Gastroparesis (GP) is a disorder that affects the motility of the stomach resulting in delayed gastric emptying (GE) without mechanical obstruction and has accompanying symptoms that include nausea, vomiting, early satiety, bloating, and epigastric pain. It was reported that increased eosinophils were identifi ed in the fi rst part of the duodenum in a subset of patients with the entity of functional dyspepsia (FD) and the main symptom of early satiety. It is recognized that approximately 40% of FD patients may also have delayed gastric emptying, termed Idiopathic GP (ID-GP). Therefore, to investigate the hypothesis that duodenal eosinophilia may be present in patients diagnosed with ID-GP we investigated whether there is any evidence of increased numbers of duodenal eosinophils in patients with the diagnosis of IDGP as compared to diabetic GP (DM-GP) patients and controls who had a normal GE.

Leakage of pancreatic enzymes leading to either formation of abdominal collection or pancreatic fi stula is one the most feared complications after pancreaticoduodenectomy. Owing to high morbidity and cost related to pancreatic fi stula, multiple interventions including various types of pancreaticoenteric anastomosis have been proposed to prevent this complication. Despite some randomized controlled trials and meta-analyses favoring pancreaticogastrostomy over pancreaticojejunostomy, clinical practice has not witnessed any change in preference of individual surgeons. One of the underlying facts is that there are various ways of doing pancreatic anastomosis and trials have compared only specifi c techniques while a few novel techniques that have been reported to have very low pancreatic fi stula risk have never been compared in randomized controlled trials comparing pancreaticogastrostomy versus pancreaticojejunostomy. Moreover individual surgeons’ comfort and training also matters, and in many instances same results are not reproduced as reported for primary center where technique was developed. So though a good number of randomized controlled trials have been conducted to compare pancreaticogastrostomy with pancreaticojejunostomy, variations in techniques of performing anastomosis limit external validity as well as pooling the data for meta-analysis. Furthermore subgroup of patients with soft pancreas, who are at high risk of pancreatic leak, should be looked at separately for potential benefi t of type of pancreatic anastomosis.

Between the hiatal hernias, the type IV is the less frequent by the great defect, but this type had a high incidence of incarceration and a mortality rate up to 27%. Case: A female patient of 80 years-old was referred to our hospital by septic shock and abdominal pain. At physical exam she refers abdominal and thoracic pain, dyspnea and occasional threw up for the last 2 days, with a background of this symptoms the last 5 years, and gastroesophageal refl ux symptoms for 10 years. At admission, she referred epigastric and retrosternal pain, dyspnea, with an 02 of 75%, bowel sounds in left hemithorax, mean arterial pressure of 50mmHg with the use of norepinephrine. Laboratories do not reveal sepsis and CT scan reports a hiatal hernia of 9 cm with left hemithorax occupied by stomach, colon, and spleen. A cardiogenic shock by compression was suspected with this data and a laparotomy was scheduled. CT scan report was confi rmed and the mentioned organs were reduced to abdomen without problems, both diaphragmatic pillars were sutured and a Nissen fundoplication completed. After 6 hours’ norepinephrine was suspended and 48 hours after the patient were discharged uneventfully. Conclusion: Giant hiatal hernia must be suspected in patients with chronic abdominal and thoracic pain with refl ux symptoms because the complications associated with this disease could have a mortality near 30% in case of strangulation and a scheduled surgery could be very safe in the correct moment.

Introduction: Hepatocellular carcinoma (HCC) is a major public health problem worldwide and is the second most common cause of cancer related deaths worldwide. If liver functional reserves and future liver remnant are adequate than liver resection is preferred choice in Child Pugh class A and selected cases of early Child Pugh class B, while Child Pugh B and C are candidates for liver transplantation.

We developed a new method: percutaneous choledochoduodenal shunt (PCDS) for complete biliary obstruction patient. At first, percutaneous transhepatic cholangiodrainage (PTCD) is performed as usual manner with local anesthesia. After the patient is recovered from bilirubinemia, percutaneous endoscopic gastrostomy (PEG) is performed with the pull-through method under local anesthesia. The catheter of PEG is replaced to jejunal catheter after the gastrostomy is completed. These two catheters (catheter of PTCD and Jejunal catheter) are connected to each other with an extra-peritoneal shunt. The method is useful for the patient with complete biliary obstruction who cannot be performed for biliary stenting.

Primary Gastrointestinal Follicular Lymphoma is very rare. It is considered as an indolent lymphoma, but a complication such as a perforation can increase the morbidity and mortality. We report the case of a 57-years-old man who had a perforation primary follicular lymphoma of the jejunum presenting as aneurismal form. He had peritonitis at his admission, and his abdominal CT revealed a massive pneumoperitoneum and a segmental dilatation of the small intestine.