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PubMed1989

Effect of X-irradiation on the stomach of the rat.

A model for localized 300 kV X-irradiation of the rat stomach was developed. After irradiation with single doses, three distinct gastric disorders were observed which occurred at different latency times. Acute death 2-3 weeks after irradiation was caused by an erosive and ulcerative gastritis and occurred in all animals given 28.5 Gy without diet, in 17% of the animals given 28.5 Gy plus diet, and in 13% of the animals given 23 Gy. Subacute to chronic fatal disorders 4 weeks to 7 months after irradiation were seen as stomach dilatation and gastroparesis, associated with the replacement of the normal gastric mucosa by a hyperkeratinized multilayered squamous epithelium. These disorders occurred in 40-100% of the animals after doses between 16 Gy and 28.5 Gy (+diet). An ED 50 value of 19.2 Gy (16.5-21.2 Gy, 95% confidence interval) was calculated for this gastroparesis. Late gastric obstruction exceeding 7 months after irradiation was seen in the rats because of profound changes in the gastric wall in 13-18% of the animals after doses between 23 Gy and 14 Gy. In animals surviving these three periods, an atrophic mucosa and intestinal metaplasia developed. From functional and morphohistological studies, it can be concluded that there are differences in the pathogenesis of the fatal radiation damage for each of these periods after irradiation.

Animals↗
PubMed2000

Prenatal diagnosis of pyloric atresia-junctional epidermolysis bullosa syndrome in a fetus not known to be at risk.

Junctional epidermolysis bullosa with pyloric atresia (PA-JEB) is a highly lethal, inherited, autosomal recessive disease. Thus far, prenatal diagnosis of this syndrome was only realized on pregnancies at risk for recurrence. We report the case of a 26-year-old woman, first cousin to her husband, who had undergone amniocentesis for polyhydramnios. The karyotype was normal but the amniotic fluid contained acetylcholinesterase. A targeted scan at 25 weeks' gestation did not find spina bifida, but polyhydramnios with a dilated stomach, and several other anomalies: echogenic particles in the amniotic fluid, a thin skin which closely adhered to the nasal bones, narrow nostrils, abnormal ears, fisted hands, malposition of both first toes, and kidney malformation. Despite no previous case in the family, it was thought that sonographic findings were suggestive of the PA-JEB syndrome. A fetal skin biopsy was carried out at 28 weeks' gestation. The ultrastructural examination of fetal skin displayed JEB. Genetic analysis detected a homozygous mutation in the gene encoding integrin alpha 6. Termination of pregnancy was carried out at 29 weeks' gestation. These results illustrate that in the case of a fetus not known to be at risk, diagnosis of PA-JEB can be achieved by ultrasound findings leading to fetal skin biopsy and ultrastructural examination of blistered epidermis. Some new sonographic signs should raise the possibility of significant cutaneous desquamation and blister formation in a fetus, especially when there is positive amniotic acetylcholinesterase coupled with elevated alpha-fetoprotein or suspected pyloric atresia.

Abnormalities, Multiple↗
PubMed1992

Aplasia cutis congenita associated with epidermolysis bullosa and pyloric atresia: the diagnostic role of prenatal ultrasonography.

Aplasia cutis congenita associated with epidermolysis bullosa and pyloric atresia is a rare congenital disease in which localized or widespread areas of skin are absent at birth. Alphafetoprotein (AFP) and skin biopsy have been used for prenatal diagnosis of this condition. A patient in whom normal levels of amniotic AFP at 16 weeks' gestation presumably excluded the disease and who was at risk for aplasia cutis congenita associated with epidermolysis bullosa and pyloric atresia is described. However, 10 weeks later, ultrasonographic examination revealed hydramnios, a dilated stomach, a deformed external ear, and a contracted fisted hand. All signs were confirmed postnatally. The role of ultrasonography and the value of other diagnostic methods in this congenital disease are discussed.

Abnormalities, Multiple↗
PubMed1992

Antroduodenal manometry. Usefulness and limitations as an outpatient study.

We performed fasting and postprandial recordings of antroduodenal manometry in 21 normal volunteers, 13 patients with insulin-dependent diabetes mellitus and gastrointestinal symptoms, and 11 patients with the irritable bowel syndrome. None of the patients or volunteers had previously undergone an intestinal intubation study. Recordings could not be obtained from four of the diabetic patients due to failure to intubate the pylorus. Catheter migration led to incomplete antral data in a further 21% of all recordings. Due to the wide variations demonstrated by the normal volunteers, parameters of either the migrating motor complex (MMC) or the fed response could not differentiate between either of the patient groups and/or the controls. Similarly, while abnormal patterns of either fasting or postprandial motility were common in the diabetic patients, manometry had a sensitivity of only 67% in comparison to the less invasive radionuclide gastric emptying study. Furthermore, manometry failed to identify any diagnostic abnormality in irritable bowel patients; in particular, the incidence of "clustered" contractions was similar in all three groups. We conclude that short duration antroduodenal manometry is of limited diagnostic usefulness due to the difficulties in pyloric intubation in the presence of a dilated stomach and the intrinsic variability in normal motor patterns, perhaps excerbated by the stressful effects of the procedure itself in tube-naive subjects.

Adult↗
PubMed1990

Altered gastric and duodenal motility in intestinal obstruction.

There are no strict clinical or radiographic criteria that consistently indicate imminent strangulation in cases of small bowel obstruction. An intestinal obstruction with vascular compromise produces a marked retention of food, fluid, or contrast material in the stomach and duodenum, while an obstruction without vascular problems may show no change or somewhat delayed gastric emptying with some duodenal hypotonia. The association of gastric atony and profound stomach dilatation with strangulating, usually closed-loop intestinal obstruction, has generally not been appreciated by radiologists. We illustrate this phenomenon in 4 patients and emphasize its usefulness in evaluating intestinal obstructions.

Adult↗
PubMed1988

Fetal jejunoileal atresia with persistent omphalomesenteric duct.

A case of fetal jejunoileal atresia in association with persistent omphalomesenteric duct is presented. The dilated stomach and proximal and distal duodenum produced a multiple bubble sign on the prenatal sonogram. The neonate underwent exploratory laparotomy, excision of the persistent omphalomesenteric duct, gastrotomy, and colostomy. Possible causes of jejunoileal atresia are presented.

Humans↗
PubMed2003

Prenatal diagnosis of megacystis-microcolon-intestinal hypoperistalsis syndrome in one fetus of a twin pregnancy.

Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) is a rare genetic disorder that affects the muscle tone in the intestinal and urinary tract systems. Prenatal diagnosis is difficult because an identifiable genetic locus is absent and there are no specific ultrasound findings. We present an interesting case of this syndrome diagnosed prenatally in one fetus of a twin pregnancy. A 26-year-old white woman gravida 4, para 2103, at 11 weeks' gestation was diagnosed with a dichorionic diamniotic twin pregnancy. The patient's history was significant for having a previous female infant diagnosed with MMIHS. During a follow-up ultrasound at 26 weeks, one of the twins had multiple anomalies including: a pelvic cystic structure with a keyhole appearance, enlarged stomach, dilated bowel, and prominent renal pelves. Prenatal diagnosis of MMIHS can be possible on ultrasound findings with a positive family history.

Abnormalities, Multiple↗
PubMed2006

Characterization of Bouveret's syndrome: a comprehensive review of 128 cases.

AIM: The aim of the study was to characterize the clinical presentation, evaluation, and therapy of Bouveret's syndrome, by comprehensively reviewing all the identified previously reported cases, to facilitate early diagnosis and thereby to improve the prognosis. METHODS: Relevant articles were identified by MEDLINE computerized searches, by consultation with all available reference books, and by review of the first author's teaching files. A new case in which the diagnosis of Bouveret's syndrome was missed at esophagogastroduodenoscopy (EGD)--despite endoscopic findings of gastric outlet obstruction caused by a hard, nonfleshy, and convex pyloric mass--prompted this review. RESULTS: Review of 128 reported cases identified syndromic characteristics. Patients on average were 74.1 +/- 11.1 (SD) yr old. The female-to-male sex ratio was 1.86. Prominent symptoms were nausea and vomiting in 87%, abdominal pain in 71%, hematemesis in 15%, recent weight loss in 14%, and anorexia in 13% of patients. Prominent signs were abdominal tenderness in 44%, signs of dehydration in 31%, and abdominal distention in 26% of patients. Endoscopy revealed gastroduodenal obstruction in nearly all cases, but identified the obstructing stone in only 69%. Abdominal ultrasound or computerized tomography was diagnostic in about 60% of cases. CONCLUSIONS: The following endoscopic findings are suggestive of Bouveret's syndrome: a dilated stomach containing old digested food from gastrointestinal obstruction together with a hard and nonfleshy mass at the obstruction. These endoscopic findings, in the setting of the currently reported characteristic epidemiologic and clinical findings, should strongly suggest this syndrome. Abdominal ultrasound or computerized tomography is recommended to confirm and extend the endoscopic diagnosis.

Cholelithiasis↗
PubMed1987

Drill biopsy in the diagnosis of lung lesions.

A high speed pneumatic drill was used to perform 190 percutaneous transthoracic biopsies in 161 patients. The resultant cores of tissue provided a definite diagnosis in 146 patients, giving a success rate of 90.7%. Complications occurred in 58 patients, subcutaneous emphysema being the most common, though only seven patients required active treatment, giving a rate of 3.7% for important complications. One patient died within 24 hours of the biopsy procedure owing to asphyxia resulting from aspiration of the contents of an acutely dilated stomach. Our experience clearly establishes that the drill biopsy as used by us is simple and safe and can be carried out in an outpatient department, yielding better overall results than any other procedure for closed biopsy of the lung currently practised.

Adolescent↗
PubMed2004

[Percutaneous gastrostomy as an urgent method of treatment of a neonate with esophageal and duodenal atresia].

The objective of this article was to present possibilities of percutaneous gastrostomy for management of a newborn with esophageal and duodenal atresia. Percutaneous gastrostomy is the most commonly employed technique for providing long-term enteral nutrition. In adults, it is also method of choice for decompression of digestive tract in palliative treatment of malignant and non malignant diseases. This is a case report of two-day old newborn with esophageal atresia with distal tracheoesophageal fistula and duodenal atresia. Percutaneous decompressive gastrostomy was used as a temporary bridge to definite surgery for management of respiratory dysfunction of this newborn, caused by dilated stomach. Surgical management (esophageal and duodenal reconstructions) as well as intra- and postoperative period were without any complications. Three months after surgical management, the infant is well and without any difficulties.

Duodenal Obstruction↗
PubMed1999

[A case of myotonic dystrophy with intestinal pseudo-obstruction syndrome].

We experienced a patient of myotonic dystrophy presenting with intestinal pseudo-obstruction syndrome (IPOS). He was admitted to our hospital because of repetitive vomiting lasting for 24 hours. Abdominal CT revealed dilated stomach, duodenum and jejunum with extensive fluid residues. This patient was successfully treated with conservative therapy by using intravenous administration of metoclopramide. The etiology of IPOS in myotonic dystrophy is not well understood. In addition to normal findings of autonomic function tests such as R-R interval, Schellong test and sympathetic skin response, the efficacy of metoclopramide in treating IPOS suggests that acetylcholine (ACh) release is relatively preserved from the intestinal nerve plexus. Denervation hypersensitivity at the ACh receptors from long-standing dysfunction of autonomic system may be related to the cause of IPOS in myotonic dystrophy.

Acetylcholine↗
PubMedDate not supplied

Cardiomediastinal tamponade and shock following three-stage transthoracic oesophagectomy.

Massive gastric tube dilatation causing cardiomediastinal tamponade is an unusual cause of obstructive shock after transthoracic oesophagectomy. A 55-year-old female was operated for total transthoracic oesophagectomy. Twelve hours after the surgery, she developed hypotension and raised central venous pressure unresponsive to fluid infusion and ionotropes. X-ray chest showed a massively dilated stomach, which was causing intrathoracic tamponade. Suction applied to the nasogastric tube led to aspiration of 150-200 ml of fluid and a large volume of air, which led to resolution of the haemodynamic instability. A simple manoeuvre like nasogastric suction in postoperative case of oesophagectomy can serve as a diagnostic as well as therapeutic tool. It must be performed before resorting to invasive and expensive examination or intervention.

Blood Pressure↗
PubMedDate not supplied

Cholangiocarcinoma presenting with severe gastroparesis and pseudoachalasia.

Tumor-associated gastroparesis, though reported in association with various malignancies, is rare in patients with cholangiocarcinoma. We report a 55-year-old woman who presented with dysphagia and recurrent vomiting. Esophagogastroduodenoscopy revealed dilated stomach and excess residue without organic obstruction. 99mTc sulfur colloid solid gastric emptying study, radio-opaque marker gut transit study, and esophageal manometry showed features suggestive of gastroparesis and achalasia cardia; electrogastrography revealed bradygastria. Cholangiocarcinoma was detected on CT scan performed after the patient developed jaundice two months later. The lesion was deemed surgically unresectable. She died four months later.

Bile Duct Neoplasms↗
PubMed2006

Severe gastroparesis causing splenic rupture: a unique, early complication after heart-lung transplantation.

Several weeks or even months after heart-lung transplantation, gastroparesis-or delayed gastric emptying-commonly presents with cough, early satiety, and bloating. As it progresses, gastroparesis can cause substantial malnutrition and impair drug absorption. Gastroparesis after heart-lung transplantation can be attributed to bilateral vagus nerve injury, which probably occurs just above the level of the carina, where the recipient's trachea is resected. We report a highly unusual case wherein gastroparesis presented early after heart-lung transplantation and was managed conservatively. However, 19 days postoperatively, the patient developed acute abdominal pain and hypotension. Laparotomy revealed a massively dilated stomach and total avulsion of the splenic capsule with hemorrhage. The patient was fed via jejunostomy tubes until the gastroparesis resolved spontaneously. This case illustrates an important sequela of heart-lung transplantation. In order to decrease the morbidity from gastroparesis in these fragile patients, a drainage procedure should be considered as an adjunct to heart-lung transplantation.

Cardiomyopathies↗
PubMed1991

Gastric volvulus--a late complication of gastrostomy.

Two cases of gastric volvulus are reviewed. Both patients were nonverbal, mentally handicapped children, who were fed through a gastrostomy. They had intermittent intolerance to bolus feeds through the gastrostomy, accompanied by abdominal distension and vomiting of gastric contents. One had a previous partial fundoplication and gastrostomy, and the other had had two pyloroplasties and gastrostomy. The axis of torsion ran from the esophagogastric junction to the gastrostomy site. Both children were treated by detorsion and gastropexy. It is postulated that the gastrostomy served as a fixed point for the volvulus. This was facilitated by the chronically dilated stomachs induced by bolus feeds. These two cases are reported to alert the clinician to this possibility when a neurologically impaired child with a gastrostomy presents with feeding difficulties and persistent vomiting.

Adolescent↗
PubMedDate not supplied

[Duplication of the alimentary tract: report of three cases].

Three cases of duplications of the alimentary tract are presented. Case 1 was a 5-month-old male baby. He was admitted due to copiously painless rectal bleeding. Tc-99m pertechnetate scanning revealed unusual tubular and spherical lesions. Laparotomy findings were that a tubular ileal duplication m assured 100cm or so in length and communicated with ileal lumen by its distal orifice. Moreover, there were 2 spherical duplications like ping-pong ball in morphology located in neighboring mesentery. Case 2 was a 2-day-old male newborn. He was admitted because of persistent bilious vomiting on his second day of life. Plain film x-ray revealed dilated stomach and scanty bowel gas. Laparotomy finding was that a cystic duplication measured 1.5cm in length which located in and obstructed the lumen of proximal jejunum. Also there was a distal orifice of duplication in communication with jejunal lumen. Case 3 was a 4-year-and-4-month-old boy who admitted after intermittently non-projectile vomiting for a period of 1 1/2 year. Sonography showed a calcification lesion at right upper quadrant of abdomen. Panendoscopy saw a refraction at second part of duodenum. The findings of laparotomy were that 2 tumor masses laid upon gastrocolic ligament. One was ossified soft tissue (gastrocolic ligament) with 1.5 x 1 x 0.8cm3 in size, and the other was cystic duplication of transverse colon in contact with beneath mesocolon. All duplications of 3 cases were lined with ectopic gastric and small intestinal mucosa, and ulcerative lesion was found in case 3 only. All lesions were resected and removed with good results.

Child, Preschool↗
PubMed1988

Pneumobilia associated with small-bowel obstruction.

We present a patient who was admitted complaining of nausea, vomiting, and abdominal distention. A roentgenogram of the abdomen revealed a dilated stomach and pneumobilia. At surgery, he was found to have proximal small-bowel obstruction. To our knowledge, this is the first case of pneumobilia associated with proximal small-bowel obstruction not associated with a gallstone.

Air↗