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Complications of open repair of ruptured abdominal aortic aneurysm
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Status of the aortic neck as determined by CTA of the abdomen and pelvis. To determine if there is adequate aortic neck length for a new proximal aortic anastomosis, the communication is between a previously placed aortic graft and the third or fourth portion of the duodenum. The patient usually presents 2–3 years following initial AAA repair with gastrointestinal (GI) bleeding. The GI bleeding may manifest as melena initially (herald bleed). Initial massive bleeding is uncommon. The patient may present with sepsis in up to 50% of instances. The communication between the GI tract and the prosthetic graft can involve the anastomosis (true AEF) or the graft body or the limb (prosthetic enteric erosion). In the aortoenteric fistula, the bleeding is from the aorta, while in the prosthetic enteric erosion bleeding is from the edge of the bowel wall. About 25% of patients may present with sepsis. Esophagogastric duodenoscopy with attention to the distal portions of the duodenum is necessary, though it is extremely uncommon to visualize the graft material on endoscopy. CTA image demonstrates perigraft fluid, thickening of the bowel wall with inflammation and fat stranding. Air in the periprosthetic area and pseudoaneurysm formation may also be present. In a hemodynamically stable patient after confirmation of the diagnosis or a strong suspicion of the diagnosis, surgeon may choose two different management options.
Esophageal Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Jennifer Kahan, Carys Morgan, Kieran Foley, Thomas Crosby
Local recurrence occurs within the first year in 10–30% of patients treated with dCRT.36 For patients who would be considered suitable for salvage surgery, it is reasonable to offer regular radiological follow-up to identify early recurrence. Optimal surveillance strategies are an ongoing area of research, but current review may include 6-monthly imaging/esophago-gastro-duodenoscopy for 3 years and thereafter annually for up to 5 years. Salvage surgery may be considered depending on extent of disease and patient factors such as performance status and fitness for major surgery. Suitable patients should be discussed within an MDT. Patients will require repeat staging investigations including CT-PET and EUS prior to a decision regarding feasibility of surgery. Survival benefit is limited but has been shown in a large multicenter study suggesting that salvage surgery after dCRT can offer acceptable short- and long-term outcomes in selected patients at experienced centers.95 Persistent cancer after dCRT seems to be more biologically aggressive, with poorer survival compared with recurrent cancer. The OS at 3 years was 40.9% in the resistant disease group and 56.2% in the recurrent disease group (p = 0.046). DFS again was lower in the resistant group (36.6% vs. 51.6%; p = 0.095), and such surgery is associated with an increased in-hospital mortality rate and increased morbidity. Informed discussion with patients of the potential high risks and poor outcomes is an integral part of the decision-making process for salvage surgery.
The Duodenum and Small Bowel
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
While duodenoscopy and biopsy are available to make preoperative diagnosis in some duodenal cases, still the majority of the cases are diagnosed intraoperatively. Biopsies via endoscopy of tumors that are located submucosally may fail to make the diagnosis preoperatively. At the time of surgery, a large number of these tumors are biopsied and a frozen section obtained to determine whether it is benign or malignant. Tumors that are located further down in the GI tract, i.e., beyond the duodenum, are usually not amenable to endoscopic examination and biopsy. These are suspected clinically and diagnosed radiologically. Therefore, the diagnosis is usually established by a frozen section intraoperatively.
Factors associated with acute pancreatitis in patients with impacted duodenal papillary stones: a retrospective cohort study
Published in Scandinavian Journal of Gastroenterology, 2022
Ming Li, Ao Wang, Shaohua Ren, Zhenyu Wang, Qing Wang, Chengyue Gou, Weichuan Zhao, Li Zhang, Ning Li
Duodenoscopy was performed with the patient in the left lateral and prone positions under general anesthesia or sedation. The tension of the duodenal papilla and the shape of its orifice were observed when the duodenoscope entered the descending duodenum. High tension was defined as a substantially dilated papilla, disappearance of the papillary folds, and a serosa that appeared smooth and shiny in appearance; low tension was defined as a slightly dilated or non-dilated papilla that had visible folds and a serosa that was not smooth in appearance. Endoscopic sphincterotomy was performed using an arcuate knife or needle-shaped knife according to the ability of the endoscopist to confirm the impaction of a stone in the papilla and the position of the stone. The size of the stone removed by sphincterotomy was measured using the known length of the operating instruments as a scale (the length from the tip to the first mark of both the arcuate knife and needle-knife is 0.5 cm; Figure 1(A,B)). Next, cholangiography was carried out to measure the diameter of the common bile duct and assess whether stones were present in the proximal portion of the common bile duct. Finally, an endoscopic nasobiliary drainage tube or, if necessary, an endoscopic retrograde pancreatic drainage tube were placed.
Prevalence of Helicobacter pylori infection and the incidence of the associated malignant and peptic ulcer disease (PUD) at Nelson Mandela Academic Hospital: a retrospective analysis
Published in Journal of Drug Assessment, 2021
The data was collected retrospectively from files of consecutive adult patients with upper gastro-intestinal symptoms who presented at the endoscopy unit for gastro-duodenoscopy over a 1-year period, from January to December, 2012. The gastric mucosal biopsy specimens were analyzed for the presence of H. pylori after staining with modified Giemsa stain. Hematoxyline & Eosin stain was used for identification of chronic gastritis which was defined as infiltration of lamina propria with mononuclear cells with or without plasma cells. Patients with carcinoma of the esophagus and those who presented for follow-up endoscopy were excluded. Data on patients’ characteristics, presentation, endoscopic findings and histopathology reports were collected and analyzed for H. pylori prevalence, the prevalence of chronic gastritis, incidence of PUD, and gastric malignancies. The proportions of patients with PUD, MALT lymphoma, and H. pylori associated gastric cancer in the background of chronic gastritis (CG) and or H. pylori infection were determined.
Different pattern of risk factors for post-ERCP pancreatitis in patients with biliary stricture
Published in Scandinavian Journal of Gastroenterology, 2018
Liang Zheng, Xiangping Wang, Qin Tao, Shuhui Liang, Biaoluo Wang, Hui Luo, Rongchun Zhang, Liyue Zheng, Shengye Yang, Jie Chen, Yanglin Pan, Xuegang Guo
Patient-related characteristics were collected retrospectively from medical records, including age, gender, history of PEP, smoking, alcohol intake, comorbidities and prior history of surgery. Laboratory tests before ERCP, including routine blood test, liver and kidney function and coagulation test. Whether the patients had diverticulum or stenosis were determined by duodenoscopy. Duodenum was considered as stenosis if scope could not pass through without the assistance of guided wire, stenting or balloon dilation or obvious resistance existed when pushing scope due to intra-lumen lesions in duodenum. Duodenal stenosis was classified according to anatomical location of stricture in relation to papilla: Type I stenosis occurs in the first segment of the duodenum, without involvement of the papilla; Type II stenosis occurs in the second segment of duodenum, with involvement of the papilla; Type III stenosis occurs in the third segment of duodenum, without involvement of the papilla. Location of BS was determined by image modalities and classified into two types: (1) hilar bile duct stricture: the stricture site was less than 2 cm to the confluence of the right and left intrahepatic ducts; (2) non-hilar bile duct stricture: the stricture site was more than 2 cm to the confluence. MBS was diagnosed by positive histology/cytology or dynamic imaging plus follow-up with rapid disease progression within three months (if histology/cytology was negative).