• Clinical Endoscopy
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• v.56 no.1
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• pp.114-118
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• 2023

Gastric wall abscess, a localized form of phlegmonous gastritis, is a rare complication of endoscopic resection. We report the first case of gastric wall abscess developing after endoscopic submucosal dissection in Korea. A 72-year-old woman visited our clinic to receive treatment for gastric adenoma. The patient successfully underwent endoscopic submucosal dissection with no complications. The final diagnosis was well-differentiated tubular adenocarcinoma. We performed follow-up endoscopy 10 weeks later and found a large subepithelial lesion on the posterior wall of the gastric antrum. Abdominal computed tomography revealed hypodense wall thickening and a 5 cm heterogenous multilobular mass in the submucosal layer of the gastric antrum. Submucosal invasion with mucin-producing adenocarcinomas could therefore not be excluded. The patient agreed to undergo additional gastrectomy due to the possibility of a highly malignant lesion. The final diagnosis was acute suppurative inflammation with the formation of multiple abscesses in the mural layers and omentum. The patient was discharged with no complications.

• The Journal of Internal Korean Medicine
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• v.29 no.1
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• pp.189-199
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• 2008

Background & Objective : Jichul-hwan(JCH) has been used for the treatment of functional dyspepsia, regarded as a gastric dysmotility disease. We investigated the effects of JCH on gastric motility and its mechanisms of action in rats. Methods : The gastric wall was injured by tracting a part of stomach body in rats. Gastric emptying was measured after administration of normal saline(NS) or JCH in normal rats and gastric wall injured rats. To evaluate the mechanism of JCH under delayed gastric emptying conditions, normal rats were treated with atropine sulfate(1mg/kg, s.c.), quinpirole HCl(0.3mg/kgg, i.p.), $NAME(N^{G}-nitro-L-arginine$ methyl ester, 75mg/kg s.c.) and cisplatin(10mg/kg, i.p.). The gastric slow waves were measured for 30 minutes before and after administration of each solution(NS, JCH). Results : JCH 110.1mg/kg improved gastric emptying for 2 hrs(p=0.014). JCH 110.1mg/kg improved gastric emptying in the gastric wall injured rats(p=0.001). Under the delayed gastric emptying, JCH 110.1mg/kg improved gastric emptying in the group treated with atropine $sulfate(1.83{\pm}0.96$ vs $8.43{\pm}8.46$, p=0.003), but aggravated it with quinpirole $HCl(4.7{\pm}2.9$ vs $1.61{\pm}2.09$, p=0.021). Administration JCH 110.1mg/kg increased EGG power in rats. Conclusions : JCH stimulates gastric motility through the cholinergic pathway, so we expect that it would be effective in the treatment of dysmotility-like functional dyspepsia with low activity of vagus nerve.

• Journal of Gastric Cancer
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• v.15 no.3
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• pp.214-217
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• 2015

Surgeons occasionally encounter a patient with a gastric cancer invading an adjacent organ, such as the pancreas, liver, or transverse colon. Although there is no established guideline for treatment of invasive gastric cancer, combined resection with radical gastrectomy is conventionally performed for curative purposes. We recently treated a patient with a large gastric cancer invading the abdominal wall, which was initially diagnosed as a simple abdominal wall abscess. Computed tomography showed that an abscess had formed adjacent to the greater curvature of the stomach. During surgery, we made an incision on the abdominal wall to drain the abscess, and performed curative total gastrectomy with partial excision of the involved abdominal wall. The patient received intensive treatment and wound management postoperatively with no surgery-related adverse events. However, the patient could not receive adjuvant chemotherapy and expired on the 82nd postoperative day.

• Advances in pediatric surgery
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• v.6 no.2
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• pp.149-152
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• 2000

Gastroduodenal intussusception, an invagination of a part of the gastric wall through the pyloric canal into the duodenum is a rare condition. Gastroduodenal intussusception is caused by a mobile usually benign gastric tumor. However, gastroduodenal intussusception by gastric submucosal hemangiomatosis is not documented. We have managed a case of gastric submucosal tumor leading to gastroduodenal intussusception in 2 years and 10 months old boy. The tumor was $10{\times}5{\times}3cm$ in size in posterior wall of gastric antrum. Laparotomy, manual reduction of the intussusception, and wedge resection of posterior gastric wall including the tumor were performed. Pathologic diagnosis was a submucosal hemangiomatosis.

• The Korean Journal of Nuclear Medicine
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• v.23 no.1
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• pp.41-48
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• 1989

$^{99m}Tc-Pertechnetate\;(TcO_4^-)$ is concentrated by the stomach after intravenous injection, allowing the detection of ectopic gastric mucosa. It has been used to develop a noninvasive test of gastric secretion. However the cellular site of concentration is still controversial, that is whether mucin-secreting epithelial cell or acid-secreting parietal cell. This study is planned to investigate the effects of cimetidine and gastric acidity on the retention of $TcO_4^-$ in the gastric wall of the rat. Also we further attempted to clarify the uptake and secreting cell of $TcO_4^-$ in the gastric mucosa. One hundred rats were divided into two groups, preliminary (40 rats) and main examination group (60 rats). Preliminary examination group was composed of fasting group (20 rats) for the detection of the time for reaching stable $TcO_4^-$ retention ratio in gastric wall and post-prandial group (20 rats) for the detection of the time for reaching the maximal gastric acidity. Main examination group was composed of fasting group (30 rats), which was subdivided into control group (10 rats), cimetidine group (10rats), $Mylanta^{(R)}$ group (10 rats) and post?prandial group (30 rats), which was subaivided into 90 min group (10 rats), 90 min cimetidine group (10 rats), and 120 min group (10 rats). Retention ratio (%) of $TcO_4$ in the gastric wall and the pH of the gastric contents were measured in the extracted stomach of the six groups. Gastric wall retention ratio of $TcO_4^-$ was calculated by the gastric wall radioactivity (cpm) divided by total gastric radioactivity (cpm) at 30 mins after intravenous injection of 0.4 mCi of $TcO_4^-$. The results were as follows: 1) The time required for reaching stable $TcO_4$ retention ratio and the lowest gastric PH were 30 min and 90 min, respectively. 2) In the fasting group, the gastric wall retention ratio of $TcO_4^-$ was significantly increased in the cimetidine group, compared with the control group (P < 0.01). However there was no significant difference between the control and $Mylanta^{(R)}$ group 3) The $TcO_4^-$ retention ratios of 90 min and 120 min groups were lower than that of the fasting control group (p < 0.05), either. After administration of cimetidine, the retention ratio was significantly increased in 90 min group (p < 0.01). 4) While $TcO_4^-$ retention ratio and gastric pH were well correlated in the post-prandial 120 min group (r=0.7112, p<0.05), in the post-prandial 90 min and 90 min cimetidine groups correlated poorly. However, there was no correlation in the three fasting groups at all. Referring the above results, we infer that $TcO_4^-$ is secreted into the gastric lumen by both parietal and non-parietal cells, with dominant non-parietal $TcO_4^-$ secretion in the fasting state and dominant parietal $TcO_4^-$ secretion in the stimulated state.

• The Journal of Internal Korean Medicine
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• v.39 no.3
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• pp.426-442
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• 2018

Objective: This study aimed to compare the effects of Zusanli and nonacupoint electroacupuncture stimulation on ultrasonographic gastric emptying and vital signs in eight healthy participants. Gastric emptying and its rate of change were analyzed to search for correlation with physical characteristics such as body mass index (BMI), sternocostal angle, and abdominal wall thickness. Methods: Eight healthy participants with no gastrointestinal disorders were enrolled in this study. Each participant went through three abdominal sonographies for gastric emptying assessment. At the second and third visits, participants received Zusanli and nonacupoint electroacupuncture stimulation in a random order. During the study period, we examined the BMI, sternocostal angle, and abdominal wall thickness of all participants. Vital signs (blood pressure, heart rate, and temperature) were also examined before and after the electroacupuncture stimulation. Results: Electroacupuncture stimulation at Zusanli significantly improved gastric emptying when compared to nonacupoint stimulation. Gastric emptying showed a positive correlation with BMI, sternocostal angle, and abdominal wall thickness, but this correlation was statistically insignificant. The improvement rate of gastric emptying by Zusanli electroacupuncture stimulation showed a positive correlation with BMI and sternocostal angle and a negative correlation with abdominal wall thickness. However, such results were also statistically insignificant. Among vital signs, only heart rate showed a significant decrease according to Zusanli electroacupuncture stimulation. Conclusions: A significant effect of Zusanli electroacupuncture was confirmed through ultrasonographic gastric emptying in healthy participants.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.4
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• pp.335-336
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• 2007

Meniscus-like presentation of ulcerating gastric carcinoma on upper gastrointestinal series radiograph was first described in 1921 by Carman and has since been known as a useful differential diagnostic sign in radiology. In 1982 using then newly introduced computed tomography (CT) Widder and Mueller revisited the meniscus sign. Their study was primarily focused on a dynamic assessment of the demonstrability of the meniscus sign that largely depends on the judgment and technical skill of examiner, especially graded compression and patient positioning. One year earlier Balfe et al. assessed the diagnostic reliability of gastric wall thickening as observed on CT scan in adenocarcinoma, lymphoma and leiomyosarcoma and concluded that it is not a reliable finding. In contrast, however, Lee et al. recently emphasized that the wall thickness measurement on CT of exophytic carcinoma, myoma and ulcers was a useful diagnostic means. Thus, it appears that gastric wall thickening or mucosal heave-up is by itself not as reliable as the meniscus sign. The electronic search of world literature failed to disclose earlier report of this sign demonstrated by $^{18}F-FDG$ positron emission tomography and computed tomography (PET/CT). The present communication documents $^{18}F-FDG$ PET/CT finding of the meniscus sign as encountered in a case of ulcerating gastric carcinoma, the histological diagnosis of which was moderately differentiated tubular adenocarcinoma. Unlike most gastric tumors without ulceration that tend to unimpressively accumulate $^{18}F-FDG$ the present case of Borrmann type III gastric carcinoma demonstrated markedly increased $^{18}F-FDG$ uptake.

• Journal of Gastric Cancer
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• v.20 no.1
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• pp.72-80
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• 2020

Purpose: Proximal gastrectomy (PG) is a function-preserving surgery in cases of proximally located early-stage gastric cancer. Because gastroesophageal reflux is a major pitfall of this operation, we devised a modified esophagogastrostomy (EG) anastomosis to fix the distal part of the posterior esophageal wall to the proximal part of the anterior stomach wall to produce an anti-reflux mechanism; we named this the SPADE operation. This study aimed to show demonstrate the clinical outcomes of the SPADE operation and compare them to those of previous PG cases. Materials and Methods: Case details of 56 patients who underwent PG between January 2012 and March 2018 were retrospectively reviewed: 30 underwent conventional esophagogastrostomy (CEG) anastomosis using a circular stapler, while 26 underwent the SPADE operation. Early postoperative clinical outcome-related reflux symptoms, endoscopic findings, and postoperative complications were compared in this case-control study. Results: Follow-up endoscopy showed more frequent reflux esophagitis cases in the CEG group than in the SPADE group (30% vs. 15.3%, P=0.19). Similarly, bile reflux (26.7% vs. 7.7%, P=0.08) and residual food (P=0.01) cases occurred more frequently in the CEG group than in the SPADE group. In the CEG group, 13 patients (43.3%) had mild reflux symptoms, while 3 patients (10%) had severe reflux symptoms. In the SPADE group, 3 patients (11.5%) had mild reflux symptoms, while 1 had severe reflux symptoms (absolute difference, 31.8%; 95% confidence interval, 1.11-29.64; P=0.01). Conclusions: A novel modified EG, the SPADE operation, has the potential to decrease gastroesophageal reflux following a PG.

• Journal of Gastric Cancer
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• v.15 no.1
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• pp.64-67
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• 2015

Inflammatory myofibroblastic tumors (IMTs) of the stomach are extremely rare in adults, and their oncologic prognosis is not well understood. We present a 28-year-old man with a proximal gastric IMT. The patient visited the emergency department of Yeouido St. Mary's Hospital with syncope and hematemesis. Hemoglobin levels were <5.5 g/dl. Gastric fibroscopy showed a protruding mass $4{\times}4cm$ in size, with central ulceration on the posterior wall of the fundus and diffuse wall thickening throughout the cardia and anterior wall of the upper body. Endoscopic biopsy revealed indeterminate spindle cells, along with inflammation. Given the risk of rebleeding, an operation was performed despite the uncertain diagnosis. Because the mass was circumferential, laparoscopic proximal gastrectomy and double-tract anastomosis were performed to ensure a safe resection margin. The pathological diagnosis was consistent with an IMT originating from the stomach, although the tumor was negative for anaplastic lymphoma kinase gene mutation.

• Journal of Yeungnam Medical Science
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• v.27 no.2
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• pp.159-164
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• 2010

Hematoma of gastric wall is very rare, and occasionally associated with coagulopathy, trauma, peptic ulcer disease, and therapeutic endoscopy. Ischemic gastric necrosis is also rare because of the abundant anastomotic supply to the stomach, and it is usually associated with surgery and disruption of the major vessels. Endoscopic submucosal injection of hypertonic saline-epinephrine (HS-E) is a safe, cost-effective, and widely used therapy for hemostasis but it may cause tissue necrosis and perforation. We describe a case of gastric wall hematoma with oozing bleeding after endoscopic gastric mucosa biopsy in 71-year old woman with chronic renal failure and angina pectoris undergoing anti-platelet medication. We injected a small dose of HS-E (7ml) for controlling oozing bleeding. Two days later, endoscopy showed huge ulcer with necrotic tissue at the site of previously hematoma. Therefore we should pay particular attention for hematoma and mucosal necrosis when performing endoscopic procedure in a patients with high bleeding and atherosclerotic risk.