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Managing an Unusual Case of a Long Segment Benign Esophageal Stricture
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Wickii T. Vigneswaran, James L. Lubawski
Then, the patient was placed supine, and an upper abdominal laparoscopy was performed. Upon entrance into the abdomen, it was noted that the loop of jejunum pexied to the anterior abdominal wall consistent with a previous feeding jejunostomy. The stomach was mobilized on the gastroepiploic artery. It appeared healthy and distensible and would be a viable source for conduit. The duodenum was then Kocherized completely. After dividing the left gastric artery and vein, the gastric conduit was created with six fires of the Endo GIA. Then two additional tacking sutures were placed to the portion of small bowel that was attached to the anterior abdominal wall. After verifying proximal and distal orientation of the bowel, an enterotomy was then made, the 16-French Malecot tube was introduced into the lumen, and the feeding tube was established. Simultaneously, a left cervical incision was made, and the proximal esophagus was delivered into the neck. The distal esophagus was then attached to the Foley catheter and then delivered through the mediastinum into the neck. A near total esophagectomy was completed. Then the gastric conduit was brought into the neck. Esophagogastrostomy was then fashioned and the liner stapled posterior anastomosis completing anterior anastomosis with interrupted (4-0 polydioxanone PDS) sutures [2,3]. The neck wound was then closed in layers as well as the abdominal port sites.
Stomach Microcirculation
Published in John H. Barker, Gary L. Anderson, Michael D. Menger, Clinically Applied Microcirculation Research, 2019
The gastroepiploic arcade is formed by the left and right gastroepiploic arteries and it extends from the lower border of the first part of the duodenum to a point on the greater curvature just distal to the lower end of the spleen.12 The left gastroepiploic artery is a branch of the splenic artery and the right gastroepiploic artery is a branch of the gastroduodenal artery. The area of the stomach on the greater curvature proximal to the gastroepiploic arcade is supplied by the short gastric arteries that are branches of the splenic artery. Usually, there are two to four short gastric arteries, but the number varies from one to nine.1 The gastroduodenal artery is a branch of the hepatic artery and it supplies the pylorus.
Single Best Answer Questions
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
Concerning blood supply of the stomach:The right gastric artery is derived from the splenic arteryThe cystic artery is derived from the left gastric arteryThe gastroduodenal branch of the hepatic artery gives off the left gastroepiploic arteryThe splenic artery gives off the superior pancreaticoduodenal arteryThe short gastric arteries are derived from the splenic artery
Gastric bleeding in giant cell arteritis
Published in Baylor University Medical Center Proceedings, 2021
Austin Childress, Thomas J. Kwarcinski, Joseph Scott H. Bittle, Clayton Trimmer
GCA is the most common vasculitis in individuals of Western descent over the age of 50, with an annual incidence of 6.9 to 32.4 cases per 100,000.1–5 Initially described in 1888 by William Bruce as senile rheumatic gout,6,7 the disease was later labeled arteritis in 1890 by Hutchinson. In 1932, Horton published the first known case reports of temporal arteritis with the histology of granulomatous disease.7–12 Since its discovery, GCA has been thought to be a localized disease affecting the few primary branches of the aortic arch, especially the temporal artery, leading to the classic symptoms.12 Imaging has proven that GCA is a systemic disease, affecting all of the major branches of the aorta, including secondary and tertiary branches.13–15 There have even been accounts of GCA affecting the abdominal aorta, resulting in dissection and aneurysm. However, celiac and mesenteric GCA is rarely diagnosed.16–18 One study identified only 12 reported cases of mesenteric ischemia due to GCA.4,19 Even rarer are reports of GCA occurring in secondary or tertiary branches of the abdominal aorta, with only a single case reporting involvement of the celiac axis and rupture of the gastroepiploic artery.17
Is Preoperative G-Tube Use Safe for Esophageal Cancer Patients?
Published in Journal of the American College of Nutrition, 2020
Sabrina M. Saeed, Jacques P. Fontaine, Aamir N. Dam, Sarah E. Hoffe, Miles Cameron, Jessica Frakes, Rutika Mehta, Erin Gurd, Jose M. Pimiento
The 2018 NCCN guidelines suggest that g-tube placement should be avoided prior to esophagogastrectomy due to the risk of injuring the gastric conduit used for reconstruction. Case reports and small retrospective studies have reported injury to the gastric vasculature caused by prior g-tube placement. Stockeld et al. reported on a case where the gastroepiploic artery was damaged, but adequate blood supply was maintained allowing for use of the gastric conduit (28). In another case reported by Ohnmacht et al., damage to the gastric vasculature resulted in abortion of the procedure (21). In our study, there were no cases documenting damage to the gastric vasculature, and the gastric conduit was used in all patients. The majority of g-tubes were placed by interventional radiologists at Moffitt Cancer Center under the direction of the primary surgeon. Some patients received g-tubes through various methods of placement at outside institutions without prior direction by the Moffitt treatment team. We feel that the risk of gastric vasculature injury, already low, can be further reduced if there is adequate communication between the gastroenterologist and surgeon regarding the approach and location of g-tube placement. The gastroenterologist may therefore take better care to avoid the greater curvature and preserve the gastric blood supply.
Tissue Oxygen Saturation during Gastric Tube Reconstruction with Cervical Anastomosis for Esophagectomy: A Case Series
Published in Journal of Investigative Surgery, 2022
Kenjiro Ishii,, Yasuhiro Tsubosa,, Shuhei Mayanagi,, Masazumi Inoue,, Ryoma Haneda,
In terms of blood supply to the gastric tube, the right gastroepiploic artery is the exclusive conduit of blood to the pedicle and the blood supply of the cranial 20% of the greater curvature of the stomach is supplied by a microscopic network of capillaries and arterioles [19]. Therefore, it is conceivable that the blood flow to the cranial side of the gastric tube gradually decreases toward the tip as it is raised to the cervical site.