ĐIỀU TRỊ CHẬM RỖNG DẠ DÀY SAU PHẪU THUẬT U MÔ ĐỆM ĐƯỜNG TIÊU HÓA (GIST) KÍCH THƯỚC LỚN GÓC BỜ CONG NHỎ DẠ DÀY

Abstract

Study aim: 1. Evaluation of clinical and paraclinical feature of delayed gastric emptying (DGE) after wedge resection of large GIST located at lesser curative. 2.The result of  DGE treatment and review of literature. Result: There was men, aged of 61 years old, admission due to abdominal epigastric pain and weight loss with out vomiting. Physical examination: palpable epigastric tumor. Gastroscopy: Tumor 4 cm in diameter submucose located at lessure curvature. CTScan: tumor 6,2-7,8 cm in diameter locating at lessure curvature. Lesion intra operation: Tumor at lesure curvature mesuasing 10-8 cm from under cardia to antral stomach. +Surgical Procedure: Wedge resection with  2 layers running suture of remnant stomach. 10 days after gastric procedure patient had symptoms: epigastric pain, nause, vomiting, naso gastric tube insertion with > 2000 ml /24h. Plain abdominal X Ray had no air-liquid level. Gastrointertinal Xray series (telebrid) showed dilatation of gastric remnant and telebrid could'nt go down to small bowel after 6 h. +2 nd operation with diagnosis of upper small bowel obstruction (post operation). Lesion intraoperation: Dilatation of gastric remnant, volume of gastric remnant was large, no gastric outlet obstruction, pylory muscle opened with out motility, gastric tube insertion and instrument for exploration  could pass though easily. There was not small bowel obstruction. Operation performed: Gastro-Jejunostomy (ante colic). Post operation was simple. Erythromycin 0,25g-3 tables daily (low dosage) was given. Patient discharged  7 days postoperatively. Histopathology: Tumor 9,5-9-6 in diameter. Immunohistochemistry: GIST with 5 mitotic count /25 HPF. Conclusion: Delayded gastric emptying  (DGE) after wedge  resection for large GIST  located at lesser curvature could occur. The reason could be lesion of vagus nerve (X). Symptom often occurred  during  7-14 post operative day: Nause, epigastric pain, vomiting (gastric liquid > 800ml). Diagnosis was elimination  of  upper bowel obstruction by CTSCan and  erected abdominal Xray. Gastro- intestinal  X ray series with  telebrix revealed dilatation of gastric remnant and  telebrix remained in gastric remnant   after 6 h. The treatment  consisted of gastric tube insertion for aspiration, fasting, intravenous nutrition,  oral erythromycine with low dosage. If DGE symptoms unchanged or got worse, surgical management  would be indicated: Gastro-enterostomy   or jejunostomy for feeding.