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Functional Efferent Stomal Obstruction Following Subtotal Gastric Resection: A Report of Two Cases Demonstrating the Role of Hypersecretion and Hyperacidity

Functional Efferent Stomal Obstruction Following Subtotal Gastric Resection: A Report of Two... Abstract INTRODUCTION Efferent stomal obstruction is an occasional complication of subtotal gastric resection, even when the procedure is carefully planned and executed. The forbearance of surgeon and patient is usually severely strained before the situation is resolved, and the post-operative management is a real challenge to good surgical judgment.Since there is no unanimity of opinion with regard to the exact etiology of this complication, we believe that any new observations should be reported. We have observed two cases in which hypersecretion and hyperacidity were present and measures directed toward the suppression of these factors apparently resulted in release of the obstruction. REPORT OF CASES Case 1 (Fig. 1). —A man of 50 years had had periodic episodes of burning, gnawing epigastric distress occurring one or two hours after meals and at night, for 12 years prior to his initial examination, in 1949. Roentgenologic examination of the upper gastrointestinal tract revealed References 1. References 12, 15, and 17. 2. References 1, 13, and 18. 3. References 1, 14, 15, 17, 19, 20. 4. References 2, 9, 12, 14, 17, and 19. 5. References 1, 2, 8, 9, 12, 13, 17, and 19. 6. Graham, cited by Maxeiner, S. R.6 7. References 3, 7, and 10. 8. Brandberg, R.: Obstruction Following Gastric Resection and Gastro-Enterostomy , Acta chir. scandinav. 92:37-64, 1945. 9. Colp, R., and Weinstein, V.: Postoperative Complications Following Subtotal Gastrectomy for Peptic Ulcer , S. Clin. North America 35:383-391 ( (April) ) 1955. 10. Dragstedt, L. R.; Oberhelman, H. A., Jr., lem, J. A. M. A. 147:1615-1620 ( (Dec. 22) ) 1951.Crossref 11. Woodward, E. R.: Physiology of Gastric Secretion and Its Relationship to the Ulcer Prob 12. Ebrill, D., and Naftalin, L.: The First Post-operative Days: A Study of Pre-Ileus Following Gastrectomy , Lancet 265:411-417 ( (Aug.) ) 1953.Crossref 13. Golden, R.: Functional Obstruction of Efferent Loop of Jejunum Following Partial Gastrectomy , J. A. M. A. 148:721-724 ( (March) ) 1952.Crossref 14. Maxeiner, S. R.: End Results and Complications of the Surgical Management of Peptic Ulcer , Minnesota Med. 34:793-803 ( (Aug.) ) 1951. 15. Ivy, A. C.: The Mechanisms of Gastric Secretion , Surgery 10:861-878 ( (Dec.) ) 1941. 16. Kurzweg, F. T.: The Mortality and Immediate Postoperative Complications of Subtotal Gastrectomy for Carcinoma and Benign Peptic Ulcer , Ann. Surg. 139:409-419 ( (April) ) 1954.Crossref 17. Nissen, R.: Local Causes of Mortality and Early Morbidity in Gastroduodenal Resection for Peptic Ulcer , J. Internat. Coll. Surgeons 13:549-553 ( (May) ) 1950. 18. Noring, O.: The Cephalic Phase of Gastric Secretion Following Partial Gastrectomy , Gastroenterology 19:118-125 ( (Sept.) ) 1951. 19. Priestley, J. T.: Reflections on Surgical Treatment of Duodenal Ulcer , A. M. A. Arch. Surg. 69:455-463 ( (Oct.) ) 1954.Crossref 20. Prohaska, J. V.; Govostis, M. C., and Kirsteins, A.: Mechanism of the Efferent Stoma Dysfunction Following Subtotal Gastrectomy , A. M. A. Arch. Surg. 68:491-499 ( (April) ) 1954.Crossref 21. Quinn, W. F., and Gifford, J. H.: The Syndrome of Proximal Jejunal Loop Obstruction Following Anterior Gastric Resection , California Med. 72:18-21 ( (Jan.) ) 1950. 22. Ravdin, I. S.: Factors Involved in the Retardation of Gastric Emptying After Gastric Operations , Pennsylvania M. J. 41:695-700 ( (May) ) 1938. 23. Sachs, A. E.: Treatment of Postgastrectomy Obstructed Exit Stoma , A. M. A. Arch. Surg. 70:443-447 ( (March) ) 1955.Crossref 24. Scribner, B. H.: Syllabus on Fluid and Electrolyte Balance , Seattle, University of Washington Press, 1953. 25. Sawyer, K. C., and Spencer, J. R.: Management of 3 Stomal Complications Following Sub-total Gastrectomy , A. M. A. Arch. Surg. 68:500-510 ( (April) ) 1954.Crossref 26. Warren, R. P.: Acute Obstruction of Afferor Efferent Loop Following Antecolic Partial Gastrectomy, with Report of 3 Cases , Ann. Surg. 139:202-205 ( (Feb.) ) 1954.Crossref 27. Welch, C. E.: Surgery of the Stomach and Duodenum: A Handbook of Operative Surgery , Chicago, Year Book Publishers, Inc., 1951. 28. Zintel, H. A.: Preoperative and Postoperative Care of Patients with Lesions of the Stomach and Duodenum , S. Clin. North America 24:1353-1364 ( (Dec.) ) 1944. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

Functional Efferent Stomal Obstruction Following Subtotal Gastric Resection: A Report of Two Cases Demonstrating the Role of Hypersecretion and Hyperacidity

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References (23)

Publisher
American Medical Association
Copyright
Copyright © 1956 American Medical Association. All Rights Reserved.
ISSN
0096-6908
DOI
10.1001/archsurg.1956.01270220167022
Publisher site
See Article on Publisher Site

Abstract

Abstract INTRODUCTION Efferent stomal obstruction is an occasional complication of subtotal gastric resection, even when the procedure is carefully planned and executed. The forbearance of surgeon and patient is usually severely strained before the situation is resolved, and the post-operative management is a real challenge to good surgical judgment.Since there is no unanimity of opinion with regard to the exact etiology of this complication, we believe that any new observations should be reported. We have observed two cases in which hypersecretion and hyperacidity were present and measures directed toward the suppression of these factors apparently resulted in release of the obstruction. REPORT OF CASES Case 1 (Fig. 1). —A man of 50 years had had periodic episodes of burning, gnawing epigastric distress occurring one or two hours after meals and at night, for 12 years prior to his initial examination, in 1949. Roentgenologic examination of the upper gastrointestinal tract revealed References 1. References 12, 15, and 17. 2. References 1, 13, and 18. 3. References 1, 14, 15, 17, 19, 20. 4. References 2, 9, 12, 14, 17, and 19. 5. References 1, 2, 8, 9, 12, 13, 17, and 19. 6. Graham, cited by Maxeiner, S. R.6 7. References 3, 7, and 10. 8. Brandberg, R.: Obstruction Following Gastric Resection and Gastro-Enterostomy , Acta chir. scandinav. 92:37-64, 1945. 9. Colp, R., and Weinstein, V.: Postoperative Complications Following Subtotal Gastrectomy for Peptic Ulcer , S. Clin. North America 35:383-391 ( (April) ) 1955. 10. Dragstedt, L. R.; Oberhelman, H. A., Jr., lem, J. A. M. A. 147:1615-1620 ( (Dec. 22) ) 1951.Crossref 11. Woodward, E. R.: Physiology of Gastric Secretion and Its Relationship to the Ulcer Prob 12. Ebrill, D., and Naftalin, L.: The First Post-operative Days: A Study of Pre-Ileus Following Gastrectomy , Lancet 265:411-417 ( (Aug.) ) 1953.Crossref 13. Golden, R.: Functional Obstruction of Efferent Loop of Jejunum Following Partial Gastrectomy , J. A. M. A. 148:721-724 ( (March) ) 1952.Crossref 14. Maxeiner, S. R.: End Results and Complications of the Surgical Management of Peptic Ulcer , Minnesota Med. 34:793-803 ( (Aug.) ) 1951. 15. Ivy, A. C.: The Mechanisms of Gastric Secretion , Surgery 10:861-878 ( (Dec.) ) 1941. 16. Kurzweg, F. T.: The Mortality and Immediate Postoperative Complications of Subtotal Gastrectomy for Carcinoma and Benign Peptic Ulcer , Ann. Surg. 139:409-419 ( (April) ) 1954.Crossref 17. Nissen, R.: Local Causes of Mortality and Early Morbidity in Gastroduodenal Resection for Peptic Ulcer , J. Internat. Coll. Surgeons 13:549-553 ( (May) ) 1950. 18. Noring, O.: The Cephalic Phase of Gastric Secretion Following Partial Gastrectomy , Gastroenterology 19:118-125 ( (Sept.) ) 1951. 19. Priestley, J. T.: Reflections on Surgical Treatment of Duodenal Ulcer , A. M. A. Arch. Surg. 69:455-463 ( (Oct.) ) 1954.Crossref 20. Prohaska, J. V.; Govostis, M. C., and Kirsteins, A.: Mechanism of the Efferent Stoma Dysfunction Following Subtotal Gastrectomy , A. M. A. Arch. Surg. 68:491-499 ( (April) ) 1954.Crossref 21. Quinn, W. F., and Gifford, J. H.: The Syndrome of Proximal Jejunal Loop Obstruction Following Anterior Gastric Resection , California Med. 72:18-21 ( (Jan.) ) 1950. 22. Ravdin, I. S.: Factors Involved in the Retardation of Gastric Emptying After Gastric Operations , Pennsylvania M. J. 41:695-700 ( (May) ) 1938. 23. Sachs, A. E.: Treatment of Postgastrectomy Obstructed Exit Stoma , A. M. A. Arch. Surg. 70:443-447 ( (March) ) 1955.Crossref 24. Scribner, B. H.: Syllabus on Fluid and Electrolyte Balance , Seattle, University of Washington Press, 1953. 25. Sawyer, K. C., and Spencer, J. R.: Management of 3 Stomal Complications Following Sub-total Gastrectomy , A. M. A. Arch. Surg. 68:500-510 ( (April) ) 1954.Crossref 26. Warren, R. P.: Acute Obstruction of Afferor Efferent Loop Following Antecolic Partial Gastrectomy, with Report of 3 Cases , Ann. Surg. 139:202-205 ( (Feb.) ) 1954.Crossref 27. Welch, C. E.: Surgery of the Stomach and Duodenum: A Handbook of Operative Surgery , Chicago, Year Book Publishers, Inc., 1951. 28. Zintel, H. A.: Preoperative and Postoperative Care of Patients with Lesions of the Stomach and Duodenum , S. Clin. North America 24:1353-1364 ( (Dec.) ) 1944.

Journal

A.M.A. Archives SurgeryAmerican Medical Association

Published: Apr 1, 1956

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