Welcome to our Vemala Surgical Speciality Clinic!
The stomach is the largest portion of the digestive tract between the oesophagus and small intestine. It is a hollow muscular organ occupying the left upper and central regions of the abdomen. The stomach acts as a reservoir of food and can store anywhere between 2 to 3 liters. Its specialized cells produce acid, and its strong muscles blend & churn the consumed food before pushing it into the duodenum, the first portion of the small intestine.
Duodenum is the first portion of the small intestine, separated from the stomach by an exit gate called the ‘pylorus’. The duodenum begins on the right, curves like a ‘C’, and crosses the midline towards the left. It receives bile and pancreatic juice from the liver and pancreas for digestion. Churned food from the stomach mixes with these digestive juices here and moves down the intestines for absorption.
Diseases of the stomach and duodenum are frequently seen in clinical practice and can vary from the common acid peptic disease or ulcers to malignancies or cancers.
Acid secreted in the stomach can damage the lining of the stomach and duodenum, causing ulcers and complications like bleeding, scarring, and blockage/outflow obstructions. Blockage can also be due to Crohn’s disease, infections, tumors, or cancers. Gastro-jejunostomy is a surgical treatment for outflow obstruction, creating an alternate route for food and gastric juices to pass into the intestines when the blockage cannot be removed.
Difficulty in swallowing, pain after eating, regurgitation or vomiting of previously swallowed food, a sensation of fullness, weight loss, blood vomiting, passage of bright red or dark blood in stool, a lump in the abdomen, recurrent cough, tiredness, or repeated episodes of such symptoms.
Upper GI endoscopy with biopsy, CT scan chest + abdomen and pelvis with oral and intravenous contrast.
Endoscopy and Surgery – Laparoscopic loop / Roux-en-y gastro-jejunostomy.
This procedure is done in two ways: a single joint between the stomach and intestine, or in a ‘Y’ fashion (Roux-en-Y). The choice of procedure depends on the disease and patient characteristics. Using 5-6 small keyholes in the abdomen, the intestine is joined to the stomach either with staplers or stitches.
Perforation is essentially a hole or tear in the stomach or intestines, often resulting from ulcers, infections, trauma, or tumors. When this occurs, intestinal contents can escape into the abdomen, leading to severe symptoms and complications.
Severe abdominal pain, abdominal fullness, vomiting, fevers with chills, inability to eat, urinary retention, difficulty breathing, dizziness, blood in motion or vomiting, etc.
Clinical examination, blood tests, X-ray chest and abdomen, CT scan abdomen and pelvis.
Surgery – Laparoscopic or Open closure of the perforation.
The surgery involves identifying the perforation in the stomach or intestines and closing it with sutures. In some cases, part of the stomach or intestine may need to be removed and reconnected.
Bleeding from the stomach or duodenum can range from mild to severe. Causes include infections, trauma, tumors, varices, and ulcers. Prompt diagnosis and treatment are crucial to managing such cases.
Vomiting, blood in vomitus, passing black or red stools, abdominal pain, abdominal fullness, chest pain, giddiness, tiredness, jaundice, etc.
Clinical examination, blood tests, Upper GI endoscopy, CT scan of the abdomen and pelvis with contrast.
Medical management, Endoscopic management, Interventional Radiology, Surgery – Laparotomy and control of bleed, Devascularization procedures.
This surgery involves identifying the bleeding blood vessel and ligating it with sutures. The procedure is chosen based on the cause of the bleeding.
The duodenum is an uncommon site for tumours. These may be functional (producing hormones) or non-functional, and can be cancerous or benign. Tumours in the duodenum are sometimes detected incidentally and require specialized diagnosis and treatment.
Abdominal pain, vomiting, blood in stool, episodes of low blood sugar (hypoglycemia), excessive sweating, palpitations, weight loss, back pain.
Clinical examination, blood tests, Upper GI endoscopy, CT abdomen and pelvis with contrast, PET-CT, Dota scan.
Endoscopic management, Surgery – Laparoscopic or open resection of tumour.
The surgical approach depends on the tumour type and location. Non-cancerous tumours are removed with staplers or excised through an opening. Cancerous tumours may require more extensive removal, possibly involving adjacent organs.
Consumption of acids or alkali can severely damage the oral cavity, oesophagus (food pipe), stomach, and small intestine. These agents can also cause injuries to the airway and windpipe, leading to a range of critical symptoms.
Severe pain and burning in the oral cavity, abdominal pain, fever with chills, chest pain, vomiting, blood in stool, dizziness, difficulty in breathing, difficulty in swallowing.
Clinical examination, blood investigations, Upper GI endoscopy, CT abdomen and pelvis with contrast.
Endoscopic management and Surgery, depending on the condition of the patient:
Surgery depends on the patient’s condition. After initial stabilization, a feeding access may be required. Using 3-4 small keyholes, a tube is inserted into the intestine and brought out through the abdomen to ensure the patient receives adequate proteins and energy through the tube until oral feeds or definitive surgery are possible.
In cases of severe injury where the stomach or oesophagus have perforated, emergency surgery may be necessary. This could involve complete removal of the stomach and/or oesophagus. In delayed cases, definitive surgery may be performed after the inflammation subsides. The extent of injury and location of strictures will determine the surgical approach.
SMA syndrome occurs when the superior mesenteric artery (SMA), the main blood vessel supplying the intestines, compresses the duodenum, causing intestinal obstruction. Weight loss may trigger this condition.
Recurrent abdominal pain, vomiting of food particles and bile, loss of weight, and decreased appetite.
Clinical examination, blood investigations, CT scan of the abdomen and pelvis with mesenteric angiography.
Conservative management and Surgery – Laparoscopic or Open Intestinal Bypass.
Using laparoscopic techniques, the obstructed segment of the intestine is bypassed, creating an alternative route for food to pass through the intestines.
Certain benign or non-cancerous tumours of the stomach and duodenum (such as GIST) can be surgically treated by removing only the affected segment, particularly when located along the greater curvature of the stomach.
Difficulty in swallowing, pain after eating, sensation of fullness, weight loss, blood vomiting, passage of bright red or dark blood in stool, a lump in the abdomen, or repeated episodes of such symptoms.
Upper GI endoscopy with biopsy, CT scan of the chest, abdomen, and pelvis with oral and intravenous contrast.
Surgery – Laparoscopic sleeve resections of the stomach or duodenum.
Using 3-5 small keyholes in the abdomen, the tumour along with a small cuff of adjoining normal tissue is removed in toto with staplers. Endoscopy may be used during surgery to ensure complete removal of the tumour.
Gastrectomy involves the removal of a portion (Partial / Distal) or the entire (Total) stomach. This procedure may be necessary for several conditions, including:
These diseases can affect any part of the stomach or duodenum. Surgery is the mainstay of treatment for cancers, with the intent being curative in early stages or palliative in advanced stages to relieve symptoms.
Difficulty in swallowing, pain after consuming food, regurgitation or vomiting of swallowed food, heartburn, a sensation of fullness, weight loss, blood vomiting, passage of bright red or dark blood in stool, a lump in the abdomen, recurrent cough, tiredness, and jaundice in advanced cases.
Upper GI endoscopy with biopsy, CT scan of the chest, abdomen, and pelvis with oral and intravenous contrast, PET CT scan.
Medical management – for cancers, Chemotherapy (Sandwich / Palliative), Endoscopic management, and Surgical management – Open / Laparoscopic Distal or Total Gastrectomy.
Using 5-6 small keyholes in the abdomen, a portion or the entire stomach is removed. Staplers are utilized to divide the segment of the stomach. When performed for cancers, the removal of lymph nodes and omentum is included in the procedure. Continuity of the digestive tract is restored by connecting a portion of the intestine to the remnant stomach or esophagus.
