Gastric necrosis complicating lately a Nissen fundoplication

Patuto, Nicola; Acklin, Yves P.; Oertli, Daniel; Langer, Igor

doi:10.1007/s00423-007-0216-z

Cited by 16 publications

(9 citation statements)

References 5 publications

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“…4 It is characterized by abdominal discomfort, early satiety, distension, flatulence, and weight loss (secondary to satiety) due to the inability to vomit or belch, resulting from a too narrow fundoplication, increasing the risk of acute gastric dilation. 2,5,6 In this case, the symptoms of gas bloat syndrome were exacerbated by the underlying intestinal occlusion. Two weeks before the current illness, the patient underwent a floppy Nissen fundoplication, involving the division of short vessels and shortening the length of the fundoplication.…”

Section: Discussionmentioning

confidence: 72%

“…Symptoms include difficulty belching and vomiting, early satiety, distension, flatulence, and weight loss due to early satiety. 2 In a patient with intestinal obstruction and a history of fundoplication, acute gastric dilation may occur due to the inability to vomit, creating a vicious circle where an increase in intragastric pressure enhances lower esophageal sphincter incompetence, resulting in increased gastric pressure due to the inability to vomit 1 . Persistent elevation of intragastric pressure causes vascular compromise of the gastric wall.…”

Section: Introductionmentioning

confidence: 99%

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What to do in case of an endoscopic image of gastric necrosis or ischaemia post-funduplication? A case report

Peña,

H. Gallo,

Tristán-Tenorio

et al. 2023

Int J Res Med Sci

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The association of gastric ischemia with a fundoplication is very rare and its management is not always surgical. The present paper describes the mechanism of post-fundoplication gastric ischemia that occurred in a patient diagnosed with gastroesophageal reflux disease treated with a Nissen-type gastric fundoplication. A clinical case of the Foregut Clinic of the Hospital General de Mexico (HGM) is presented. This is a 24-year-old patient undergoing a Nissen-type fundoplication who was discharged without eventualities and who presented intestinal occlusion, acute gastric dilation and gastric ischemia.

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Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

What to do in case of an endoscopic image of gastric necrosis or ischaemia post-funduplication? A case report

Peña,

H. Gallo,

Tristán-Tenorio

et al. 2023

Int J Res Med Sci

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“…Unlike previous studies, Dynamic MRI was used for the first time to evaluate gastric fundus and splenic circulation in patients who underwent LNF, which was performed dissecting the GB. The development of novel MRI may provide a new opportunity for evaluating abdominal pathologies [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Dynamic MRI Evaluation of the Gastric Fundus and Splenic Circulation to Assess the Gastric Breves Dissection during Laparoscopic Nissen Fundoplication

Akkurt¹,

Sürgit²,

Ataş³

et al. 2018

Open Access Maced J Med Sci

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AIM:We aimed to evaluate the possible effects of dissecting gastric breves (GB) during the Laparoscopic Nissen Fundoplication (LNF) on the gastric fundus and splenic circulation using dynamic Magnetic Resonance Imaging (MRI).METHODS:In total 14 patients with gastroesophageal reflux disease (GERD) that was diagnosed with esophagogastroduodenoscopy and 24 - hour PH monitorization and undergoing LNF surgery were included. All patients underwent LNF surgery between October 2006 and March 2010. All patients were evaluated regarding gastric fundus and splenic circulation one week before and 15 days after the surgery with dynamic MRI. Alteration of the signal intensity before and after surgery was used to assess gastric fundus and splenic circulation.RESULTS:We detected a significant decrease in DeMeester score before and after surgery (p < 0.001). There were no statistical differences between preoperative and postoperative dynamic MRI measurements of the spleen, anterior wall measurements, posterior wall measurements in different MRI phases (Bonferroni corrected p < 0.01). Postoperative measurements of anterior and posterior gastric wall measurements were comparable (Bonferroni corrected p < 0.0033).CONCLUSIONS:We did not detect any significant differences in the abovementioned tissues regarding perfusion.

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“…Some studies have shown that an intragastric pressure greater than 20-30 cm H2O is necessary to cause the occlusion of the gastric luminal blood circulation [15] . Cases of gastric necrosis following acute small bowel obstruction based on adhesions and gastric outlet obstruction based on antral gastric cancer and trichophytobezoar after an antireflux technique [3][4][5] have been reported. In infants, this rare post Nissen complication has also been described [16] .…”

Section: Discussionmentioning

confidence: 99%

“…gastricae breves). Notwithstanding this fact, acute gastric dilatation accompanied with or without gastric outlet obstruction [2][3][4][5][6][7] , eating disorders [8][9][10] or gas-bloat syndrome are recognized causes of ischemic gastric necrosis.…”

Section: Introductionmentioning

confidence: 99%

Gastric necrosis: A late complication of nissen fundoplication

Salinas

Georgiev

González-Sánchez

et al. 2014

WJGS

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Gastric necrosis is a rare condition because of the rich blood supply and the extensive submucosal vascular network of the stomach. "Gas-bloat" syndrome is a well known Nissen fundoplication postoperative complication. It may cause severe gastric dilatation, but very rarely an ischemic compromise of the organ. Other factors, such as gastric outlet obstruction, may concur to cause an intraluminal pressure enough to blockade venous return and ultimately arterial blood supply and oxygen deliver, leading to ischaemia. We report a case of a 63-year-old women, who presented a total gastric necrosis following laparoscopic Nissen fundoplication and a pyloric phytobezoar which was the trigger event.No preexisting gastric motility disorders were present by the time of surgery, as demonstrated in the preoperative barium swallow, thus a poor mastication (patient needed no dentures) of a high fiber meal (cabbage) may have been predisposing factors for the development of a bezoar in an otherwise healthy women at the onset of old age. A total gastrectomy with esophagojejunostomy was performed and patient was discharged home after a 7-d hospital stay with no immediate complications. We also discuss some technical aspects of the procedure that might be important to reduce the incidence of this complication.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Gastric dilatation; Gastric outlet obstruction; Necrosis; Fundoplication; Nissen operation Core tip: Gastric necrosis is a rare condition because of the rich blood supply and the extensive submucosal vascular network of the stomach. "Gas-bloat" syndrome is a Nissen fundoplication postoperative complication that causes gastric dilatation, but very rarely an ischemic compromise of the organ. We report a case of a 63-year-old women, who presented a total gastric necrosis following laparoscopic Nissen fundoplication and we discuss technical aspects of the procedure that are important to prevent this complication.Salinas J, Georgiev T, González-Sánchez JA, López-Ruiz E, Rodríguez-Montes JA. Gastric necrosis: A late complication of nissen fundoplication.

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Gastric necrosis complicating lately a Nissen fundoplication

Abstract: Early diagnosis and treatment of gastric dilatation after Nissen fundoplication are essential to prevent from severe secondary complications but can be difficult to establish because of atypical symptoms.

Cited by 16 publications

References 5 publications

What to do in case of an endoscopic image of gastric necrosis or ischaemia post-funduplication? A case report

What to do in case of an endoscopic image of gastric necrosis or ischaemia post-funduplication? A case report

Dynamic MRI Evaluation of the Gastric Fundus and Splenic Circulation to Assess the Gastric Breves Dissection during Laparoscopic Nissen Fundoplication

Gastric necrosis: A late complication of nissen fundoplication

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