Report of a case involving novel use of a post-operative esophagogastroduodenoscopy to re-evaluate a duodenal ulcer bleed.
Surgery; Endoscopy; Case report; Bleeding; Duodenum; Repair; Ulcer
INTRODUCTION: Acute gastrointestinal (GI) bleeding can be a life-threatening condition. This is usually diagnosed and managed by an upper GI tract endoscopy. When treating actively bleeding duodenal ulcers, surgical intervention, or arterial embolization by Interventional Radiology (IR) is warranted in the event of failed initial management. We present a patient with a significant GI bleed and failure of management through endoscopy, necessitating emergent surgical intervention. PRESENTATION OF CASE: An 87-year-old female presented to the emergency department after a fall. Her hemoglobin level dropped significantly and an esophagogastroduodenoscopy (EGD) revealed a large pool of blood in the stomach but had a limited view of an active bleed. The patient was taken emergently to the operating room (OR) where she underwent an exploratory laparotomy, gastroduodenostomy, suture ligation, and pyloroplasty. The following day, she had increased sanguineous output from her nasogastric (NG) tube. Re-evaluation was done with an EGD in the OR. The patient tolerated all procedures well and was transferred to a facility with IR capabilities for further management. DISCUSSION: An EGD hours after gastroduodenostomy runs a high risk for perforation and is not the typical course of action. Given the lack of IR availability and concern for rebleeding, this procedure was performed in the OR to minimize risk. CONCLUSION: A favorable outcome was achieved with this patient and hemostasis was confirmed with the post-operative EGD. Further studies will determine whether this approach is a viable option for facilities without IR until the patient can be transferred.
DeVito R;Shoukry S;Arif A;Fullmer R;Simpson M;Kimyaghalam A
International Journal of Surgery Case Reports
2020
2020-10-23
journalArticle
<a href="http://doi.org/10.1016/j.ijscr.2020.10.094" target="_blank" rel="noreferrer noopener">10.1016/j.ijscr.2020.10.094</a>
Management of grade IV renal injury in children
endoscopy; kidney; lacerations; nonpenetrating; trauma; Urology & Nephrology; wounds
Purpose: Conservative nonsurgical management of major renal trauma in children is well established. However, when blunt trauma is accompanied by significant urinary extravasation, options are less than clearly defined. Endoscopic techniques, such as stents and percutaneous drainage, have not been widely used because of small caliber. We present our experience with endoscopic management of grade IV renal trauma. Materials and Methods: From 1983 to 1996, 15 children satisfied the criteria for grade IV renal trauma. We retrospectively reviewed the charts to assess the mechanism of injury, associated injury, treatment, hospital stay and transfusion requirement. Patients were followed clinically with blood pressure and creatinine monitoring, and by radiograph with computerized tomography. Results: Nine patients with isolated kidney injury were successfully treated with observation, 1 underwent early partial nephrectomy for persistent anemia and hypotension, and 5 had a urinoma, which was successfully treated with percutaneous drainage only in 2. The other 3 patients underwent cystoscopy and ureteral stent placement for high drainage output, leading to the resolution of urine leakage. In 1 patient who underwent percutaneous drainage only renovascular hypertension developed, requiring partial nephrectomy 3 months after the original injury. The remaining 13 patients had complete radiographic resolution of the injury and no evidence of hypertension. Conclusions: In the pediatric population grade IV blunt renal trauma usually resolves without intervention. When a symptomatic urinoma develops, percutaneous drainage, accompanied at times by ureteral stenting provides the complete resolution of persistent urine leakage.
Russell R S; Gomelsky A; McMahon D R; Andrews D; Nasrallah P F
Journal of Urology
2001
2001-09
Journal Article
<a href="http://doi.org/10.1016/s0022-5347(05)65917-4" target="_blank" rel="noreferrer noopener">10.1016/s0022-5347(05)65917-4</a>
NOTES: issues and technical details with introduction of NOTES into a small general surgery residency program.
Humans; Feasibility Studies; *Internship and Residency; Endoscopy; Clinical Competence; General Surgery/*education; *Laparoscopy; Catheterization; Anastomosis; Surgical/methods; Gastrointestinal/*methods
BACKGROUND AND OBJECTIVES: Natural orifice translumenal endoscopic surgery (NOTES) is a development of recent origin. In 2004, Kalloo et al first described NOTES investigation in an animal model. Since then, several investigators have pursued NOTES study in animal survival and nonsurvival models. Our objectives for this project included studying NOTES intervention in a laboratory environment using large animal (swine) models and learning to do so in a safe, controlled manner. Ultimately, we intend to introduce NOTES methodology into our surgical residency training program. The expertise of an experienced laparoscopic surgeon, fellowship-trained laparoendoscopic surgeon, and veterinarian along with a senior surgical resident was utilized to bring the input of several disciplines to this study. The Institutional Animal Care and Use Committee (IACUC) of Northeastern Ohio Universities College of Medicine and Pharmacy (NEOUCOM/COP) approved this study. METHODS: A series of 5 laboratory sessions using mixed breed farm swine varying in weight from 37 kg to 43.1 kg was planned for the initial phase of NOTES introduction into our residency program. Animals were not kept alive in this investigation. All animals were anesthetized using a standard swine protocol and euthanized following guidelines issued by the American Veterinary Medical Association Panel on Euthanasia. Equipment included a Fujinon EVE endoscope 0.8 cm in diameter with a suction/irrigation channel and one working channel. Initially, a US Endoscopy gastric overtube, 19.5 mm OD and 50 cm in length, was used to facilitate passage of the endoscope. However, this device was found to have insufficient length. Subsequently, commercially available 5/8" diameter clear plastic tubing, 70 cm to 80 cm in length, was adapted for use as an overtube. Standard endoscopic instruments included Boston Scientific biopsy forceps, needle-knife, papillotome, endoscopic clip applier, and Valley Lab electrosurgical unit. A Karl Storz laparoscope and tower were used for laparoscopic observation of NOTES maneuvers. Necropsy was performed to determine specific details of surgical intervention. RESULTS: NOTES intervention is feasible in an animal model. Insight into the potential of NOTES was obtained in this investigation. CONCLUSIONS: NOTES investigation in a controlled, laboratory setting using an animal model proved to have value for our program. A steep learning curve was encountered despite the availability of an investigator familiar with elementary NOTES procedures. The authors strongly suggest investigators adopt the ASGE/SAGES working group recommendations for a multidisciplinary team possessing advanced therapeutic endoscopic and advanced laparoscopic skills to study NOTES before human investigation. Animal laboratory facilities to perform research and training should be available to the multidisciplinary team for exploration of NOTES techniques and procedures. Institutional Review Board (IRB) approval must be obtained before introduction of NOTES procedures in human patients.
Kavic Michael S; Mirza Brian; Horne Walter; Moskowitz Jesse B
JSLS : Journal of the Society of Laparoendoscopic Surgeons
2008
2008-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Colon sarcoidosis presenting with abdominal pain.
Abdominal Pain – Etiology; Abdominal Pain/*etiology; Adult; Biopsy; Colon – Pathology; Colon/pathology; Colonic Diseases – Complications; Colonic Diseases/*complications; Colonoscopy; Female; Humans; Sarcoidosis – Complications; Sarcoidosis/*complications
Bat Taha; Morgan Charles M; Marx Robert; Bailey Rebecca S
Endoscopy
2014
1905-7
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1055/s-0034-1364890" target="_blank" rel="noreferrer noopener">10.1055/s-0034-1364890</a>
Cobblestone Airways.
Bronchi/*pathology; Endoscopy; Humans; Male; Middle Aged; Mucous Membrane/*pathology; Trachea/*pathology
Barreiro Timothy J
Mayo Clinic proceedings
2016
2016-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.mayocp.2016.09.012" target="_blank" rel="noreferrer noopener">10.1016/j.mayocp.2016.09.012</a>
Adenocarcinoma arising in interposed colon: report of a case.
Adenocarcinoma/diagnosis/*etiology/pathology; Aged; Anastomosis; Colonic Neoplasms/diagnosis/*etiology/pathology; Diagnosis; Differential; Endoscopy; Esophagoplasty/*adverse effects; Gastrectomy/*adverse effects; Humans; Male; Postoperative Complications; Surgical; Tomography; X-Ray Computed
A rare occurrence of primary adenocarcinoma arising in an interposed colon nearly seven years after the surgery is described. Remarkably, there were no symptoms from a large mass in the transposed bowel. Diagnosis was made fortuitously while searching for the cause of the patient's iron-deficiency anemia. The rationale for careful preoperative screening of the colonic segment intended for transplant to exclude pre-existing pathology is reemphasized. The various methods of evaluating the postoperative colon graft and their advantages and limitations are discussed.
Goyal M; Bang D H; Cohen L E
Diseases of the colon and rectum
2000
2000-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/bf02237206" target="_blank" rel="noreferrer noopener">10.1007/bf02237206</a>