R Januschowski1. 1. Medizinische Klinik I, Klinikum Herford.
Abstract
HISTORY: Two patients were admitted because of subtotal gastric outlet obstruction. In case 1, a 56-year-old man, who 16 months previously had undergone a pancreatic resection and Billroth II gastrectomy for pancreatic carcinoma, started to vomit due to a subtotal obstruction at the Billroth II anastomosis. In case 2, a 53-year-old woman with incurable metastasising gall-bladder carcinoma was seven months later found to have almost complete obstruction in the postgastric portion of the duodenum. Both patients vomited even after liquid food and had to be fed intravenously. FINDINGS: Radiology revealed some markedly twisted and high-grade stenoses in the postgastric small intestine. TREATMENT AND COURSE: In the first patient (postgastrectomy) a wall stent, 10 cm long and 2.2 cm in diameter, was placed across the stenosis without difficulty. In the other patient a similar stent was placed, but with great difficulty. Both patients were afterwards able to eat normal food without problem. CONCLUSION: Even when normal gastric anatomy has been preserved endoscopic placement of a stent can provide optimal results without surgery. Further advances will be achieved without great expense by further improving the equipment used for introducing the stent.
HISTORY: Two patients were admitted because of subtotal gastric outlet obstruction. In case 1, a 56-year-old man, who 16 months previously had undergone a pancreatic resection and Billroth II gastrectomy for pancreatic carcinoma, started to vomit due to a subtotal obstruction at the Billroth II anastomosis. In case 2, a 53-year-old woman with incurable metastasising gall-bladder carcinoma was seven months later found to have almost complete obstruction in the postgastric portion of the duodenum. Both patientsvomited even after liquid food and had to be fed intravenously. FINDINGS: Radiology revealed some markedly twisted and high-grade stenoses in the postgastric small intestine. TREATMENT AND COURSE: In the first patient (postgastrectomy) a wall stent, 10 cm long and 2.2 cm in diameter, was placed across the stenosis without difficulty. In the other patient a similar stent was placed, but with great difficulty. Both patients were afterwards able to eat normal food without problem. CONCLUSION: Even when normal gastric anatomy has been preserved endoscopic placement of a stent can provide optimal results without surgery. Further advances will be achieved without great expense by further improving the equipment used for introducing the stent.