recurrence for formal antiulcer procedures.

Eosinophilic Gastroenteritis Presenting as Acute Gastric Perforation

Eosinophilic Gastroenteritis Presenting as Acute Gastric Perforation

Gastric Rupture After Cardiopulmonary Resuscitation in a Burn Patient

Burn injury, especially severe facial burn injury, poses a unique challenge for emergency health care personnel in administering cardiopulmonary resuscitation. Because of the perioral and oral edema with severe facial burns, intubation may be difficult, and bag-valve mask or mouth-to-mouth resuscitation may be prolonged. As a result of the difficulty in establishing a patent airway, various complications can arise. One of these includes gastric perforation which, although rare in the setting of difficult intubation or prolonged oral ventilation, may be possible. To our knowledge, acute gastric perforation after prolonged cardiopulmonary resuscitation in burn injured patients has not previously been reported thus the incidence is unknown. We report here a case of gastric perforation after a difficult tracheal intubation in a patient with extensive burns of the head and neck and 63% TBSA burn.

Acute Gastric Perforation in a Bulimic Patient

Acute Gastric Perforation in a Bulimic Patient

Acute Gastric Perforation after Acid Ingestion

Gastric outlet obstruction is a common late result after acid ingestion; early complications, such as gastric necrosis or perforations are unusual. This is a report of a patient with the history of strong acid ingestion who underwent total gastrectomy due to perforation and extensive necrosis of the stomach.

Acute Gastric Perforation after Acid Ingestion

ABSTRACTGastric outlet obstruction is a common late result after acid ingestion; early complications, such as gastric necrosis or perforations are unusual. This is a report of a patient with the history of strong acid ingestion who underwent total gastrectomy due to perforation and extensive necrosis of the stomach.

14 PERSISTENT HYPERINSULINENIC HYPOGLYCEMIA OF INFANCY – LONG-TERM EXPERIENCE WITH 28 PATIENTS

We studied 28 patients with Persistent Hyperinsulinemic Hypoglycemia of Infancy (PHHI). Twenty-two developed symptomatic hypoglycemia within 2 days of life (15 of these required surgery) while 5 developed first symptoms at age 2-7 months (1 required surgery). Twelve patients belonged to 5 families indicating a genetic basis for the disease (autosomal recessive). Non-pancreatectomized patients received frequent high carbohydrate feedings, raw cornstarch, diazoxide and/or somatostatin analogue (Sandostatin™, Sandoz, Switzerland, n=5). All 85-90% pancreatectomized patients (n=15) required some medical treatment for hypoglycemia post-operatively. Three patients died (2 of sepsis and 1 of acute gastric perforation). Diabetes developed only in the 1 patient who had a total pancreatecomy. Of 25 living patients, 16 entered remission between 0.3 & 8 years of age (follow-up 0.3-12 years, mean 5.5 years). Of the 22 living patients who were not retarded at diagnosis, 21 developed normally while 1 is retarded (IQ 65). Pathologic examination of 16 pancreata showed focal findings in 3, the rest being histologically normal for age. Beta-cells from 3 histologicaly normal pancreata were cultured on extra-cellular matrix and showed significant & unchanged insulin secretion at all levels of glucose tested (0-16.7 mmol), which suppressed with epinephrine or somatostatin and stimulated with IBMX or forskolin. In conclusion: PHHI appears to be caused by a functional β-cell defect, presumably genetic in origin, manifested by a lack of suppression of insulin secretion by low glucose, and which may resolve spontaneously with time. Intensive conservative treatment, with 85-90% pancreatectomy only when absolutely necessary, resulted in a good long-term prognosis in 95% of our patients in whom the diagnosis was made before the onset of neurologic damage.