[Ischemic necrosis of the lesser curvature of the stomach after supraselective vagotomy. Apropos of 2 personal cases and 43 cases published in the literature]

Abstract

The author presents two personal cases (from a series of 176 operations) of this complication of which 43 cases have already been reported in the literature. Necrosis perforating into the peritoneum is the most dramatic form: fever, pain, abdominal distension and most importantly, the appearance of gastric fluid in the drain (hence the importance of drainage). X-rays show a gas-fluid level in the left hypochondrium. It is important to be aware of this complication, as the prognosis depends on early re-operation (most often an overlapping suture): the mortality is presently 23,5%. One external gastric fistula has been reported. A common form is a necrotic ulcer walled off by neighbouring tissues. It is sometimes quite small, revealed by endoscopy in which case it generally heals with medical treatment. It can be very large requiring operation because of its persistence or because of haemorrhages. In this case, it is most often treated by gastrectomy. The pathogenesis of this condition is uncertain; it seems preferable not to denude the esophagus too much and not to interfere with collateral blood supply: ligature of small vessels, splenectomy, fundoplication has also been implicated. Only one fact is certain: the high incidence in patients with renal failure and hypertension; in no case should these patients be submitted to a highly selective vagotomy.