Blackshaw et al [3] showed that patients presenting as an emerge

Blackshaw et al. [3] showed that buy MK0683 patients presenting as an emergency had a median GSI-IX survival of 6 months, compared to 12 months for patients referred as an outpatient. Therefore, although emergency presentation is relatively rare, it may significantly affect prognosis. Recent advances in diagnostic tools and new oncological treatments may improve the overall outcome of gastric carcinoma, but emergency presentation continues to be associated with higher stage of disease at presentation and lower rates of operability. The majority of the peer-reviewed papers report 10-25 patients

in the emergency group [4–7]. Perforated gastric cancer is rare accounting for 0.3-3% of gastric cancer cases [6–8], but gastric cancer is present in 10-16% of patients presenting with gastric perforation [9]. Only one-third of cases of perforated

gastric cancer are diagnosed pre-operatively [7]. The diagnosis of gastric cancer is usually confirmed by post-operative histological examination. A two-staged procedural approach is sometimes used for the treatment of perforated gastric carcinoma; the first procedure controls the perforation and treats peritonitis, followed by a second procedure involving definitive gastrectomy with appropriate lymph node dissection [10, 11]. Minor bleeding is a well-known characteristic of gastric cancer, often causing chronic microcytic hypochromic anaemia, prompting gastroscopy. However, gastric cancer can also selleck inhibitor present with major bleeding in up to 5% of patients [12]. These patients may require blood transfusion to prevent haemodynamic compromise. Endoscopic therapy can be used to control bleeding with the use of injection of adrenaline to the tumour

base, argon plasma coagulation or with application of endo-clips [13]. However patients may require surgery for bleeding control if endoscopic measures for haemostasis fail. Gastric outlet obstruction is more common than other emergency presentations and is usually a sign of locally advanced 3-oxoacyl-(acyl-carrier-protein) reductase incurable disease. Traditionally, surgical bypass with gastrojejunostomy or palliative distal gastrectomy were the only therapeutic options to restore the gastric outflow. However increasingly, endoscopic stenting is utilised for to relieve obstruction in gastric cancer [14]. With specialist oesophagogastric surgeons being increasingly based in tertiary referral centres, there have been concerns that specialist surgeons may not be available should emergency surgical intervention be necessary in cases of gastric cancer. This raises the question of how commonly specialist oesophagogastric intervention is necessary in the emergency setting and how hospitals should plan their surgical service. Aims This study aims to compare the influence mode of presentation (emergency or elective) has on the outcome of patients with gastric cancer in a deprived inner city area.

Diverticulitis occurs in 2% to 6% of patients and can progress to

Diverticulitis occurs in 2% to 6% of patients and can progress to gangrene with full-thickness necrosis and perforation, which has a mortality rate as high as 40%. Perforation presents either with localized or generalized BLZ945 supplier peritonitis, and the mainstay of treatment includes resection of the affected segment and primary anastomosis. Obstruction occurs in 2% to 4% of patients, due to adhesions, intussusceptions, volvolus, extrinsic compression from a fluid-filled diverticulum, enteroliths [81, 85]. Bleeding complications interest 3% to 8%

of patients with JID. The proximity of the neck of the diverticula to PARP cancer the mesenteric vessel is responsible for bleeding resulting from erosion and ulceration of the mucosa. In case of massive hemorrhage, surgical resection of the affected bowel and anastomosis STI571 manufacturer is mandatory [81, 86]. Acute mesenteric ischemia Acute mesenteric ischemia (AMI) is an uncommon event, according for less than 1 case in every 1000 hospital admissions. Females are affected with three times the frequency of males and patients are usually between the age of 60 and 70 with

several comorbidities [81]. Arterial embolism is the major cause of AMI, according for 40% to 50% of cases [87]. Most events are thromboembolic and arise from a cardiac source [87]. Thromboemboli tend to lodge in proximal superior mesenteric artery (SMA), just beyond the first jejunal branches, a minority (15%) may lodge at the SMA origin, whereas about 50% lodge distal to the middle colic artery [88, 89]. In this case, proximal intestine and ascending colon are spared. Instead atheroembolic emboli tend to be smaller and to lodge in the distal SMA, therefore affecting bowel perfusion less often and in more localized areas. Acute arterial thrombosis superimposed on preexisting severe atherosclerotic disease accounts for 25% to 30% of all cases [87, 90]. Bowel infarction is more insidious because extensive collateral are able to maintain viability until there is a final closure of critically

stenotic vessel or collateral. click here The infarction is more confluent, without sparing of small bowel or right colon circulation, because SMA is often interested at its origin. Acute presentation on a history of cronic mesenteric ischemia is usual. The small bowel is able to tolerate a significant reduction in blood flow. However, when the ischemia is prolonged, it leads to disruption of the intestinal mucosa. Patients present abdominal pain. SMA embolism has the more rapid clinical decline due to the lack of collateral vessels. The advent of high-quality computed tomography angiography has supplanted angiography to make the diagnosis of AMI [91, 92]. However angiography still plays an important role not only in the diagnosis but also in the treatment [93]. Diagnostic laparoscopy is not widely accepted because it may miss areas of nonviable bowel.