Intraoperative upper gastrointestinal endoscopy and biopsy

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Several reports in the literature emphasize the usefulness of endoscopy during operative colonoscopy.1, 2 The indications for colonoscopy during laparotomy are relatively well defined, and include localization of lesions and bleeding sites. There has been little reported on the use of intraoperative upper gastrointestinal endoscopy, and the indications for its use are poorly defined. Yet there are some situations in which it can be useful during the operative procedure. This paper illustrates the use of intraoperative fiberoptic examination and biopsy of the upper gastrointestinal tract.

Case report

A 79-year-old white man was admitted to the hospital with a 7-week history of progressive jaundice and pruritus associated with intermittent chills and fever. In addition he complained of nausea and vomiting and had lost 22.7 kg. He was cachectic and icteric. The gallbladder was palpable on abdominal examination, but the liver was not enlarged.

Pertinent abnormal laboratory data included a total bilirubin of 18 mg/100 ml. The blood urea nitrogen (BUN) was 40 mg/100 ml with a serum creatinine of 3.0 mg/100 ml. Contrast roentgenography of the upper gastrointestinal tract demonstrated a widened “C-loop” of the duodenum with effacement of the mucosa of the medial duodenal wall (Fig. 1). The clinical diagnosis was carcinoma of the pancreas.

Efforts were made to restore renal function, and following this the patient underwent abdominal exploration at which time a palpable mass was found in the head of the pancreas. No regional lymph nodes suggestive of metastasis could be found, nor was there any evidence of metastasis to the liver,. . .



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