Perforated Gastric Ulcer Research Articles

Liver Involvement by Perforated Peptic Ulcer: A Systematic Review.

Background and Objective:Liver penetration by a confined perforation of peptic ulcer is a rare but severe event. Its clinical and pathological features are unclear.Methods:In total, 41 qualified English publications were identified using the PubMed database and one in-house case.Results:Among the 42 patients, 20 patients had liver involvement by a perforated duodenal ulcer and 22 by a gastric ulcer. Among the 23 cases of known ulcer histology, 2 ulcers were malignant and were adenocarcinomas in the gastric remnant and the remaining 21 ulcers were confirmed as histologically benign (for frequency of malignancy in duodenal versus gastric ulcers, p = 0.48). The presence of hepatocytes was the clue of diagnosis for 19 cases. The median ages of the patients were 64.5 years (95% Confidence Intervals [CI] 53.40–71.90) for duodenal ulcer and 65.5 years (95% CI: 59.23–70.95) for gastric ulcer, respectively. The male to female ratio was 1.5:1 for duodenal ulcers and 2:1 for gastric ulcers. Patients with liver involvement of a perforated gastric ulcer were more likely to have a larger ulcer (median largest dimension, 4.75 cm versus 2.5 cm, p = 0.014). Female patients with liver involvement of a gastric ulcer were older than male patients (median age 72 versus 60 years, p = 0.045). There were no differences in gender, region (Asia, Europe, America versus others), use of non-steroidal anti-inflammatory drugs (n = 15), H. Pylori positivity (n = 10), possible history of peptic ulcer disease (n = 19) or mortality (n = 32) between duodenal and gastric ulcers.Conclusions:Careful histologic examination, clinicopathological correlation, and immunohistochemistry are critical to establish the diagnosis and avoid misdiagnosing liver involvement as malignancy.

Valentino Syndrome: an uncommon cause of acute abdomen. Case Report

BACKGROUND: Valentino’s syndrome is secondary to a perforated peptic ulcer, which could be located in the stomach or the duodenum, patients present with clinical features that suggest acute appendicitis, with localized peritonitis. There are few case reports about this syndrome worldwide and no one submitted in Ecuador. It is essential to transmit this clinical case for the knowledge of the medical- scientific community. CASE REPORT: A 63-year-old male patient came to the emergency department with abdominal pain, located in the right iliac fossa, that began 12 hours ago, associated to peritoneal irritation signs and hemodynamic decompensation; suggestive of peritonitis. An exploratory laparotomy was performed. EVOLUTION: During exploratory laparotomy, no inflammatory changes were identified in the appendix. After abdominal cavity exploration, a perforated gastric ulcer was found. Primary raffia was stitched in two planes, incidental appendectomy and lavage of the abdominal cavity were performed. The patient had a successful recovery; and was discharged after 7 days at hospitalization. CONCLUSION: The perforation of a peptic ulcer can generate right iliac fossa pain, simulating acute appendicitis due to its clinical similarity. The medical team should consider Valentino’s Syndrome as an important differential diagnosis during the evaluation of a patient that arrives to the emergency room with abdominal pain, suggestive of appendicitis. KEYWORDS: ABDOMINAL PAIN, ILIUM, APPENDICITIS, PEPTIC ULCER PERFORATION, ABDOMEN ACU-TE, PERITONITIS

Abstract 15305: Gastric Ulcer Perforation Mimicking Inferoposterior ST Elevation Myocardial Infarction on Electrocardiogram

Introduction: ST elevation myocardial infarction (STEMI) and gastric perforation are emergencies with progressively higher mortality without emergent intervention. Here we present a case of gastric ulcer perforation presenting as an apparent inferoposterior STEMI. Case: A 63-year-old male with hypertension presented with two days of intermittent abdominal pain. While awaiting imaging, the patient developed acute inferoposterior STEMI (figure 1). In route to the cardiac catheterization lab, abdominal CT was emergently reported as gastric ulcer perforation (figure 2). Incorporating multidisciplinary discussions with the cardiac critical care attending, interventionalist, and surgeon, exploratory laparotomy was pursued instead of cardiac catheterization, and the perforation was repaired. Repeat EKG after surgery showed resolution of ST elevations (figure 3) and serial troponins were negative. With no evidence of coronary ischemia, further workup was deferred. Conclusion: The unique aspects of this case include how an acute intra-abdominal process can mimic an inferoposterior STEMI and a rapid multidisciplinary approach to decision-making facing two potential concurrent emergencies that was potentially life-saving.

S3594 The Way to a Man’s Heart Is Through His Stomach

INTRODUCTION: ‘Pneumoperitoneum’ is the accumulation of free gas in the peritoneal cavity. Common causes include ventilator-induced barotrauma, bowel perforation, endoscopic procedures and abdominal surgeries. Tension pneumoperitoneum (TPP) is the acute excessive accumulation of free gas resulting in venocompression and cardiovascular compromise. We present an unusual case of TPP that could have led to cardiac arrest. CASE DESCRIPTION/METHODS: 64-year-old man with history of alcohol abuse and abdominal pain for 2 days was brought to ER after he was found collapsed at home with last known normal 20 minutes prior. CPR was initiated and EMS was called. EMS noted empty beer cans near the patient. He was resuscitated per ACLS protocol and ROSC was achieved. On ER examination, patient was unresponsive, in shock and with a tensely distended abdomen. Labs showed AST 435 units/L, ALT 236 units/L, lactic acid 13.4 mMol/L, alcohol level 19 mg/dL and ammonia 155 mcg/dL. CXR demonstrated air under diaphragm bilaterally (Figure 1). CT showed large pneumoperitoneum, free fluid and compressed IVC (Figures 2a and 2b). He underwent emergent laparoscopy. Intra-abdominal pressure was 28 mmHg using an indwelling foley catheter with an initial release of gas during laparoscopy. He was found to have a large 1.5 cm perforated gastric ulcer which was repaired. Patient had multiorgan dysfunction but was stabilized in ICU. However, he did not awaken and was declared brain dead 3 days after admission to hospital. DISCUSSION: We hypothesize that our patient had TPP causing severe abdominal compartment syndrome leading to cardiovascular collapse and cardiac arrest. The rapid deterioration culminating in arrest suggests a mechanical component to the arrest rather than a pure hypovolemic and inflammatory state. Radiologic findings of a large pneumoperitoneum compressing the abdominal viscera as well as the IVC have previously been described with TPP. Smet et al described a case like ours of spontaneous TPP presenting with cardiac arrest. In such cases emergent needle decompression can be lifesaving.Figure 1.: demonstrating CXR finding of air under diaphragm bilaterally (Yellow arrows).Figure 2a.: (Axial view) demonstrate CT scan findings of a large pneumoperitoneum (yellow arrows) compressing the abdominal viscera and IVC into a central mass (blue arrows) with free fluid in the peritoneal cavity (red arrows).Figure 2b.: (Sagittal view) demonstrate CT scan findings of a large pneumoperitoneum (yellow arrows) compressing the abdominal viscera and IVC into a central mass (blue arrows) with free fluid in the peritoneal cavity (red arrows).

Epidemiology of perforating peptic ulcer: A population-based retrospective study over 40 years.

BACKGROUNDThe incidence of peptic ulcer disease has decreased during the last few decades, but the incidence of reported peptic ulcer complications has not decreased. Perforating peptic ulcer (PPU) is a severe form of the disease.AIMTo assess trends in the incidence, presentation, and outcome of PPU over a period of 40 years.METHODSThis was a single-centre, retrospective, cohort study of all patients admitted to Levanger Hospital, Norway, with PPU from 1978 to 2017. The patients were identified in the Patient Administrative System of the hospital using International Classification of Diseases (ICD), revision 8, ICD-9, and ICD-10 codes for perforated gastric and duodenal ulcers. We reviewed the medical records of the patients to retrieve data. Vital statistics were available for all patients. The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable, and sex, age, and calendar year from 1978 to 2017 as covariates. Relative survival analysis was performed to compare long-term survival over the four decades.RESULTSTwo hundred and nine patients were evaluated, including 113 (54%) men. Forty-six (22%) patients were older than 80 years. Median age increased from the first to the last decade (from 63 to 72 years). The incidence rate increased with increasing age, but we measured a decline in recent decades for both sexes. A significant increase in the use of acetylsalicylic acid, from 5% (2/38) to 18% (8/45), was observed during the study period. Comorbidity increased significantly over the 40 years of the study, with 22% (10/45) of the patients having an American Society of Anaesthesiologists (ASA) score 4-5 in the last decade, compared to 5% (2/38) in the first decade. Thirty-nine percent (81/209) of the patients had one or more postoperative complications. Both 100-day mortality and long-term survival were associated with ASA score, without significant variations between the decades.CONCLUSIONDeclining incidence rates occurred in recent years, but the patients were older and had more comorbidity. The ASA score was associated with both short-term mortality and long-term survival.

255 OUTCOME OF ADDITIONAL ESOPHAGECTOMY AFTER NON-CURATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION FOR C-MM-SM1ESOPHAGEAL CANCER.

Abstract For patients diagnosed cT1(MM-SM1)N0 esophageal cancer, we perform endoscopic submucosal dissection (ESD) as a primary treatment. Furthermore, additional treatments were performed for the patients diagnosed pT1b(SM) in resected tumor by ESD. Our aim of this study is to investigate whether additional esophagectomy after non-curative ESD can be considered a valid treatment. Methods Forty-four patients who received esophagectomy with lymph node (LN) dissection in neck, mediastinum and upper abdomen as additional surgery after non-curative ESD between 2006 and 2019 were enrolled. Histological examination revealed that squamous cell carcinoma in 41 and adenocarcinoma in 3 patients. We examined the rate of pathological LN metastasis and outcomes of patients received esophagectomy. Results The cT was LPM in 9(20%), MM-SM1 in 35 (80%) patients. However, the pT was MM in 3(7%), SM1 in 14 (32%) and SM2 in 27 (61%) patients. Lymphatic invasion was positive in 32 (73%) and venous invasion was positive in 16(36%) patients. Seven patients had pathological metastatic LN (1–2 LNs/case) (total 10 metastatic LNs). The metastatic LNs existed in neck, mediastinum and upper abdomen. The recurrences were occurred in 2 patients (No.106recL LN and No. 112ao-A LN). One patient died by esophageal cancer (LN recurrence, 38 months alive). One patient died of gastric tube ulcer perforation (16 months). Conclusion We showed that esophagectomy with extended LN dissection is sufficient as additional treatment for the patients treated non-curative ESD. To expand the indications of ESD for pSM esophageal cancer, new methods are needed, such as the risk diagnosis of LN metastasis using genetic analysis.

Omental patch versus gastric resection for perforated gastric ulcer: Systematic review and meta-analysis for an unresolved debate

BackgroundPerforated gastric ulcers are surgical emergencies with paucity of data on the preferred treatment modality of resection versus omental patch. We aim to compare outcomes with ulcer repair and gastric resection surgeries in perforated gastric ulcers after systematic review of literature. MethodsA systematic literature search was performed for publications in PubMed Medline, Embase, and Cochrane Central Register of Controlled Trials. We included all studies which compared ulcer repair vesus gastric resection surgeries for perforated gastric ulcers. We excluded studies which did not separate outcomes gastric and duodenal ulcer perforations. ResultsThe search included nine single-institution retrospective reviews comparing ulcer repair (449 patients) versus gastric resection surgeries (212 patients). Meta-analysis was restricted to perforated gastric ulcers and excluded perforated duodenal ulcers. The majority of these studies did not control for baseline characteristics, and surgical strategies were often chosen in a non-randomized manner. All of the studies included were at high risk of bias. The overall odds ratio of mortality in ulcer repair surgery compared to gastric resection surgery was 1.79, with 95% CI 0.72 to 4.43 and p-value 0.209. ConclusionIn this meta-analysis, there was no difference in mortality between the two surgical groups. The overall equivalence of clinical outcomes suggests that gastric resection is a potentially viable alternative to ulcer repair surgery and should not be considered a secondary strategy. We would recommend a multicenter randomized control trial to evaluate the surgical approach that yields superior outcomes. Level of evidenceSystematic review and meta-analysis, level III.

Robotic \u201cDouble Loop\u201d Roux-en-Y gastric bypass reduces the risk of postoperative internal hernias: a prospective observational study

BackgroundInternal herniation (IH) is a potentially serious complication after laparoscopic Roux-en-Y gastric bypass (RYGB). The aim of the study is to evaluate the incidence of IH after robot-assisted RYGB (RA-RYGB) performed with the “Double Loop” technique at our Institution.MethodsProspective cohort study of patients submitted to RA-RYGB with the “Double Loop” technique, with a minimum follow-up of 2 years. Patients with complaints of abdominal pain at clinical visits or entering the emergency department were evaluated. Primary outcome was the incidence of IH, defined as the presence of herniated bowel through a mesenteric defect, diagnosed at imaging or at surgical exploration.ResultsA total of 129 patients were included: 65 (50.4%) were primary procedures, while 64 (49.6%) were revisional operations after primary restrictive bariatric surgery. Mean age was 47.9 ± 10.2 years, mean weight, and body mass index were, respectively, 105.3 ± 22.6 kg and 39.7 ± 9.6 kg/m2. Postoperative morbidity rate was 7.0%. Mean follow-up was 53.2 ± 22.6 (range 24–94) months. During the follow-up period, a total of 14 (10.8%) patients entered the emergency department: 1 patient had melena, 4 renal colic, 1 acute cholecystitis, 2 gynecologic pathologies, 2 anastomotic ulcers, 1 perforated gastric ulcer, 1 diverticulitis and 2 gastroenteritis. There were no diagnoses of IH. During the follow-up period, no patient experienced recurrence of symptoms.ConclusionsIn the present study, the robotic approach confirms the low complication rate and absence of IH after “Double Loop” RA-RYGB in a large case-series at a medium-term follow-up.

Outcomes of laparoscopic primary gastrectomy with curative intent for gastric perforation: experience from a single surgeon.

Gastric cancer perforation is rare and difficult to distinguish from gastric ulcer perforation before surgery. Peritonitis caused by gastric perforation requires emergency surgery. The optimal surgical strategy for gastric perforation has not been established. Data from 43 patients who underwent primary gastrectomy with curative intent for gastric perforation between June 2010 and November 2019 were reviewed. Patients were classified into gastric ulcer and gastric cancer groups. Early surgical outcomes and overall survival were assessed. There were no significant differences in clinical characteristics between the two groups except regarding preoperative shock. Laparoscopic gastrectomy was performed in 35 of 43 patients. There were no conversions to open surgery. The surgical findings demonstrated that the gastric cancer group had larger mass lesions with significantly larger perforations than did the gastric ulcer group. There were no significant differences in early surgical outcomes. Severe postoperative complications occurred in nine patients, five of whom died within one month of surgery. The majority of patients (90%) had stage III or IV gastric cancer. The 5-year survival rate was 19.5%. We found no definitive differences in clinical characteristics distinguishing gastric cancer from ulcers. Considering our surgical outcomes, laparoscopic primary gastrectomy performed by an expert is a useful technique for emergency gastric perforation. However, unless an expert is available, caution should be used when selecting laparoscopic primary gastrectomy with curative intent as a surgical method.

Risk Factors that Affect Morbidity and Mortality in Patients with Perforated Peptic Ulcer Diseases in a Teaching Hospital.

This study was done to identify risk factors that affect the morbidity and mortality of patients operated for a perforated peptic ulcer in a resource-limited setting. A two years (January 1, 2016 -December 30, 2018) retrospective cross-sectional study was done on patients admitted and operated for PPU at Yekatit 12 Hospital, Addis Ababa, Ethiopia. A total of 93 patients were operated. The median age affected was 29 years (Range 15-75 years). Male to female ratio was 7.5:1. Chewing chat, smoking and alcohol use were seen in 22 (23.6%), 35(37.6%), and 34(36.5%), cases respectively. Only 23.6% gave previous history of dyspepsia. The median duration of illness was 48hours and the duodenal to gastric ulcer perforation ratio was 6.5:1. In majority of the cases (63.3%) the perforation diameter was =10mm (63.3%). Cellan-Jones repair of the perforations was done in 92.5% of cases. A total of 47 complications were seen in 25 cases. The total complications and mortality rates were 25(26.8%) and 6(6.5%) respectively. The most common postoperative complication was pneumonia (13.97%) followed by superficial surgical site infection (10.8%). Mortality rate was highest among patients >50yrs [AOR (95%CI) =2.4(230)]. Delayed presentation of >24 hours [AOR (95%CI) =4.3(1.4-13.5)] and a SBP =90mmhg [AOR (95%CI) =4.8(1-24)] were found to be significantly related with higher complication rate. Patients who presented early and immediate corrective measures were instituted had better outcomes while those seen late developed unfavorable out-come with significantly higher complications. Therefore, early detection and treatment of PPU is essential.

Perforated gastric ulcer following perforated appendicitis

Abstract Stress ulcers and gastric ulcer perforations are rare in the pediatric population, and there is insufficient evidence to support routine stress ulcer prophylaxis in children. Our case is of a 13-year-old male who presented with appendicitis. He underwent laparoscopic appendectomy and was found to have perforated appendicitis. Postoperatively, he had a prolonged course secondary to ileus and was kept NPO. On postoperative day seven, he acutely worsened with pain and fever. A CT scan was performed to assess for abscess formation and significant free air and fluid was identified without abscess formation. Laparoscopy was performed. He was found to have a large perforated gastric ulcer along the lesser curvature. Conversion to laparotomy was undertaken secondary to poor visualization and significant enteric spillage. The perforation was repaired with a modified Graham patch. This represents a rare case of a perforated stress ulcer in a pediatric patient that was not critically ill and would not have met the most generally accepted indications for stress ulcer prophylaxis in children.

Treatment of subhepatic abscess due to complicated perforation of gastric ulcer

Formation of abdominal abscesses with perforated ulcers of the stomach and duodenum with conservative treatment ranges from 3% to 14%. The main strategy for their treatment is a minimally invasive puncture treatment. A case of a patient’s late treatment of 56 years with a perforated giant gastric ulcer, the formation of a subhepatic abscess and its drainage into the lumen of the stomach is presented. Used methods of drainage of an abscess through a mini-access under the control of gastroscopy. A complex of therapeutic measures has been described, which allowed for the obliteration of an abscess cavity and the healing of a giant stomach ulcer within a month. It is concluded that the need for early use of gastroscopy in the differential diagnosis of perforated ulcers.

Surgical tetralogy: simultaneous perforated gastric ulcer and appendicular perforation with liver and cerebral abscesses

Surgical tetralogy: simultaneous perforated gastric ulcer and appendicular perforation with liver and cerebral abscesses

Spontaneous gastric rupture presenting as severe pneumoperitoneum in a cat with presumed idiopathic gastric ulceration

An 11-year-old female British blue cat was referred for investigation of acute onset vomiting and marked abdominal enlargement. Diagnostic investigations confirmed a large volume of free gas within the abdomen...

Gastric Cancer Revealed by a Perforated Ulcer: A Case Report and Review

Introduction: Gastric cancer is not typically a surgical emergency. However, it can evolve into urgent complications such as a perforation. We report a case of a perforated gastric ulcer that turned out to be a cancer. Observation: A 52-year-old man was admitted to the emergency department of Hubert-Koutoukou-Maga National University Medical Center in Cotonou for generalized abdominal pain. He was diagnosed with acute generalized peritonitis with perforated gastric ulcer, establishing a surgical indication. An antral perforation was found and a simple closure was performed. Anatomopathological examination of the surgical piece revealed a gastric adenocarcinoma within the granulation tissue. Following the impact assessment, he underwent a second surgery where a distal gastrectomy was performed with D2 lymphadenectomy followed by gastrojejunostomy. He developed an anastomotic gastrointestinal fistula during the postoperative period but was successfully medically treated. The patient received adjuvant chemotherapy with Epirubicin, Cisplatin and 5-Fluorouracil. The patient is still alive, 3 years after the gastrectomy. Conclusion: When faced with a perforated gastric ulcer, one must also consider a neoplastic cause. The emergency surgical treatment depends on the general condition of the patient and the pre-existing co-morbidities, the choice being made between a one-stage versus two-stage gastrectomy.

Invasive primary gastric mucormycosis-associated gastric perforation in an immunocompetent host

Introduction: Mucormycosis is a rare opportunistic fungal infection associated with high morbidity and mortality. Immunocompromised hosts are most at risk. Primary gastric mucormycosis is rarely reported, with rhinocerebral and pulmomary being most common sites for infection. Objectives/Aims: Here we describe a case of spontaneous gastric perforation due to invasive primary gastric mucormycosis infection in an immunocompetent host. No approval of the institutional review committee was needed as this was in the course of common clinical practice. Methods: A 28-year-old male with depression and anxiety, and subdural hematoma three months prior was found down after seizure. On arrival he was haemodynamically unstable, admitted to the intensive care unit (ICU) for management of sepsis and multisystem organ dysfunction, and initiated on renal replacement. Further evaluation revealed viscous perforation and pneumoperitoneum. An emergent exploratory laparotomy was performed. Surgical exploration revealed a 10 cm perforated gastric ulcer on the superior portion of greater curvature with necrosis, and necrotic posterior and superior portions of the stomach measuring 5 cm and 7 cm, respectively. He underwent splenectomy, total gastrectomy and was left in discontinuity. Histopathology of gastric tissue confirmed mucormycosis. Results: Liposomal amphotericin 5 mg/kg of B daily was initiated following surgical intervention. He underwent multiple intraabdominal wash outs, liver biopsy and had additional cultures obtained. A jejunostomy was placed for nutritional support. He had an exploration of the left neck with cervical oesophagostomy. The patient was transitioned to isavuconazoium but due to concerns for malabsorption via jejunostomy micafungin was continued concurrently. He completed his course and responded appropriately, with plans for proposed anastomosis. Conclusion: Few cases of invasive gastric mucormycosis associated spontaneous gastric perforation have been reported. Furthermore, occurrence in an immunocompromised host is minimal. Rapid and aggressive identification and intervention are crucial for minimising morbidity and mortality associated with mucormycosis.

Une péritonite encapsulante

IntroductionEncapsulating peritonitis is a rare but severe chronic fibrotic condition related to the development of a white fibrous membrane surrounding the digestive tract. Idiopathic forms have been described, however the disease is most often secondary to peritoneal dialysis or more rarely to surgery. Treatment is difficult and not codified. Case reportWe report here the observation of a 36-year-old patient whose diagnosis of encapsulating peritonitis was made after a long sub-occlusive history, eight years after a gastric ulcer perforation. DiscussionWe discuss the possible etiologies and we present a focus on this rare and little-known entity.

2724 Systemic Fungemia Following Gastric Ulcer Perforation in a Patient With Hepatocellular Carcinoma: A Case Report and Review of Literature

INTRODUCTION: The frequent overgrowth of Candida in the intestinal microbiota has made candidemia one of the most common bloodstream infections in the United States. Such infections are capable of infecting organs leading to several threatening conditions such as fungal endocarditis, meningitis, osteomyelitis, or Candida endophthalmitis. In rare occurrences, Candida species overgrowth has also been theorized to promote perforations of gastric ulcers. CASE DESCRIPTION/METHODS: We are reporting the case of a 56-year-old immunocompromised male with a history of cirrhosis of liver secondary to Hepatitis C, hepatocellular carcinoma and gastric ulcers who presented with generalized abdominal pain and distention. Physical exam showed him to be in moderate distress with diffuse severe tenderness to palpation with guarding and rebound tenderness. A CT of the abdomen revealed pneumoperitoneum, and a subsequent diagnostic laparoscopy discovered a 5 mm gastric ulcer perforation with an opening into the antrum of the stomach. Following surgical repair of the perforation, blood and peritoneal fluid cultures revealed the growth of Candida galbrata. Despite aggressive antifungal therapy, the patient expired due to multisystem organ failure. DISCUSSION: While most gastric perforations are caused by complications with peptic ulcer disease, nonsteroidal anti-inflammatory drugs, or certain neoplasms, studies have shown that Candida overgrowth may also promote the perforation of a pre-existing ulcer. Fungal overgrowth most frequently occurs in immunocompromised patients or those on certain medications. Patients with a Candida infection are at an increased risk for organ failure, surgical site infections, a prolonged hospitalization, and a significantly higher mortality rate.

Percutaneous drainage under the control of ultrasound of the left-sided subphrenic abscess after gastrectomy: A case report.

IntroductionAbdominal abscesses are one of the frequent and dangerous postoperative complication. They occur as a result of failure of seams esophagojejunal anastomosis after gastrectomy (17%), perforation of gastric and duodenal ulcers (26.8%), splenectomy (25.4%), failure of biliodigestive anastomoses (23.8%), inadequate drainage of the subphrenic space (22.2%), acute pancreatitis (14%). Left-sided subphrenic abscesses are the most common of them.Case presentationWe present a patient with the left-sided subphrenic abscess, formed as a result of insolvency of the esophagojejunal anastomosis after gastrectomy and splenectomy, which underwent percutaneous drainage under the control of ultrasound and X-ray. Sanitation of the abscess cavity and the introduction of fibrin glue into it made it possible to close the fistula and heal the patient.DiscussionThe described case shows that the rehabilitation of the abscess and the injection of fibrin glue into it, made it possible to avoid surgery, eliminate the abscess and close the connection with the esophagojejunal anastomosis in a short time.ConclusionPercutaneous drainage under the control of ultrasound made it possible to avoid surgery and heal the patient with the left-sided subphrenic abscess in a short time. Fistula treatment with fibrin glue is not only effective, but is also less risky than surgery.

Feasibility and Outcome of Laparoscopic Approach for Acute Generalized Peritonitis in Africa: Single Low-Center Results After 25 Consecutive Cases in Cameroon

surgery is associated with lower morbidity and mortality. However, the laparoscopic approach to the management of peritonitis remains marginalized in low and middle-income countries (LMICs) due to financial and technical limitations.Methods: We conducted a seven-year prospective study on patients with acute generalized peritonitis in Yaounde, Cameroon. Inclusion criteria were an age range of between 5 to 55 years, admission within 48 hours after the onset of symptoms, hemodynamic stability, and no major comorbidities. Excluded from this study were patients with colonic perforation, prior history of abdominal surgery, or primary and localized peritonitis after proper resuscitation. The patients included were managed via laparoscopy; operative and postoperative data were collected and analyzed. Some technical artifices were used to circumvent the lack of standardequipment. Results: The study involved twenty-five patients with a mean age of 32.1 years. The etiology of peritonitis was identified as appendicitis in 20 cases, perforated duodenal ulcer in 2 cases, gastric ulcer perforation in 2 cases, and jejunal perforation in 1 case. In two cases (8%), the operation was onverted to laparotomy. The postoperative course was uneventful in 21 cases (84%), whereas morbidity was seen in 4 cases (16%); no mortality was recorded. The mean length of hospital stay was 5.5 days.Conclusions: This study demonstrates that the laparoscopic management of acute generalized peritonitis in African LMICs is afeasible, safe, and effective surgical option in properly selected patients.