This term refers to syndromes that sometimes occur after resection of the stomach. Some of them appear in a few weeks, while others only a few months after the operation. Conventionally, local ( recurrence of peptic ulcer , chronic gastritis of the stump of the stomach , “adherent loop” syndrome ) and general ( dumping syndrome and malabsorption syndrome ) disorders are conventionally distinguished .
Peptic ulcer anastomosis
Often develops directly in the area of the anastomosis or in the jejunum, less often the stomach stump. The main factor leading to the development of this complication is considered to be the remaining secretion due to incomplete removal of the antrum and preservation of cells secreting gastrin . When an ulcer forms, intense pain characteristic of peptic ulcer develops, it is often complicated by gastrointestinal bleeding.
With a peptic ulcer of the anastomosis that developed after an insufficiently radical operation, in which part of the antrum is preserved , a higher resection or proximal vagotomy is performed . In rare cases, the peptic ulcer of the anastomosis can penetrate into the colon adjacent to the anastomosis, forming a gastrointestinal fistula. In this case, after eating, rumbling in the abdomen, loose stools with the remains of undigested food are observed. In patients, absorption is significantly impaired, severe general dystrophy may develop. An X-ray examination does not always reveal the presence of an anastomosis between the stomach (or jejunum) and the colon. The presence of a fistula can be confirmed by the administration of a staining solution (for example, methylene blue) in the enema, simultaneously with gastric probing, in which rapid staining of the gastric contents is observed. Timely repeated surgical intervention can save the life of such a patient.
Chronic gastritis of the stump of the stomach
Chronic atrophic gastritis, which occurs after resection of the pylorus, is to some extent inevitable, since after this operation there are no G-cells and thus the second most important phase of gastric digestion falls out. The fundus glands remaining in the stomach cult , deprived of physiological stimulation by gastrin , cannot fully function and gradually atrophy. Thus, during resection of the stomach, preservation of part of the pyloric stomach leads to the appearance of a peptic ulcer of the anastomosis, and its complete removal is one of the reasons for the subsequent development of chronic gastritis. In addition to the lack of stimulation of gastric secretion, regurgitation of duodenal contents into the stomach is also important in the development of gastritis of the gastric stump .
Impaired iron absorption may also be of some importance.
Chronic gastritis of the gastric stump, depending on its severity, can cause various symptoms – from a slight feeling of discomfort that occurs after eating, to severe gastric dyspepsia with belching, nausea, and vomiting, while there is often an admixture of bile in the vomit. Patients with chronic gastritis of the stump of the stomach are shown a strict diet, fractional nutrition. With a decrease in secretion, gastric juice may be prescribed.
Cancer can also develop in a stomach cult, usually many years later (up to 10 years or more) after resection of the stomach. For the diagnosis of chronic gastritis of the stump of the stomach and the determination of its severity, as well as the exclusion of cancer, gastroduodenoscopy and clinical follow-up are necessary .
It usually occurs after Billroth-2 surgery, in which a more distal section of the intestine is sutured to the stomach and a small section of the proximal part of the intestine remains stitched , i.e., a blind section of the intestine forms. In these cases, food and gastric contents can be thrown into the blind section of the intestine, causing a feeling of heaviness in the epigastric region, dull pain, vomiting, sometimes with an admixture of bile. Two variants of the afferent loop syndrome are described. At the first, dyspeptic phenomena are mainly observed due to stagnation of food in the blind segment of the intestine. Unpleasant sensations appear 30-60 minutes after eating. Often, an increase in the secretion of bile and pancreatic juice, stimulated, apparently, from the blind section of the intestine, as well as an increase in the level of blood amylase, is often determined. The second option is due to the development of the infectious process in the blind segment of the intestine against the background of stasis, which subsequently leads to the development of chronic enteritis with malabsorption syndrome . In both variants of the lead loop syndrome, reconstructive surgery is indicated, including the elimination of the lead loop. In the second option, antimicrobial therapy is preliminarily performed.
It develops as a result of the rapid entry of food through the anastomosis into the small intestine. Rapid emptying of the stomach stump causes stretching of the loops of the jejunum and an increase in pressure in its lumen. The osmolarity of food not sufficiently diluted with bile and pancreatic juice is usually higher than under normal conditions. The ingestion of such food into the small intestine leads to the appearance of fluid flow from tissue and blood into the intestinal lumen. As a result, after 20-30 minutes after eating (early, or true, dumping syndrome), the patient has a feeling of heat in the body, dizziness, palpitations, cold sweat, as well as nausea, vomiting, pain, sometimes diarrhea, the more pronounced the higher the osmolarity of food. Such an attack lasts 30-60 minutes and passes on its own. In the development of an attack, they also attach importance to an increase in the release of biologically active substances (histamine, serotonin, adrenaline), both due to an increase in the tone of the sympathetic nervous system during intestinal distension and the rapid advancement of food, as well as osmotic disorders. The release of biologically active substances causes the appearance of unpleasant sensations 11 / g-3 hours after a meal. The development of late dumping syndrome depends on the nature of the food taken, the presence of easily digestible carbohydrates in it. In the origin of late dumping syndrome, hypoglycemia, resulting from an inadequately high release of insulin, is of great importance, due to a dysregulation due to a violation of the integrity of the stomach and an unusual route of food passage. As a rule, a dumping -indrom does not lead to any grave consequences; basically, only more or less pronounced unpleasant subjective sensations arise. In mild expressed syndrome shows diet correction: the exception of sugar and sweet dishes are too hot or cold food, postprandial recommended to take a horizontal position. In more severe cases, during an exacerbation, it is generally necessary to recommend a meal in a horizontal position. Only in relatively rare cases, they resort to surgical treatment.
As a result of resection of the stomach, the absorption of food may be impaired. The severity of malabsorption syndrome depends on the degree of digestion compensation in the lower parts of the gastrointestinal tract. Patients may experience weight loss, sometimes osteoporosis and osteomalacia, iron deficiency and B ^ -deficient or folic-deficiency anemia. Severe malabsorption syndrome develops in rare cases when the patient had latent small bowel disease or chronic pancreatitis before surgery.