This paper covers 1,150 proximal gastric vagotomies (PGV) performed from August 1970 to February 1986 on 1,017 duodenal ulcers (DU) and 133 gastric ulcers (GU) types II and III (178 emergency cases). Our technique is described: no isolation of vagal trunk and branches, double and simultaneous ligature and section of the epiploon sheets and control of vagal denervation completeness with pH direct mucosa test. Mortality is 0.1 % in 972 elective PGVs (2 nonrelated deaths among 178 emergency cases) and morbidity is minimal and temporary. Follow-up covers 81 % (mean, 84 months) and involves an interview, X-ray examination, endoscopic control and acid secretory output valoration (69%). Visick stages: 82, 10, 5 and 4% (in cases operated on more than 10 years ago, the Visick stages are: 69, 22, 3 and 6%). Recurrences: 19 DUs (94% inadequate vagotomies) and 15 ‘new GU’ (adequate secretory denervation and 3 of 4 are pyloric stenoses only dilatated). We have only 1 DU recurrence in 489 PGVs with pH over 6.4 at all five gastric mucosa points.
Peptic ulcers generally appear in the stomach and the first segment of the duodenum as a result of mucosal erosion caused by pepsin and gastric acid secretion, with up to 70% of these occurring amongst patients aged 25-64. Currently, endoscopic procedures combined with proton pump inhibitors are considered the gold standard for managing complicated peptic ulcers, leaving surgical management as an option for endoscopic management failure or in scenarios such as incoercible bleeding, perforation, penetration and intestinal occlusion. Penetration of a gastric ulcer to adjacent organs is a rare complication; penetration to the liver and endoscopic diagnosis is even rarer. We have presented the case of a 54 year old diabetic male, who presented to the emergency room with upper gastrointestinal bleeding due to a chronic duodenal ulcer, with haemodynamic instability, requiring surgical management, revealing penetration to the liver with rupture of the right hepatic artery. The patient successfully recovered after surgery and was discharged 7 days after surgical intervention. We did not find any similar case reports in the current literature
Meckel´s diverticulum is an abnormality in the development of the gastrointestinal system, its origin and clinical significance was first described by Johan Friedrich Meckel in 1809. It is a remnant of the omphalomesenteric duct which is usually observed following the rule of 2’s, located 2 feet proximal to the ileocecal valve, before 2 years of age in approximately 2% of the population, and is twice as common in male population. It is considered a true diverticulum because it presents all the histopathological layers of the bowel; 6% of the cases present with heterotopic tissue, mainly pancreatic, gastric, colonic or jejunal. We present the case of a 37-year-old patient who presented with acute onset epigastric pain which migrated to the right iliac fossa, he had a history of chronic non-steroidal anti-inflammatory drugs (NSAIDs) usage for articular pain. He underwent abdominal contrast tomography (CT) scan with double iodine contrast enhancement, which revealed the presence of a perforated Meckel´s diverticulum in the antimesenteric portion of the terminal ileum. The patient underwent laparoscopic diverticulectomy with no complications and was discharged 72 hours after the procedure. Histopathological confirmation of a perforated meckel’s diverticulum with heterotopic gastric mucosa confirmed the clinical suspicion of perforation secondary to chronic NSAIDs usage.
Choristoma is a term which refers to the presence of histologically normal tissue in a heterotopic location; hepatic choristoma is a condition in which hepatic tissue can be found in abnormal locations above or below the diaphragm, the gallbladder wall being the most frequent heterotopic site for implantation, this disease is usually asymptomatic and is rarely detected preoperatively with imaging studies due to a general lack of knowledge of this entity. We present the case of a 37 year old male patient who presented with acute abdominal pain in the right upper quadrant, colicky in nature, accompanied by nausea and vomiting; a HIDA 99 mTc scan revealed gallbladder diskynesia as well as a radiolucent bilobulated image. Upon laparoscopy, we encountered two masses on the superoanterior gallbladder wall and Hartmann´s pouch, which upon histopathological specimen examination revealed the presence of hepatic choristoma. This entity should be considered whenever a soft tissue mass is reported on the anterior gallbladder wall on imaging studies; It has been reported that hepatic choristoma is at higher risk for development of hepatocellular carcinoma and should be removed en bloc with the gallbladder.
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