The small intestine is a frequent site of melanoma metastases and the most common cause of secondary intestinal tumors. Even though, its presentation with intestinal obstruction due to intussusception is very rare. We present a 47-year-old woman with a medical history of facial melanoma operated 17 years ago and recently diagnosed of cervical recurrence who complained of abdominal pain of one week duration accompanied with vomiting and abdominal distension. Computed tomography (CT) scan revealed marked distension of the small intestine with features suggesting intussusception of the distal ileum. At laparoscopic exploration a massive ileocolic intussusception was found with invagination of the last 60 cm of ileum inside the cecum and ascending colon. Surgical reduction revealed a tumor of approximately 2 cm in the distal end of the intussuscepted intestine acting as the lead point. Resection of non-viable ileum along with the tumor and end-to-end anastomosis was performed. Many other lesions of smaller size were found distantly in the proximal small bowel but were not treated. The patient had a full recovery and was discharged three days after surgery. Pathological examination showed metastatic melanoma and a positron emission tomography (PET) scan confirmed disseminated disease with brain metastasis. The patient died three months after surgery. Intestinal occlusion due to metastatic disease is a rare condition but should be taken into account particularly in patients with history of cancer. Surgical intervention with a mini-invasive laparoscopic approach is feasible. Intestinal resection and anastomosis is mandatory for either curative or palliative intentions providing a satisfactory treatment.
Hyper-reduced grafts provide an alternative approach for low-weight pediatric recipients. The relatively high immediate postoperative morbidity could be related to the complexity of these patients.
HighlightsThere is big concern about reflux appearance after sleeve gastrectomy.Chronic reflux increases risk of esophageal adenocarcinoma.We present a case of an esophageal adenocarcinoma after sleeve gastrectomy.Relationship between sleeve gastrectomy and reflux needs further study.
A shortage of liver donors for low-weight transplant recipients has prompted the development of procedures for liver-reduction, split-liver, and living related donor transplantations. For pediatric recipients weighing less than 10 kg, the left lateral segment is often still too large. We describe the procedure of monosegmental transplantation using segment II after segment III was resected in situ from a living related donor. Successful monosegmental transplantation is technically feasible and is a valid alternative to be considered for cases of size discrepancy between the recipient's volume and the donor's left lateral segment. Copyright 2000 by the American Association for the Study of Liver DiseasesT he main obstacle to the development of pediatric liver transplantation is the disparity between available small-sized donors and the exponential growth of waiting lists. This situation is even worse when recipients weigh less than 10 kg. The development of procedures for liver-reduction, split-liver, and living related donor transplantations has partially palliated this situation. There is a group of low-weight pediatric patients who cannot benefit from these procedures, either because the left lateral segment of a cadaver donor is too big for the recipient's abdomen or because this segment taken from a living donor was, until recently, the maximum reduction that could be achieved. Living related donors are frequently ruled out because the sizes of segments II and III exceed the recipient's abdominal capacity. Under these circumstances, implantation of a single segment can save the life of infant patients. This report discusses the use of pediatric monosegmental transplantation using a liver segment resected in situ from a living related donor. Materials and Methods Case PresentationsPatient 1 is an 8-month-old girl, weighing 7.25 kg, with biliary atresia who underwent transplantation from a living related donor in March 1997. The donor mother was 26 years old and weighed 64 kg.Patient 2 is an 11-month-old girl, weighing 7 kg, with a history of Kasai-type portal enterostomy at the age of 3 months caused by biliary atresia who underwent transplantation from a living related donor in April 1998. The donor father was 28 years old and weighed 56 kg. Surgical ProcedureDonor surgery. Abdominal approach by bilateral subcostal incision was used. The falciform and left triangular ligaments were sectioned, as well as the pars flaccida and condensa of the gastrohepatic omentum. After dissecting the portal vascular pedicle and the left hepatic vein, intraoperative ultrasound was used to confirm the distribution of these structures in the left lateral segment. Once the portal structures (hepatic artery, portal vein, and bile duct) and the left hepatic vein were isolated, the liver parenchyma was excised well to the right of the attachment of the falciform ligament (Fig. 1). The portal pedicle was identified with ultrasound guidance within the left lateral segment, and the parenchyma was sectioned caudal to the portal path (F...
Occlusive complications after a laparoscopic Roux-in Y gastric bypass (LRYGB), appear mainly as fibrous membranes of wounds, internal hernias or intussusception. Intussusception after a bariatric surgery occurs in 0.1–0.3% of the cases. We present a case of intussusception in a pregnant patient after a LRYGB.
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