Obstruction Of Pylorus Research Articles

Gallstone ileus associated with cholecystogastric fistula: Case report, diagnosis and surgical treatment.

IntroductionGallstone Ileus is a rare complication of cholelithiasis, associated with multiple episodes of cholecystitis, with the formation of adhesions and fistulas between the gallbladder and adjacent organs. Its diagnosis is difficult, requiring complementary imaging tests such as computed tomography or radiography.Presentation of caseFemale patient, with intestinal obstruction for 7 days, associated with abdominal pain and previous episodes of pain in the right hypochondrium for 3 months. Abdominal CT scan identified aerobilia, gallstone impacted in the ileocecal valve and small loop dilatation, in addition to a probable cholecystogastric fistula. Opted for exploratory laparotomy, enterolithotomy and fistula correction in one surgical time.DiscussionGallstone ileus is rare among the complications of cholelithiasis, in addition to the fact that cholecystogastric fistula is associated with gastric pylorus obstruction and not impaction on the ileocecal valve. Imaging tests are useful to complement the diagnosis, and if Rigler's triad is present, the suspicion of gallstone ileus is increased. The presence of fistula between the gallbladder and stomach presents a frequency between 0 and 13.3%. There is no gold standard treatment for gallstone ileus, but surgery options for each type of patient and severity level.ConclusionThere is no definitive protocol for optimal surgical treatment for biliary ileus, but the possibility of enterolithotomy associated with cholecystectomy and fistula correction can be evaluated in selected patients.

Causes of upper gastrointestinal tract obstruction

Obstruction of the upper gastrointestinal tract, caused by blocked passage in the oesophagus, stomach or duodenum, is an important clinical and diagnostic problem in gastroenterological practice. The typical symptoms are dysphagia, postprandial vomiting, epigastric pain and weight loss. Post-inflammatory oesophageal lesions associated with reflux oesophagitis are the most common cause of obstruction. Other common causes include foreign bodies, neoplasms, chemical burns of the oesophagus and radiation-induced stenosis. In more than 2/3 cases, foreign bodies are localised in the proximal part of the oesophagus, but anatomical abnormalities, such as a Schatzki ring or post-inflammatory stenosis, increase the risk of food bolus impaction in the distal part of the oesophagus. Radiotherapy of head and neck tumours may cause stenosis, which affects more than 7% of patients treated this way. For the stomach and duodenum, 50–80% of obstruction cases are associated with neoplastic processes, with gastric cancer and pancreatic adenocarcinoma accounting for 35% and 15–25% of these cases, respectively. Mild causes of peripyloric obstruction include gastric and duodenal peptic ulcer, peritoneal adhesions, gastric polyps and Crohn’s disease. Symptoms of temporary pylorus obstruction can be caused by large, gastric hyperplastic pedunculated polyps. Therapeutic endoscopy is the most commonly used method for upper gastrointestinal tract obstruction. Depending on the cause, it involves foreign body removal, balloon enteroscopy, stenting with self-expanding metallic stents, and, in the case of treatment failure, surgical resection or palliative gastrojejunostomy.

Case report and literature review: patient with gastroduodenal intussusception due to the gastrointestinal stromal tumor of the lesser curvature of the gastric body

BackgroundIntussusception in adult patient is rare. Gastroduodenal intussusception due to the gastrointestinal stromal tumors is infrequently described in the literature. Authors present a case of gastroduodenal intussusception due to the low-risk gastrointestinal stromal tumor of the lesser curvature of the gastric body with literature review.Case presentationSixty-two-year-old male was admitted to our hospital with symptoms of acute gastric outlet obstruction. Imaging studies confirmed a lesion of the gastric wall producing gastroduodenal intussusception with pylorus obstruction. Upon laparotomy a tumor mass of the lesser curvature of the gastric body that invaginated through the pylorus into the duodenum was found. Desinvagination and resection of the tumor with the adequate resection margins were performed. Histology reveled a low-risk gastrointestinal stromal tumor. Due to favorable outcome only observation was suggested by the multidisciplinary team.ConclusionsGastroduodenal intussusception due to the gastrointestinal stromal tumor of the gastric wall is a rare event. Surgical resection is the treatment of choice. In selected cases laparosopic resection of the tumor can be performed.

Laparoscopic re-gastrostomy for obstruction of pylorus after gastrostomy in a patient with severe motor and intellectual disabilities.

Laparoscopic re-gastrostomy for obstruction of pylorus after gastrostomy in a patient with severe motor and intellectual disabilities.

Peptic ulcers accompanied with gastrointestinal bleeding, pylorus obstruction and cholangitis secondary to choledochoduodenal fistula: A case report.

Peptic ulcers are an extremely common condition, usually occurring in the stomach and proximal duodenum. However, cases of peptic ulcers accompanied with multiple complications are extremely rare and hard to treat. The present case reinforces the requirement for the early recognition and correct treatment of peptic ulcers accompanied with multiple complications. A 67-year-old man presented with recurrent abdominal pain, fever and melena. The laboratory results showed anemia (hemoglobin 62 g/l) and hypoproteinemia (23 g/l). Abdominal imaging examinations revealed stones in the gallbladder and right liver, with air in the dilated intrahepatic and extrahepatic bile ducts. Endoscopic retrograde cholangiopancreatography failed due to a deformed pylorus. The patient was finally diagnosed with peptic ulcers accompanied with gastrointestinal (GI) bleeding, pylorus obstruction and cholangitis secondary to a choledochoduodenal fistula during an emergency pancreatoduodenectomy, which was performed due to a massive hemorrhage of the GI tract. The patient recovered well after the surgery.

Imaging presentation of pylorus obstruction caused by foreign bodies in the gastric anrum and granulomatous inflammation

Pylorus obstruction caused by foreign bodies in the gastric anrum and granulomatous inflammation is rarely seen.The clinical symptoms of this disease are unspecific.Combination of X-ray radiography,computed tomography and gastroscopy could make definite diagnosis.Differential diagnosis between pylorus obstruction and peptic ulcer,gastric cancer and duodenal obstruction should be done before operation.On April 13,2012,a patient with pylorus obstruction caused by foreign bodies in the gastric anrum and granulomatous inflammation was treated at the Second Hospital of Jiaxing,the imaging characteristics of the disease were summarized to provide referrence for the diagnosis and treatment of this disease. Key words: Pylorus obstruction; Foreign body ; Granulomatous inflammation

A comparative study on endoscopic placement methods of nasal jejunum nutrition tube

Objective To compare the clinical application effect of placing nasal jejunum nutrition tube by gastroscope and transnasal gastroscope. Methods In Jun 2011, the patients who need nasal jeju- num nutrition tube due to obstruction of gastric antrum, pylorus and duodenum were assigned randomly into gastroscope pushing group （GP） and transnasal gastroscope guide wire group （TNGGW）. Operation time, achievement ratio, and tube displacement ratio were compared. Results Nasal jejunum nutrition tubes were successfully placed in all patients by two methods. In GP group, the success rate was 85%, and mean time cost was （750. 3 ± 445.9） s, and tube displacement ratio was 30%. In TNGGW group, the success rate wasl00%, and mean time cost was （ 157.4 ± 79. 3）s with no tube displacement ratio. There was a statisti- cally significant difference in mean time cost between GP group and TNGGW group （ P 〈 0. 01 ）. Conclusion It is a more reliable and convenient method to place nasal jejunum nutrition tube by transnasal gastroscope than by gastroseope. Key words: Jejunum; Enteral nutrition; Transnasal gastroscope; Guide wire

Risk factors of gastroparesis syndrome after abdominal non-gastroduodenal operation and its prevention

ObjectiveTo investigate risk factors of gastroparesis syndrome (PGS) after abdominal non-gastroduodenal operation and its prevention. MethodsClinical data of 22 patients with PGS after abdominal non-gastroduodenal operation was analyzed retrospectively, and compared with the patients of non-PGS after abdominal non-gastroduodenal operation during the same time. The possible influencing factors of PGS were analyzed by single factor analysis and logistic regression analysis. ResultsAll 13 selected factors related with PGS, including age, disease category (benign and malignant), operation time, intraoperative blood loss, postoperative analgesic pump, postoperative enteral nutrition time, postoperative parenteral nutrition time, perioperative blood glucose level, perioperative nutrition status (anaemia or lower proteinemia), pylorus obstruction before surgery, intra-abdominal infection after surgery, and spiritual factor were related with PGS. The statistical analysis showed that the difference was statistical significant (P<0.05), and gender had no correlation with PGS (P>0.05); non-conditional multivariate analysis showed that malignant tumor, perioperative nutrition status, pylorus obstruction, operation time, blood loss, intra-abdominal infection after surgery, and mental factor were significant related with PGS as dependent variable and related risk factors in single factor analysis as independent variables (P <0.05). ConclusionsPGS is a result of multiple factors, and among these factors, malignant tumor, poor nutrition status, pylorus obstruction before surgery, longer operation-time, more blood loss, intra-abdominal infection after surgery, and mental factor are major risk factors of PGS.

Gastric outlet obstruction caused by focal nodular hyperplasia of the liver: A case report and literature review

INTRODUCTIONHere, we present a case of gastric outlet obstruction due to focal nodular hyperplasia of the liver. PRESENTATION OF CASEA 23-year-old female presented to our emergency clinic with nausea, vomiting, and abdominal pain. Endoscopy showed that the prepyloric region of the stomach was externally compressed by a lesion. Computed tomography and magnetic resonance imaging revealed a 70mm solid mass originating from the liver, extending caudally in an exophytic manner, and compressing the stomach. Laparotomy revealed an irregular and exophytic mass originating from the liver, which caused gastric outlet obstruction. The mass was resected with a 10mm safety margin. The histopathology report of the mass returned as focal nodular hyperplasia. DISCUSSIONGastric outlet obstruction is a clinical syndrome characterized by abdominal pain, nausea, and postprandial vomiting. This clinical condition frequently develops as a result of peptic ulcer disease, pyloric stenosis, and obstruction of pylorus by foreign bodies including phytobezoars, congenital duodenal webs, malignant disorders, and various lesions externally compressing the stomach. Gastric outlet obstruction due to hepatic lesions is extremely rare; few cases have been reported. CONCLUSIONThis is the first reported case of gastric outlet obstruction that developed due to focal nodular hyperplasia of the liver.

Altered expression of P2X3 in vagal and spinal afferents following esophagitis in rats

Purinergic P2X(3) receptors are predominantly expressed in small diameter primary afferent neurons and activation of these receptors by adenosine triphosphate is reported to play an important role in nociceptive signaling. The objective of this study was to investigate the expression of P2X(3) receptors in spinal and vagal sensory neurons and esophageal tissues following esophagitis in rats. Two groups of rats were used including 7 days fundus-ligated (7D-ligated) esophagitis and sham-operated controls. Esophagitis was produced by ligating the fundus and partial obstruction of pylorus that initiated reflux of gastric contents. The sham-operated rats underwent midline incision without surgical manipulation of the stomach. Expressions of P2X(3) receptors in thoracic dorsal root ganglia (DRGs), nodose ganglia (NGs), and esophageal tissues were evaluated by RT-PCR, western blot and immunohistochemistry. Esophageal neurons were identified by retrograde transport of Fast Blue from the esophagus. There were no significant differences in P2X(3) mRNA expressions in DRGs (T1-T3) and NGs between 7D-ligated and sham-operated rats. However, there was an upregulation of P2X(3) mRNA in DRGs (T6-T12) and in the esophageal muscle. At protein level, P2X(3) exhibited significant upregulation both in DRGs and in NGs of rats having chronic esophagitis. Immunohistochemical analysis exhibited a significant increase in P2X(3) and TRPV1 co-expression in DRGs and NGs in 7D-ligated rats compared to sham-operated rats. The present findings suggest that chronic esophagitis results in upregulation of P2X(3) and its co-localization with TRPV1 receptor in vagal and spinal afferents. Changes in P2X(3) expression in vagal and spinal sensory neurons may contribute to esophageal hypersensitivity following acid reflux-induced esophagitis.

Letters to the Editor

25 May 2008 Dear Editor, MALROTATION ASSOCIATED WITH INFANTILE HYPERTROPHIC PYLORIC STENOSIS IN A NEONATE We would like to share our experience with you about a patient with infantile hypertrophic pyloric stenosis (IHPS). This 29-days-old male patient presented to us with complaints of projectile vomiting for 12 days along with signs of dehydration. Ultrasound of abdomen revealed pyloric olive, typical of IHPS. The patient was managed by rehydration, and, when he was fit for surgery after 2 days, Ramstedt pyloromyotomy was performed successfully. The next day, when the patient was allowed oral sips, he again developed vomiting. He was put on conservative therapy of nasogastric placement, intravenous antibiotics and fluid, but, from the next day onwards, he had started having bilious aspirate. The contrast study was done to look for any site of obstruction but it was inconclusive. The patient was then planned for exploratory laparotomy on clinical suspicion of distal to pylorus obstruction. Laparotomy revealed associated malrotation, which was corrected. The patient fared well in the post-operative period. He was allowed orally on the fifth day and discharged in satisfactory condition on the ninth day post operative. IHPS has been found to be associated with certain malformations like malrotation,1 genitourinary tract abnormalities2 and esophageal atresia,3 but these are probably so less common that they are even missing from the discussion of standard texts.4 We searched extensively for the association of IHPS and malrotation but could get only one study about this association. Most of the work has found that IHPS associated with malrotation is also associated with short bowel,1 which is not like the case of our patient. In other study, IHPS was found secondary to previously diagnosed malrotation or both diagnosed simultaneously.1 Our patient had no evidence of bilious vomiting or bilious aspirate prior to pyloromyotomy, suggesting that probably it was tight enough to prevent bile reflux, which manifested after the operation. Although, as described, IHPS and malrotation have been diagnosed in the same patient, it is probably for the first time that IHPS had preceded the malrotation. The intent of this information is to let others know that, although rare IHPS can be associated with malrotation and can present in this manner so if any patient operated for IHPS do present like this, immediate reoperation can give excellent result.

Displacement of the abomasum to the left side and pyloric obstruction in a goat

Summary A 4-year-old female native goat with the history of inappetence and no defecation was referred to the Department of Clinical Sciences, School of Veterinary Medicine of Shiraz, Shiraz, southern Iran. During exploratory laparotomy, pyloric obstruction and displacement of the abomasum to the left side was observed. Obstruction of pylorus was due to a ball-shaped phytobezoar. The goat was followed and had a good condition one month after the operation. It was concluded that the displacement of the abomasum to the left side has been occurred subsequent to the abomasal obstruction.

The clinical management of intestinal obstruction.

Much of the controversy which persists in the treatment of patients with bowel obstruction concerns the decisions of whether and when to advise celiotomy. In view of these and other differences of opinion and continued advances in therapy, the experience obtained in treating obstruction on the Surgical Service of the University of Utah at the Salt Lake Veterans Administration Hospital has been utilized in formulating a rational method of management. Plan of Management Seventy-six patients with 88 episodes of obstruction were admitted during the decade 1948 to 1958. Males predominated 73 to 3, and the ages ranged from 21 to 84 years. This group was limited to those with a history of vomiting, distention, cramping abdominal pain, the roentgenographic demonstration of distended bowel, and/or proof of mechanical obstruction at surgery or autopsy. Patients with obstruction of pylorus or anal canal were excluded from the study. The plan of management adopted

Organic Acidosis in Hypochloremic Azotemia after Pylorus Obstruction.

Acta Medica ScandinavicaVolume 93, Issue 1-2 p. 42-47 Organic Acidosis in Hypochloremic Azotemia after Pylorus Obstruction. P. GÖMÖRI, P. GÖMÖRI First Internal Clinic of the University in Budapest. (Chef: Prof. F. Herzog.)Search for more papers by this authorP. MARSOVSZKY, P. MARSOVSZKY First Internal Clinic of the University in Budapest. (Chef: Prof. F. Herzog.)Search for more papers by this author P. GÖMÖRI, P. GÖMÖRI First Internal Clinic of the University in Budapest. (Chef: Prof. F. Herzog.)Search for more papers by this authorP. MARSOVSZKY, P. MARSOVSZKY First Internal Clinic of the University in Budapest. (Chef: Prof. F. Herzog.)Search for more papers by this author First published: January/December 1937 https://doi.org/10.1111/j.0954-6820.1937.tb17596.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume93, Issue1-2January/December 1937Pages 42-47 RelatedInformation

Protein Disintegration in Hypochloremic Azotemia after Pylorus Obstruction and its Mechanism

Protein Disintegration in Hypochloremic Azotemia after Pylorus Obstruction and its Mechanism

A Case of Gastro-Enterostomy for Cancerous Obstruction of the Pylorus

A Case of Gastro-Enterostomy for Cancerous Obstruction of the Pylorus

A Case of Gastro-Enterostomy for Cancerous Obstruction of the Pylorus

A Case of Gastro-Enterostomy for Cancerous Obstruction of the Pylorus