Hepatogastroenterology

Bouveret's syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a large gallstone which passes into the duodenal bulb through a cholecystogastric or cholecystoduodenal fistula. Initial attempts at endoscopic retrieval with or without mechanical or extracorporeal lithotripsy should be performed as first-line treatment, though success rates with endoscopic treatment are variable. We describe a case of Bouveret's Syndrome in an elderly patient that was successfully treated with endoscopic extraction combined with mechanical lithotripsy, and review the literature on this uncommon condition.

Superficial mucosal damage is associated with mucosal hyperemia and release of histamine into venous blood and gastric lumen. This study was designed to examine if histamine administrated directly to gastric mucosa becomes absorbed and transported away with blood, and if so whether it is capable of increasing gastric mucosal blood flow. Superficial mucosal injury was induced by exposing chambered rat stomachs to 2 M NaCl for 10 min, and 45 min later 4.5 x 10(-2) or 4.5 x 10(-3) M histamine was instilled into the chamber. Mucosal blood flow was determined by radioactive microspheres and continuously by Laser Doppler flowmetry. Histamine concentration in arterial blood was markedly increased 15 min after administration of histamine. The mucosal blood flow did not increase after application of histamine. Significant increase in heart rate and fall in arterial blood pressure were observed. Similar results were obtained after application of histamine to normal mucosa. Histamine applied t...

Background/Aims : This comparative study was conducted on 111 patients to evaluate the long term outcome of endoscopic variceal therapy in patients with portal hypertension, and particularly with schistosomiasis. Patients and Methods : There were 45 patients with chronic liver ...

The effect of hepatocellular cancer (HCC) in patients transplanted for hepatitis B and D virus (HB/DV) cirrhosis is not well studied. Our aim was to study the long-term survival outcomes of patients who underwent liver transplantation for HB/DV cirrhosis with and without HCC. A total of 231 primary, adult, single- organ liver transplants were performed from 1990 to 2007. HB/DV was the cause of cirrhosis in 36 patients. Nine patients died during the first 3 postoperative months from surgical complications. The study group comprised the remaining 27 patients. The median follow-up was 1515 days. The mean patient survival was 3760 days (95% CI: 3013-4507). Six patients were diagnosed with HCC. The mean patient survival was 3011 days (95% CI: 2344-3679) and 4036 days (95% CI: 3002-5070) for recipients without and with HCC, respectively. For the same groups, the incidence of microbial infections was 61.9% and 33.3%, respectively (p=0.219). HCC has not recurred in any of the six patients. ...

The objectives of surgical management in carcinoma esophagus are A complete resection of the esophagus Adequate lymph node clearance Replacement of the esophagus by a suitable conduit Minimum morbidity The salient features of the technique of combined thoracoscopic and laparoscopic esophagectomy with anastomosis in the neck described in this chapter are: Thoracoscopic esophageal mobilization with lymphadenectomy, including the paratracheal, subcarinal, parabronchial and paraesophageal nodes. Laparoscopic stomach mobilization with regional lymphadenectomy, including the lymph nodes along the lesser curvature of the stomach, the coeliac axis and the paraaortic nodes. Specimen delivery through a small epigastric incision, and extracorporeal formation of stomach tube. Intrathoracic placement of stomach tube and esophagogastric anastomosis in the neck. Feeding jejunostomy in all patients.