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Acute Dilatation, Ischemia, and Necrosis of Stomach without Perforation.

Sahoo MR, Kumar AT, Jaiswal S, Bhujabal SN - Case Rep Surg (2013)

Bottom Line: About 4 litres of brownish fluid along with semisolid undigested food particles was sucked out (mainly undigested pieces of meat).Limited resection of gangrenous areas and primary repair were done along with feeding jejunostomy.The patient recovered well and was discharged on the tenth postoperative day.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, SCB. Medical College, Cuttack, Odisha 753007, India.

ABSTRACT
Acute gastric dilatation can have multiple etiologies which may lead to ischemia of the stomach. Without proper timely diagnosis and treatment, potentially fatal events such as gastric perforation, haemorrhage, and other serious complications can occur. Here we present a 36-year-old man who came to the casualty with pain abdomen and distension for 2 days. Clinically, abdomen was asymmetrically distended more in the left hypochondrium and epigastrium region. Straight X-ray abdomen showed opacified left hypochondrium with nonspecific gaseous distension of bowel. Exploratory laparotomy revealed dilated stomach with patchy gangrene over lesser curvature and fundic area. About 4 litres of brownish fluid along with semisolid undigested food particles was sucked out (mainly undigested pieces of meat). Limited resection of gangrenous areas and primary repair were done along with feeding jejunostomy. Necrosis of the stomach was confirmed on histopathology. The patient recovered well and was discharged on the tenth postoperative day.

No MeSH data available.


Related in: MedlinePlus

Nasogastric tube tip visible after sucking of semisolid thick brown contents.
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fig5: Nasogastric tube tip visible after sucking of semisolid thick brown contents.

Mentions: A 36-year-old male patient, referred from periphery hospital with nasogastric tube in place, presented to the casualty with pain abdomen and abdominal distension for two days which was not relieved with conservative treatment. Two days ago he had taken nonvegetarian meal twice, in increased quantity than usual, within a short gap of 3 hours between those two meals. Then he had two episodes of vomiting 6 hours later. His past history was not significant. He was not suffering from any psychiatric illness or any co-morbidity like diabetes and had not undergone any surgeries. His vital parameters were within normal limits. Abdominal examination showed more asymmetrical distension in left hypochondrium and epigastrium with tympanicity all over the abdomen without signs of peritonitis. Straight X-ray abdomen showed opacified left hypochondrium with nonspecific gaseous distension of bowel (Figure 1). Even after conservative treatment, when the distension and pain did not subside, he was planned for exploratory laparotomy. Ryle's tube aspiration in this case was unproductive. On opening the abdomen through upper midline incision it was found that stomach was dilated with patchy gangrene at two areas, one on the lesser curvature (Figure 2) and the other on the fundus of stomach (Figure 3). Handling at the gangrenous area leads to perforation at the lesser curvature which showed that there was impending perforation in that area. Through this perforation about, 4 litres of thick brown coloured fluid mixed with undigested food particles (mainly undigested pieces of meat) was sucked out (Figure 4) and removed. The tip of the nasogastric tube now became visible through the defect (Figure 5). The gangrenous area was resected till there was fresh bleeding from the margin (Figure 6). Specimen was sent for histopathological examination. The defect thus created was suture repaired primarily in single layer interrupted fashion with vicryl 2-0 suture material (Figure 7). The same was repeated for gangrene of the fundus. Feeding jejunostomy was done (Figure 8). Postoperatively, patient was started with feeds through feeding jejunostomy tube on the 3rd day. He was given liquids orally on the 7th day and semisolid diet on the 8th day and was discharged on the 10th postoperative day. Histopathological examination revealed mucosal ulceration, prominent areas of haemorrhage and edema in submucosa, and thinning of the muscle layer suggestive of necrosis of the resected specimen of the stomach.


Acute Dilatation, Ischemia, and Necrosis of Stomach without Perforation.

Sahoo MR, Kumar AT, Jaiswal S, Bhujabal SN - Case Rep Surg (2013)

Nasogastric tube tip visible after sucking of semisolid thick brown contents.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814073&req=5

fig5: Nasogastric tube tip visible after sucking of semisolid thick brown contents.
Mentions: A 36-year-old male patient, referred from periphery hospital with nasogastric tube in place, presented to the casualty with pain abdomen and abdominal distension for two days which was not relieved with conservative treatment. Two days ago he had taken nonvegetarian meal twice, in increased quantity than usual, within a short gap of 3 hours between those two meals. Then he had two episodes of vomiting 6 hours later. His past history was not significant. He was not suffering from any psychiatric illness or any co-morbidity like diabetes and had not undergone any surgeries. His vital parameters were within normal limits. Abdominal examination showed more asymmetrical distension in left hypochondrium and epigastrium with tympanicity all over the abdomen without signs of peritonitis. Straight X-ray abdomen showed opacified left hypochondrium with nonspecific gaseous distension of bowel (Figure 1). Even after conservative treatment, when the distension and pain did not subside, he was planned for exploratory laparotomy. Ryle's tube aspiration in this case was unproductive. On opening the abdomen through upper midline incision it was found that stomach was dilated with patchy gangrene at two areas, one on the lesser curvature (Figure 2) and the other on the fundus of stomach (Figure 3). Handling at the gangrenous area leads to perforation at the lesser curvature which showed that there was impending perforation in that area. Through this perforation about, 4 litres of thick brown coloured fluid mixed with undigested food particles (mainly undigested pieces of meat) was sucked out (Figure 4) and removed. The tip of the nasogastric tube now became visible through the defect (Figure 5). The gangrenous area was resected till there was fresh bleeding from the margin (Figure 6). Specimen was sent for histopathological examination. The defect thus created was suture repaired primarily in single layer interrupted fashion with vicryl 2-0 suture material (Figure 7). The same was repeated for gangrene of the fundus. Feeding jejunostomy was done (Figure 8). Postoperatively, patient was started with feeds through feeding jejunostomy tube on the 3rd day. He was given liquids orally on the 7th day and semisolid diet on the 8th day and was discharged on the 10th postoperative day. Histopathological examination revealed mucosal ulceration, prominent areas of haemorrhage and edema in submucosa, and thinning of the muscle layer suggestive of necrosis of the resected specimen of the stomach.

Bottom Line: About 4 litres of brownish fluid along with semisolid undigested food particles was sucked out (mainly undigested pieces of meat).Limited resection of gangrenous areas and primary repair were done along with feeding jejunostomy.The patient recovered well and was discharged on the tenth postoperative day.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, SCB. Medical College, Cuttack, Odisha 753007, India.

ABSTRACT
Acute gastric dilatation can have multiple etiologies which may lead to ischemia of the stomach. Without proper timely diagnosis and treatment, potentially fatal events such as gastric perforation, haemorrhage, and other serious complications can occur. Here we present a 36-year-old man who came to the casualty with pain abdomen and distension for 2 days. Clinically, abdomen was asymmetrically distended more in the left hypochondrium and epigastrium region. Straight X-ray abdomen showed opacified left hypochondrium with nonspecific gaseous distension of bowel. Exploratory laparotomy revealed dilated stomach with patchy gangrene over lesser curvature and fundic area. About 4 litres of brownish fluid along with semisolid undigested food particles was sucked out (mainly undigested pieces of meat). Limited resection of gangrenous areas and primary repair were done along with feeding jejunostomy. Necrosis of the stomach was confirmed on histopathology. The patient recovered well and was discharged on the tenth postoperative day.

No MeSH data available.


Related in: MedlinePlus