Spontaneous pneumomediastinumIntroduction: Pneumomediastinum or Hamman syndrome usually appears in young males; any condition provoking Valsalva maneuvers can be a predisposing factor. Clinical case: We report an 18 years old male admitted to the emergency room for polydipsia, polyphagia, malaise, profuse vomiting and chest pain. A diabetic ketoacidosis was diagnosed and a chest X ray film showed a pneumomediastinum. The patient was compensated metabolically and an esophageal X ray examination discarded esophageal perforation. He was discharged in good conditions seven days after admission.
Intussusception after Roux-en-Y Gastric Bypass causing bowel obstruction. Report of one case We report a 41 years old female who underwent a gastric bypass 10 years ago. She presented an excess weight loss of 114%. She required a cholecystectomy and another surgical procedure due to an internal hernia. The patient complained of recurrent abdominal pain and an abdominal computed tomography showed an intestinal intussusception located at the jejuno-jejuno anastomosis. She was operated and the diagnosis was confirmed. An enlargement of the biliopancreatic loop and a bezoar were also found. A 15 cm intestinal resection of the enlarged portion of the biliopancreatic loop and a new jejuno-jejuno anastomosis were performed. The patient recovered uneventfully and was discharged on the fourth postoperative day. The occurrence of intestinal intussusception as a cause of intestinal obstruction after gastric bypass is rare. It has been reported after open and laparoscopic surgery. There are several theories about the cause of intussusceotion, like changes in intestinal motility, a high excess weight loss, but a conclusive cause has not been identified. Generally the location of the intussusceptions is at the jejuno-jejuno anastomosis and it appears to be in a retrograde fashion in the majority of cases. The treatment is controversial, with several options; simple reduction, reduction and intestinal fixation, but apparently intestinal resection has better results.
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