Background Gastric necrosis and perforation after Nissen funduplication is a rare and life-treatening complication. Prompt diagnosis of acute gastric dilatation is mandatory to avoid gastric necrosis. A tight funduplication can cause a gastric dilatation because of the inability to vomit. Other causes of gastric dlatation include trauma, volvulus, anorexia and bulimia diabetes, polyphagia, acute infections and others. Methods A 56-year-old man was admited to emergency room with acute-onset epigastric pain and persistent nausea for the past 4 hours. Nine years ago he underwent a laparosocpic Nissen-Rossetti funduplication for a reflux disease.The examination showed abdominal distension and defense. Computed tomography of the abdomen (TAC) show a important pneumoperitoneum distributed diffusely throughout the abdomen, marked gastric distension with abundant content inside. Free intraperitoneal fluid and postsurgical changes in relation to Nissen fundoplication. An emergentcy laparotomy was indicated. Results Emergency laparotomy showed free peritoneal fluid with gastric dilatation and two areas of necrosis and perforation (localized in fundus and gastric body). We performed a total gastrectomy with esophagojejunal anastomosis. The patient sufferd a pulmonary embolism 8 days after laparotomy Pathological examination reported gastric dilatation and two areas of ischemia and trasnmural necrosis with perforation and peritonitis. Conclusion If the intragastric pressure excede gastric venous pressure can result in ischaemia and infarctation.Increased intragastric pressure is usually the result of a closed loop, secondary to mechanical compresion of the cardio-esophageaal and pyloroduodenal junctions, as can occur in patients with a Nissen procedure. CONCLUSION: Early diagnosis of gastric dilatation in these patients is mandatory to avoid major complications. Disclosure All authors have declared no conflicts of interest.
Background Basaloid cell carcinoma of the esophagus (BSCCE) is a rare (0.07–4%) poorly-differentiated variety of squamous cell carcinoma (SCC), more aggressive and with a worse prognosis than typical SCC. There are no published studies on the best therapeutic option for these tumors or on of the effectiveness of Neoadjuvant chemoradiotherapie; so there is no standard treatment. We describe the characteristics and the therapeutic strategy applied to a patient with an avanced basaloid squamous cell carcinoma of the distal esophagus. Methods A 70-year-old woman with dysphagia and severe malnutrition was diagnosed with locally advanced esophageal cáncer of lower esophagus The biopsy indicated moderately differentiated basaloid cell carcinoma. The clinical diagnosis was cT4NxM0, We decided multimodal treatment with curative intent: Neoadjuvant chemoradiotherapie at a dose of 41.4 Gy and concomitant carboplatin and pacliotaxel 5 cycles (CROSS scheme) plus surgery. Results PET-TAC post-neoadjuvant re-evaluation showed partial morphological response (reduction of tumor metabolism in 34.7%). 6 weeks after radiochemotherapy we performed a three fields total esophagectomy. Postoperative course without incidents. The pathological diagnosis was BASALOID cell CARCINOMA located in distal esophagus of 10 cm long with 30% tumor residual; it affects gastro-oesophageal junction. Stage TNM 7th ed: ypT3 N0 (0/17) L0V1R0 Our patient is fine and without evidence of recurrence after 15 meses. Conclusion Basal squamous cell carcinoma is more common in men around 60 years old, being rare in older women. They are located more frequently in the middle than in lower esophagus. They are tumors of poor prognosis (poorly differentiated, locally advanced and with an aggressive biological behavior that predisposes to early metastasis) although the latest publications relate the prognosis especially with the stage of the tumor. There are no published data about the use of Neoadjuvant treatment for these tumors. We have carried out a multimodal treatment (Cross scheme) followed by surgery with clinical, radiological (PET-TAC) and pathological response (30% of residual tumor in the piece) CONCLUSION The multimodal treatment with Cross scheme and surgery was useful in patients with Basaloid tumor of the esophagus can be considered for patients with this type of tumor. Disclosure All authors have declared no conflicts of interest.
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