Post Surgical Status, El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy

 

 
Choledocoduodenostomy and The Sump syndrome.Although endoscopic phincterotomy of Oddis sphincter has now become the treatment of choice for residual common bile duct stones and dilated common duct, choledochoduodenostomy CD was a commonly performed procedure in the past to improve biliary drainage.

Video Endoscopic Sequence 1 of 10.

Choledocoduodenostomy and The Sump syndrome.

 Although endoscopic sphincterotomy of Oddi's sphincter
 has now become the treatment of choice for residual
 common bile duct stones and dilated common duct,
 choledochoduodenostomy (CD) was a commonly performed
 procedure in the past to improve biliary drainage.

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 screen mode.

 
The sump syndrome is a rare but important complication of CD and choledochojejunostomy (CJ) not well known to the primary-care physician. The sump syndrome develops when obstruction occurs in the limb of the common bile duct distal to the anastomosis, owing to siphoned entry of intestinal contents, lithogenic bile, residual calculi, or all of the latter conditions.5,6 A stagnant reservoir develops with subsequent bacterial proliferation and recurrent stone formation that predispose the individual to recurrent cholangitis or pancreatitis. Described herein is an elderly patient who presented with acute abdominal pain, fever, chills, and elevated liver enzymes 14 years after cholecystectomy with CD. The patient was successfully treated with endoscopic sphincterotomy. This case demonstrates that the sump syndrome must be a part of the differential for those elderly patients with a history of CD or CJ, who present with cholangitis or pancreatitis, or both, of uncertain origin.

Video Endoscopic Sequence 2 of 10.

 The role of choledochoduodenostomy (CDD) in the
 management of lower common bile duct (CBD) obstruction
 is controversial because of the long-term complications
 such as ascending cholangitis, sump syndrome and alkaline
 reflux gastritis. In spite of the good long-term results
 observed in some studies, CDD is considered a last trial
 for lower CBD obstruction.

 Indications for choledochoduodenostomy were: multiple or
 irremovable common or hepatic duct stones, doubtfulness
 of complete clearing of the duct, primary common bile duct
 stones or mud and sludge, a grossly dilated biliary duct
 system, and ampullary stenosis.

 
Biliodigestive anastomosis; technic of transverse choledochoduodenostomy, this image shows the anastomosis between the bile duct and post bulbar duodenum.

Video Endoscopic Sequence 3 of 10.

 Biliodigestive anastomosis; technic of transverse
 choledochoduodenostomy, this image shows the
 anastomosis between the bile duct and post bulbar
 duodenum.

 
Questions connected with choledochoduodenostomy, particular as regards indications, are discussed on the basis of a personal series and of a critical examination of concepts reported in the literature. The operation should certainly be considered in non-neoplastic bile duct pathology, although there are some fairly rigorous limitations. The disadvantages of the method are minimised to some extent and the surgeon is urged, in certain cases, to enhance the positive aspects so as not to lose opportunities which might otherwise not have been grasped.

Video Endoscopic Sequence 4 of 10.

 Questions connected with choledochoduodenostomy,
 particular as regards indications, are discussed on the
 basis of a personal series and of a critical examination of
 concepts reported in the literature. The operation should
 certainly be considered in non-neoplastic bile duct
 pathology, although there are some fairly rigorous
 limitations. The disadvantages of the method are
 minimised to some extent and the surgeon is urged, in
 certain cases, to enhance the positive aspects so as not to
 lose opportunities which might otherwise not have been
 grasped.
 
Abdominal ultrasound revealed slight dilatation and the presence of air in the intrahepatic biliary radicals. The extrahepatic bile duct was normal. These findings were considered nonspecific in view of the previous history of CD.

Video Endoscopic Sequence 5 of 10.

 Abdominal ultrasound revealed slight dilatation and the
 presence of air in the intrahepatic biliary radicals. The
 extrahepatic bile duct was normal. These findings were
 considered nonspecific in view of the previous history of
 CD.

 
The sump syndrome is a rare but important complication of CD and choledochojejunostomy (CJ). The sump syndrome develops when the drainage of bile and gastrointestinal debris from the distal common bile duct is obstructed and bacterial infection takes place Anastomotic stricture or stenosis has been noted as a possible cause of the obstruction. The partially digested debris itself is believed to cause intermittent partial or complete obstruction of the stoma, leading to stasis of the bile and food and subsequent bacterial proliferation as well as secondary stone formation. The newly formed stones may then also obstruct either the stoma or the papilla. Although some researchers have noted that coexisting papillary dysfunction (stenosis or stricture) plays an important role in the development of the sump syndrome, obstruction of the enterostomy is believed to be the major pathophysiological event.

Video Endoscopic Sequence 6 of 10.

The sump syndrome is a rare but important complication of CD and choledochojejunostomy (CJ).

 The sump syndrome develops when the drainage of bile
 and gastrointestinal debris from the distal common bile
 duct is obstructed and bacterial infection takes place.
 Anastomotic stricture or stenosis has been noted as a
 possible cause of the obstruction. The partially digested
 debris itself is believed to cause intermittent partial or
 complete obstruction of the stoma, leading to stasis of the
 bile and food and subsequent bacterial proliferation as well
 as secondary stone formation. The newly formed stones
 may then also obstruct either the stoma or the papilla.
 Although some researchers have noted that coexisting
 papillary dysfunction (stenosis or stricture) plays an
 important role in the development of the sump syndrome,
 obstruction of the enterostomy is believed to be the major
 pathophysiological event.

 
The intrahepatic bile ducts are observed with a thin endoscope 5.9 mm pediatrics.

Video Endoscopic Sequence 7 of 10.

The intrahepatic bile ducts are observed with a thin endoscope 5.9 mm (pediatrics).
More images and video clips.

Video Endoscopic Sequence 8 of 10.

More images and video clips.
biliodigestive9

Video Endoscopic Sequence 9 of 10.

 
biliodigestive10

Video Endoscopic Sequence 10 of 10.

 
Penetration of adjustable laparoscopic gastric banding. A 37 year-old male, that underwent a bariatric weight loss surgery 18 months ago, due to overweight. Two weeks before the patient has had severe abdominal pain. Physical examination was negative to an acute abdomen. Due to this procedure he lost seventy pounds of weight.

Video Endoscopic Sequence 1 of 4.

 Penetration of Adjustable Laparoscopic Gastric Banding.

 A 37 year-old male, that underwent a bariatric (weight loss)
 surgery 18 months ago, due to overweight.
 Two weeks before the patient has had severe abdominal
 pain.
 Physical examination was negative to an acute abdomen.
 Due to this procedure he lost seventy pounds of weight.

                                           Medline.
Penetration of adjustable laparoscopic gastric banding. This is the most serious complication, but its occurrence is rare. Since the placement of the band, the patient did not return to his medical control to adjust the band. After placement, the band may be loosened or tightened in the physician's office.

Video Endoscopic Sequence 2 of 4.

Penetration of Adjustable Laparoscopic Gastric Banding.

 This is the most serious complication, but its occurrence is
 rare.
 Since the placement of the band, the patient did not return
 to his medical control to adjust the band.

 After placement, the band may be loosened or tightened in
 the physician's office.

 

                                            
                                     Medline.       

Penetration of adjustable laparoscopic gastric banding. This image displays the gastric banding that has penetrated into the gastric cardias.

Video Endoscopic Sequence 3 of 4.

 This image displays the gastric banding that has
 penetrated into the gastric cardias.
 

Penetration of adjustable laparoscopic gastric banding. This image and the video display a view from the esophagus cardias seeing the adjustable gastric banding.

Video Endoscopic Sequence 4 of 4.

 This image and the video display a view from the
 esophagus cardias seeing the adjustable gastric banding.
Appearance post surgical statust due perforated duodenal ulcer. This is patient is a 67 year-old female, who towards twenty years underwent a exploratory laparotomy due acute abdomen.

Appearance post surgical status due perforated duodenal ulcer.

 This is patient is a 67 year-old female, who towards twenty
 years ago underwent a exploratory laparotomy due acute
 abdomen.
Esophago-Jejunostomy Roux-en-Y. A 71 year-old male that two months before underwent a total gastrectomy due to a diffusely infiltrating gastric adenocarcinoma that infiltrated from the pylorus to the fundus (linitis plastica).

Video Endoscopic Sequence 1 of 6.

Esophago-Jejunostomy Roux-en-Y.

 A 71 year-old male that two months before underwent a
 total gastrectomy due to a diffusely infiltrating gastric
 adenocarcinoma that infiltrated from the pylorus to the
 fundus (linitis plastica).

                     
                                          Medline.
Esophago-Jejunostomy Roux-en-Y. The afferent loop is seen below and the efferent is up. The surgeon resected the stomach, segments of duodenum and esophagus, keeping a margin of 2 cm. free of neoplasic tissue. The duodenal stump was closed with a linear stapler. There were resected regional lymphatic nodes, corresponding to R2 resection. Once performed the gastrectomy, it was develop an esophagus jejunum anastomosis termino lateral, using a circular stapler. It was performed a Roux-en Y of jejunum 50 cm distal to the esophagus jejunum anastomosis, using GIA linear stapler. The post surgical recovery was excellent.

Video Endoscopic Sequence 2 of 6.

 The afferent loop is seen below and the efferent is up.
 The surgeon resected the stomach, segments of duodenum
 and esophagus, keeping a margin of 2 cm. free of
 neoplasic tissue. The duodenal stump was closed with a
 linear stapler.
 There were resected regional lymphatic nodes,
 corresponding to R2 resection. Once performed the
 gastrectomy, it was develop an esophagus jejunum
 anastomosis termino lateral, using a circular stapler.
 It was performed a Roux-en Y of jejunum 50 cm distal to
 the esophagus jejunum anastomosis, using GIA linear
 stapler. The post surgical recovery was excellent.
Biliar secretion is observed near to the Jejuno-Jejuno anastomosis.

Video Endoscopic Sequence 3 of 6.

 Biliar secretion is observed near to the Jejuno-Jejuno
 anastomosis.
Jejuno-jejuno anastomosis, aproximately a 40 cm. from the total gastrectomy is observed.

Video Endoscopic Sequence 4 of 6.

 Jejuno-jejuno anastomosis, aproximately a 40 cm. from
 the total gastrectomy is observed.
Another image and video of Jejuno-Jejuno anastomosis.

Video Endoscopic Sequence 5 of 6.

 Another image and video of Jejuno-Jejuno anastomosis.
Another image and the video of the esophagus-jejuno anastomosis.

Video Endoscopic Sequence 6 of 6.

 Another image and the video of the esophagus-jejuno
 anastomosis.
Gastrojejunostomy due to neoplasia of duodenal bulb. The anastomosis is observed with reduced diameter, preventing the solid food from passing to the jejunum. There are some remnant threads. This is a case's description of a patient with carcinoma of the pancreatic head, which infiltrates the duodenal bulb.

Video Endoscopic Sequence 1 of 2.

 Gastrojejunostomy due to neoplasia of duodenal bulb.
 The anastomosis is observed with reduced diameter,
 preventing the solid food from passing to the jejunum.
 There are some remnant threads.
 This is a case’s description of a patient with
 carcinoma of the pancreatic head, which infiltrates the
 duodenal bulb. See that case.
 
Another image and video clip of this sequence.The video clip displays the jejunum.

Video Endoscopic Sequence 2 of 2.

 Another image and video clip of this sequence.
 The video clip displays the jejunum.
Ileum-transverse anastomosis. A 42 year-old female, who previously underwent a right hemicolectomy resection three years ago, due to colon leiomyoma of the ascending colon.

Video Endoscopic Sequence 1 of 3.

           Ileum-transverse anastomosis.

 A 42 year-old female, who previously underwent a right
 hemicolectomy resection three years ago, due to colon
 leiomyoma of the ascending colon.
                 
 See that leiomyoma.

 
A close up of the anastomosis.

Video Endoscopic Sequence 2 of 3.

 A close up of the anastomosis.
Another image and video of this anastomosis.

Video Endoscopic Sequence 3 of 3.

 Another image and video of this anastomosis.
Cyst-Gastrostomy. Surgical internal drainage due to pseudocyst of the pancreas. A 50 year-old male that had an acute attack of pancreatitis, and developed pancreatic pseudocyst. The surgeon drained the pseudocyst. We present a endoscopic image of this case at the anterior wall of the gastric body. Most surgeons have adopted internal drainage technique whenever is possible. This possibility is determined by the location of the pseudocyst. Cyst-gastrostomy or cyst-duodenostomy is available if the pseudocyst is adherent to the stomach or the duodenum. Cyst-jejunostomy can be performed if the anatomy is different. A pseudocyst in the tail of the pancreas can be removed by resection of the tail; splenectomy is often required in these cases.

Video Endoscopic Sequence 1 of 5.

Cyst-Gastrostomy.

 Surgical internal drainage due to pseudocyst of the
 pancreas.

 A 50 year-old male that had an acute attack of pancreatitis,
 and developed pancreatic pseudocyst. The surgeon
 drained the pseudocyst.
 We present a endoscopic image of this case at the anterior
 wall of the gastric body.
 Most surgeons have adopted internal
 drainage technique whenever is possible. This possibility is
 determined by the location of the pseudocyst.
 Cyst-gastrostomy or cyst-duodenostomy is available if the
 pseudocyst is adherent to the stomach or the duodenum.
 Cyst-jejunostomy can be performed if the anatomy is
 different.
 A pseudocyst in the tail of the pancreas can be removed by
 resection of the tail; splenectomy is often required in these
 cases.
 
Cyst-Gastrostomy. At the anterior wall of the proximal body some nodular ulcerations were observed. At the beginning, we thought that those lesions were of a neoplastic etiology; but in a closer look, we observed some sutures, and we were convinced that those lesions were ulcerated granulomas from the suture. They came from the surgical wound where the surgeon opened the stomach to approach the posterior wall to drainage the pseudocyst.

Video Endoscopic Sequence 2 of 5.

Cyst-Gastrostomy.

 At the anterior wall of the proximal body some nodular
 ulcerations were observed. At the beginning, we thought
 that those lesions were of a neoplastic etiology; but in a
 closer look, we observed some sutures, and we were
 convinced that those lesions were ulcerated granulomas
 from the suture. They came from the surgical wound where
 the surgeon opened the stomach to approach the posterior
 wall to drainage the pseudo cyst. 

Cyst-Gastrostomy. Another image and the video of that granulomas.

Video Endoscopic Sequence 3 of 5.

Cyst-Gastrostomy.

 Another image and video of that granulomas.  
Endoscopic image of Cyst-Gastrostomy. Pseudocysts occur after an acute attack of pancreatitis in approximately 10 percent of cases, Most pseudocysts are asymptomatic They can, however, produce a wide range of clinical problems depending upon the location and extent of the fluid collection. Expansion of the pseudocyst can produce abdominal pain, duodenal or biliary obstruction, vascular occlusion, or fistula formation into adjacent viscera, the pleural space, or pericardium. Can develop Spontaneous infection with abscess formation. Pancreatic ascites and pleural effusion can result from disruption of the pancreatic duct, leading to fistula formation to the abdomen or chest, or rupture of a pseudocyst with tracking of pancreatic juice into the peritoneal cavity or pleural space. Digestion of an adjacent vessel can result in a pseudoaneurysm, which can produce a sudden expansion of the cyst or gastrointestinal bleeding due to bleeding into the pancreatic duct (hemosuccus pancreaticus).

Video Endoscopic Sequence 4 of 5.

Endoscopic image of Cyst-Gastrostomy.

 Pseudocysts occur after an acute attack of pancreatitis in
 approximately 10 percent of cases, Most pseudocysts are
 asymptomatic They can, however, produce a wide range of
 clinical problems depending upon the location and extent of
 the fluid collection. Expansion of the pseudocyst can
 produce abdominal pain, duodenal or biliary obstruction,
 vascular occlusion, or fistula formation into adjacent
 viscera, the pleural space, or pericardium. Can develop
 Spontaneous infection with abscess formation.
 Pancreatic ascites and pleural effusion can result from
 disruption of the pancreatic duct, leading to fistula
 formation to the abdomen or chest, or rupture of a
 pseudocyst with tracking of pancreatic juice into the
 peritoneal cavity or pleural space.
 Digestion of an adjacent vessel can result in a
 pseudoaneurysm, which can produce a sudden expansion of
 the cyst or gastrointestinal bleeding due to bleeding into the
 pancreatic duct (hemosuccus pancreaticus).

 
Endoscopic image of Cyst-Gastrostomy. An alternative treatment is endoscopic drainage of pancreatic pseudocysts. Endoscopic ultrasonography (EUS) has become an increasingly popular technology in evaluating cystic lesions of the pancreas since it can delineate complex wall structures and internal cyst contents. Combined with fine needle aspiration, EUS can assist in differentiating a cystic neoplasm from a pseudocyst. The presence of well-defined septation, echogenic mucin, or a mass lesion suggest a cystic tumor requiring resection rather than drainage alone.

Video Endoscopic Sequence 5 of 5.

         Endoscopic image of Cyst-Gastrostomy.

 An alternative treatment is endoscopic drainage of
 pancreatic pseudocysts.
 Endoscopic ultrasonography (EUS) has become an
 increasingly popular technology in evaluating cystic lesions
 of the pancreas since it can delineate complex wall
 structures and internal cyst contents. Combined with fine
 needle aspiration, EUS can assist in differentiating a cystic
 neoplasm from a pseudocyst. The presence of well-defined
 septation, echogenic mucin, or a mass lesion suggest a
 cystic tumor requiring resection rather than drainage alone. 
Choledochoduodenostomy. Post surgical status of biliodigestive surgery to the duodenal bulb. A 99 year-old male, that over forty years ago underwent biliodigestive surgery, the endoscopic image displays a duodenal bulb with two holes, afferent and efferent, one of them has tiny fistula.

Choledochoduodenostomy.

 Post surgical status of biliodigestive surgery to the
 duodenal bulb.
 A 99 year-old male, that over forty years ago underwent
 biliodigestive surgery, the endoscopic image displays a
 duodenal bulb with two holes, afferent and efferent, one of
 them has tiny fistula.
 
Status Post Gastrectomy. Marginal ulcer at the anastomosis is observed. A 90 year-old male with a previous gastrectomy that over forty years ago due to bleeding gastric ulcer that caused severe bleeding and hipovolemic shock We performed a successful emergency endoscopy to stop the hemorrhage injecting alcohol through the endoscope.

Status Post Gastrectomy.

 Marginal ulcer at the anastomosis is observed.
 A 90 year-old male with a previous gastrectomy that
 over forty years ago due to bleeding gastric ulcer that
 caused severe bleeding and hipovolemic shock.
 We performed a successful emergency endoscopy to stop
 the hemorrhage injecting alcohol through the endoscope.

 

Status Post Gastric Surgery. An 80 year-old male with melena. The image and video display silk thread remains of gastric surgery performed 20 years ago. The silk thread caused the mucosa to ulcerate which resembles infiltrating plastic linitis as a consequence of foreign body reaction; with the aid of special scissors as a large biopsy forceps, we managed to extract thesethreads.

Status Post Gastric Surgery.

 An 80 year-old male with melena.
 The image and video display silk thread remains of
 gastric surgery performed 20 years ago.
 The silk thread caused the mucosa to ulcerate which
 resembles infiltrating plastic linitis as a consequence of
 foreign body reaction; with the aid of special scissors as a
 large biopsy forceps, we managed to extract these threads.                                                                              

Status Post hemicolectomy due to cecum carcinoma. The patient had episodic abdominal pseudo obstruction, one year after surgery; the small diameter of the anastomosis was found to be invaginated. The colonoscope passed through to the ileon for 20 cm. and the pseudo obstruction was overcome.

Video Endoscopic Sequence 1 of 2.

 Status Post hemicolectomy due to cecum carcinoma.
 The patient had episodic abdominal pseudo obstruction, one
 year after surgery; the small diameter of the anastomosis
 was found to be invaginated. The colonoscope passed
 through to the ileon for 20 cm. and the pseudo obstruction
 was overcome.  
A case of pseudo obstruction due to a status post surgery of right hemicolectomy due to cecum carcinoma. The video clip displays the invagination opening and the colonoscope pass through to the ileon to the ileum-anastomosis.

Video Endoscopic Sequence 2 of 2.

 A case of pseudo obstruction due to a status post surgery
 of right hemicolectomy due to cecum carcinoma.
 The video clip displays the invagination opening and the
 colonoscope pass through to the ileon to the
 ileum-anastomosis.

 
Retained suture after a surgery due to shotgun (9 mm ball) that caused two perforation of her stomach. It was a failed kidnapp intent.


 Retained suture after a surgery due to shotgun (9 mm
 ball) that caused two perforation of her stomach. It was a
 failed kidnapp intent.

Status post appendectomy, an inverted appendiceal stump. Stump resembles a polyp at appendiceal orifice in patients post-appendectomy.


 Status post appendectomy, an inverted appendiceal stump.
 Stump resembles a polyp at appendiceal orifice in patients
 post-appendectomy.
A 44 year-old male, who 6 months previously underwent a colectomy due to a toxic megacolon due to an ulcerative colitis. The image displays a retroflexed maneuver at the anastomosis recto-jejunum.

Video Endoscopic Sequence 1 of 4.

 A 44 year-old male, who 6 months previously underwent a
 colectomy due to a toxic megacolon due to an ulcerative
 colitis.
 The image displays a retroflexed maneuver at the
 anastomosis recto-jejunum.

Restorative Procto-Colectomy. The image and the video display the anastomosis The image and the video display the anastomosis recto-ileum.

Video Endoscopic Sequence 2 of 4.

Restorative Procto-Colectomy.

 The image and the video display the anastomosis
 recto-ileum.