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Pancreatic Pseudocyst
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Patients with a possible PS who have no prior history of acute/chronic pancreatitis episodes or symptoms (or trauma) should prompt consideration of an alternative diagnosis of cystic neoplasm of the pancreas. However, up to 15% of PS have no clearly identified antecedent pancreatitis episode or trauma and a significant percent of pancreatic cystic neoplasms may initially present as an episode of acute pancreatitis. There are essentially no symptoms or exam findings that are specific to PS and the majority of patients will have either minimal or no symptoms. If symptoms are present, they most commonly will feature vague upper abdominal and/or back pain, bloating, early satiety or pain shortly after meals, or less commonly, symptoms of gastric outlet obstruction. Elevated serum amylase levels are seen in approximately 50% of patients with PS and are often mistakenly attributed to “recurrent pancreatitis.”
The Abdomen
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
The haematoma develops in the submucosal or subserosal layers of the duodenum. The duodenum is not perforated. Such haematomas can lead to obstruction. The symptoms of gastric outlet obstruction can take up to 48 hours to present. This is due to the gradual increase of the size of a haematoma as the breakdown of the haemoglobin makes it hyperosmotic, with resultant fluid shifts into it. The diagnosis can be made by double-contrast CT scan or upper gastrointestinal contrast studies that show the ‘coiled spring’ or ‘stacked coin’ sign.6
SBA Answers and Explanations
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
Meconium ileus can cause neonatal intestinal obstruction and typically presents in patients with cystic fibrosis (CF) in 10 per cent of cases, where the deficiency of pancreatic enzymes causes the meconium to be thick and viscous. It presents within the first few hours of life with absolute constipation, bile-stained vomiting, and abdominal distension. Meconium is normally passed within the first 24 hours but this fails to occur. Abdominal X-ray (AXR) may display a mottled appearance from the lipid droplets within the meconium. It may be difficult to differentiate from Hirschsprung disease but this typically has multiple air fluid levels on erect AXR. Treatment is with gastrografin enema, provided that there is no evidence of perforation. Gastric outlet obstruction usually presents with non-bilious vomiting.
Combined endovascular and surgical treatment of a giant celiac artery aneurysm with consequent gastric outlet obstruction: a case report and literature review
Published in Acta Chirurgica Belgica, 2023
Nick Smet, Thijs Buimer, Tim Van Meel
Only a few cases in the literature were found of visceral artery aneurysms where gastric outlet obstruction or jaundice was the presenting symptom [16,23]. Tipaldi et al. reported a high technical and clinical success rate of 91% of endovascular treated GVAAs. However, only one out of 11 patients presented with obstructive symptoms (jaundice) due to a hepatic aneurysm of 5.6 cm [16]. As proved by this case, it is of paramount importance to exclude all inflow and outflow vessels to diminish the risk of reperfusion (the double blockage technique) and prevent rupture of the aneurysm. Furthermore, this case emphasizes the benefit of an endovascular first approach. The need for subsequent treatment of the gastric outlet obstruction remains. In this case, no extensive dissection or visceral rotation for arterial control is needed to perform an aneurysmectomy due to the previous embolization of feeding arteries. Unfortunately, our patient required several abdominal interventions to resolve the delayed gastric emptying. The reason for persisting gastroparesis remains unclear, but a possible hypothesis could be the chronic compression/irritation of nerve plexuses around the stomach and duodenum by this giant CAA.
Symptomatic gastric involvement in a parastomal hernia: uncommon presentation
Published in Acta Chirurgica Belgica, 2020
Maaike Vierstraete, Dirk Van de Putte, Piet Pattyn
In patients presenting with obstructive symptoms, one should be aware of a possible gastric outlet obstruction because of its involvement in a PSH, although sporadic. Increased laxity of the gastric ligaments due to mechanical stress (expansion of the abdominal cavity or increased abdominal pressure) is thereby essential. Regarding our two cases and the limited experience in literature, mainly older females with colostomies are at risk and most of them need surgery. Surgery might thus be considered as the treatment of choice because conservative treatment mostly fails. Earlier surgery might perhaps reduce postoperative hospital stay and gastroparesis, but larger series are needed to confirm these findings.
Acute gastric outlet obstruction secondary to exclusive paraoesophageal small bowel herniation: a case report
Published in Acta Chirurgica Belgica, 2018
Jean-Charles de Schoutheete, Alex M. Reece-Smith, Saj A. Wajed
This particular presentation provided particular diagnostic difficulties and is presented as a rare cause of gastric outlet obstruction which is important to identify due to the relative ease and success of treating such a condition.