A rare cause of parastomal hernia: stomach herniation

Our case of a parastomal hernia is rare because the stomach became incarcerated in the hernial sac. The diagnosis of parastomal hernia is not a difficult one, but one must be aware of the possible complications of the colostomy and the rare occurrence of the parastomal hernia containing the stomach.

Gastric duplication cyst. Endoscopic presentation as an ulcerated antral mass

A case of a 53-year-old man who presented with epigastric pain and weight loss is described. Endoscopy showed a smooth antral mass with what appeared to be a central overlying ulcer. Computerized tomography and upper gastrointestinal series confirmed the presence of a gastric mass. Laparotomy and local resection showed a gastric duplication comprised of two cysts, one with communication to the stomach lumen. Gastric duplication is a rare entity, especially in the adult. Though generally benign, local ulceration or fistula formation can cause symptoms and may suggest a more malignant process that warrants investigation.

Abomasal foreign body and left-sided displacement in a pregnant cow

By percussion left displaced abomasum (LDA) was identified in a 7-month pregnant Ayrshire cow which had presented with progressive abdominal distension despite a 5-day history of inappetence. An explorative laparotomy was performed and extensive fibrinous adhesions were identified between the abomasum, diaphragm and left abdominal wall. At the centre of these adhesions a 10 cm length of wire had penetrated the abomasal wall. Haematological analysis undertaken pre-surgery revealed a marked inflammatory response and profound disturbance of serum chloride and sodium concentrations. Following surgical correction of the LDA and intensive supportive therapy the cow made an uneventful recovery.

[Gastrointestinal amyloidosis: differential diagnosis and indications for surgical therapy]

The diagnosis of gastrointestinal amyloidosis may be difficult for both the radiologist and the examining surgeon because clinical symptoms are often uncharacteristic. Upper gastrointestinal series may show stenosing submucosal masses in the esophagus or gastric antrum with diminished peristalsis and pliability mimicking malignancies. With small bowel involvement, diminished motility and segmental or complete distension, a prolonged transit time, and eventually obstruction are common findings. In the present study, we report four cases of gastrointestinal amyloidosis and review the indications for operative treatment. Surgery should be avoided for abdominal pseudo-obstruction and but may be indicated in patients with gastrointestinal bleeding, perforation or other severe complications. The postoperative course is characterized by impaired wound healing, a high rate of heart and kidney failures, and considerable perioperative mortality. Thus, results are frequently unsatisfactory.

The risk of cancer at all sites following gastric operation for benign disease. A cohort study of 4,224 patients

This report represents the results of a historical cohort analysis of 3,360 males and 864 females who had a gastric resection or gastroenterostomy for benign disease between 1990 and 1969. Within the period 1970 to 1988 the cohort was cross-checked with the data files at the Cancer Registry of Norway to identify the patients in whom cancer had been diagnosed. When analyzed according to cancer sites, increased risk was recorded for the oropharynx, stomach, colon, pancreas, liver, biliary tract, larynx, lungs, urinary bladder and non--melanomatous cancers of the skin in males. In females, increased risk was only observed for the oropharynx, but was close to a statistically significant level also for cancer of the stomach. A lower number of tumors of the central nervous system than expected was observed in both males and females. The increased risk of cancer of the lungs, larynx and urinary bladder in males can be regarded as evidence of the high prevalence of smokers in the cohort. We suggest that the increased risk of cancer of digestive organs is mainly related to life-style factors, particularly tobacco-specific nitrosamines whose effect is enhanced by surgical sequelae.

Angiocentric immunoproliferative lesion of the stomach

We report here a rare case of angiocentric immunoproliferative lesion (AIL) of the stomach. The patient was a 61-year-old Japanese female whose medical history was unremarkable. Following a complaint of abdominal discomfort, a submucosal tumour of the stomach was found and gastrectomy was done. Histological examination of the tumour revealed multiple angiocentric or angiodestructive lesions with numerous lymphocytic infiltrates. These vascular lesions were histologically the same as those in benign lymphocytic vasculitis with granulomatosis (BLV) of the respiratory tract. AIL is a distinct entity, including BLV, lymphomatoid granulomatosis and angiocentric lymphoma with BLV representing a good prognosis group of AIL. A survey of the literature suggests that AIL is a spectrum of T-lymphocyte proliferative disorders. To our knowledge, this is the first case of AIL involving the stomach primarily.

[The treatment of left abomasal displacement in cattle]

In this paper the treatment of left abomasal displacement in cattle is discussed. Special attention is paid to the different surgical methods. Each method has advantages and disadvantages that, together with economical aspects, should be considered when choosing the approach to be used.

Watermelon stomach: an unusual cause of chronic gastrointestinal blood loss

Watermelon stomach, or gastric antral vascular ectasia, is an uncommon cause of gastrointestinal blood loss, which can easily be overlooked and which is eminently curable. A 76 year old woman who was repeatedly misdiagnosed as having incidental antral gastritis with occult iron deficiency is described.

Management of gastric outlet obstruction caused by ovarian cancer

Three patients with ovarian cancer who developed gastric outlet obstruction due to loculated ascites in the lesser omental sac are presented. Surgical decompression was utilized, in one case with significant morbidity. Percutaneous drainage under CT or ultrasound guidance allows palliation and avoids potential morbidity and prolonged hospitalization and can be repeated if the condition recurs.

[Rumen fistula operation in a sitatunga antelope (Tragelaphus spekei gratus)]

It is reported on a fistula of the rumen in a Sitatunga caused by the butt of a horn. Surgical removal was successful.

Successful control of bleeding from gastric antral vascular ectasia (watermelon stomach) by laser photocoagulation

We report a case of gastric antral vascular ectasia in a patient with primary biliary cirrhosis in whom chronic blood loss was a major problem. She required repeated blood transfusions that were complicated by reactions and still had persistent anaemia. She was treated with laser phototherapy in the form of quadrantic photocoagulation with a neodynium yttrium-aluminium-garnet laser. This greatly improved the endoscopic appearance of the gastric lesions and effectively controlled blood loss. She required no further transfusions. Bleeding recurred after 11 months which was controlled by further laser photocoagulation.

Partial gastrectomy with an automatic stapling instrument for treatment of gastric necrosis secondary to gastric dilatation-volvulus

A gastrointestinal anastomosis stapling instrument was used to perform partial gastrectomy in nine dogs undergoing emergency surgery for gastric dilatation-volvulus. The amount of necrotic stomach resected was 20% to 50%. Permanent gastropexy was performed, and six dogs also required partial or total splenectomy. Six dogs (67%) were normal after surgery, with follow-up periods of 6 to 16 months for five dogs. One dog died and two dogs were euthanatized because of postoperative complications unrelated to the surgical technique. There were no complications involving the partial gastrectomy staple line.

Vagus nerve morphology in diabetic gastropathy

Two patients were treated with gastroenterostomy and vagotomy for intractable vomiting due to diabetic gastropathy. A morphometric examination of nerve fibres and capillaries in their resected abdominal vagi was performed and the results were compared with findings from two diabetic and two non-diabetic patients undergoing gastroenterostomy and vagotomy for duodenal ulceration. All four diabetic patients had pathological changes of a similar character: reduced myelinated fibre density, degeneration and regeneration of unmyelinated fibres, and capillary basement membrane thickening. Abnormalities were more pronounced in the two diabetic patients with gastropathy but intact and regenerating nerve fibres were still present. The findings support the view that vagal neuropathy could be a causal factor in diabetic gastropathy but imply that severe gastropathy with vomiting is not simply a consequence of autovagotomy. The morphological observations indicated that structural changes can occur in the autonomic nerves of diabetic patients who do not develop autonomic symptoms or have easily detectable abnormal autonomic physiology.

Accuracy of radiography of the reticulum for predicting surgical findings in adult dairy cattle with traumatic reticuloperitonitis: 123 cases (1981-1987)

Radiographic and surgical findings were compared in 123 cattle suspected of having traumatic reticuloperitonitis. Radiography of the reticulum proved to be a sensitive test for detection of a foreign body (FB). An abnormal FB position on a radiograph was a good predictor of FB perforation. If an FB was fully attached to a magnet, it was unlikely to be perforating the reticular wall. When abnormal reticulum size, abnormal reticulum location, and gas shadows adjacent to the reticulum were found simultaneously on a radiograph, hepatic or perireticular abscess was likely. Reticular radiography proved to be a useful diagnostic aid in cattle suspected of having traumatic reticuloperitonitis.

Afferent loop obstruction presenting as acute pancreatitis and pseudocyst: case reports and review of the literature

Afferent loop obstruction after gastrectomy and Billroth II reconstruction is an uncommon problem. Complete acute obstruction requires emergent laparotomy. However, chronic obstruction may begin insidiously and its symptoms may reflect other gastrointestinal diseases. Two patients are described who developed acute abdominal pain, marked hyperamylasemia, and palpable abdominal masses 5 and 15 years after Billroth II gastrectomy. The masses were initially interpreted as pancreatic pseudocysts. Both patients were found to have chronically obstructed afferent limbs, and in one the obstruction was associated with hundreds of stasis stones within the afferent limb. Surgical decompression was accomplished in each patient. Patients who have undergone Billroth II reconstruction have signs, symptoms, and laboratory findings consistent with acute pancreatitis. A history of previous gastrectomy, recurrent or severe abdominal pain, hyperamylasemia with characteristic tomography, and endoscopic findings will establish the diagnosis and necessitate surgical evaluation and intervention.

Surgery of the bovine forestomach compartments

Surgery of the forestomach compartments is performed in bovine practices for the diagnosis and treatment of many diseases, including traumatic reticuloperitonitis, perireticular abscess, vagal indigestion, and grain overload. Through a left flank laparotomy, the cranial abdomen is first explored by palpation for adhesions or masses. A rumenotomy allows thorough examination of the lumen of the rumen and reticulum. Surgical correction of disease may require emptying of the rumen, removal of a foreign body, or drainage of an abscess into the reticulum. With some abscesses, single aspiration and lavage of the abscess capsule or drainage of the abscess through the body wall, following a ventral celiotomy, is required. If adhesions associated with disease do not affect the innervation of the forestomach, the prognosis for return to functional status within the herd is good. Adhesions involving the medial wall of the reticulum or pericardial and myocardial disease due to extensions of traumatic reticuloperitonitis have a very poor prognosis, and thus slaughter should be considered in affected cases.