Gastric necrosis associated with acute gastric dilatation and small bowel obstruction

Powell, John L.; Payne, J. Howard; Meyer, C; Moncla, Paul R

doi:10.1016/s0090-8258(03)00204-x

Cited by 25 publications

(21 citation statements)

References 4 publications

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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%

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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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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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“…(5) Moreover, Kernstein reported that gastric capacity was about 15 L in bulimia patients. (1) It was known that intragastric pressure must exceed gastric venous pressure to result in ischemia(9) and that occlusion of both the artery and vein secondary to intragastric pressure was necessary to foster ischemia. (10) The stomach has a rich blood supply, and infarction did not occur even if four major gastric arteries were ligated.…”

Section: Discussionmentioning

confidence: 99%

“…Although gastric necrosis has been reported in patients with small-bowel obstruction, patients with bulimia and patients who cannot belch or vomit after Nissen fundoflication,(1-3) there was no report on near-total gastric necrosis resulting from gastric outlet obstruction due to sludge of the laver associated with advanced gastric cancer. Herein, we report our experience in patients with near-total gastric mucosal necrosis following large sludge of the soaked laver with advanced gastric cancer, which was successfully treated by total gastrectomy.…”

Section: Introductionmentioning

confidence: 99%

Acute Gastric Necrosis Due to Gastric Outlet Obstruction Accompanied with Gastric Cancer and Trichophytobezoar

2011

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Gastric necrosis due to gastric outlet obstruction is a very rare condition, but it might be fatal if missed or if diagnosis is delayed. Our patient was a 73-year-old male complaining of abdominal pain, distension and dyspnea for 1 day. In plain radiography and computed tomography, a markedly distended stomach and decreased enhancement at the gastric wall were noted. He underwent explo-laparotomy, and near-total gastric mucosal necrosis accompanied by sludge from the soaked laver was noted. A total gastrectomy with esophagojejunostomy was performed, and he recovered without sequelae. Final pathologic examination revealed advanced gastric cancer at the antrum with near-total gastric mucosal necrosis.

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“…Some investigators have detected metabolic acidosis in arterial gas analysis [2,8,15,16,20,24]. Absence of bowel sounds in cases without rupture [2,14,17,20,22,24,26] indicates paralysis of the gut, which means a decrease in absorptive function, further contributing to shock. In the present case, the gut from jejunum to cecum showed marked veno-dilatation and congestion, suggestive of paralysis of the gut.…”

Section: Discussionmentioning

confidence: 99%