Background: We evaluated the condition of postoperative gastroesophageal reflux disease (GERD) after distal gastrectomy. Subjects and Method: We investigated the questionnaires about reflux for ...109patients who underwent distal gastrectomy for gastric cancer. On the basis this, we examined the pre-and postoperative His angle, the length of the residual stomach's lesser curvature, sex, lymphnodal dissection and connection with reflux symptoms. In 26cases, the severity of esophageal biliary reflux was determined with Bilitec2000 postoperatively. Based on these findings, the presence or absence of reflux esophagitis and above factors and severity of biliary reflux were examined. Results: A questionnaire showed reflux symptoms (reflux group) in 23 (21%). Among etiological factors positive for reflux, postoperative His angles were 92.6±32.2° in the reflux group and 74.7±26.5° in the non-reflux group. In the reflux group, the angle increased (p=0.007). We studied the length of the residual stomach's lesser curvature (N cm).Reflux was observed in 9 (41%) of 22 patients with an N of 5 or less, (p=0.026). The incidences of reflux in men was 15.5% and women 31.6%. We measured the frequency of bile regurgitation in 26 patients using a Bilitec 2000 (Synectics Medical AB, Stockholm, Sweden) device. In 20 patients in whom the frequency of bile regurgitation was 5% or more, the His angle was 90.6±21.5°. In 6 with regurgitation of less than 5%, the His angle was 74.5±14.2°. In the group with bile regurgitation, the His angle increased. Conculusions: Based on these results, we concluded that morphological changes in the cardia, demonstrated by enlargement of the His angle, residual stomach size, and gender are important in determining the onset of GERD after distal gastrectomy.
Purpose: To improve prognosis, we evaluated preoperative factors for treating colorectal perforation and potentially fatal factors and postoperative complications. Methods: Subjects were 35 persons ...undergoing emergency surgery for colorectal perforation between January 2004 and August 2008. We analyzed preoperative factors of age, complications, perforation cause and site, white blood cell count, creatinine, prothrombin time, base excess, body temperature, blood pressure, APACHE II score, time from perforation onset to surgical intervention, ascites, and surgical procedure. We then analyzed potentially fatal postoperative complications for mortality. Results: Overall mortality was 23% (N=8) for which significant predictive factors in univariate analysis were creatinine, prothrombin time, base excess, body temperature, blood pressure, APACHE II score, and ascites. Multivariate logistic regression analysis, however, showed only the APACHE II score to be significantly associated with mortality (relative risk 1.89, p=0.005). Mortality in those with an APACHE II score of ≥20 was 83%, compared to 10%, in those with an APACHE II score of <20 (p=0.001). Postoperative mortality increased significantly from zero in those without the postoperative infection such as intraperitoneal infection, bacteremia or pneumonia to 53% in those with the infections (p<0.001). Mortality increased significantly from 13% in those without disseminated intravascular coagulation (DIC) to 80% in those with it (p=0.006). Conclusions: The APACHE II score is significantly predictive in those with colorectal perforation. And, it indicated that successful management of the postoperative infections could reduce mortality.
A CASE OF CALCULUS IN A MECKEL'S DIVERTICULUM KAWA, Yoshitetsu; KASUYA, Shinobu; MIYAZAKI, Syoujirou ...
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association),
1999, Letnik:
60, Številka:
5
Journal Article
Odprti dostop
We present the case of calculus in a Meckel's deverticulum. A 67-year-old woman with a history of repeated attacks of lower back pain and vomiting several times a year was seen at the hospital ...because of lower back pain and vomiting. The patient was diagnosed with having intestinal obstruction by abdominal X-ray examination, and was admitted on the same day. After admission symptoms ameliorated following conservative treatment. Radiological enteroclysis and CT performed after symptomatic remission showed an abnormal shadow accompanied by polygonal calcification 2.5cm in diameter in the bowel, which was likely to be the ileum. Abdominal section performed to diagnose the intestinal abnormality revealed a projected diverticulum in a sac at a site 40cm towards the mouth from the terminal ileum. A foreign body was palpable within the lumen. There were no other abnormal findings such as stenosis or tumor of the small intestine. A section of the ileum about 5cm in range including the diverticulum was excised. The foreign body within the diverticulum was polygonal blackish brown stone with the size of 2.5×2.0cm and the thickness of 0.5cm, considered to be an intestinal stone. Histologically, the membrane of the diverticulum was ileal mucosa membrane. No findings of ectopic gastric mucosa nor malignancy was seen. Meckel's diverticulum containing an intestinal stone was diagnosed. We rarely encounter reports of Meckel's divertidulum containing an intestinal stone. This paper reports such a rare case together with some bibliographical comments.
We describe a case of multiple jejunal gastrointestinal stromal tumors (GIST) accompanied with von Recklinghausen's disease. A 63-year-old man presented with melena at a local clinic and was referred ...to our hospital for further evaluation because of anemia. Upper gastrointestinal series and abdominal CT scans revealed a jejunal tumor. Surgery was performed for the tumor in October, 2004. An outside protruding lesion of 5.5cm in diameter at the beginning of the jejunum was confirmed, and a smaller jejunal mass was also found near the lesion. Resection of partial jejunum was done for the main tumor, and wedge resection of jejunum was performed for the smaller one. Histopathological findings revealed a fascicular proliferation of spindle-shaped cells in the tumors. Immunohistochemical findings demonstrated that both tumors' cells were positive for c-kit, CD34 and S-100, and negative for SMA. The pathological diagnosis was multiple GIST, since both tumors were located between the submucosa and subserosa. There are no signs of recurrence to date.
A 70-year-old man was found to have multiple liver tumors on ultrasonographic examination for abdominal pain and fever, and was introduced to our hospital for further evaluation and treatment. ...Additional examinations revealed multiple liver metastases of a jejunal submucosal tumor. Surgery was performed in December 2004, and multiple solid tumors in the liver and a mass of 5cm in diameter at the beginning of the jejunum were found. Partial resection of the jejunum was performed to remove the main jejunal tumor. Histopathological findings revealed fascicular proliferation of spindle-shaped cells in the tumor. Innunohistochemical findings demonstrated that the tumor cells were positive for c-kit, and negative for SMA and S-100. The pathological diagnosis was gastrointestinal stromal tumor (GIST). The patient was given imatinib mesylate at a dose of 400mg/day to treat liver metastases. CT scans and ultrasonographic examination obtained three and a half months after the treatment with imatinib mesylate showed that the hepatic metastatic lesions had disappeared. There are no further signs of recurrence as of 7 months after the drug regimen. Complete response of GIST to imatinib mesylate is rare. We report this patient with liver metastasis of jejunal GIST which responded to the medication completely after the resection of the jejunal tumor.
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