Gastrointestinal complications may follow organ transplantation. A patient who underwent heart lung transplantation due to patent ductus arteriosus and Eisenmenger's syndrome had an episode of acute cardiac rejection and was treated with a bolus injection of methylprednisolone followed by a high oral dose of prednisone. On the 22nd postoperative day, the patient complained of acute abdominal pain with muscular rigidity and a plain chest x-ray showed free air in the right subdiaphragmatic area. Under the suspicion of bowel perforation, an emergency laparotomy was performed and the perforated stomach had a wedge-shaped resection that included the perforation. Following the laparotomy, the postoperative course was uneventful and the patient was discharged on post-laparotomy day 10.
Adult ; Heart-Lung Transplantation/*adverse effects ; Human ; Male ; Peptic Ulcer Perforation/*etiology/*surgery ; Stomach Ulcer/*surgery

OBJECTIVETo study the long-term results of extended parietal cell vagotomy (EPCV) in the treatment of patients with duodenal ulcer and their complications.

METHODSForm 1979 to 2001, EPCV was performed in 321 patients with duodenal ulcer and their complications. Of these patients 56 had chronic duodenal ulcer, 204 perforation, 16 hemorrhage and 40 stenosis. The following items were evaluated: complications of operation, gastric secretion, gastric emptying, endoscopical and radiographical findings, nutritional status, absorption function, and Visick scale.

RESULTSPostoperative follow-up ranged from 0.5 to 22.0 years (mean 11.3 years) in 289 of the 321 patients with a follow-up rate of 90.0%. Neither operative mortality nor dumping syndrome was noted. Episodic postprandial fullness occurred in 19 patients (6.5%), acid regurgitation in 17 (5.8%) and adhesive ileus in 4 (1.4%). Ulceration recurred in 16 patients (5.5%). Duodenal ulcer was seen in 8 patients (19.5%), hemorrhage in 0 (0%), stenosis in 2 (5.3%), and perforation in 6 (3.1%). Ulcers healed rapidly after medical therapy in 10 patients. Six patients received antrectomy and gastrectomy. In 289 (91.7%) patients of Grade I and II of Visick scale, 191 (95.3%) had perforation.

CONCLUSIONSEPCV is easy to perform with a low rate of post operative complication and ulcer recurrence. It should be a treatment of choice for acute perforation, hemorrhage or stenosis due to duodenal ulcer.

Duodenal Ulcer ; surgery ; Female ; Follow-Up Studies ; Gastric Acid ; secretion ; Gastroscopy ; Humans ; Male ; Peptic Ulcer Perforation ; surgery ; Postoperative Complications ; etiology ; Recurrence ; Vagotomy ; adverse effects ; methods

OBJECTIVETo evaluate the long-term therapeutic efficacy of extended parietal cell vagotomy (EPCV) in the treatment of duodenal ulcer complicated with acute perforation.

METHODSTherapeutic efficacy of EPCV in 176 cases subjected to duodenal ulcer with acute perforation since 1979 was evaluated, including postoperative complication, ulcer recurrence rate, gastric empting function, endoscopic and radiographical examination, nutritional status and Visick classification.

RESULTSAmong 176 patients, 153 (86.9%) cases were successfully followed-up for 5 years after operation. No operative death was found. Postprandial superior belly fullness occurred in 13 cases (8.5%) and heartburn in 12 cases (7.8%), which could be relieved by Domperidone. Adhesive ileus was noted in 4 cases (2.6%) which was cured by adhesiolysis. The total ulcer recurrence rate was 2.6% (4 cases) within 2 to 3 years after operation. Superficial gastritis occurred in 21 cases (13.7%) and duodenal bulb in 31 cases (20.3%). Sinus ventriculi vermicular motion was good and gastric emptying was normal. No anemia was found. Body weight gained in 116 cases (75.8%). One hundred and forty-six cases(95.4%) were reforming Visick grade I and II , 3 cases(2.0%) grade III , and 4 cases (2.6%) IV .

CONCLUSIONSEPCV is convenient for performance with low postoperative complication rate. Its long-term efficacies are quite good, which including normal nutritional status, high quality of life and low ulcer recurrence rate. EPCV is one of effective and safe treatments for duodenal ulcer complicated with acute perforation.

Adolescent ; Adult ; Aged ; Duodenal Ulcer ; complications ; surgery ; Female ; Humans ; Male ; Middle Aged ; Peptic Ulcer Perforation ; etiology ; surgery ; Treatment Outcome ; Vagotomy, Proximal Gastric ; Young Adult

Intrahepatic abscess is an unusual complication of peptic ulcer disease. We present a case of gastric cancer in which the ulcer penetrated into the left lobe of liver with subsequent abscess and fistula formation. Esophagogastroduodenoscopy confirmed ulcers and a fistula opening in the antrum. Abdominal computed tomogram showed a subcapsular liver abscess adjacent to the gastric antrum. Subtotal gastrectomy with curettage of the fistulous tract was performed. The final diagnosis was the signet ring cell gastric carcinoma complicating subcapsular liver abscess. To our knowledge, this is the first reported case in Korea.
Endoscopy, Gastrointestinal ; Female ; Humans ; Klebsiella pneumoniae/isolation & purification ; Liver Abscess/diagnosis/*etiology/microbiology ; Middle Aged ; Peptic Ulcer Perforation/*complications/diagnosis ; Stomach Neoplasms/complications/*diagnosis/surgery ; Tomography, X-Ray Computed

OBJECTIVETo study the long-term curative effects of suture plus proximal gastric vagotomy (PGV) and suture plus triad-therapy (omeprazole, amoxycillin and flagyl taken orally) for the treatment of duodenal ulcer with acute perforation.

METHODSThree hundred and twenty-nine patients with duodenal ulcer and acute perforation were treated with 2 different methods, respectively. Method A was suture plus PGV (group A, 153 cases), and method B was suture plus triad-therapy (group B, 176 cases). Follow-up was made by means of correspondence, outpatient reexamination and cooperation with local hospitals in 5 to 8 years after operation. The contents of follow-up included symptom acquisition (such as upper abdominal pain or distention, pyrosis, belch, acid regurgitation, vomiting, diarrhea and conditions of living or working), gastroscopy and Helicobacter pylori (HP) detection. The curative effects were evaluated by the Visick scale.

RESULTSThree hundred and one patients were followed up (group A 142 and group B 159). According to the Visick scale, 97 (68.3%), 19 (13.4%), 13 (9.15%) and 13 (9.15%) patients in group A, and 31 (19.5%), 28 (17.6%), 24 (15.1%) and 76 (47.8%) in group B were classified as Visick I, II, III and IV respectively (Z = -9.818, P < 0.01). As for HP detection, there were 130 (91.5%) patients in group A and 94 (59.1%) in group B (chi(2) = 41.438, P < 0.01).

CONCLUSIONSThe long-term curative effects of suture plus PGV were superior to those of suture plus triad-therapy for duodenal ulcer with acute perforation although HP positive rate was higher in group A than in group B. HP infection is one of the etiological factors of duodenal ulcer. The increased excitability of the vagus nerve remains to play an important role in duodenal ulcer.

Acute Disease ; Adolescent ; Adult ; Aged ; Amoxicillin ; administration & dosage ; Drug Therapy, Combination ; Duodenal Ulcer ; drug therapy ; etiology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Metronidazole ; administration & dosage ; Middle Aged ; Omeprazole ; administration & dosage ; Peptic Ulcer Perforation ; drug therapy ; surgery ; Suture Techniques ; Vagotomy, Proximal Gastric ; methods

OBJECTIVETo observe the effect of Tongfu Xiere Recipe (TXR) on surgical abdominal diseases accompanied with systemic inflammatory response syndrome (SIRS).

METHODSForty-six patients in the post-operational stage were treated by basic therapy, including conventional treatment and antibiotics applying, and combined use of TXR, and compared with the 43 patients treated by basic therapy alone as the control group.

RESULTSCompared with the control group, the incidence of complications in the treatment group was significantly lower (P<0.01). The incidence of multiple organ dysfunction syndrome (MODS) and the mortality in the treatment group showed an decreasing tendency. Moreover, levels of plasma endotoxin, TNF-alpha, IL-6 and IL-8 in the treatment group after treatment decreased significantly, while IL-2 level increased (P < 0.01), and showed a significant difference (P < 0.01) as compared with those in the control group.

CONCLUSIONThe combined therapy can decrease the levels of blood endotoxin and inflammation promoting cytokine and increase the level of cytokine that directly related with immune function to regulate immunity and inhibit the inflammatory reaction, and furthermore, to prevent MODS and decrease the mortality of patients with surgical abdominal diseases accompanied SIRS.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; therapeutic use ; Appendicitis ; complications ; surgery ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Peptic Ulcer Perforation ; complications ; surgery ; Phytotherapy ; Postoperative Complications ; drug therapy ; Systemic Inflammatory Response Syndrome ; drug therapy ; etiology

Although cervical epidural abscess is rare, it should be strongly suspected in any patient with unexplainable neck pain and fever, especially when the patient has a predisposing factor for this infectious process. The authors report a case of cervical epidural abscess in a 39-yr-old man with an aorto-duodenal fistula, which complicated the interposition of artificial graft for abdominal aortic aneurysm rupture, which had undertaken 40 months before. Timely detection and intervention rendered him a full neurological recovery. This extremely rare case is presented with a literature review.
Adult ; Aneurysm, Dissecting/complications ; Aneurysm, Dissecting/surgery ; Aortic Aneurysm, Abdominal/complications ; Aortic Aneurysm, Abdominal/surgery ; Aortic Diseases/complications* ; Aortic Rupture/complications ; Aortic Rupture/surgery ; Blood Vessel Prosthesis Implantation ; Cervical Vertebrae* ; Duodenal Diseases/complications* ; Duodenal Ulcer/complications ; Enterococcus ; Epidural Abscess/etiology* ; Epidural Abscess/microbiology ; Epidural Abscess/surgery ; Fistula/complications* ; Gram-Positive Bacterial Infections/complications ; Human ; Male ; Peptic Ulcer Perforation/complications ; Salmonella Infections/complications ; Staphylococcal Infections/complications