Gastric rupture - Forum

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Jorjo

Re: Gastric rupture - Ärzteforum

Post#11 »

I agree that he is lucky to survive considering that we started the intervention almost without an arterial pressure and he had a 2-3 liters hemoperitoneum. Pulling out the stomach was the most time sparing thing one can do in that condition (I forgot to include in my first message that the subdiaphragmatic aorta was clamped). No extension on the GEJ. I checked the definitive histology: cavernous AV hemangioma (surprise!).


Proctologist

Re: Gastric rupture - Ärzteforum

Post#12 »

It is interesting whether the patient had a bout of vomitting just prior to the acute event.

If he did, then I suspect this is a deeper than usual Mallory-Weiss tear.

When these retching associated tears occur in the stomach side of the cardia, they don't normally tear the wall, and cause bleeding. On the esophageal side, they perforate (Boerhaave syndrome). I always thought the difference was due to the lack of serosal covering in the esophagus. Very interesting case.

I suspect that you were afraid to narrow the cardia by simple suturing. and I agree that total gastrectomy is a better option than proximal gastrectomy, in terms of late morbidity and quality of life. However, there is a better solution than either, and that is a Thal patch. The Thal patch is good because it will allow you to close the defect without narrowing the cardia, and at the same time act as an anti reflux procedure.

Scalpel

Re: Gastric rupture - Ärzteforum

Post#13 »

In order to avoid total gastrectomy, as it was necessary to perform in this pt because of the risk of stretching the EGJ, we always try to do an esophagoyeyunogastrostomy l-t. For such an instance, we prepare a Roux-en-Y loop, close the distal end, open the loop on its antimesenteric side and make the esophagoyeyunogastroanastomosis latero-terminal to the stump,starting the suture at the esophagus.

This permits to avoid the stretching of the EGJ and enlarges the gastric stump.

This has been a surgical procedure used in cases that presented a peptic ulcer in a yuxtacardial location and its resection might have compromised the EGJ.

We have not seen any particular complications due to the procedure, at least not more than the usual expected for a subtotal gastrectomy.

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Resident

Re: Gastric rupture - Ärzteforum

Post#14 »

Big ulcer? What did the path show?

Noro

Re: Gastric rupture - Ärzteforum

Post#15 »

I think this procedure is just overcomplication. Thal patch is fast, simple, and is a usefull tool for a variety of problems in the GE junction. It is an excellent anti-reflux procedure - as proven by the work of Holder and Ashcraft in children. It is excellent treatment for benign esphageal stricture and is fast. Try it.

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