Postoperative pseudoaneurysms (PA) of visceral arteries are rare and usually secondary to vascular injury after pancreato-biliary and liver surgery. They usually present with bleeding and nowadays most are amenable to initial control by interventional radiology.
Case Report
ABSTRACTMorbid obesity has been considered a contraindication for cardiac transplantation in some patients with Dilated cardiomyopathy (DCM). However, the positive effect of bariatric surgery on this population, with improvement in Ventricular Ejection Fraction (VEF), could even avoid the necessity of a cardiac transplant. Obesity produces cardiac dysfunction and weight loss operations can partially revert it.The impact of bariatric surgery among people with DCM has been studied in two patients with morbid obesity. Both male patients suffered from DCM with a VEF less than 27%, and other co-morbidities. Their Body Mass Index (BMI) was 44 kg/m 2 and 37 kg/m 2 , respectively. They underwent a sleeve gastrectomy and reached a BMI of 28 kg/m 2 , 18 months after the operation, with more than 10% improvement in their VEF. The second patient had a gastric leak, due a stapler failure, and finally underwent an uneventful total gastrectomy after unsuccessful endoscopic procedures.In conclusion, bariatric surgery offers a significant benefit for obese patients with DCM and should be considered by cardiologists as other therapeutic approach when other weight loss strategies had failed.
CASE REPORTSCase 1: A 54-year-old male with Sleep Apnea Syndrome (SAS), Diabetes Mellitus (DM) type 2, hypertension, Morbid Obesity (MO) and Dilated cardiomyopathy (DCM) was referred to our hospital for bariatric surgery. In addition, the preoperative cardiac ultrasound showed a Ventricular Ejection Fraction (VEF) of 24%. He had a Body Mass Index (BMI) of 41 kg/m 2 and underwent an uneventful Sleeve Gastrectomy (SG). Three years after the surgical procedure, the patient co-morbidities and quality of life have improved, and the cardiac ultrasound confirmed an increase of his VEF from 24% to 36% ( Figure 1A-1B).
We present the case of a young male patient who suffered from leptomeningeal carcinomatosis and comment on the pitfalls encountered during the management of this devastating illness.A twenty-five-year-old Moroccan man came to the Emergency Department presenting with abdominal pain and constipation of a four day duration. The patient also reported rectal bleeding and weight loss. A tympanic abdomen was observed on physical examination. A rectal examination uncovered an obstructive solid mass at 6 cm from the anal verge. A CT scan revealed a large bowel obstruction due to rectal diffuse thickening. Thus, at this time a differential diagnosis of inflammatory bowel disease (IBD) or rectal neoplasia was made. Although there was no pathological report from the lesion, an emergency transverse colostomy with a rectal biopsy was carried out.The pathology report described a signet-ring cell carcinoma originating in the rectum. Magnetic resonance imaging (MRI) showed a T2N0 large rectal neoplasia. Endoanal ultrasound revealed a T3N0 rectal tumor.After two months of neoadjuvant therapy the patient returned to the Emergency Department due to headaches, vomiting, diplopia and a limited abduction in the right eye. A brain MRI showed protein content in the parietal sulci. A lumbar puncture was positive for malignant cells.The patient received systemic and intrathecal chemotherapy. However, due to the poor prognosis of this disease the patient passed away eleven months after the surgery.
DiscussionA signet-ring cell adenocarcinoma of colorectal origin, which commonly presents between the fourth and sixth decades of life, can cause leptomeningeal metastasis (1-4). Due to the young age of the patient, a benign rectal obstruction was initially diagnosed, as there are various case reports of patients with IBD with a clinical presentation of a colorectal obstruction due to transmural inflammation (5). This case demonstrates how colorectal signet-ring cell adenocarcinomas cause leptomeningeal metastasis early in the course of disease.
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