Dilatation Of Stomach Research Articles

Wilkie’s syndrome: an uncommon cause of intestinal obstruction

A 10-year-old boy presented with 9 months history of gradually worsening, recurrent postprandial upper abdominal pain, bilious vomiting and loss of weight. On examination the child was undernourished, had epigastric fullness and succusion splash was positive. Ultrasonography of the abdomen suggested a massively distended stomach, while an upper gastrointestinal contrast study showed a hugely dilated stomach along with dilated first and second parts of the duodenum with abrupt cut off at the level of third part of duodenum. Contrast enhanced CT scan of the abdomen revealed dilatation of the second part of the duodenum without any obvious abnormality of the aorta-superior mesenteric artery angle. Upper gastrointestinal endoscopy showed retained fluid and food material within a dilated stomach and second part of the duodenum; scope could not be negotiated into the third part because of an extrinsic compression. The child was diagnosed to be suffering from Wilkie's syndrome. Exploratory laparotomy, performed when conservative management failed, revealed compression of the third part of duodenum by a shortened ligament of Trietz and dense peritoneal bands near the third part of duodenum. The duodenal obstruction was bypassed by performing duodenojejunostomy. The child had an uneventful postoperative recovery. He gained around 6.8 kilograms within next five months.

Severe Paraneoplastic Gastroparesis Associated with Anti-Hu Antibodies Preceding the Manifestation of Small-Cell Lung Cancer

Gastroparesis is a common but challenging disorder which can be idiopathic or induced by a variety of underlying diseases, most frequently by diabetes, or post-surgical conditions of the upper abdomen. Clinicians must also consider rare causes of gastric motor dysfunction, such as collagen vascular disorders and paraneoplastic syndromes. Here we present the case of a patient with severe gastroparesis, who was admitted to our hospital for vomiting and weight loss of 25 kg within four months. Endoscopy showed a dilated fluid-filled stomach without peristalsis but no obstruction. High titres of anti-Hu antibodies were detected in patient's serum, supporting the diagnosis of severe paraneoplastic gastroparesis with chronic intestinal pseudo-obstruction. Fine-needle aspiration of suspicious mediastinal lymph nodes guided by endoscopic ultrasound revealed lymphatic metastases of a small-cell lung carcinoma. Jejunal tube feeding and chemotherapy with carboplatin and etoposide were initiated. Paraneoplastic gastrointestinal dysmotility is rare, however, clinicians should consider this differential diagnosis in otherwise unexplained gastrointestinal motor dysfunction. The pathophysiology of paraneoplastic gastroparesis, the diagnostic relevance of anti-Hu antibodies as well as therapeutic options are discussed.

The outcome of gastroschisis after a prenatal diagnosis or a diagnosis only at birth: Recommendations for prenatal surveillance

Objectives To establish in infants with gastroschisis whether outcome is different when comparing a prenatal diagnosis with a diagnosis only at birth with the intention to develop a prenatal surveillance protocol. Intestinal atresia established after birth and preterm versus term delivery were studied as risk factors. Study design All 24 fetuses and 9 infants diagnosed with gastroschisis and referred to our tertiary center between January 1991 and June 2003 were studied retrospectively. Results The infants of the prenatal subset delivered at our tertiary center and 18 survived. There were two pregnancy terminations, three intrauterine deaths at 19, 33 and 36 weeks respectively and one neonatal death. All nine infants in the postnatal subset survived. Eight were out born and one was delivered at our tertiary center. Prenatal bowel dilatation did not correlate with outcome. Between the prenatal and postnatal subset no significant difference in outcome of live-born infants was established. For four infants with intestinal atresia a significant difference was demonstrated for induction of preterm labour ( P < 0.05), duration of parenteral nutrition ( P < 0.01), number of additional surgical procedures ( P < 0.001) and length of hospital stay ( P < 0.01). The fifteen infants born prior to 37 weeks of gestation spent a significantly longer period in hospital compared to those delivered at term. When the cases with bowel atresia were excluded this difference was no longer present. Five of the 33 cases were diagnosed with associated anomalies which mainly involved the urinary tract. Conclusion Neonatal outcome of live born infants following a prenatal diagnosis of gastroschisis is not different from a diagnosis at birth. The presence of intestinal atresia is the most important prognostic factor for morbidity. The supplemental value of prenatal diagnosis to the outcome of infants with gastroschisis may be in the prevention of unnecessary intrauterine death and detection of intestinal complications. A proposed surveillance protocol for fetuses with gastroschisis focused on intrauterine signs of pending distress such as a dilated stomach, intra abdominal bowel dilatation with peristalsis, notches in the umbilical artery Doppler signal, development of polyhydramnios and an abnormal CTG registration may improve outcome.

Die Bedeutung der elektronischen CTG-Analyse bei einem fetalen Volvulus in der 32. SSW

Intrauterine intestinal volvulus is a difficult diagnosis to make, but has life-threatening implications for the fetus. We present a case of vulvulus without malrotation in a single fetus revealed in the 32nd gestation week in a 44-year-old woman. The presenting complaint of this patient was reduced fetal movements. Ultrasound examination showed a normal result except for a dilated stomach. Doppler ultrasound results were within the normal range. Computed cardiotocography (CTG) showed pathological results for acceleration and suspect values for variability. Short-term variability (STV) was at 2.80 ms. Due to the pathological computed CTG results a Caesarian section was carried out. The newborn received prompt postnatal surgical treatment and continues to be in good overall condition.

Extreme gastric dilation caused by chronic lead poisoning: A case report

Lead is a toxic metal that affects many organ systems and functions in humans. In the majority of adults, chronic lead poisoning comes from exposures to work places and can occur in numerous work settings, such as manufacturing, lead smelting and refinement, or due to use of batteries, pigments, solder, ammunitions, paint, car radiators, cable and wires, certain cosmetics. In some countries, lead is added to petrol. We present a rare case of gastric dilation caused by long-term petrol ingestion. A 16-year-old young man was admitted to our hospital due to a 6-mo history of exhaustion, dizziness, nausea, abdominal cramps and constipation. X-ray examination revealed dilated stomach descending into the pelvis and small bowel distension. After a long clinical observation, we found that the reason for the chronic lead poisoning of the patient was due to a 3-year history of petrol ingestion. The patient spontaneously recovered and stomach returned to its normal position and size. Lead poisoning should be taken into consideration in all unexplained cases of gastric dilation.

Gastric dilation and intestinal obstruction in 76 rabbits

Eighty-four incidents of gastric dilation (bloat) were investigated in 76 pet rabbits, and an intestinal obstruction was confirmed in 64 of them. In 49 the obstruction was due to pellets...

Outcomes of Pregnancies With Fetal Gastroschisis

To describe pregnancy outcomes with fetal gastroschisis, including the associations of prenatal ultrasound findings with neonatal surgical complications and other morbidities. This was a review of pregnancies complicated by fetal gastroschisis and delivered from January 1998 through June 2006. The last ultrasonogram before delivery was reviewed to determine stomach dilatation, bowel dilatation, or abnormalities of amniotic fluid volume. Neonatal records were reviewed to determine type of closure and any bowel complications. There were 66 pregnancies with gastroschisis, 1 per 2,000 deliveries. There were three stillbirths and three neonatal deaths. Delayed closure was necessary in 49% who underwent surgery. Birth weight below the third percentile, which occurred in 38%, was associated with need for delayed closure, 64% compared with 25% without growth restriction, P<.001, but was not associated with longer hospital stay or neonatal death. Fetal gastroschisis was diagnosed by prenatal ultrasonography in 58 cases. Bowel complications requiring surgery were more frequent when ultrasonography had demonstrated stomach dilatation (five cases), 60% compared with 10%, P=.002. Fetuses with defects so large that no normal ventral wall could be visualized ultrasonographically (three cases) were at increased risk for neonatal death, 100% compared with 0%, P<.001. Ultrasound findings associated with adverse outcome in fetal gastroschisis included stomach dilatation and a defect so large that no normal ventral wall could be visualized. Fetal growth restriction was common, and such infants were more likely to require delayed gastroschisis closure. Despite more than 90% survival, morbidity with gastroschisis remains high. II.

Hiccups: A Subtle Sign of Gastric Volvulus?

Purpose: Volvulus is defined as an abnormal twisting of bowel upon itself resulting in luminal obstruction. This often occurs in the small intestine of pediatric patients with malrotation leading to obstruction. It is also seen in the large intestine, most commonly causing obstruction in the cecal and sigmoid regions. Another less common condition is gastric volvulus. Acute gastric volvulus is an emergency and an accurate timely diagnosis is essential. We present two cases of gastric volvulus where a major complaint of both patients was hiccups. These cases are reported to alert physicians to the possibility of hiccups as a subtle but important finding to suggest the diagnosis of gastric volvulus in the appropriate clinical setting. This is important because untreated gastric volvulus can potentially lead to incarceration and mesenteric ischemia with a high mortality. Results: Case 1: A 63 year old man presented with a one week history of nausea, vomiting, abdominal pain and progressively worsening hiccups. Physical exam showed some abdominal distention with mild diffuse tenderness. CT of the abdomen showed a distended, fluid-filled stomach with a twisting pattern consistent with an organoaxial gastric volvulus. Exploratory laparotomy showed a dilated stomach and paraesophageal hernia. Hernia repair was performed and the patient did well after surgery. Case 2: An 89 year old man presented with complaints of epigastric pain, nausea, vomiting, coffee ground emesis, and progressively worsening hiccups. Four months prior, an EGD had shown the presence of a large hiatal hernia. Presenting symptoms and known history of hiatal hernia suggested a possible diagnosis of gastric volvulus. Abdominal CT was consistent with a mesenteroaxial gastric volvulus confirming our clinical diagnosis. The patient was taken to the operating room, and a laparoscopic reduction of his gastric volvulus was performed. Conclusion: Gastric volvulus is an uncommon but potentially devastating condition if not diagnosed in a timely manner. In 1904 Borchadt described the classic triad of epigastric pain, retching and inability to pass a nasogastric tube in patients with a gastric volvulus. In our cases, an interesting finding was the presence of hiccups in both patients. Irritation of the diaphragm by a sliding gastric volvulus or paraesophageal hernia could theoretically trigger hiccups. In the presence of signs and symptoms suggestive of gastric volvulus, it may be appropriate for physicians to inquire about the presence of hiccups while obtaining the patient's history.

Duodenal atresia in an infant with triple‐X syndrome: A new associated malformation in 47,XXX

An association between the triple-X syndrome (47,XXX) and gastrointestinal malformations is extremely rare. Most 47,XXX patients present with a normal phenotype, but genitourinary malformations have been described. We report a case of a child with 47,XXX and duodenal atresia. Antenatal ultrasound scan showed a dilated fetal stomach and upper part of the duodenum (double bubble phenomenon) at 31 weeks of gestation in a 31-year-old woman with polyhydramnion. The amniotic fluid karyotype showed 47,XXX. After a scheduled delivery, duodenal atresia was confirmed and treated with duodeno-duodenostomy. The possible association of gastrointestinal and genitourinary tract anomalies requires a detailed postnatal clinical investigation and ultrasonographic examination of the abdomen, retroperitoneum, and pelvis on all triple-X syndrome patients.

Imaging diagnosis of two unusual forms of gallstone ileus

ileus caused by gallstone has become more and more common recently due to popular usage of computed tomography (CT) and magnetic resonance imaging (MRI). In the past, imaging diagnosis relied primarily on conventional radiography and contrast-enhanced fluoroscopy. 1 CT has subsequently been shown to be quite useful for this diagnosis. 2,3 Recently, MR cholangiopancreatography (MRCP) has emerged as a valuable noninvasive technique for evaluation of biliary disease. Here we described the CT, MRCP and gastroenterography findings in two patients with unusual form of gallstone ileus (GI), one is Bouveret's syndrome and the other is negative gallstone-induced ileus. Few reports about GI with angiografin and MRCP findings of Bouveret's syndrome has been published. 3-8

Gastro-ileal Stenosis and Gastroparesis after a Biliopancreatic Diversion

Biliopancreatic diversion (BPD) is a very effective bariatric operation particularly for super-obese patients (BMI > or = 50 kg/m(2)). We present the development of a stricture at the gastro-ileal anastomotic site, with subsequent dilatation and aperistalsis of the stomach in a female patient who had undergone a standard open Scopinaro BPD. The patient remained symptomatic and persisted in losing weight, despite endoscopic balloon dilatations of the stricture and surgical revision of the anastomosis. She finally underwent conversion to a standard Roux-en-Y proximal gastric bypass. We describe the development of the stricture after the use of the stapling gun, subsequent gastric dilatation and dysmotility.

Characterization of Bouveret's Syndrome: A Comprehensive Review of 128 Cases

The aim of the study was to characterize the clinical presentation, evaluation, and therapy of Bouveret's syndrome, by comprehensively reviewing all the identified previously reported cases, to facilitate early diagnosis and thereby to improve the prognosis. Relevant articles were identified by MEDLINE computerized searches, by consultation with all available reference books, and by review of the first author's teaching files. A new case in which the diagnosis of Bouveret's syndrome was missed at esophagogastroduodenoscopy (EGD)--despite endoscopic findings of gastric outlet obstruction caused by a hard, nonfleshy, and convex pyloric mass--prompted this review. Review of 128 reported cases identified syndromic characteristics. Patients on average were 74.1 +/- 11.1 (SD) yr old. The female-to-male sex ratio was 1.86. Prominent symptoms were nausea and vomiting in 87%, abdominal pain in 71%, hematemesis in 15%, recent weight loss in 14%, and anorexia in 13% of patients. Prominent signs were abdominal tenderness in 44%, signs of dehydration in 31%, and abdominal distention in 26% of patients. Endoscopy revealed gastroduodenal obstruction in nearly all cases, but identified the obstructing stone in only 69%. Abdominal ultrasound or computerized tomography was diagnostic in about 60% of cases. The following endoscopic findings are suggestive of Bouveret's syndrome: a dilated stomach containing old digested food from gastrointestinal obstruction together with a hard and nonfleshy mass at the obstruction. These endoscopic findings, in the setting of the currently reported characteristic epidemiologic and clinical findings, should strongly suggest this syndrome. Abdominal ultrasound or computerized tomography is recommended to confirm and extend the endoscopic diagnosis.

Estimation of morbidity risk in aged patients undergoing resections of esophagus carcinoma and gastric cardiac carcinoma using physiological and operative severity score

To test the clinical validity of physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) in aged patients undergoing resections of esophagus carcinoma and gastric cardiac carcinoma. POSSUM was used in 167 aged patients undergoing esophagus carcinoma and gastric cardiac carcinoma resection. The physiological score and the operative severity score were compared between the groups with and without postoperative complications. The morbidity rates were calculated. Observed morbidity rates were compared with the rates predicted by POSSUM. Seventy-six of the 167 patients suffered from postoperative complications. The physiological score of the group with complications was 16.75 +/- 0.4, significantly higher than that of the group without complications (15.4 +/- 0.3, P < 0.0017). The number of the patients with complications predicted by POSSUM was 70, not significantly different from the observed number of the patients with complications (78, P = 0.378). There were 94 person-times of complications in these 78 patients, 12 being with hypertension, 37 with arrhythmia; 5 with asthma; 3 with febrile; 2 with pneumonia; 1 with atelectasis; 1 with respiratory failure; 3 with wound infection; 3 with wound liquefaction; 2 with anastomotic leakage; 6 with phlebitis; 2 with pneumothorax; 2 with acute dilatation of stomach; 1 with chylothorax; 2 with hemorrhage; 1 with cardiac failure; 1 with infectious shock; 2 with empyema; 2 with deep vein thrombo-embolism; 1 with pulmonary infarction; 1 with cerebral infarction; 1 with urinary infection; and 1 with psychiatric symptom. The POSSUM makes satisfactory prediction of postoperative morbidity in aged patients undergoing esophagus carcinoma and gastric cardiac carcinoma resection. Intensive monitoring and organ supporting therapy after the operation according to the score is of great benefit to decrease the post-operative complications.

Early removing gastrointestinal decompression and early oral feeding improve patients' rehabilitation after colorectostomy

To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma. Three hundred and sixteen patients submitted to operations associated with colorectostomy from January 2004 to September 2005 were randomized to two groups: In experimental group (n=161), the nasogastric tube was removed after the operation from 12 to 24 h and was promised immediately oral feeding; In control group (n=155), the nasogastric tube was maintained until the passage of flatus per rectum. Variables assessed included the time to first passage of flatus, the time to first passage of stool, the time elapsed postoperative stay, and postoperative complications such as anastomotic leakage, acute dilation of stomach, wound infection and dehiscense, fever, pulmonary infection and pharyngolaryngitis. The median and average days to the first passage of flatus (3.0+/-0.9 vs 3.6+/-1.2, P<0.001), the first passage of stool (4.1+/-1.1 vs 4.8+/-1.4, P<0.001) and the length of postoperative stay (8.4+/-3.4 vs 9.6+/-5.0, P<0.05) were shorter in the experimental group than in the control group. The postoperative complications such as anastomotic leakage (1.24% vs 2.58%), acute dilation of stomach (1.86% vs 0.06%) and wound complications (2.48% vs 1.94%) were similar in the groups, but fever (3.73% vs 9.68%, P<0.05), pulmonary infection (0.62% vs 4.52%, P<0.05) and pharyngolaryngitis (3.11% vs 23.23%, P<0.001) were much more in the control group than in the experimental group. The present study shows that application of gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications. On the contrary, it may increase the incidence rate of fever, pharyngolaryngitis and pulmonary infection. These strategies of early removing gastrointestinal decompression and early oral feeding in the patients undergoing colorectostomy are feasible and safe and associated with reduced postoperative discomfort and can accelerate the return of bowel function and improve rehabilitation.

Fatal outcome from extreme acute gastric dilation after an eating binge

A 22-year-old woman is presented with acute gastric dilation after an eating binge, who died of complications of acute reperfusion syndrome. A young patient was admitted in our clinic with critical condition without any significant previous medical history. Her initial complaints--diarrhea, vomiting and abdominal pain--began after an enormous food intake. There was no history of medications or toxic substances. Physical examination showed a normally-developed, well-nourished female in severe distress with an extremely distended abdomen. Femoral pulses were absent. The US and CT scan showed a dilated stomach, extended into the pelvis, dislocating the intestinal organs and compressed the aorta and mesenteric veins. Urgent laparotomy was performed. An enormously distended stomach was encountered without volvulus, obstruction or adhesions. About 11 liters of gastric content was removed gastrotomy and nasogastric tube. Following the gastric decompression, the mesenteric and femoral pulses reappeared. During the operation, the cardio-respiratory status was stabilized, but in the following 24 hours irreversible shock developed, possibly due to the reperfusion of the retroperitoneal organs and the lower extremities. In the postoperative period disseminated intravascular coagulopathy developed. In an uncontrollable state of diffuse bleeding, 36 hours post-operation, the patient died. In retrospective investigation, the family confessed that previous psychological treatments which aimed at her bulimic attacks. Acute gastric dilatation is very uncommon and is of various etiologies, two of these being anorexia nervosa and bulimia. Several cases documenting complications of gastric dilatation were published; however, such severe complications, involving gastric infarction and compression of the aorta with ischemic injury of the bowels and lower extremities, are rare.

Gastric Dilatation Secondary to Diabetic Autonomic Neuropathy

A 75-year-old woman was admitted to the hospital due to severe nausea and vomiting. she had a 12-year history of type 2 diabetes with erratic glucose control complicated by severe bilateral retinopathy and peripheral neuropathy. Symptoms of bloating had developed during the previous several months. A plain abdominal radiograph showed a very dilated stomach (arrows) occupying most of the abdomen. A nasogastric tube was inserted, which decompressed her stomach and relieved her acute symptoms. She underwent placement of a percutaneous endoscopic gastrostomy tube with jejunal extension for the management of symptoms. Two weeks later, she died of complications from aspiration . . .

Acute dilatation of the stomach after vagotomy.

Acute dilatation of the stomach after vagotomy.

Annular Pancreas Causing Duodenal and Biliary Obstruction

Purpose: The incidence of annular pancreas is about 1:20,000. It is a congenital abnormality of pancreatic tissue that circles the duodenum and is of ventral pancreas in origin. Its most common presentation is of duodenal stenosis, peptic ulceration, and pancreatitis. In this rare case we will present a patient who presents with both duodenal obstruction and biliary obstruction. Methods: Case: A 42 y/o male with past medical history significant for diabetes and hypertension presents with a three day history of intractable nausea and vomiting. On admission patient was in acute renal failure with a creatinine of 1.7. He was also jaundiced with a total bilirubin of 12.2 mg per dL and a conjugated fraction of 9 mg per dL. Other laboratory testing revealed an AST of 149 U/L, an ALT of179 U/L, an Alkaline Phosphatase of 103 U/L, and an albumin of 2.2 mg per d/L. An abdominal series revealed air fluid levels in the distal stomach and the fundus. A CT scan was then performed that revealed a 1.5 cm common bile duct, a 7 mm pancreatic duct, a dilated stomach with no filling of contrast into the duodenum. No mention was made of annular pancreas. An EGD was performed to evaluate for gastric outlet obstruction. This revealed a massively dilated duodenum with a stenotic area in the second portion of the duodenum proximal to the ampulla. This stenosis made ERCP impossible. Annular pancreas was suspected at this time and the patient was taken to surgery for a bypass operation. Results: Discussion: Annular pancreas has a bimodal presentation, the first peak being in neonates and the second being in the fourth and fifth decades of life. Trisomy 21, duodenal atresia, tracheoesophageal fistula, and cardiorenal abnormalities have an association with annular pancreas. Because the pancreatic tissue often extends into the duodenal wall and may contain a large pancreatic duct, symptomatic cases of annular pancreas are best treated by surgical bypass rather than surgical resection. Conclusions: This case illustrates the importance of suspecting annular pancreas when patients present with either duodenal stenosis or biliary obstruction even if ct scan findings are negative.

Late-onset primary gastric outlet obstruction—an unusual cause of growth retardation

We describe our experience of 2 children and review 6 previously reported cases of late-onset primary gastric outlet obstruction. The patients presented with abdominal pain, recurrent nonbilious vomiting, and growth retardation after a variable period of normal food intake. There was no history of peptic ulceration and corrosive ingestion. Barium meal showed dilated stomach with delayed gastric emptying. Exploration demonstrated dilated stomach with no intrinsic or extrinsic mechanical obstruction at the pylorus. Heineke-Mikulicz pyloroplasty was curative. Patients improved postoperatively and started thriving. We propose etiology and the term pyloric achalasia for this late-onset functional gastric outlet obstruction.

Vagal afferent discharge in sleeve gastrectomy

Purpose: The vagus autonomic reflexes elicited by stomach dilation and presence of food may control satiety. Sleeve gastrectomy effectively reduces excess weight; however, the physiology remains unclear. We analyzed the activity of the vagal nerve in response to stomach distension after creation of a proximal gastric pouch and sleeve gastrectomy.