〈Case Reports〉Successful treatment of a necrotizing soft tissue infection with sepsis caused by Aeromonas hydrophila following gastric cancer surgery

A 70-year-old man underwent total gastrectomy and splenectomy for gastric cancer. On the second post-operative day, swelling with redness was noted at the site of drain insertion. The site of redness expanded rapidly and the patient developed purpura with blood blisters complicated by concomitant shock, respiratory failure, and disseminated intravascular coagulation (DIC), leading to a sudden worsening of his general condition. He was diagnosed with a necrotizing soft tissue infection. A drain was inserted through the superficial fascia to initiate irrigation drainage. Aeromonas hydrophila was detected in the subcutaneous effusion and blood cultures. The drainage region was enlarged as needed based on the amount of necrosis. Debridement was performed after his general condition had stabilized. Ninety-two days postoperation, he was transferred to another hospital for skin grafting. Necrotizing soft tissue infections due to A. hydrophila usually have a life-threatening course. However, irrigation drainage through the superficial fascia might be effective when extensive debridement cannot be provided immediately because of a bleeding tendency due to shock or DIC

Modified delta-shaped gastroduodenostomy consisting of linear stapling and single-layer suturing with the operator positioned between the patient's legs: A technique preventing intraoperative duodenal injury and postoperative anastomotic stenosis.

BACKGROUND:The drawback of the delta-shaped gastroduodenostomy (DSG) in totally laparoscopic distal gastrectomy (TLDG) is the presence of intraoperative duodenal injury and postoperative anastomotic stenosis, which can occur due to a relatively short duodenal bulb diameter. MATERIALS AND METHODS:From June 2013 to June 2019, 35 patients with gastric cancer underwent TLDG with a modified DSG consisting of linear stapling and single-layer hand suturing in our institution. All anastomotic procedures were performed by the right hand of the operator positioned between the patient's legs. Linear stapling of the posterior walls of the remnant stomach and duodenum without creating a gap was performed using a 45-mm linear stapler, considering the prevention of intraoperative duodenal injury. The stapler entry hole was closed using a single-layer full-thickness hand suturing technique with knotted sutures and a knotless barbed suture. We described the clinical data and outcomes in the present retrospective patient series. RESULTS:No intraoperative duodenal injury occurred in any of the 35 patients. The median staple length at linear stapling of the posterior walls of the remnant stomach and duodenum was 41.7 ± 4.2 (30-45) mm, and 2 patients (5.7%) had a staple length of 30 mm. There were no incidences of postoperative anastomotic stenosis. CONCLUSIONS:We suggest that a modified DSG consisting of linear stapling and single-layer hand suturing performed by an operator positioned between the patient's legs can be one option for B-Ⅰ reconstruction following TLDG because it can aid in preventing both intraoperative duodenal injury and postoperative anastomotic stenosis