Abstract: Diagnostic criteria for extranodal lymphoma (non-Hodgkin's lymphoma) are well known and described in the literature. However, primary extranodal lymphomas are rare and pose problems for differential diagnosis with primary or secondary lesions. In the presented clinical case of a woman, 58 years old, with primary extranodal lymphoma of the stomach and spleen, an incorrect preoperative diagnosis was made: a tumor of the stomach and spleen abscess. It was mainly due to the presence of pain in the epigastric region and hospitalization for "severe acute biliary pancreatitis" in anamnesisd. Similar complaints and a "blurry" picture of manifestations of lymphoma did not allow her to be suspected preoperatively. The tumor nature of the focal lesion of the stomach was not in doubt, while the underestimation of MRI data, combined with the anamnesis, led to the erroneous diagnosis o f" spleen abscess". Patient underwent surgical operation: extended combined gastrectomy, distal resection of pancreas, splenectomy “en-bloc”, lymphadenectomy, cholecystectomy, “Roux-Y" reconstruction. The clinical picture of extranodal lymphoma depends on its primary localization and the degree of its spread. Clinical manifestations of primary lymphoma of the stomach and spleen are often nonspecific, therefore, against the background of previously transferred diseases of the hepatopancreatobiliary zone and their residual manifestations, an erroneous assessment of the situation is possible. In the presence of focal lesions, it is advisable to be more attentive to results of radiology examination, which can provide comprehensive information about their nature.
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Abstract: Aim: was to study motor-evacuation and reservoir functions after gastrectomy followed by jejuno- gastroplasty by x-ray method in late-postoperative period. Material and methods: for the period from 2011 to 2017 inA.VVishnevskyNationalResearchScientificSurgicalCenter, stomach was totally replaced with a segment of the intestine in 154 patients, after gastrectomy - 144, after extirpation of the stomach stump - 8, after resection of the esophagus - in 2 cases. Indications for surgery were gastric cancer in 142 (92.2%) patients, stump cancer and cancer recurrence in esophagojejunoanastomosis - in 8(5,2%), diseases of the operated stomach - in 4(2,6%). There were 94(61,1%) men and 60(38,9%) women. The follow-up period ranged from 6 months up to 5 years, the average value was 17±2.5 months. In different terms of the long-term period, the evaluation of the evacuation (motor) and reservoir (depositing) function of the intestinal graft was carried out by means of a standard x-ray contrast study with per oral barium suspension on an empty stomach. After that, the patient took the whole portion of barium suspension (200 ml) and was examined after 20 minutes, 45, and 2 hours. Results: evaluation of reservoir capability of the reconstructed upper digestive tract was made according to rate of complete emptying of the jejunal segment and the duodenum.The speed of emptying remained within normal limits at 133(86,3%), did not exceed 20 min. and was considered to be fast - in 21(13,7%) patients. None of patients had a slow evacuation. To assess the motor function of the small intestine in new conditions of digestion, the time of passage of barium suspension through its loops was studied in 56(36,3%) patients in the long-term period, and 13(23,6%) patients revealed accelerated evacuation, and 43(76,4%) evacuation time approached the physiological norm. Conclusion: X-ray examination carried out in the remote period after gastrectomy, shows that the EGP (esophagogastro plastic) restores the normal anatomical and physiological pathway of fooc promotion in the gastrointestinal tract, and the interpolated segment of the jejunum in combination with the duodenum compensates for the reservoir function of the stomach, creating conditions for portion evacuation of food to the underlying intestine. Thus, motor-evacuation function of the gastrointestinal tract in patients with EGP in the long term is approaching the physiological norm. References 1. Zakharov EI. On the issue of gastrectomy using a new method. Protocols of the Pirogov Surgical Society in Leningrad on December 18, 1938. Vestnik khirurgii im. I.I. Grekova. 1939; 58(1): 75 [In Russ]. 2. Henley FA., Hudson RV. Gastrectomy with replacement. A preliminary communication with an introduction. British Journal of Surgery. 1952; 40(160): 118-128. 3. Mateshuk RV. Symposium materials on gastroplasty in gastrectomy and resection of the stomach. Simferopol. 1962; 21-28 [In Russ]. 4. Kurtseitov NE. The role of reduodenization with the formation of areflux anastomoses in the treatment of certain forms of diseases of the operated stomach. Dis. . dokt. med. scie. Tomsk, 2013; 330 p [In Russ]. 5. Yan Tsin. Jejunogastroplasty as a method of reconstruction of the digestive tract after gastrectomy. Dis. ... kand. med. Scie. Moscow, 2015; 154 p [In Russ]. 6. Busalov AA., Komorovskiy Yu.T. Pathological syndromes after gastrectomy. - M.: Meditsina, 1966; 240 p [In Russ]. 7. Zherlov GK., Koshel' АР Primary and reconstructive jejunogastroplasty in surgery of diseases of the stomach. Tomsk: Izd-vo Tomskogo un-ta, 1999; 212 p [In Russ]. 8. Gaiton AK., Kholl Dzh. E. Medical physiology. Trans. engl.; Ed. by V.I. Kobrina. - M.: Logosfera, 2008; 1296 p [In Russ]. 9. Ganichkin AM., Reznik SD. Methods for restoring gastrointestinal continuity during gastrectomy. - Leningrad: Meditsina. 1973; 178 p [In Russ]. 10. Frolkis AV. Functional diagnosis of bowel disease. - M.: Meditsina, 1973; 265 p [In Russ]. 11. Zherlov GK. Basics of functional surgical gastroenterology: pract. guide for doctors. - Tomsk: Izd-vo Tom. un-ta, 2009; 274 p [In Russ]. 12. Yang YS. Chen LQ., Yan XX., Liu YL. Preservation versus Non-preservation of the Duodenal Passage Following Total Gastrectomy: A Systematic Review. Journal of Gastrointestinal Surgery. 2013; 17(5): 877-886. DOI: 10.1007/s11605-013-2174-9.
