Gastrojejunostomy Stoma Research Articles

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Jejunogastricintussusception through a gastrojejunostomy stoma is one of the rarest complications of the previous gastric surgery. The incidence is reported to be less than 0.1%. An elderly male presented to the hospital with h/o vomiting, pain in abdomen since 10 days. The patient was undergone upper G I Scopy and CT scan abdomen as a suspected c/o carcinoma stomach. A primarily healed midline scar from the previous surgery for large duodenal perforation. On exploration it was found that there was a mass in the stomach, which on gastrotomy revealed gangrenous jejunal loops herniated through previous stoma. Gangrenous jejunum was resected and Billroth II was done. KEYWORDS: Jejunogastric, intussuception, gangrenous, gastrojejunostomy. INTRODUCTION: Jejunogastric intussusception (JGI) is a rare complication of gastrectomy with an incidence of 0.1%. It usually presents with severe epigastric pain, vomiting, and hematemesis. A history of gastric surgery can help in making an accurate and early diagnosis, which calls forth an urgent surgical intervention. Only reduction or resection with revision of the previously performed anastomosis is the choice which is decided according to the operative findings. We present a case of JGI in a patient with a history of operation for large duodenal perforation 6 yrs back. At emergent laparotomy, an efferent loop Jejunogastricintussuception was found. Due to necrosis, resection of the intussuscepted bowel with Roux-en-Y anastomosis was performed. Postoperative recovery was uneventful. A mortality rate of 10% and even as high as of 50% has been reported if surgical intervention has been delayed, (5, 6) therefore, early diagnosis of this condition is mandatory. Although a history of gastric surgery may help in making such a diagnosis, preoperative awareness of this condition has been reported to be difficult in most of the cases.

Jejunojejunal intussusception with internal herniation in the stomach.

Jejunojejunal intussusception with internal herniation of the stomach through a gastrojejunostomy stoma is one of the rarest complications of the previous gastric surgery. The incidence is reported to be less than 0.1%. An elderly male presented to the emergency room with signs of intestinal obstruction for 1day. There was also history of appearance of a lump in the mid-abdomen. A primarily healed midline scar of the previous surgery was present; the details of which were not known. X ray abdomen in the erect posture showed multiple air fluid levels. Ultrasonography (USG) revealed dilated stomach with central hyperechogenicity with a peripheral rim of decreased echogenecity. Contrast-enhanced computed tomography (CECT) scan showed jejunojejunal intussusception with internal herniation of the stomach. On laparotomy, it was found that there was a previous gastrojejunostomy with jejunal invagination leading to gangrene of a segment. Resection anastomosis was done. The postoperative period was uneventful.

Isolated corrosive pyloric stenosis without oesophageal involvement: An experience of 21 years

Background and study aims Corrosive ingestion is common in Asia and it is a frequent cause of morbidity secondary to intense fibrotic reaction and stricture formation of the oesophagus. Isolated corrosive pyloric stenosis without oesophageal involvement is an uncommon phenomenon. Patients and methods All consecutive patients, with corrosive ingestion in the last two decades, were reviewed and analysed. Eleven out of 201 patients with corrosive ingestion had isolated gastric outlet obstruction. Results Patients’ age ranged from 11 to 29 years with a male:female ratio of 1.75:1. All patients developed pyloric stenosis following ingestion of solution of acids. Barium study revealed complete/near-complete gastric outlet obstruction in all patients. On laparotomy, there was gastric dilatation in 10 patients, who underwent posterior gastrojejunostomy, whereas the stomach was contracted in one patient, and hence anterior gastrojejunostomy was performed. Seven patients were completely relieved of their symptoms; persistent postprandial epigastric fullness and/or dyspepsia was observed in four patients whose gastrojejunostomy stoma was found adequate on barium study, suggestive of gastric motility disorder. We did not encounter gastrojejunostomy-related complication of stomal ulcer/stenosis in our patients. Conclusion Isolated corrosive pyloric stenosis is not as rare as is commonly thought. Gastrojejunostomy is effective, although a fair percentage of patients appear to develop gastric motility disorder secondary to corrosive injury.

The Micropouch Gastric Bypass: Technical Considerations in Primary and Revisionary Operations

Roux-en-Y gastric bypass is an effective procedure for the long-term control of morbid obesity. An eventual revisionary operation, however, is necessary for some patients (0.8-29%). Redo procedures are required for pouch enlargement, staple-line dehiscence, or marginal ulceration. In 1994, the micropouch gastric bypass (MBG) was developed to eliminate the need for a repeat operation. Its design was based on two anatomical principles: 1) The fundus is elastic, aperistaltic, and may significantly dilate over time; 2) The proximal magenstrasse contains a high concentration of parietal cells, which potentiates the risk for marginal ulceration or gastroesophageal reflux after vertical pouch restriction. Construction of a micropouch limited to the gastric cardia avoids using the fundus and proximal lesser curvature, but requires a greater mobilization of the stomach and its peritoneal attachments. Between February 1994 and February 2000, 1,120 patients underwent the MGB as a primary or revisionary operation. The fundus was mobilized completely, including transection of the left phreno-esophageal and gastrophrenic ligaments. The transected pouch was limited to the gastric cardia with 1 cm of fundus incorporated into the gastrojejunostomy stoma (GJS). There were 10 anastomotic leaks at the GJS (0.9%). All leaks sealed following surgical drainage or parenteral nutrition. One patient required re-operation (0.09%) for a dilated pouch and marginal ulceration. An additional patient (0.09%) developed a gastrogastric fistula secondary to a pharmacobezoar and stomal stenosis. With an appreciation for the finer anatomy of the proximal stomach and intra-abdominal esophagus, the micropouch can be constructed safely in both primary and redo procedures. The MGB, now in its seventh year, is durable and has, with rare exception, eliminated pouch enlargement, staple-line separation, reflux esophagitis, and marginal ulceration.

Prolapsed gastric mucosa through a gastrojejunostomy.

PROLAPSED GASTRIC MUCOSA THROUGH A GASTROJEJUNOSTOMYWILLIAM B. SEAMAN, M.D.Audio Available | Share

Retrograde Jejunogastric Intussusception: A Case Report

Jejunogastric Intussusceptions is a rare but potentially life threatening complication of a previous gastrectomy or gastrojejunostomy. A 70 years old man presented with severe epigastric pain followed by haematemesis, 8 years after truncal vagotomy and gastrojejunostomy for pyloric stenosis. Ultrasonography revealed dilated stomach with a large intragastric mass which has minimal peristaltic movement. Endoscopy of upper GIT revealed prolapsed segment of jejunal loops through the gastrojejunostomy stoma. Laparotomy disclosed a retrograde type II jejunogastric intussusception and was managed by reduction of jejunogastric intussusception, resection of gangrenous segment and end to end anastomosis. Post operative recovery was uneventful. Retrograde jejunogastric intussusceptions is a rare condition and around 200 cases has been reported since its first description in 1914. Urgent recognition and surgical treatment is mandatory to reduce the mortality rate from this complication. Key words: Retrograde Jejunogastric Intussusception; gastrojejunostomy; gastric surgery. DOI: 10.3329/fmcj.v5i1.6812Faridpur Med. Coll. J. 2010;5(1):32-34

Jejunogastric Intussusception: an Unusual Cause of Haematemesis

Intussusception most commonly occurs in children and is rare in adults, accounting for only 5% of all cases of intussusceptions. Intussusception following gastric surgery is an extremely rare postoperative complication. We present a case where following gastrojejunostomy with truncal vagotomy a retrograde intussusception of the efferent limb into the gastrojejunostomy stoma occurred. The intussusception was well visualized by upper GI endoscopy prior to surgery. Exploratory laparotomy was done within 24 hours after the onset of the symptoms. After resection of loop of intussusceptum, gastrojejunostomy and jejunoileostomy was done. Keywords: Intususception, Intestinal invagination, Jejunogastric intussusception DOI:10.3329/jom.v11i1.4282 J Medicine 2010: 11: 86-89

胃リンパ路廓清術後の修復に関する実験的研究

1) The lymphatics and lymph nodes which concerned the drainage of the certain parts of the stomach were visualized with dye solution and removed in nineteen adult mongrel dogs. About two months after the operation, the reparation of the lymph drainage of the stomach was precisely studied.2) Oedema was never seen in the stomach or in the other viscera which had been drained by the removed lymph paths. In the operated sites, the tissue loss had been replaced with scar, and neither lymph cyst nor lymphrrhoe was seen.3) The removed lymph routs were, in general, reconstructed in those normal courses which had been visualized preoperatively, such as the left gastric, the right gastric, the right gastroepiploic, the left gastroepiploic and the fundic rout. However, the lymph drainage through the right gastric rout was seldom reconstructed.4) Usually the lymph drainage was repaired postoperatively through the normal routs. Sometimes, abnormal routs appeared besides the normal routs.5) Most of the postoperative routs were reconstructed in the preoperative course, but a few were visualized only postoperatively, which had not been visualized preoperatively.6) The reconstruction of the preoperatively visualized routs was established by opening of traversing paths through the operated site or of circumventing paths in the pre-existing net of lymphatics. After removal of the lymph paths adjacent to the stomach the reconstruction depended mainly upon circumvention, while after removal of the distant lymph paths mainly upon opening of traversing paths. Commonly to both types of removal, the lymph drainage was reconstructed usually in the original courses as to the regions distal and proximal to the removed site.7) Postoperative opening of the normal routs which had not been visualized preopeoatively was established through circumvention of the removed site via the pre-existing net of anastomosing lymphatics in the stomach wall.8) In the postoperative lymph paths through the normal routs, visualization showed often such morphologic changes of lymphatics as increase in number and dilatation and retrograde migration of dye. These changes appeared to respond to increased resistance in lymph flow.9) Abnormal lymph rout through anastomosing lymphatics, usually not visualized but pre-existing, appeared infrequently. Some of the lymphatics which drained the greater curvature side of the body via the left gastroepiploic rout passed onto the spleno-mesenteric ligament, a part of the greater omentum, and reached to the middle colic lymph nodes.10) When adjacent organs adhered to the removed sites, new formation of connection between the gastric lymphatics and the lymphatics of the adherent organs appeared in an higher percentage only in firm adhesions, and never in loose adhesions. New connection of lymphatics between the gastric remnant and the anastomosed jejunum through gastrojejunostomy stoma was infrequently visualized. Several abnormal lymph routs were established through such new formation of connection between the lymphatics of adherent organs. Of these new routs, the ones through the pancreas, the anastomosed jejunum or the posterior leaf of the greater omentum terminated in the truncus intestinalis or in the rete intestinale, and the one via the right costal part of the diaphragm passed through the sternal lymph node.

Carcinoma at the Margin of the Gastrojejunostomy Stoma Review of the Literature and Report of a Case

Carcinoma at the Margin of the Gastrojejunostomy Stoma Review of the Literature and Report of a Case

The effect upon free hydrochloric acid production of Heidenhain pouches with variation in size and position of a gastrojejunostomy stoma

Under the conditions of this experimental study we found that there was only a moderate increase in Heidenhain pouch secretion following a low antral gastrojejunostomy if the stoma was constructed 2 cm. in diameter. If, however, the gastrojejunostomy stoma was constructed 4 cm. in diameter, there was a marked increase. The average increase in secretion of free hydrochloric acid from the Heidenhain pouch when stimulated by a 2 cm. diameter gastrojejunostomy stoma was 43.3 per cent. For a 4 cm. stoma the similar average was 144.9 per cent, or over three times as much. If the 34.3 per cent increase produced by multiple operations alone is considered, this difference is even greater.