Esophageal ulcer due to ingestion of melted copper

Summary We report a patient with esophageal stricture as a result of the accidental swallowing of melted copper by a 49-year-old male. As a result, esophagogastric ulcers developed and left a cicatrical stricture. The patient could only manage to swallow liquid food. Radiology of the upper gastrointestinal tract showed marked stricture of the esophagus from the middle thoracic portion to the esophagogastric junction and shortening of the lesser curvature of the stomach. The patient underwent a single-session total gastrectomy, and excision of the thoracic esophagus and construction of anterior thoracic esophagocolic and duodenocolic anastomoses were performed by right thoracotomy and laparotomy, respectively. Macroscopic findings of the surgical specimens showed extensive circular ulcers at the esophagus, and microscopic findings showed deep ulcers extending to the muscle layer with marked fibrosis. The postoperative course was uneventful.     

Long-term follow-up of dilatation treatment of oesophageal strictures

A review of the endoscopy records of 100 consecutive patients with oesophageal strictures was undertaken to determine the effectiveness of endoscopic dilatation therapy. The follow-up period from presentation ranged from 6 to 72 (mean 39 months) and the symptom-free period after the last dilatation ranged from 3 to 66 months (mean 29 months). Three hundred and fifty procedures were performed with no perforations and minimal morbidity. Eighty-one patients who had been followed for at least 12 months since their last dilatation were free of significant dysphagia. Of these 81 patients, 77% became symptom-free within 1 year, and 88% within 2 years. Only 35 patients required more than three dilatations; 30 patients required one dilatation and 35 required two to three dilatations. Age, sex, the presence of Barrett's oesophagus, or the oesophageal lumen diameter at presentation was not significantly correlated with outcome.     

Balloon catheter dilatation of focal intestinal strictures following necrotizing enterocolitis

Dilatation with a balloon catheter was successfully employed for 9 focal intestinal strictures which occurred in 5 infants following necrotizing enterocolitis. Eight of the 9 strictures were located in defunctionalized colon distal to an enterostomy; no infant had clinical intestinal obstruction. Because the dilatation achieved distal patency, subsequent closure of the enterostomy was accomplished without a formal laparotomy. The balloon dilatation technique may be valuable in the management of focal strictures that are not causing clinical intestinal obstruction.     

Zonal colonic aganglionosis

The customary approach to the diagnosis of Hirschsprung's disease is based on the existence of a single distal aganglionic region extending to the anal margin. Segmental aganglionosis, however, may involve only a limited segment of colon which is interposed between lengths of normal bowel. Awareness of this variant aids in the interpretation of the barium enema in children with signs and symptoms of aganglionosis, especially when the rectal biopsy is normal.     

布－加综合征的影像诊断

本文分析了１４例布一加综合症的影像学资料，将此病分为Ａ、Ｂ、Ｃ三型。结果显示：传统Ｘ线、Ｂ超对此病的诊断有一定的意义，而经皮腔静脉造影是确诊此病的唯一方法。     

Modes of biliobiliary anastomosis in relation to the healing process and occurrence of postoperative stricture

The inverting and everting methods of biliobiliary anastomoses were compared histopathologically and electron microscopically. Epithelialization started on the 3rd post-operative day and occurred within 8 mm of the anastomosis with an earlier and more active epithelialization being seen in the proximal area than in the distal. A rapid decrease of the mucosal defect was seen for 3–5 days which slowed down thereafter, and closure was achieved by 30 days after the anastomosis in both groups. The everted group showed a smoother and more rapid healing process, quicker epithelialization, and less mucosal defects than the inverted group. In the chronic phase, the inverted group showed more papillary hyperplasia and more pronounced fibrosis of the wall. The stricture index, being the internal circumference of the common bile duct: proximal×2/anastomosis site + duodenal×100, of the everted group was 123.7% compared to 146.7% for the inverted group, but there was no statistical difference. There was no difference in the total area of crypts, representing the epithelialization, between the two groups. Anastomoses with proximal dilatation therefore healed more slowly than those without dilatation. These findings show everted anastomosis to be superior to inverted anastomosis and thus support the usefulness of T-tube drainage to prevent post-operative dilatation of the bile duct.     

Post-gastrostomy gastroesophageal reflux and peptic stricture of the esophagus relieved by releasing the gastrostomy fixation

A 3-year-old boy who had an esophageal stricture with short-bowel syndrome is reported. The stricture was suspected to have resulted from severe gastroesophageal reflux (GER) induced by a gastrostomy performed for enteral nutrition. Twenty-four-hour intraesophageal pH monitoring demonstrated improvement of the GER after the release of the gastrostomy fixation.     

Fundic patch operation in the treatment of esophageal stricture with Barrett's esophagus —A case report—

A 66-year-old woman, who had a stricture of the distal esophagus with Barrett's epithelium caused by gastroesophageal reflux, was operated upon by means of the fundic patch method. Preoperative manometric and pH studies revealed that the patient had a cardiac incompetence and a delayed acid clearance of the esophagus. Endoscopic biopsies between 33–35 cm from the incisors, above the gastroesophageal junction, showed columnar metaplasia with a villiform surface, mucous glands, intestinal goblet cells, moderate inflammatory changes and focal mild dysplasia. After the operation, relief of the dysphagia and reflux symptoms were obtained successfully, and an endoscopy done 7 months later demonstrated that the esophageal lumen was adequate enough for passage, and that there was improvement of the esophagitis, though persistent Barrett's esophagus without malignancy still existed. These results indicate that the fundic patch operation with the formation of a mucosal valve and 270° fundoplication is a useful method of choice for benign strictures of the lower esophagus.     

Benign Esophageal Stricture Caused by Diffuse Severe Esophagitis Presenting as Ascending Fibrosis: Report of a Case

(Received for publication on Aug. 22, 1996; accepted on July 8, 1997)     

自体组织修复肝门部胆管良性狭窄

目的 总结应用自体组织修复肝门部胆管良性狭窄的经验。方法 回顾分析我院自1989～2002年应用带蒂胆囊壁瓣修复肝门部胆管良性狭窄33例，应用肝圆韧带修复肝总管狭窄2例。结果 35例术后无明显胆瘘、出血等并发症，无手术死亡。术后T管造影显示无狭窄。术后30例(30/35)随访2个月至12年，仅有2例因术后胆管炎发作，经非手术治愈，收到良好效果。结论 应用自体组织带蒂胆囊壁瓣及肝圆韧带修复肝门部胆管良性狭窄符合生理性，取材方便，操作简便，效果良好。