Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy. The treatment of pulmonary artery embolism includes remittance of pulmonary arterial hypertension, anticoagulation, thrombolysis, operative thrombectomy, interventional therapy and extracorporeal membrane oxygenation (ECMO). Hemorrhage is a rarely occurred but relatively serious complication after bariatric surgery. The primary cause of anastomotic bleeding after laparoscopic gastric bypass is incomplete hemostasis or weak laparoscopic repair. The common bleeding site in laparoscopic sleeve gastrectomy is gastric stump and close to partes pylorica, and the bleeding may be induced by malformation and weak repair technique. Patients with hemodynamic instability caused by active bleeding or excessive bleeding should timely received surgical treatment. Anastomotic fistula in gastric bypass can be divided into gastrointestinal anastomotic fistula and jejunum-jejunum anastomotic fistula. The treatment of postoperative anastomotic fistula should vary with each individual, and conservative treatment or operative treatment should be adopted. Anastomotic stenosis is mainly related to the operative techniques. Stenosis after sleeve gastrectomy often occurs in gastric angle, and the treatment methods include balloon dilatation and stent implantation, and surgical treatment should be performed when necessary. Marginal ulcer after gastric bypass is a kind of peptic ulcer occurring close to small intestine mucosa in the junction point of stomach and jejunum. Ulcer will also occur in the vestige stomach after laparoscopic sleeve gastrectomy, and the occurrence site locates mostly in the gastric antrum incisal margin. Preoperative anti-HP (helicobacter pylorus) therapy and postoperative continuous administration of proton pump inhibitor (PPI) for six months is the main means to prevent and treat marginal ulcer. For patients on whom conservative treatment is invalid, endoscopic repair or surgical repair should be considered. Different surgical procedures will generate different related operative complications. Fully understanding and effectively dealing with the complications of various surgical procedures through multidisciplinary cooperation is a guarantee for successful operation.
Anastomosis, Surgical ; adverse effects ; Anticoagulants ; therapeutic use ; Bariatric Surgery ; adverse effects ; Catheterization ; China ; Conservative Treatment ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Fistula ; etiology ; therapy ; Endoscopy, Gastrointestinal ; methods ; Extracorporeal Membrane Oxygenation ; Gastrectomy ; adverse effects ; Gastric Bypass ; adverse effects ; Gastric Mucosa ; pathology ; Gastric Stump ; physiopathology ; surgery ; Gastrointestinal Hemorrhage ; etiology ; prevention & control ; surgery ; Hemostasis, Surgical ; adverse effects ; methods ; Hemostatic Techniques ; Heparin ; therapeutic use ; Humans ; Intermittent Pneumatic Compression Devices ; Intestine, Small ; pathology ; Laparoscopy ; adverse effects ; Margins of Excision ; Peptic Ulcer ; etiology ; therapy ; Postoperative Complications ; diagnosis ; prevention & control ; therapy ; Pulmonary Embolism ; etiology ; therapy ; Stents ; Stockings, Compression ; Thrombectomy ; Thrombolytic Therapy ; Venous Thrombosis ; etiology ; prevention & control ; therapy

Idiopathic cecal ulcer is a rare disease entity of unknown cause diagnosed by ruling out other known causes of cecal ulceration. The most common complication of an idiopathic cecal ulcer is bleeding; perforation, peritonitis, abscess, and stricture formation have been noted. The authors treated a 53-year-old woman who presented with fever and intermittent right upper quadrant abdominal pain. Multiple pyogenic liver abscess and a solitary cecal ulcer were diagnosed by radiologic, endoscopic, and pathologic examination, followed by laparoscopic cecectomy. After extensive study, we concluded that this patient's liver abscesses were a complication of the idiopathic cecal ulcer. Herein, we report a case of multiple pyogenic liver abscess caused by microperforation of idiopathic cecal ulcer.
Cecal Diseases/complications/*diagnosis/surgery ; Colonoscopy ; Female ; Humans ; Laparoscopy ; Liver/pathology ; Liver Abscess, Pyogenic/*diagnosis/etiology ; Middle Aged ; Tomography, X-Ray Computed ; Ulcer/complications/*diagnosis/surgery

Since the Korean College of Helicobacter and Upper Gastrointestinal Research has first developed the guideline for the diagnosis and treatment of Helicobacter pylori infection in 1998, the revised guideline was proposed in 2009 by the same group. Although the revised guideline was made by comprehensive review of previous articles and consensus of authoritative expert opinions, the evidence-based developmental process was not applied in the revision of the guideline. This new guideline has been revised especially in terms of changes in the indication and treatment of H. pylori infection in Korea, and developed by the adaptation process as evidence-based method; 6 guidelines were retrieved by systematic review and the Appraisal of Guidelines for Research and Evaluation (AGREE) II process, 21 statements were made with grading system and revised by modified Delphi method. After revision, 11 statements for the indication of test and treatment, 4 statements for the diagnosis and 4 statements for the treatment have been developed, respectively. The revised guideline has been reviewed by external experts before the official endorsement, and will be disseminated for usual clinical practice in Korea. Also, the scheduled update and revision of the guideline will be made periodically.
Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Aspirin/therapeutic use ; Bismuth/therapeutic use ; Breath Tests ; Clarithromycin/therapeutic use ; Gastroesophageal Reflux/etiology ; Gastroscopy ; Helicobacter Infections/complications/*diagnosis/drug therapy ; *Helicobacter pylori ; Humans ; Lymphoma, B-Cell, Marginal Zone/complications ; Metaplasia/complications ; Metronidazole/therapeutic use ; Peptic Ulcer/complications/drug therapy ; Proton Pump Inhibitors/therapeutic use ; Republic of Korea ; Stomach Neoplasms/complications/surgery ; Tetracycline/therapeutic use

INTRODUCTIONLaparoscopic simple closure (LSC) coupled with Helicobacter pylori eradication is a well-recognised treatment for perforated duodenal ulcers. This study aimed to evaluate its safety and efficacy.

METHODSThis was a retrospective cohort study conducted on patients who underwent LSC of perforated duodenal ulcers from January 2002 to December 2009. Patients were stratified according to the American Society of Anesthesiologist classification and Boey's risk score.

RESULTSOf the 213 patients, 22 (10.3%) were excluded as they required conversion to open surgery. 191 (89.7%) patients who underwent successful laparoscopic repair were included in the study. The median age of the patients was 39 (range 19-73) years, and the majority were male (n = 180, 94%). Median duration of pre-hospital symptoms was eight hours and median time from admission to surgery was six hours. Median operative time was 65 minutes and median hospital stay was five days. Ten patients (median age 53.5 years) required intensive care unit admission. Two patients developed leakage from the suture line - one required re-exploration and the other was managed conservatively. Four patients had intra-abdominal abscesses - one required re-exploration, while three were managed by percutaneous radiological drainage. One patient developed pneumonia and one had pulmonary embolism. There were no surgical site infections. All patients were followed up as surgical outpatients (median duration 36 days). None of the patients required definitive surgery. There was one death in the cohort.

CONCLUSIONLSC of perforated duodenal ulcers is a reliable, safe and minimally invasive procedure that has low morbidity.

Adult ; Aged ; Duodenal Ulcer ; diagnosis ; surgery ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Peptic Ulcer Perforation ; surgery ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Young Adult

Superior mesenteric artery (SMA) syndrome is an uncommon cause of duodenal outlet obstruction. Symptoms and signs suggestive of this condition are nonspecific, and a high index of suspicion coupled with appropriate imaging studies are necessary for diagnosis. We present the case of a 70-year-old man who developed SMA syndrome following prolonged hospitalisation for a surgically treated bleeding duodenal ulcer. His SMA syndrome resolved after successful nonoperative management based on accepted guidelines for nutritional therapy, thus avoiding the need for reoperation and its attendant risks in a malnourished patient.
Aged ; Duodenal Obstruction ; drug therapy ; Duodenal Ulcer ; complications ; surgery ; Endoscopy ; Hospitalization ; Humans ; Male ; Malnutrition ; Nutrition Therapy ; methods ; Refeeding Syndrome ; diagnosis ; Superior Mesenteric Artery Syndrome ; diet therapy ; Treatment Outcome

Intravariceal injection of N-butyl-2-cyanoacrylate is widely used for the hemostasis of bleeding gastric varices, but not routinely for esophageal variceal hemorrhage because of various complications such as pyrexia, bacteremia, deep ulceration, and pulmonary embolization. We report a rare case of esophageal sinus formation after cyanoacrylate obliteration therapy for uncontrolled bleeding from post-endoscopic variceal ligation (EVL) ulcer. A 50-year-old man with alcoholic liver cirrhosis presented with hematemesis. Emergent esophagogastroscopy revealed bleeding from large esophageal varices with ruptured erosion, and bleeding was initially controlled by EVL, but rebleeding from the post-EVL ulcer occurred at 17th day later. Although we tried again EVL and the injections of 5% ethanolamine oleate at paraesophageal varices, bleeding was not controlled. Therefore, we administered 1 mL cyanoacrylate diluted with lipiodol and bleeding was controlled. Three months after the endoscopic therapy, follow-up endoscopy showed medium to large-sized esophageal varices and sinus at lower esophagus. Barium esophagography revealed an outpouching in esophageal wall and endoscopic ultrasonography demonstrated an ostium with sinus. It is noteworthy that esophageal sinus can be developed as a rare late complication of endoscopic cyanoacrylate obliteration therapy.
Cyanoacrylates/administration & dosage/*adverse effects ; *Embolization, Therapeutic ; Endoscopy, Digestive System ; Esophageal and Gastric Varices/complications/*diagnosis/therapy ; Esophagus/radiography/ultrasonography ; Ethiodized Oil/therapeutic use ; Gastrointestinal Hemorrhage/surgery/*therapy ; Humans ; Ligation ; Liver Cirrhosis, Alcoholic/*complications/diagnosis ; Male ; Middle Aged ; Tissue Adhesives/administration & dosage/*adverse effects ; Ulcer/*complications

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

A gastropericardial fistula, defined as penetration of a gastric lesion into the pericardium, is a rare occurrence. Such a fistula is usually associated with a huge ulcer in the gastric fundus, an ulcer within a hiatus hernia, a history of esophagogastric surgery, the concurrent use of non-steroidal anti-inflammatory drugs (NSAIDs), or Zollinger-Ellison syndrome. The patient in this case presented with shoulder pain and melena, caused by a gastropericardial fistula that had occurred as a late complication of postoperative esophagogastrostomy and a refractory gastric ulcer. Despite the severity of the condition, the patient showed great improvement after medical treatment and the fistula was cured at the end.
Esophagectomy/*methods ; Gastric Fistula/*diagnosis/*etiology ; Humans ; Male ; Middle Aged ; Pericardium/*pathology ; Stomach Ulcer/*complications/*surgery

Intramural duodenal hematoma is an uncommon condition, which usually develops after blunt abdominal trauma. It is also reported as a complication of anticoagulant therapy, blood dyscrasia, pancreatic disease, and diagnostic and therapeutic endoscopy. The typical clinical pictures of intramural duodenal hematoma consist of upper abdominal pain, vomiting, fever, and hematochezia, and it is rarely accompanied by intestinal obstruction, peritonitis, and pancreatitis as its complication. We report a case of intramural duodenal hematoma extended to peritoneal cavity, and accompanied by acute pancreatitis following therapeutic endoscopy for duodenal ulcer bleeding in a 32-year-old man who was on maintenance of anti-coagulation therapy after valvular heart surgery.
Acute Disease ; Adult ; Diagnosis, Differential ; Duodenal Diseases/*diagnosis/pathology/surgery ; Duodenal Ulcer/*complications ; Hematoma/*diagnosis/pathology/surgery ; *Hemostasis, Endoscopic ; Humans ; Male ; Pancreatitis/complications/*diagnosis ; Peptic Ulcer Hemorrhage/*therapy ; Postoperative Complications ; Tomography, X-Ray Computed

Endoscopic mucosal resection (EMR) is widely accepted as a standard treatment for early gastric cancer or gastric adenoma. However, EMR inevitably results in the formation of large iatrogenic ulcer at the resected area. Although the characteristics of EMR-induced ulceration are not fully understood, this type of ulcer is thought to heal faster and to recur less often than non-iatrogenic gastric ulcer. Current available evidences have suggested that EMR-induced ulcers heal within 2-3 months. Herein, we report two cases of non-healing persistent gastric ulcers after EMR. One is a case of gastric carcinoma which developed at the same site of previous EMR site for the low grade dysplasia. The other is a case in which persistent EMR-induced ulcer was healed in the long run after Helicobacter pylori eradication therapy.
Aged ; Endoscopy, Gastrointestinal ; Gastric Mucosa/pathology/*surgery ; Helicobacter Infections/complications/drug therapy ; Helicobacter pylori ; Humans ; Iatrogenic Disease ; Male ; Middle Aged ; Stomach Neoplasms/complications/diagnosis/*surgery ; Stomach Ulcer/diagnosis/*etiology/pathology