Case Of Gastric Perforation Research Articles

A Case of Gastric Perforation Caused by Acute Short-Axis Volvulus in a Parkinson's Patient

A Case of Gastric Perforation Caused by Acute Short-Axis Volvulus in a Parkinson's Patient

Lightning strike: an unusual etiology of gastric perforation

Lightning strike is an unusual form of trauma in terms of being one of the leading causes of death from natural phenomenon. Lightning strike can cause severe damage to many systems and results in a high mortality. The most common cause of death in the lightning strike victim is cardiopulmonary arrest. The most vulnerable subjects for lightning strike are individuals who work in open fields, farmers, and swimmers. The cardiac and neurological injuries are the most serious injuries. Burns, tinnitus, blindness, and secondary blunt trauma have also been reported. Gastrointestinal complications have been documented very rarely. In this study, we present a case of gastric perforation after lightning strike. No report related to gastric perforation caused by lightning strike has been identified in the literature.

Gastric perforation caused by metastatic lung carcinoma

A case of gastric perforation caused by metastases of small-cell lung carcinoma in an 85-year-old man is reported. This complication revealed the neoplasm. Biopsy should always be done in patients with gastric perforations, even if there is no palpable tumor. Minimal surgery is warranted because this event occurs often in patients with advanced disease and poor prognosis.

An unusual cause of gastric perforation in childhood: trichobezoar (Rapunzel syndrome). A case report

Trichobezoars are hair balls found in the stomach and formed following trichitillomania and trichopaghia. Rapunzel syndrome is a rare condition in which the presence of giant trichobezoars causes mechanical obstruction. To date, only two cases of stomach perforation caused by trichobezoars have been reported among pediatric patients. We report a 14-year-old female patient who experienced nausea, vomiting and severe abdominal pain for 1 month. Physical examination revealed diffuse abdominal distension. Palpation detected a mobile and sensitive mass, 15 x 15 cm , which filled the upper quadrant. Urgent surgery revealed that the stomach was perforated by the trichobezoar ball. This trichobezoar mass was totally excised by expanding the perforation area. Conclusion This is the reported third case of gastric perforation caused by trichobezoar in a pediatric patient. Among acute abdominal cases, gastric perforation should remain a possibility in differential diagnosis.

Seven Cases of Gastric Perforation in Roux-en-Y Gastric Bypass Patients: What Lessons Can We Learn?

Patients undergoing Roux-en-Y gastric bypass for the resolution of morbid obesity have significant medical sequelae related to their weight. One of the most common comorbid conditions is joint pain requiring the use of non-steroidal anti-inflammatory medications (NSAIDs). In addition to NSAIDs, patients may engage in behaviors such as smoking and alcohol misuse that increase the risk of long-term postoperative complications to include gastric perforation. Data on 1,690 patients undergoing gastric bypass surgery were collected prospectively and reviewed retrospectively. We identified seven patients who presented to an emergency room and subsequently required emergent surgical intervention for repair of gastric perforation. Six of the seven cases involved use or abuse of NSAIDs. Important characteristics were identified including the use of NSAIDs, alcohol use, and non-compliance with routine long-term postoperative follow-up. Identifying those patients at high risk may decrease the incidence of this potentially life-threatening complication.

Late Gastric Perforations After Laparoscopic Fundoplication

Late complications are rarely encountered after laparoscopic Nissen fundoplication. These complications include acute gastric herniation through the esophageal hiatus, port-site herniation, recurrent reflux, and anatomic failure of the fundoplication. Only three cases of late gastric perforation after laparoscopic Nissen fundoplication have been reported, all associated with intrathoracic wrap herniation. We retrospectively reviewed all cases of gastric perforation after laparoscopic antireflux procedures performed between July 1991 and March 2002 by a single surgeon. In this series of 1,600 laparoscopic antireflux procedures, we found six delayed gastric fundal perforations occurring in three patients at 1, 41, 48, 51, 68, and 72 months after surgery. All the perforations were on the anterior wall of the fundus of the stomach and were distant from the stitches of the fundoplication. None of the perforations was associated with severe peritoneal contamination. This series of late gastric fundal perforations in 0.2% of our patients after laparoscopic fundoplication may have been caused by medications, gastric stasis, ischemia, or a foreign body such as a stitch or Teflon pledget.

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.

R-CHOP-14 in patients with diffuse large-B-cell lymphoma (DLBCL) younger than 70 years: A multicentric and prospective study

7592 Background: Several studies have shown that the addition of rituximab (R) to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisona), or shortening the interval between cycles of chemotherapy to two weeks, improves survival of patients with DLBCL. These studies prompted our group (GOTEL) to evaluate in a prospective study, the feasibility and efficacy of R-CHOP-14 in patients (pts) with DLBCL. Methods: Patients (younger than 70 years) with stage II bulky, III or IV DLBCL, and no significant co-morbidities were included in the study. R was administered on day 1 before chemotherapy. R-CHOP was recycled every 14 days. No antimicrobial prophylaxis was administered. All pts received filgrastim (5 μg/kg) from day +3 to +10. Pts received 6 cycles if CR was achieved after 3 cycles; those in PR, and those pts with bone marrow disease at diagnosis, received 8 cycles. Involved field radiation therapy was permitted for pts with stage II bulky disease. Results: From May 2002 to august 2004, 77 pts were included. Median age was 54 years (range, 15–70); 55 patients were younger than 60 years. According to the age adjusted International Prognostic Index (aaIPI), 13 pts (17%) had low risk disease, 27 pts (35%) low-intermediate risk, 29 pts (38%) high-intermediate risk, and 8 pts (10%) high risk disease. Grade 3–4 toxicity occurred as follow: neutropenia in 15 pts (19%), anaemia in 7 pts (9%), thrombocytopenia in 4 pts (5%), mucositis in 4 pts (5%) and peripheral neurotoxicity in 4 pts (5%). Ten pts were hospitalized (febrile neutropenia: 8 cases, one case of gastric perforation and one pulmonary embolism). After therapy, 61 pts (79%) achieved a CR/CRu (C.I. 95%: 57%-90%) and 14 pts (18%) a PR. 2 pts (3%) had refractory disease. With a median follow-up of 20 months, progression-free and overall survival at 24 months were 68% and 87%, respectively. Conclusions: Administration of R-CHOP-14 (with filgrastim support) is feasible and effective in patients younger than 70 years. [Table: see text]

Clinical Features of Complications From Transesophageal Echocardiography: A Single-Center Case Series of 10,000 Consecutive Examinations

Transesophageal echocardiography (TEE) is an essential diagnostic tool that has gained widespread use in clinical cardiology. It is considered reasonably noninvasive and safe; however, insertion and operation of the TEE probe may cause hypopharyngeal, esophageal, or gastric trauma. The current study reports a single-center experience of esophagogastric trauma in 10,000 consecutive TEE examinations. TEE examinations were performed by 9 attending physicians who were trained in endoscopic procedures and had been performing TEE studies for at least 1 year. One case of hypopharyngeal perforation (0.01%), 2 cases of cervical esophageal perforation (0.02%), and no cases of gastric perforation (0%) occurred after TEE examination. No fatalities (0%) occurred. We describe the clinical characteristics of individuals who experienced esophageal perforation during this 10-year period. This single-center study demonstrates that TEE examinations are associated with a very low risk of esophagogastric trauma when performed in a safe setting by experienced operators.

Videothoracoscopic talc poudrage pleurodesis for the treatment of malignant pleural effusions secondary to breast cancer

8216 Background: Metastatic breast cancer (mbc) is a most frequent reason of malignant pleural effusion(MPE) in women. The effective treatment of pleural fluid reaccumulation is a important aim in managment and paliative care of patients (pts) with mbc.The aim of this report is to evaluate the results of videothoracoscopic talc poudrage (TPP) pleurodesis secondary to mbc. Methods: Between November 1999 and December 2003, 57 pts with MPE with primary breast cancer uderwent videothoracoscopy (VATS). Clinical symptoms of MPE were observed in all pts and ECOG PS were:1–39pts, 2–16pts,3–2pts. Pleural fluid was a single site of mbc in 8 pts and was the first site of mbc in 24 pts. Median time from radiologic diagnosis to VATS was 34days (r 6–517). Histology of mbc was confirmed in 52pts(91%). Pleurodesis was performed with 5 g of sterile purified talc insufflated through a talc atomizer. One chest tube was left in pleural space until the fluid drainage was less than 200ml per postoperative day. 50pts were treated by systemic therapy after TPP. Results: No perioperative mortality was observed. We noted 7(12%) severe postoperative complications: 3 cases of acute respiratory failure,one case of heart failure one case of renal insufficiency, one case of pulmonary embolism and one case of gastric perforation. Averange hospitalisation was 6 days (3–51). We noted 6 cases of incomplete lung reexpansion (10%).It correlated with long time from radiologic to VATS diagnosis (over 6 mts). 51 pts (90%) had succesful pleurodesis and regresion of symptoms. In this group we observed 3 reccurences of effusion-after 2,3 and 7 mts. After a median follow-up of 10 mts (range 1–37), talc pleurodesis was succesful in controlling recurrence of effusion in 52 pts (91%). 35 pts died as a result of progression of mbc. 22 pts alive without recurrence of effusion. Overall survival (OS) at 6,12 and 24 mts was 65%, 52% and 28% and correlated with number of metastatic sites and PS. We noted better prognosis in pts with single metastatic site in pleura (median survival time 18 vs 8mts, p<0,001). Conclusions: TPP is an effective and safe method of lifelong pleurodesis in pts with mbc. It is able to help efficiency of systemic therapy and supportive care. No significant financial relationships to disclose.

Our experience with 250 laparoscopic adjustable silicone gastric bandings.

In 1999, after having performed more than 2500 open bariatric surgery procedures, we began to conduct the laparoscopic adjustable silicone gastric banding (LASGB) procedure. The purpose of this report is to present the results of our first 250 operations using this technique. The 250 patients included 212 females and 38 males. The mean age was 36 years (range, 16-62). The mean BMI was 44 (range, 35-76). Patients were selected in accordance with standard criteria. The mean follow-up time was 18 months (range, 3-24). Two hundred and forty procedures were completed by laparoscopy; conversion to open surgery was required in 10 cases. The mean operating time was 50 min (range, 20-145). There was no mortality. Perioperative complications included two cases of gastric perforation. Late complications included 13 cases of band slippage (5%), of which three involved penetration to the stomach, five cases of port disconnection (2%), and four cases of port site infection (1.5%). The mean weight loss at 12 months was 70% of the original excess weight. Most patients prefer laparoscopy as the surgical technique in the treatment of morbid obesity. Our initial experience with 250 operations confirms that this approach is as good as open surgery. The long learning curve is steep, requiring at least 100 cases to guarantee low complication rates.

‘Spontaneous’ neonatal gastric perforation: Is it really spontaneous?

Background/Purpose: Most historical reports have described gastric perforation in the neonatal population as “spontaneous.” More recently, several variables, including prematurity and nasal ventilation, have been implicated as contributing factors. The authors sought to analyze the etiology, course, and outcome of newborns with spontaneous gastric perforation from one institution over a 16-year period. Methods: The authors reviewed retrospectively the charts of all infants who underwent operation or had perforation of the stomach diagnosed in the newborn period. Results: Among more than 84,000 live births, 7 newborns were identified with perforation of the stomach. Four had coexisting gastrointestinal lesions (2 necrotizing enterocolitis, 1 undiagnosed tracheoesphageal fistula, 1 meconium plug), and 1 received nasal continuous positive airway pressure (CPAP). In only 2 cases were no other gastrointestinal lesions or other presumed contributing factors (nasal CPAP) present, and thus, only 2 cases could be classified as “spontaneous.” Mortality rate was 57%. Three of the patients were premature, all of whom died. Conclusions: Whereas in the older literature, most cases of gastric perforation were considered spontaneous, and were full term, the authors' review of 7 cases over a 16-year period leads us to question the cause as spontaneous. The authors found that prematurity and concomitant gastrointestinal lesions were associated with gastric perforation in the neonate and that few cases truly are spontaneous. The authors suggest that when gastric perforation occurs in neonates, a contributing cause should be sought. J Pediatr Surg 35:1066-1069. Copyright © 2000 by W.B. Saunders Company.

Non-Surgical Treatment with Primary Chemotherapy, with or without Radiation Therapy, of Stage I-II High-Grade Gastric Lymphoma

Morbidity, mortality and discomfort related to gastrectomy has led some investigators to treat patients with stage I-II primary gastric high-grade lymphoma (PGL) with a conservative strategy. Here we report a retrospective series of 21 patients with PGL treated with primary chemotherapy alone or followed by radiation therapy and analyze previously reported series, focusing on therapeutic results, treatment-related morbidity and stomach preservation rate. All 21 patients with stage I-II PGL received an initial anthracycline-containing chemotherapy, which was followed by involved field-radiation therapy in 8 cases. Data regarding toxic-ity, response and relapse rates and survival of this patient group and 14 previously published series, involving 316 patients treated with conservative modality, were also analyzed.In the present series two patients did not complete the planned treatment, while the remaining 19 achieved a complete remission (response rate: 90%). Three patients relapsed, all of whom had been treated with chemotherapy alone. Two patients died of lymphoma, one of sepsis and the other of lung cancer while still relapse-free. The survival rate at 50 months is 81%, and the 5-year actuarial cause-specific survival is 82%. The stomach preservation rate is 100%.Previously reported series showed a response rate ranged between 76% and 100%. Gastrointestinal bleeding was observed in only 3% of cases, while no cases of gastric perforation were reported. Treatment mortality rate was 2.5%. 5-year actuarial survival ranged between 73% and 90% and stomach preservation rate was 97%. Short-term chemotherapy obtained similar results to more prolonged treatment. In conclusion, conservative treatment with primary chemotherapy followed by involved field-radiation therapy should be used for the first-line treatment of patients with stage I/II PGL considering that it is associated with a high response and survival rates, and with an insignificant risk of bleeding or perforation, high stomach preservation rate and good quality of life.

Laparoscopic fundoplication and gastrostomy.

Fundoplication and gastrostomy are among the more common operative procedures performed in infants and children. This article reviews the techniques, results, and complications of the surgical treatment of gastroesophageal reflux in 389 consecutive pediatric patients over the last 5 years. Chronic unremitting vomiting, failure to thrive, and an array of pulmonary symptoms were the leading indications for fundoplication in these children. Children who eat by mouth were primarily treated by a Toupet fundoplication, whereas gastrostomy-fed children generally received a Nissen fundoplication. The time to perform fundoplication and gastrostomy in our patients averaged about 3 hours for the first 10 patients but required a little over 1 hour for the last 50 patients. Most patients were discharged by the second or third postoperative day. Recurrent symptoms have developed in about 5% of our patients. Five of the 201 children who received a Toupet fundoplication (partial wrap) have been converted to a complete wrap fundoplication. Two of the patients having a Nissen fundoplication have required reoperation for their symptoms. The primary complications were seven cases of transient dysphagia, one case of esophageal perforation, and one case of gastric perforation. Laparoscopic fundoplication seems to achieve results equivalent to open fundoplication and is associated with considerably less postoperative pain and morbidity as well as a more rapid recovery.

A Case of Gastric Perforation Associated with Concomitant Use of Nonsprescription Drug.

We describe a presumed case of drug-induced gastric perforation arising during treatment of rheumatoid arthritis in an outpatient. A 48-year-old male was given diclofenac sodium and misoprostol at the University Hospital. However, the patient also took two non-prescription drugs produced in Taiwan without the consent of his doctors or pharmacists for about three months. The patient was then admitted to another hospital due to upper abdominal pain. A diagnosis of peritonitis due to perforation of the digestive tract was made by thoracic and abdominal radiography, and extended gastrectomy was carried out. We detected indometacin and prednisolone from one non-prescription drug. From the findings, it was considered that the perforated gastric ulcer in this patient was induced by the concomitant use of a corticosteroid and NSAIDs. In this case, the adverse reaction might have been prevented by sufficient patient counseling about the medication. For high-quality and appropriate pharmaceutical care, the pharmacist must provide patient counseling about non-prescription as well as prescrintion drugs

Two Cases of Gastric Perforation Over 85 Year-old Age Saved by Gastrectomy

Two Cases of Gastric Perforation Over 85 Year-old Age Saved by Gastrectomy

Gastric erosion from alkali ingestion

A case of gastric perforation as a result of ingestion of Clinitest tablets is presented. The case is unusual in that the patient suffered alkaline injury to the stomach without esophageal involvement. Also, the injury in this case was that of severe necrosis and perforation of the antral greater curvature, which is uncommon. Although the containers of Clinitest tablets clearly indicate that the product is a poison, the extensive use of this material makes it readily accessible either for suicidal or accidental ingestion. To our knowledge there have been no previously reported cases of gastric injury without esophageal injury secondary to Clinitest ingestion.

12. 重篤な 4 つの合併症を伴った 1, 586g 未熟児の胃穿孔例(新生児消化管 I)

12. 重篤な 4 つの合併症を伴った 1, 586g 未熟児の胃穿孔例(新生児消化管 I)

Total Esophagogastric Replacement after Ingestion of Household Ammonia

THE ingestion of caustics, either suicidal or accidental, is a worldwide problem and by no means rare. Household-ammonia water, in contrast to lye, is a less commonly ingested agent, and severe complications are rare. Two cases of antral stricture have been reported by Norton.1 In addition he discussed 3 cases with complications that followed ingestion of ammonia. In the case reported below, swallowing of ammonia was followed by gastric necrosis, esophageal perforation and duodenal and jejunal strictures, with survival after three lifesaving operations. As far as we know no other case of gastric perforation after ingestion of alkali with survival . . .