OVERVIEW
Residual sinus syndrome is a syndrome of anastomotic ulceration caused by incomplete resection of the gastric sinus and residual sinus during Billroch II surgery. The incidence of recurrent ulcers in the residual gastric sinus is 40%.
Etiology
The cause of this syndrome is that the mucosa of the residual gastric sinus is stimulated by refluxed alkaline duodenal fluid and produces a large amount of gastrin, which is absorbed into the bloodstream and acts on the mucous membrane of the fundus of the stomach to stimulate the mural cells of the residual stomach, which contributes to the excessive secretion of gastric juice and the high gastric acidity, leading to the occurrence of postoperative anastomotic ulcers.
Symptoms
Typical symptoms are excessive secretion of gastric juice and a series of symptoms caused by anastomotic ulceration, such as long-term, cyclic, hunger-induced epigastric pain, burning sensation in the epigastric area, acid reflux, belching, etc.
Examination
The preoperative diagnosis of residual sinus syndrome is difficult. Gastroscopy helps to clarify the diagnosis, and most patients need surgical exploration of the duodenal stump to confirm the diagnosis.
Diagnosis
Diagnosis can be made on the basis of surgical history and clinical manifestations. Gastroscopy helps to clarify the diagnosis, and in some cases the diagnosis is confirmed during reoperation.
Differential diagnosis
This disease should be differentiated from Zollinger-Ellison syndrome, in which gastrin is elevated, usually 280-500 ng/L. In this syndrome, the gastrin level is usually 30-176 ng/L. The insulin test can lead to a significant decrease in serum gastrin, which can be used to differentiate the disease.
Treatment
The treatment is to completely resect the remnant gastric sinus and restore the smooth, physiologic duodenal pathway, i.e., change Billroch II style to I style, such as direct end-to-end anastomosis of the stomach and duodenum and replacement of free jejunal loops; some people advocate the simultaneous addition of bilateral vagal trunk severance surgery.