Pyloric Area Research Articles

990 A Rare Case of Adenomyoma in Gastric Pylorus of a Young Adult Female: A Case Report

Abstract Introduction Gastric adenomyoma is a rare benign tumour which occurs 85% in antrum and 15% in pylorus. Although adenomyomas are benign, diagnosis is difficult as they are commonly found alongside with adenocarcinomas. Case report A 20-year-old previously healthy female presented with epigastric pain, gastric outflow obstruction features and weight loss for 3 months. Initial USS was followed by a CECT which, showed intramural mass lesion with necrotic centre arising from the inferior wall of the pre pyloric area of the stomach with acute inflammatory changes of the adjacent omental fat, giving differential diagnosis of GIST or gastrinoma at pyloric region. Subsequent upper GI endoscopy revealed a protruding pyloric mass without mucosal lesions. Unfortunately, the unavailability of EUS and biopsy posed a diagnostic hurdle. Intraoperatively, a mass intricately adhered to the transverse colon and omentum was discovered, leading to a surgical intervention involving distal gastrectomy, gastrojejunostomy, and jejunojejunostomy. Unexpectedly, histological analysis unveiled adenomyoma at the prepyloric area, characterized by Brunner’s glands, dilated glands, and heterotrophic small intestinal tissue. Discussion This rare manifestation of adenomyoma in the gastric pylorus, particularly in a young adult, highlights the challenges in accurate preoperative diagnosis. The favourable postoperative outcome prompts reflection on the potential role of advanced diagnostic tools, emphasizing the significance of EUS and biopsy in steering clear of extensive surgeries. Conclusions This case report underscores the crucial role of personalized diagnostic methods, especially in cases like ours where a rare adenomyoma mimicking other tumours.

Inter-Rater Reliability of Scoring Systems for Abomasal Lesions in Quebec Veal Calves.

The objective of this study was to determine the inter-rater reliability of current scoring systems used to detect abomasal lesions in veal calves. In addition, macroscopic lesions were compared with corresponding histological lesions. For this, 76 abomasa were retrieved from veal calves in a slaughterhouse in Quebec and scored by four independent raters using current scoring systems. The localisations of the lesions were separated into pyloric, fundic, or torus pyloricus areas. Lesions were classified into three different types, i.e., erosions, ulcers, and scars. To estimate the inter-rater reliability, the coefficient type 1 of Gwet's agreement and Fleiss κ were used for the presence or absence of a lesion, and the intra-class correlation coefficient was used for the number of lesions. All veal calves had at least one abomasal lesion detected. Most lesions were erosions, and most of them were located in the pyloric area. Overall, a poor to very good inter-rater agreement was seen for the pyloric area and the torus pyloricus regarding the presence or absence of a lesion (Fleiss κ: 0.00-0.34; Gwet's AC1: 0.12-0.83), although a higher agreement was observed when combining all lesions in the pyloric area (Fleiss κ: 0.09-0.12; Gwet's AC1: 0.43-0.93). For the fundic area, a poor to very good agreement was also observed (Fleiss κ: 0.17-0.70; Gwet's AC1: 0.90-0.97). Regarding the inter-rater agreement for the number of lesions, a poor to moderate agreement was found (ICC: 0.11-0.73). When using the scoring system developed in the European Welfare Quality Protocol, a poor single random rater agreement (ICC: 0.42; 95% CI: 0.31-0.56) but acceptable average random rater agreement (ICC: 0.75; 95% CI: 0.64-0.83) was determined. Microscopic scar lesions were often mistaken as ulcers macroscopically. These results show that the scoring of abomasal lesions is challenging and highlight the need for a reliable scoring system. A fast, simple, and reliable scoring system would allow for large scale studies which investigate possible risk factors and hopefully help to prevent these lesions, which can compromise veal calves' health and welfare.

Histology of the stomach in the Caucasian squirrel, a scanning electron microscope and immunohistochemical study.

This study was performed to investigate the gross anatomy, histochemistry, and immunohistochemistry of the stomach in the Caucasian squirrel. A total of five male squirrels were included. The obtained results showed that the shape of the stomach was acutely crescent and consisted of four regions namely; cardiac, fundus, body, and pylorus. The stomach glandular and its wall was consisted of four layers; serosa, muscularis, submucosa, and mucosa. All part of the mucosa was covered by a simple columnar epithelium. Furthermore, gastric glands were of the simple tubular type. The mucous cells of the fundic and body regions were PAS-positive. In the lower third of the gastric glands, parietal, and chief cells were identified. The number of chief cells was increased toward the pyloric area. Scanning electron microscopy showed that the fundus region contained many plicae and grooves and each plica carried numerous glands opening. In the body region, cells were polygonal and formed network-like structures. In the pyloric region, a mucosal ridge between the body and antrum and a thick mucosal crest on the lesser curvature were identified. Immunohistochemical staining showed that Sox9 was strongly expressed in the fundic region, however, its expression in the body and pylorus was moderate to weak. In conclusion, there are some similarities and differences between the stomach of the Caucasian squirrel and other mammals including rodents. The obtained results may enhance our basic knowledge regarding the feeding habits and digestive system histophysiology of this species.

Association between gastrointestinal tract, claw disorders, on-farm mortality and feeding management in veal calves

This study analysed potential associations between the prevalence of rumen, abomasum, liver, and claw disorders detected in 26 batches of Holstein veal calves through a post-mortem inspection at the slaughterhouse, and on-farm mortality and feeding management data. Organs of 15–16 calves per batch (16.5 rumens, 15.9 abomasa, 15.1 livers, and 31.1 claws) were inspected by 3 veterinarians in the slaughter-line. ‘Batch’ refers to group of calves belonging to the same farm and slaughter group. Hyperkeratosis and plaques were detected in over 60% of rumens per batch, and some cases, in all rumens. More than 85% of abomasa showed ulcerations. Sole haemorrhages were detected in 64 to 97% of claws. During fattening, calves received on average 312 kg of milk-replacer (MR) and 162 kg of solid feed (SF), composed mainly of corn grain (85–93% as-fed basis). Rumens with hyperkeratosis were positively correlated to the percentage of corn grain. Abomasa with large-sized-lesions in the pyloric area were positively correlated to the SF amount. Ulcerated abomasa were positively correlated to calves’ mortality reported by farmers. Cluster analysis identified 3 feeding plans. The first, based on MR administration and moderate SF amount, produced lighter carcasses and low-developed rumens, but reduced the prevalence of rumen hyperkeratosis and sole haemorrhages; the other two, more ‘aggressive’ by increasing the amount of SF or both SF and MR, produced heavier carcasses but worsened rumen and claw conditions. This study suggests the existence of different feeding practices used by veal producers that should be reviewed to improve calves’ welfare. Highlights Feeding plans based on moderate amount of solid feed together with the liquid diet reduce the prevalence of rumen alterations and sole haemorrhages The provision of greater amount of high-grain solid feed throughout the fattening rises the prevalence of rumen hyperkeratosis and sole haemorrhages None of the feeding plans were capable of decreasing the occurrence of abomasal ulcerations, which were positively associated with on-farm mortality

Prevalence of gastrointestinal, liver and claw disorders in veal calves fed large amounts of solid feed through a cross-sectional study

The impact of the current practice of feeding veal calves with large amounts of solid feed (SF) on the prevalence of specific disorders on rumen, abomasum, liver and claws was investigated through a post-mortem inspection at the abattoir. Forty-one batches (“batch” referred to a group of calves of the same breed, coming from the same farm and belonging to the same slaughter group) of crossbred male calves from dairy breed were randomly inspected at 213.6 days old. On average 16.0 rumens, 15.6 abomasa, 15.1 livers, and 30.5 hind claws were checked per batch. Rumens were evaluated for the presence of hyperkeratosis and plaques; abomasa for the presence of lesions in the pyloric area; livers for the presence of lipidosis, abscess or fibrous adherence; and claws for the presence of sole hemorrhages. More than 60% of rumens per batch had signs of hyperkeratosis and plaques, and 80 to 100% of abomasa per batch showed at least 1 lesion in the pyloric area. On average 24% of livers per batch were diseased and about 65% of claws per batch had sole hemorrhages. Affected abomasa were positively correlated to rumens with plaques. Claws with sole hemorrhages tended to be positively correlated to rumens with hyperkeratosis. Calves of inspected batches were fed 311 ± 31 kg DM/cycle of milk-replacer and 158 ± 44 kg DM/cycle of SF containing more than 85% of corn grain. Based on the recorded prevalence of alterations, this feeding strategy should be reconsidered in order to improve veal calves' welfare.

Self-expandable metal stent of esophagogastric junction versus pyloric area obstruction in advanced gastric cancer patients

Upper gastrointestinal stenting is a palliative treatment for relieving symptoms such as nausea, vomiting, and dietary intake in patients with obstruction due to inoperable advanced stomach cancer. Self-expandable metal stent (SEMS) implantation for malignant obstruction has recently become more effective, safer, and less expensive than operative modality. It also has better short-term outcomes, particularly a shorter hospital stay and a more rapid return to oral intake, than surgical treatment. However, there is no comparative analysis regarding the efficacy, side effects, and survival rate of stenting between the esophagogastric junction (EGJ) and pyloric obstructions.To compare the prognoses and complications after SEMS implantation between EGJ and pyloric obstructions in advanced gastric cancer.Among advanced gastric cancer patients with gastrointestinal obstruction diagnosed from January 2008 to December 2017 at the Gastroenterology Department of Chungnam National University Hospital, 42 and 76 patients presented with EGJ (EGJ obstruction group) and gastric pyloric obstructions (pyloric obstruction group), respectively. We retrospectively reviewed the survival period, changes in food intake, and complications of these patients before and after SEMS placement.The prevalences of aspiration pneumonia were 11.9% (5/42) and 2.6% (2/76) in the EGJ and pyloric obstruction groups, respectively, before SEMS placement (P value: .041). Other symptoms associated with gastric malignant obstruction were not statistically different between the groups. Success rate and adverse events did not significantly differ between the EGJ and pyloric obstruction groups. There was no difference in frequency of stent reinsertion procedures performed owing to reobstruction, but the reprocedure average period was statistically significantly longer in the EGJ obstruction group [EGJ obstruction: 158.3 days (±42.4); pyloric obstruction: 86.0 days (±29.1)] (P value: .022). As an index of improved dietary status, the Gastric Outlet Obstruction Scoring System score was not significantly different between the groups before and after SEMS placement.The EGJ and pyloric obstruction groups did not significantly differ in prognosis or complication rates. However, EGJ stent was more stable than pyloric stent when reobstruction was considered.

P-064 - Self-expandable metal stent (SEMS) for esophageal-gastric junction versus pyloric area obstruction in advanced gastric cancer patients: a retrospective, comparative, single-center study

P-064 - Self-expandable metal stent (SEMS) for esophageal-gastric junction versus pyloric area obstruction in advanced gastric cancer patients: a retrospective, comparative, single-center study

Prevalence of abomasal lesions in Danish Holstein cows at the time of slaughter

Abomasal lesions in cattle are challenging to diagnose because the clinical signs are often subtle and nonspecific. An increasing number of studies suggests that abomasal lesions are commonly found in cattle of all ages, but the number of recent prevalence studies in dairy cows is limited. The main objective of this study was to estimate the prevalence of abomasal lesions in a population of Danish Holstein dairy cattle in Denmark. An abattoir survey of 1,327 dairy cows apparently suitable for slaughter was performed in 2016 and 2017. Abomasal lesions are usually classified using a standardized protocol with the following types: abomasal ulcer type I: erosions and nonperforating ulcers; type II: ulcers with arterial bleeding; type III: perforating ulcer with localized peritonitis; and type IV: perforating ulcer with diffuse peritonitis. A further subdivision of the nonperforating abomasal ulcers type I were classified as subtype Ia: erosions; subtype Ib: small ulcers with localized hemorrhage; subtype Ic: ulcers with a crater-like appearance; and subtype Id: retention of the mucosa due to tissue loss with either radial wrinkles converging at a central point or perforations of the spiral folds. Type I abomasal lesions were found in 84% of the examined cows. No ulcers with arterial bleeding (type II) or perforating ulcers with diffuse peritonitis (type IV) were found, but one perforating abomasal ulcer (type III) was observed. The total number of lesions found was 7,418 and when the lesion subtypes were evaluated individually the majority of subtypes Ia and Ic were found in the pyloric area (85 and 94%, respectively), whereas lesion subtypes Ib and Id dominated the fundus/corpus area (71 and 67%, respectively). When considering lesion subtypes according to parity, there was a high prevalence of subtype Ib across the 3 groups of parity (51, 58, and 55% for parity 1, 2, and ≥3, respectively). The prevalence of lesion subtype Id seemed to increase with increasing parity, and the prevalence of lesion subtype Ia seemed to decrease with increasing parity. The prevalence of abomasal lesions was higher than that shown in similar studies of cattle at the time of slaughter. However, the expectedly most painful cases were rare, with only one perforating and no arterial bleeding ulcers found. The etiology of the different subtype I lesions is still unknown, and further investigations are needed to establish the possible influence these lesions might have on welfare and production.

Hybrid endoluminal stapled pyloroplasty: an alternative treatment option for gastric outlet obstruction syndrome.

Gastroparesis is a rapidly increasing problem with sometimes devastating consequences. While surgical treatments, particularly laparoscopic pyloroplasty, have recently gained popularity, they require general anesthesia, advanced skills, and can lead to leaks. Peroral pyloromyotomy is a less invasive alternative; however, this technique is technically demanding and not widely available. We describe a hybrid laparo-endoscopic collaborative approach using a novel gastric access device to allow endoluminal stapled pyloroplasty as an alternative treatment option for gastric outlet obstruction. Under general anesthesia, six pigs (mean weight 33kg) underwent endoscopic placement of intragastric ports using a technique similar to percutaneous endoscopic gastrostomy. A 5mm laparoscope was used for visualization. A functional lumen imagine probe was used to measure the cross-sectional area (CSA) and diameter of the pylorus before, after, and at 1week after intervention. Pyloroplasty was performed using a 5mm articulating laparoscopic stapler. Gastrotomies were closed by endoscopic clips, endoscopic suture, or combination. After 6-8days, a second evaluation was performed. At the end of the protocol, all animals were euthanized. Six pyloroplasties were performed. In all cases, this technique was effective in achieving significant pyloric dilatation. The median pre-pyloroplasty pyloric diameter (D) and cross-sectional area (CSA) were 8mm (4.9-11.6mm) and 58.6mm2 (19-107mm2), respectively. After the procedure, these values increased to 13.41mm (9.8-17.6mm) and 147.7mm2 (76-244mm2), respectively (p = 0.0152). No important intraoperative events were observed. Postoperatively, all animals did well, with adequate oral intake and no relevant complications. At follow-up endoscopy, all incisions were healed and the pylorus widely patent. Hybrid endoluminal stapled pyloroplasty is a feasible, safe, and effective alternative method for the treatment of gastric outlet obstruction syndrome.

Exploring pyloric dynamics in stenting – Using a distensibility technique

Perforated duodenal ulcers can be treated with a stent. Stent migration is a severe complication, sometimes requiring surgery. Pyloric physiology during stent-treatment has not been studied and mechanisms for migration are unknown. To investigate the pyloric response to distention, mimicking stent-treatment, using the EndoFLIP, a non-survival study in five pigs was carried out, followed by a pilot study in one volunteer. Animals were gastroscoped during anaesthesia and the EndoFLIP was placed straddling the pylorus. Baseline distensibility readings were performed at stepwise balloon distentions to 20 ml, 30 ml, 40 ml and 50 ml, measuring pyloric Cross Sectional Area and pressure. Measurements were repeated after administration of a pro-kinetic drug and after a liquid meal. In the human study readings were performed in conscious sedation at baseline and after stimulation with metoclopramide. During baseline readings the pylorus was shown to open more with increasing distention together with higher amplitude motility waves. Reaching maximum distention-volume (50 ml), pyloric pressure increased significantly (p = 0.016) and motility waves disappeared. After pro-kinetic stimulation the pressure decreased and the motility waves increased in frequency and amplitude. After food stimulation the pressure stayed low and the motility showed increase in amplitude. During both tests the pylorus showed higher pressure and lack of motility waves at maximum probe distention. The pylorus seems to acts as a sphincter at low distention but when further dilated starts acting as a pump. Fully distended the pyloric motility disappears and the pressure remains high, suggesting that a stent with high radial force might show less migration.

XZ-1 regulates cell apoptosis of gastric epithelial dysplasia via NF-κB/p53/Ki67 signaling pathway.

We aimed to determine the effect of ‘Xiaozeng No. 1’ (XZ-1) on cellular apoptosis changes of gastric epithelial dysplasia (GED) and to explore the underlying mechanism. Specimens taken from the pyloric area of the stomachs from rats in each group were subjected to Hematoxylin and Eosin (H&E) staining for pathological examination, TUNEL staining for apoptosis detection, and Western blot analysis for apoptosis-related proteins. The results showed that XZ-1 decreased GED incidence and enhanced gastric epithelial apoptosis. Furthermore, XZ-1 up-regulated the proapoptotic proteins including cleaved caspases (cysteine-dependent aspartate-specific protease) (-3, -8, and -9), Fas, Bax, and Bid, and facilitated the release of cytochrome c from mitochondria to the cytoplasm. Interestingly, XZ-1 enhanced protein expression of NF-κB p65, Ki67, and p53. Moreover, inhibition of NF-κB pathway suppressed the XZ-induced p53 expression, whereas inhibition of NF-κB or p53 pathway suppressed the XZ-induced Ki67. More importantly, inhibition of NF-κB or p53 pathway attenuated the XZ-1-mediated induction of gastric epithelial apoptosis and decline of GED incidence. Collectively, our results demonstrated that XZ-1, almost equivalent effect exerted by the positive control Retin-A, dramatically decreased GED incidence and enhanced gastric epithelial apoptosis. Meanwhile, XZ-1 activated the NF-κB/p53/Ki67-apoptosis signaling pathway, which might be one of the mechanisms whereby XZ-1 reversed GED.

Differences in pyloric caeca counts between lean and siscowet lake trout (Salvelinus namaycush) in southern Lake Superior

Abstract There are four documented morphotypes of lake trout (Salvelinus namaycush) in Lake Superior, with the two dominant forms being the shallow water lean and the deep water siscowet. These morphotypes are differentiated externally by morphometrics and meristics. Pyloric caeca counts have been used to distinguish closely related fish species including the Salvelinus genus. From samples collected in 2009, 2011–2013, and 2017, we counted and measured pyloric caeca from 116 lean and 119 siscowet lake trout from southern Lake Superior. For a subset of 22 leans and 19 siscowets between 575 and 625 mm, we measured individual pyloric caecum basal diameter, length, and estimated individual caecum and total caeca surface areas. Siscowets had significantly fewer and thicker pyloric caeca than leans, but caecum length did not differ between the morphotypes. Mean pyloric caeca count for siscowets and leans was 131 and 153, respectively. Mean individual caecum surface area was 31% higher in siscowets than in leans. When adjusted for mean total number of pyloric caeca, total caecum surface area for siscowets was 12% greater than leans. We postulate that greater pyloric caecum surface area in siscowets may be an adaption for greater lipid uptake because they have substantially higher lipid content than leans. Based on our findings, pyloric caeca counts can be used in addition to other meristic and morphometric characteristics to help distinguish lean and siscowet lake trout.

Reaction of stomach for feeding young pigs probiotics

The basis for the diets of pigs of different technologies of production and productivity in all areas and forage species are of plant origin, which is associated primarily with their availability. This group consists of feed grain cereals, grain legumes, green coarse, juicy, waste flour and other technical industries and others. Although omnivorous pig feed them digestion features displayed on the feasibility of forming foundations diet of concentrated feed. For industrial production of pork proportion of concentrated feed often 100%. However, partly in used feed feeding that are of poor quality, which in turn worsens their nutritional value and complicates digestion and nutrient absorption of food. Besides the low digestibility of grain mixtures in which a third of organic matter is not absorbed by the animals, lack of nutrients adversely affect the resistance and other reactions, reproductive function and performance. Studying the formative influence of the new feed factor on the structure of the digestive system of animals must pay attention to the morphological features of individual organs as the result of direct exposure to chemicals in the diet of the wall of the gastrointestinal tract. The effect of different doses of probiotic preparation Entero–active in growing young pigs on morphological indicators of cardiac, fundic and pyloric stomach areas and established its laws. The data indicate a probable thickening of the stomach wall for probiotic action by thickening muscle and mucous membranes in all investigated areas. The changes have no pathological character, and show an adaptive response to the action of gastric certain doses of the new feed factor.

Impact of feeding with protein–vitamin mineral supplement «Minaktyvit» on the structure of gastrointestinal tract of young pigs

The research was conducted on two groups–analogues of young pigs of large white breed with 10 pigs each. Weaned piglets at the age of 28 days were fed with the protein–vitamin mineral supplement «Minaktyvit» – starter in the amount of 25% of grain feed (33 days), while young pigs in growing were given the protein–vitamin mineral supplement «Minaktyvit» – grower in the amount of 15% (50 days) and those in fattening the protein–vitamin mineral supplement «Minaktyvit» – finisher in the amount of 10% (62 days). The control group received protein–vitamin mineral supplement. At the end of growing with the live weight of 100 – 110 kg a control slaughter was carried out and samples of stomach, small and large intestines for laboratory tests were picked out. Studies have shown that feeding of young pigs with the protein–vitamin mineral supplement «Minaktyvit» increases the average daily gains by 95 g or 15.68%, while their level is 701 g in the experimental group of animals and 606 g in the control one. The protein–vitamin mineral supplement «Minaktyvit» incredibly affected the morphological parameters of the stomach in the experimental group of pigs. However, the thickening of the walls by 4.3%, 5% and 10.9% respectively is observed in cardiac, fundic and pyloric areas of the experimental group, compared to the control one. The thickening of the walls in stomach areas under the influence of feed factor is associated with increasing of the mucosa thickness. Mucosa increased by 0.1 mm in the cardiac area, 0.36 mm in fundic and 0.53 mm in the pyloric one. The change in the structure of the investigated jejunum is observed while consuming the protein–vitamin mineral supplement «Minaktyvit» in the diet. The wall thickness increased by 17.57% (P < 0.05), including the thickening of mucosa by 16.7% and that of serous–muscular shell by 18.8%. No significant difference in the structure of the colon in the experimental group of animals was determined.

Mucosal lesions in the pyloric area – retrospective study on 315 equine patients (2004 – 2013)

Mucosal lesions in the pyloric area – retrospective study on 315 equine patients (2004 – 2013)

Recovery of gastric ileus following laparoscopic ventral rectopexy within an enhanced recovery protocol.

The enhanced recovery after surgery (ERAS) protocol has had limited adoption in laparoscopic ventral rectopexy (LVR), and the extent of gastric ileus shortly after LVR remains unknown. This study was designed to assess the degree of gastric emptying shortly after LVR within an ERAS protocol. From August 2012 to June 2014, 40 patients diagnosed with external or internal rectal prolapse were recruited. All patients underwent LVR within an ERAS protocol. Carbohydrate solution (CS) was administered before and 5h after surgery on the same day. The pyloric area (PA) was measured using ultrasonography before and after each CS intake. The PA was measured in 34 patients. The PA measured prior to CS intake, before surgery, was not significantly different from that after surgery. The rate of increase in the PA, which was calculated by the PA measured 1h after CS intake divided by the PA measured prior to CS intake before surgery, was not significantly different from that after surgery. The postoperative hospital stay was 1 (1-2) day, and 36 patients (90%) were discharged on the first postoperative afternoon. Postoperative gastric ileus was resolved in most cases within 5h after LVR under an ERAS protocol.

May anatomy explain the origin of the leak after gastrectomy Sleeve?

The aim of this study was to realize cartography of the arterial gastric vascular supply on fresh cadaver after performing a sleeve gastrectomy to evaluate the rule of potential vascular changes on the gastric leak.Sleeve Gastrectomy is a bariatric surgical procedure with a specific morbi‐mortality due to gastric fistula in the upper part of the gastric tube. Two theories are currently proposed to explain this specific leak location: a vascular one and a mechanical one.We performed a sleeve gastrectomy on 11 cadaveric trunks and achieved a detailed anatomical study of the gastric vascular supply after latex injection.In 55% of cases, sleeve procedure induced a change in the gastric vascular supply and in 9,1%, it lead the section of the three left gastric artery branches arising the lesser curvature. Few changes were noticed in the antrum and pylorus area.This anatomical study allowed to demonstrate that the vascular supply of the upper part of the gastric tube could be damaged by a Sleeve procedure, severing one or more of the branches arising from the left gastric artery. The antrum and pyloric area get an invariable vascular supply. It could explain the preferential localization of the fistula to the upper part of the gastric tube.

Surgical treatment of injuries caused by fishing gear in the intracoelomic digestive tract of sea turtles

We report the surgical techniques used to remove accidentally ingested hooks and branchlines localized in different parts of the digestive tract of 129 loggerhead sea turtles Caretta caretta, together with the characteristics and localization of lesions, and final outcome related to their severity. Hooks were removed from the cervical esophagus via the ventral surface of the neck, while the supraplastron approach was performed for hooks wedged in the intracoelomic portion of the esophagus. An approach through the left axillary region was preferred for fishhooks in the stomach, while hooks and long branchlines in the intestine or pyloric area were removed by approaching the coelomic cavity through the right or left prefemoral fossa. The ingestion of fishhooks, and/or longlines, often induces severe injuries in the digestive tract that could lead to the death of the turtles, with the extent of damage engendered by lines often more severe than that caused by hooks, leading to strangulation, intussusception, and tears that require resection of long tracts of intestine. Spontaneous expulsion of hooks, even where possible, involves long waiting times, with the possible impairment of the turtle's clinical condition, and should be avoided when the line is evident or suspected. The development of diversified surgical techniques enabled us to approach the coelomic cavity with minimally invasive and easy-to-perform methods, and survival rates proved very satisfactory.

Síndrome de estenose pilórica por adenocarcinoma de piloro

We present a case of primary malignant pylorus neoplasia, emphasizing its rarity, the difficulty of diagnosis and the importance of an adequate prepare before the endoscopic procedure. Literature shows that tumors compromising the first, third and fourth segments of duodenum are rare, especially those of the pyloric area, representing only 0.35% of all malignant tumors of the gastrointestinal tract. Adenocarcinoma is the most common histological type, representing 50% of all malignant neoplasias at this site. The most common symptoms are weight loss, nausea, vomiting, abdominal pain, abdominal mass, sudden changes in intestinal habits and iron deficiency anemia secondary to chronic intestinal hemorrhage. Survival after five years is only 18%. We report a case of a seventy-one year-old male referring early satiety, epigastric pain, retrosternal burning and dyspepsia, with unspecific results in complementary exams, since complete gastric emptying was not achieved. As symptoms worsened, the patient was submitted to laparotomy, with identification of gastric dilation and severe pyloric stenosis, macroscopically suggesting malignancy. The chosen procedure was a subtotal gastrectomy. Adjuvant radiotherapy and chemotherapy were not used. The patient is been followed-up without tumor recurrence so far.

Duplication cyst of the pylorus: a case report

IntroductionPyloric duplication is an extremely rare gastrointestinal tract malformation in neonates. This is the first case report of pyloric duplication in our country (Lithuania).Case presentationWe report the case of a 2-day-old Lithuanian girl who suffered from pyloric duplication mimicking an alternative common bile duct cyst or other intra-abdominal organs cysts. A laparotomy was performed and the cystic formation of the pyloric area was successfully resected. The postoperative course was uneventful.ConclusionsThere are only a few reports describing abdominal masses caused by pyloric duplication mimicking common bile duct cyst or other intra-abdominal organs cysts. Therefore thorough clinical and instrumental examination is needed to determine the most accurate diagnosis that allows one to choose the right treatment.