Stylianos Germanos

Acute Gastric Volvulus: Diagnosis and Management over 10 Years

Background/Aims: Gastric volvulus is a rare, potentially life-threatening condition, which is difficult to diagnose. This study represents a series of patients with acute gastric volvulus. Methods: All patients presenting with acute gastric volvulus over a 10-year period were reviewed. Results: Twenty-one patients with a median age of 66 years were identified. Acute gastric volvulus was secondary to a paraesophageal hiatus hernia in 16 patients. The major symptoms were abdominal pain, vomiting and upper gastrointestinal bleeding/anemia. The most useful investigations were barium studies and upper gastrointestinal endoscopy. Treatment was open surgery in all patients. There were no major complications and no deaths. Median hospitalization was 8 days. Conclusion: Acute gastric volvulus is a rare condition which requires a high index of suspicion for diagnosis, which is usually based on imaging studies. The treatment is immediate surgery. Volvulus can be treated successfully by open surgery with minimal morbidity and short hospitalization.

Control of presacral venous bleeding during rectal surgery

BACKGROUND Presacral venous hemorrhage is an uncommon but potentially life-threatening complication of rectal surgery. It is difficult to control presacral venous hemorrhage with conventional hemostatic measures and several alternative methods for hemostasis have been proposed. We described our experience of using the combination of a hemostatic matrix and an absorbable hemostat as an alternative method of hemostasis. METHODS From September 2007 to March 2009, 83 patients underwent rectal surgery for cancer, ulcerative colitis, or familial adenomatous polyposis. Three patients (3.6%) had severe presacral hemorrhage, which was controlled by the combined use of a hemostatic matrix (FloSeal; Baxter, USA) and an absorbable hemostat (Surgicel Fibrillar; Ethicon, USA). RESULTS Intraoperative blood transfusion was required in 1 patient. Postoperative blood loss was minimal and drain was removed on day 4 in all 3 patients. CONCLUSIONS The use of synthetic hemostatic agents is an effective and simple way to arrest presacral bleeding where conventional methods fail.

Vitelline artery remnant causing intestinal obstruction in an adult

presented to our hospital with a12-hourhistory of severe central abdominal pain ofacute onset, nausea, and vomiting. He had no his-tory of any abdominal surgery in the past but com-plained of rare episodes of self-limiting epigastricand periumbilical pain for years.Physical examination revealed a diffusely tenderabdomen with generalized rebound tenderness. Thewhite cell count was elevated at 12. 2 3 10

Avoiding emergency stoma surgery with the use of sugar

George Theofanis, Mahmud Saedon, Soo Hua Kho, Francesk Mulita, Stylianos Germanos and Edmund Leung discuss the use of sugar as an aid to reducing a stomal prolapse.

A Gastrointestinal Stromal Tumor Presenting as an Emergency: a Case Report.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract [1, 2]. They can occur anywhere in the gastrointestinal tract with the commonest sites of origin are the stomach (60– 70%) and small bowel (30%). The rectum, colon, esophagus, and appendix are less frequently involved [3, 4]. The clinical presentation of GISTs is highly variable depending on their size, location, and the presence of mucosal ulceration [3]. The most common clinical presentation of GISTs has been reported to be gross gastrointestinal (GI) bleeding, usually associated with melena, or chronic anemia (48–50%) [2]. Intraperitoneal bleeding secondary to surface tumor ulceration or rupture is a rare clinical condition [5, 6]. Emergency surgery after resuscitation is the treatment of choice for severely hemorrhagic GIST. Surgical R0 excision is the goal standard therapy for primary disease [7, 8].