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He J, Zhang M, Li W, Peng Y, Fu B, Liu C, Wang J, Wang R. SaB-Net: Self-attention backward network for gastric tumor segmentation in CT images. Comput Biol Med 2024; 169:107866. [PMID: 38134751 DOI: 10.1016/j.compbiomed.2023.107866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/04/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Abstract
Gastric cancer is a significant contributor to cancer-related fatalities globally. The automated segmentation of gastric tumors has the potential to analyze the medical condition of patients and enhance the likelihood of surgical treatment success. However, the development of an automatic solution is challenged by the heterogeneous intensity distribution of gastric tumors in computed tomography (CT) images, the low-intensity contrast between organs, and the high variability in the stomach shapes and gastric tumors in different patients. To address these challenges, we propose a self-attention backward network (SaB-Net) for gastric tumor segmentation (GTS) in CT images by introducing a self-attention backward layer (SaB-Layer) to feed the self-attention information learned at the deep layer back to the shallow layers. The SaB-Layer efficiently extracts tumor information from CT images and integrates the information into the network, thereby enhancing the network's tumor segmentation ability. We employed datasets from two centers, one for model training and testing and the other for external validation. The model achieved dice scores of 0.8456 on the test set and 0.8068 on the external verification set. Moreover, we validated the model's transfer learning ability on a publicly available liver cancer dataset, achieving results comparable to state-of-the-art liver cancer segmentation models recently developed. SaB-Net has strong potential for assisting in the clinical diagnosis of and therapy for gastric cancer. Our implementation is available at https://github.com/TyrionJ/SaB-Net.
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Affiliation(s)
- Junjie He
- Engineering Research Center of Text Computing & Cognitive Intelligence, Ministry of Education, Key Laboratory of Intelligent Medical Image Analysis and Precise Diagnosis of Guizhou Province, State Key Laboratory of Public Big Data, College of Computer Science and Technology, Guizhou University, No. 2288, Huaxi Avenue, Guiyang, 550025, Guizhou, China; Department of Radiology, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guizhou Provincial People's Hospital, No. 83, Zhongshan Dong Road, Guiyang, 550002, Guizhou, China
| | - Mudan Zhang
- Department of Radiology, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guizhou Provincial People's Hospital, No. 83, Zhongshan Dong Road, Guiyang, 550002, Guizhou, China
| | - Wuchao Li
- Department of Radiology, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guizhou Provincial People's Hospital, No. 83, Zhongshan Dong Road, Guiyang, 550002, Guizhou, China
| | - Yunsong Peng
- Department of Radiology, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guizhou Provincial People's Hospital, No. 83, Zhongshan Dong Road, Guiyang, 550002, Guizhou, China
| | - Bangkang Fu
- Department of Radiology, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guizhou Provincial People's Hospital, No. 83, Zhongshan Dong Road, Guiyang, 550002, Guizhou, China
| | - Chen Liu
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), No. 30, Gao Tan Yan Street, 400038, Chongqing, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), No. 30, Gao Tan Yan Street, 400038, Chongqing, China
| | - Rongpin Wang
- Department of Radiology, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guizhou Provincial People's Hospital, No. 83, Zhongshan Dong Road, Guiyang, 550002, Guizhou, China.
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Yoon JH, Jun CH, Han JP, Yeom JW, Kang SK, Kook HY, Choi SK. Endoscopic repair of delayed stomach perforation caused by penetrating trauma: A case report. World J Clin Cases 2021; 9:1228-1236. [PMID: 33644189 PMCID: PMC7896642 DOI: 10.12998/wjcc.v9.i5.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/13/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary endoscopic closure of a perforated gastric wall during endoscopic procedures is mostly effective and well-tolerated; however, there are very few studies on the efficacy of endoscopic management of delayed traumatic gastric perforation. Herein, we report a novel case of a patient who was successfully treated for delayed traumatic stomach perforation using an alternative endoscopic modality.
CASE SUMMARY A 39-year-old woman presented with multiple penetrating traumas in the back and left abdominal cavity. Initial imaging studies revealed left diaphragmatic disruption and peri-splenic hemorrhage without gastric perforation. An emergency primary repair of the disrupted diaphragm with omental reduction and suturing of the lacerated lung was performed; however, delayed free perforation of the gastric wall was noted on computed tomography after 3 d. Following an emergency abdominal surgery for the primary repair of the gastric wall, re-perforation was noted 15 d postoperatively. The high risk associated with re-surgery prompted an endoscopic intervention using 2 endoloops and 11 endoscopic clips using a novel modified purse-string suture technique. The free perforated gastric wall was successfully repaired without additional surgery or intervention. The patient was discharged after 46 d without any complications.
CONCLUSION Endoscopic closure with endoloops and clips can be a useful therapeutic alternative to re-surgery for delayed traumatic gastric perforation.
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Affiliation(s)
- Jae Hyun Yoon
- Department of Gastroenterology and Hepatology, Chonnam National University Hospital and College of Medicine, Gwangju 61469, South Korea
| | - Chung Hwan Jun
- Department of Internal Medicine, Mokpo Hankook Hospital, Mokpo 58643, South Korea
| | - Jae Pil Han
- Department of Internal Medicine, Mokpo Hankook Hospital, Mokpo 58643, South Korea
| | - Ji-Woong Yeom
- Department of Surgery, Mokpo Hankook Hospital, Mokpo 58643, South Korea
| | - Seung-Ku Kang
- Department of Cardiothoracic Surgery, Mokpo Hankook Hospital, Mokpo 58643, South Korea
| | - Hyun Yi Kook
- Department of Nursing, Chonnam National University Hospital, and College of Nursing, Gwangju 61469, South Korea
| | - Sung Kyu Choi
- Department of Gastroenterology and Hepatology, Chonnam National University Hospital and College of Medicine, Gwangju 61469, South Korea
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Kim DH, Choi H, Kim KB, Yun HY, Han JH. Endoluminal closure of an unrecognized penetrating stab wound of the duodenum with endoscopic band ligation: A case report. World J Clin Cases 2019; 7:3271-3275. [PMID: 31667178 PMCID: PMC6819306 DOI: 10.12998/wjcc.v7.i20.3271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/18/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A penetrating injury of a hollow viscus is an obvious indication for an exploratory laparotomy, but is not typically an indication for endoscopic treatment.
CASE SUMMARY A 27-year-old man visited the emergency department with a self-inflicted abdominal stab wound. Injuries to the colon and ileum were detected, but an injury to the second portion of the duodenum was missed. On the day following admission to our institution, the patient became hemodynamically unstable with massive hematochezia, although there was no evidence of bleeding in the Levin tube or Jackson-Pratt drain. We thus performed an upper gastrointestinal endoscopy and discovered a missed duodenal injury that was actively bleeding. An endoscopic band ligation was performed for hemostasis and closure of the perforation. The patient was subsequently discharged without any complications.
CONCLUSION A penetrating injury of the duodenum can be overlooked, so careful abdominal exploration is very important. If a missed duodenal injury is suspected, a cautious endoscopic approach may be helpful.
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Affiliation(s)
- Dae Hoon Kim
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si 28644, South Korea
| | - Hanlim Choi
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si 28644, South Korea
| | - Ki Bae Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si 28644, South Korea
| | - Hyo Yung Yun
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si 28644, South Korea
| | - Joung-Ho Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si 28644, South Korea
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Li K, Sun X, Wang G. A case report of blunt gastric perforation treated with endoscopic clip closure. Medicine (Baltimore) 2017; 96:e6774. [PMID: 28471974 PMCID: PMC5419920 DOI: 10.1097/md.0000000000006774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Gastroscopymay not only allow identification of gastric injury, but may also facilitate prompt repair. PATIENT CONCERNS A 39-year-old male patient was admitted 3 hours after abdominal injury caused by penetration of a screwdriver. Physical examination and computed tomography showed no evidence of gastric injury. However, 3000 mL fresh blood was vomited during the subsequent observation period. DIAGNOSES Gastroscopy identified a ruptured artery and gastric perforation. INTERVENTIONS Repaired immediately using titanium clips. OUTCOMES After operation, the patient recovered well without complications. No more bleeding was observed after the operation. LESSON SUBSECTIONS ASPER STYLE Interventional endoscopy has evolved as an effective alternative to primary surgery for treating gastrointestinal perforation.
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