Endoscopic approach to gastric remnant outlet obstruction after gastric bypass: A case report.

Autor:	Zarrin A; Department of Internal Medicine, Aventura Hospital and Medical Center, Miami, FL 33180, United States. arash.zarrin@hcahealthcare.com., Sorathia S; Department of Gastroenterology, Aventura Hospital and Medical Center, Miami, FL 33180, United States., Choksi V; Department of Gastroenterology, Aventura Hospital and Medical Center, Miami, FL 33180, United States., Kaplan SR; Department of Gastroenterology, Aventura Hospital and Medical Center, Miami, FL 33180, United States., Kasmin F; Department of Gastroenterology, Aventura Hospital and Medical Center, Miami, FL 33180, United States.
Jazyk:	angličtina
Zdroj:	World journal of gastrointestinal endoscopy [World J Gastrointest Endosc] 2020 Sep 16; Vol. 12 (9), pp. 297-303.
DOI:	10.4253/wjge.v12.i9.297
Abstrakt:	Background: Acute gastric remnant bleeding is a rare complication of bariatric surgery. Furthermore, acute bleeding from the gastric remnant resulting in gastric remnant outlet obstruction has not been described previously. Endoscopic management of gastric remnant bleed has been challenging due to difficulty accessing the excluded stomach. Traditionally, this necessitates surgical intervention. Recently, however, the adoption of endoscopic ultrasound-directed transgastric intervention provides an alternative approach to management. Case Summary: A 65-year-old male with a prior gastric bypass presented with the sudden onset of progressive abdominal distension, nausea, and melena of two days duration. His imaging illustrated a massively distended stomach. A nasogastric tube did not result in drainage of fluid or decompression of his abdomen. His endoscopy revealed a normal-appearing gastro-jejunal anastomosis and confirmed the distended "fluid"-filled gastric remnant. An endoscopic ultrasound-directed gastrogastrostomy was created to decompress the gastric remnant. Two liters of blood was suctioned before a large adherent clot was visualized in the gastric antrum. The patient underwent emergent angiography with embolization of the gastroduodenal artery. He was discharged with a stable hemoglobin level and resolution of symptoms. Healing superficial gastric ulcers were visualized on a follow-up endoscopy. Gastric biopsies were consistent with Helicobacter pylori infection for which the patient was treated, and successful eradication was achieved. Conclusion: This patient benefited from a timely diagnosis and effective therapy of an acute gastric remnant obstruction from a bleeding ulcer with endoscopic ultrasound-directed transgastric intervention. (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)
Databáze:	MEDLINE
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