Four Unusual Complications of Partial Gastrectomy

Abstract

Summary Four late complications of partial gastrectomy are described. The partial gastrectomies were all of the antecolic Polya type with anastomosis of the afferent loop to the lesser curve. In the first of the cases described, partial gastrectomy was followed by perforation of a jejunal ulcer of the afferent loop. In the second case it was followed by “dumping” symptoms and then acute intestinal obstruction due to impaction of orange pith in the lower jejunum. In the third case partial gastrectomy was followed by obstruction of the afferent jejunal loop by adhesions; the distended loop was palpable as an epigastric tumour and the patient developed jaundice. In the fourth case the ileum was mistaken for the jejunum and was used in making the anastomosis.

Intestinal Obstruction Due to Food

“…One of these was due to orange pith, and has been reported elsewhere by Fleming and Ward-McQuaid (1950).…”

“…Latchmore (1940) had the exceptional experience of operating in one year on no fewer titan four cases of obstruction due to food. There have been only four s,uch cases at the Radcliffe Infirmary in the last 20 years.One of these was due to orange pith, and has been reported elsewhere by Fleming and Ward-McQuaid (1950).Elliot (1932) listed 40 cases of food impaction, and Fantus and Kopstein (1940) brought this number up to 75. Since their paper, single instances of small series have been reported.…”

“…Two of these patients suffered from " dumping" symptoms. The obstructing agent was orange pith in those two (Baumeister and Darling, 1947;Fleming and Ward-McQuaid, 1950), and also in one other (Allen and Smithwick, 1942), while impaction of sauerkraut had occurred in the case described by Seifert (1930). Orangepith obstruction followed gastro-enterostomy in one of the cases recorded by Delrio et al (1944).…”

“…One of these was due to orange pith, and has been reported elsewhere by Fleming and Ward-McQuaid (1950). Elliot (1932) listed 40 cases of food impaction, and Fantus and Kopstein (1940) brought this number up to 75.…”

Gastrointestinal Bezoars

“…A barium transit shows a repletion defect, which may suggest a neoplasm [5,8] but which changes position, such as occurred in 10 of our patients. Endoscopy is the fundamental explora tory technique for diagnosis [31][32][33][34], and in our series diagnosis was made in all the patients in whom it was performed. Furthermore, it enables associated gastric ul cers to be identified in patients with digestive bleeding.…”