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PubMed2003

Enteropathy-associated T-cell lymphoma of the jejunum complicated with intestinal perforation.

Enteropathy-associated T-cell lymphoma (EATL) is a rare, well-documented complication of celiac disease, accounting for less than 1% of the non-Hodgkin's lymphomas. Perforation as the presentation of intestinal lymphoma is rare, and as the presentation of EATL is even rarer. Herein, we report a 56-year-old female with EATL of the jejunum complicated with intestinal perforation. She was admitted because of sudden onset of severe abdominal pain. Emergent exploratory laparatomy was done under the impression of perforative peptic ulcer, however, an ulcerative tumor with perforation was noted unexpectedly at the proximal jejunum. After tumor resection and end-to-end anastomosis of the jejunum, the patient received eight courses of CHOP (cyclophosphamide, adriamycin, oncovin and prednisolone) chemotherapy. Now she has been disease-free for one and half years after the diagnosis. From our experience and that of others, we consider that combination chemotherapy should be helpful for patients with EATL.

Celiac Disease↗
PubMed1987

[Perforation of a stomach ulcer into the left heart ventricle. Case report and review of the literature].

We present a case of peptic-ulcer perforation from the stomach into the left ventricle. The patient who had no prior cardiac or abdominal symptoms was admitted with gastrointestinal bleeding and the electrocardiographic signs of myocardial infarction of the posterior wall. After the bleeding had subsided for 5 hours the patient died suddenly from massive upper gastrointestinal bleeding. At autopsy a peptic ulcer was found 3 cm beneath the cardia in the anterior wall on the lesser curvature which had perforated dorsal from the papillar muscle into the left ventricle. In the literature 19 such ulcer perforations have been reported which are compared with the present case.

Aged↗
PubMed1999

A pneumoperitoneum perpetuates severe damage to the ultrastructural integrity of parietal peritoneum in gastric perforation-induced peritonitis in rats.

BACKGROUND: Minimal invasive surgery is increasingly used in conditions complicated by peritonitis-e.g., peptic ulcer perforation. This study was devised to assess the effect of a pneumoperitoneum (PP) on the ultrastructural integrity of parietal peritoneum in perforation-induced peritonitis. METHODS: Anesthetized rats were subjected either to standardized gastrotomy simulating gastric perforation (groups Ia-d; IIa-d) or to sham perforation (groups IIIa-d, IVa-d). In group I (a-d) and III (a-d), CO2 was insufflated 12 h after gastrotomy for 60 min (Pia 4 mmHg). Glutaraldehyde was administered intraperitoneally at the end of the PP period while the abdominal wall was still extended (group index a), as well as 30 sec (b), 2 h (c), and 12 h (d) after desufflation. Specimens were taken from the parietal peritoneum of the left diaphragm for scanning electronic-microscopic (SEM) analysis. In groups II (a-d) and IV (a-d), simple puncture of the abdominal cavity was performed, and specimens were taken at corresponding times. RESULTS: In group Ia (gastric perforation with PP), distortion of the mesothelial cell layer with concomittant opening of stomata to the submesothelial tissue was already observed in specimens harvested while the abdominal wall was still extended. Concomitantly, scarce microvilli, which appeared coarse and thickened, were lying flat on top of the mesothelial cells. After desufflation (groups Ib-c), a rapid process of mesothelial disintegration with disruption from the submesothelial layer and vanishing of microvilli occurred. At 12 h after PP (group Id), complete deterioration of mesothelial cell integrity was observed. In groups IIa-c (gastric perforation without PP), microvilli appeared shrunk and coarse, while integrity of the mesothelial cell layer remained intact up to 2 h after the abdominal puncture. At 12 h after abdominal puncture (group IId), the microvilli had nearly completely vanished and the mesothelium was breaking apart into multiple soils. CONCLUSIONS: In SEM analysis of parietal peritoneum, premature distortion, and disintegration of the mesothelial cell layer was observed in animals exposed to increased abdominal pressure in addition to gastric perforation-induced peritonitis.

Animals↗
PubMed1994

Laparoscopic proximal gastric vagotomy.

Proximal gastric vagotomy, considered the conventional surgical treatment of choice for peptic ulcer disease, is now performed laparoscopically. Thirty-three patients underwent the procedure. Seven patients were treated on an emergency basis for perforated peptic ulcer. Morbidity and mortality of the procedure were zero. Patient acceptance (Visick staging) was good to excellent in 22 of 25 patients in follow-up. Laparoscopic proximal gastric vagotomy appears to be a good treatment in chronic peptic ulcer disease even when complicated by an acute perforation.

Adult↗
PubMed1998

Laparoscopic vs open repair of gastric perforation and abdominal lavage of associated peritonitis in pigs.

BACKGROUND: Laparoscopy is increasingly used in conditions complicated by peritonitis, e.g., peptic ulcer perforation. Of some theoretical concern is the capnoperitoneum, which may aggravate peritonitis and induce septic shock due to increased intraabdominal pressure and distension of the peritoneum. This animal study was devised to analyze the effectiveness of laparoscopic versus traditional open repair of gastric perforation and abdominal lavage for associated peritonitis. METHODS: To simulate gastric perforation, female Duroc pigs were subjects to standardized gastrotomy. Either 6 or 12 h after gastric perforation, the animals underwent either traditional open or laparoscopic repair of the gastric defect and peritoneal lavage. The subjects were divided into the following four groups: peritonitis for 6 h and open surgery (group I) or laparoscopic surgery (group II); peritonitis for 12 h and open surgery (group III) or laparoscopic surgery (group IV). After an observation period of 6 days, the surviving animals were killed. The main outcome criteria were survival, perioperative changes of hemodynamics suggestive for septic shock, bacteremia, and endotoxemia. RESULTS: There were no significant differences between group I and II. Mortality was 22% in group III, as compared to 78% in group IV (p = 0.045). In group IV, the incidence of perioperative bacteremia and plasma endotoxin concentrations were significantly higher than in group III. Concomitantly, decreased mean arterial pressure and systemic vascular resistance, and increased cardiac output suggested a higher incidence of septic shock in group IV. CONCLUSION: Critical appraisal of laparoscopic surgery is warranted in conditions associated with severe, longstanding peritonitis.

Animals↗
PubMed1989

[Vagotomy of the oxyntic cells associated with simple closing as surgical treatment of perforated duodenal ulcer. A comparative study with simple closing alone].

To evaluate the incidence of ulcer recurrence, mortality and morbidity derived from the surgical technique, we made a prospective and randomized study in patients with perforated duodenal peptic ulcer, within 10 hours after the acute episode and without intercurrent serious diseases. In a total of 180 patients, oxyntic cell vagotomy (VCO) with simple closure or simple closure alone were performed alternatively in the period from 1971 to 1977. Periodic controls were established that included clinical, radiographic and gastroduodenoscopic evaluation. Twelve years after operation, 115 of the patients could be evaluated. Recurrence was defined as endoscopic or surgical evidence of the ulcerous lesion. The endoscopic results after 12 years showed 1.56% of relapses in the group that underwent oxyntic cell vagotomy with simple closure, and 54.9% in the group that only had simple closure (p less than 0.0005). There were also significant differences in the clinical and radiographic controls, and in the degree of comfort achieved with the technique. Mortality was null in both groups and there were no differences between the two techniques as regards morbidity. The results obtained in this study show that oxyntic cell vagotomy with simple closure of the perforation may be the technique of choice in the treatment of perforated duodenal peptic ulcer, which is why we think is should be more extensively used in emergency services.

Adult↗
PubMed2005

Comparison of laparoscopic versus open repair for perforated duodenal ulcers.

BACKGROUND: There is great controversy regarding the choice of procedure for perforated duodenal ulcer patients. The purpose of this study was to compare the early outcome results of laparoscopic and open repair and to propose which risk factors influence the outcome. METHODS: Between October 1996 and May 2004, 60 patients underwent laparoscopic and 162 patients underwent open repair of perforated peptic ulcers in a tertiary care academic center. The results were retrospectively analyzed. The primary outcome measures included operative time, duration of hospital stay, morbidity, and mortality. RESULTS: The operative time was significantly longer in the laparoscopy group compared to the open repair group (76.2 +/- 35.3 vs 57.3 +/- 26.1 min, respectively). The hospital stay in surviving patients appeared to be significantly shorter after laparoscopy than after open repair (7.8 +/- 5.3 vs 10.3 +/- 10.6 days, respectively). Eight patients (13%) in the laparoscopic group and 41 patients (25%) in the open repair group had morbidity in the postoperative period. Suture leakage was confirmed in four patients (7%) following laparoscopic repair and in three patients (2%) in the open repair group. There were 20 deaths (9%), all in the open repair group. CONCLUSIONS: Independent Boey risk factors, patient age, and large perforation size have a negative impact on patient recovery. Both laparoscopic and open repair are equally safe and effective in perforated duodenal ulcer patients with a Boey score of 0 or 1.

Adult↗