We report 3 cases of spontaneous rupture of pancreaticoduodenal arteries (PDA). In the first case, an aneurysm of the PDA was demonstrated with stenosis of the celiac trunk; in the second case occlusion of the hepatic artery was shown. In both cases, arterial pancreatic arcades were enlarged and blood flow was retrograde from the superior mesenteric artery. Local high intravascular pressure due to retrograde blood flow through the arterial pancreatic arcades was thought to be the cause of aneurysm development and arterial rupture which necessitated surgical intervention. The third patient presented with a mycotic aneurysm that could be treated by intra-arterial embolization. The characteristics of this rare affliction are discussed, as is the treatment which first entails percutaneous embolization.

No abstract

Duodenal diverticula are relatively common and usually asymptomatic (95%). Their perforation is a rare but harmful event. Traumatic perforation is exceptional. We report the case of a patient with such a lesion following a blunt trauma secondary to a car accident, and review the literature. Clinical presentation is aspecific and diagnosis is based upon CT scan imaging. Surgery is the recommended treatment consisting of diverticulectomy with transverse duodenal closure of the duodenum associated with retroperitoneal drainage.

Intramesh T1 is a safe and effective composite mesh with favourable short and midterm outcome and morbidity. (NCT01816867).

The aim of this study was to match the type of fundoplication and preoperative low esophageal sphincter (LES) pressure values. A posterior 180° fundoplication (180° FP) was performed when LES pressure was above 10 cm H₂0, and a 270° FP when it was below 10 cm H₂0. Among the 45 patients included in this study, 38 underwent a 270° FP and 7 a 180° FP. In patients with 270° FP, the median pre- and postoperative Kaye scores were 263.1 ± 130.6 and 1.8 ± 6.8, respectively; pre- and postoperative LES pressure values were 4.2 ± 2.9 and 24.5 ± 14.7 cm H₂0, respectively. In patients with 180° FP, the median pre- and postoperative Kaye scores were 265.1 ± 89 ± 4 and 3.3 ± 7.6, respectively; pre- and postoperative LES pressure were 13.6 ± 2.1 and 20.4 ± 6 cm H₂0, respectively. LES pressure could be the deciding factor in selecting the type of fundoplication, with which functional and pH-metric normalization could be achieved after surgery.

We describe a rare complication of Laparoscopic Nissen Fundoplication in the presence of a Gastric greater curvature Plication (LNFGP). An overweight 64-year-old woman was admitted for severe abdominal pain, dysphagia and fever 2 weeks after a Nissen fundoplication. She had pneumoperitoneum on scanner. At laparoscopy, we found a generalized peritonitis secondary to a perforated Nissen wrap in the presence of a gastric greater curvature plication. Gastric bypass and sleeve gastrectomy can be irrelevant in case of moderately and severely obese patients with gastroesophageal reflux disease. Four studies have investigated the risks and rewards of the LNFGP as an alternative. Only one case of leakage has been reported. We present another severe complication: the pylorus stenosis caused by a plication performed too close to the pylorus, causing gastric dilatation in the presence of the wrap, leading to wrap perforation.

The case of a 37-year-old man in whom a massive hemoperitoneum developed a few hours after running is described. The patient disclaimed any trauma and clearly noted that symptoms appeared after running. Findings at laparoscopy showed that the bleeding was caused by the rupture of adhesions between the omentum and left inguinal abdominal wall. These adhesions, which had resulted from a previous laparoscopic transperitoneal bilateral inguinal hernia cure, were resected. Recovery was simple and follow-up assessment was uneventful. Hemoperitoneum secondary to the rupture of intraperitoneal adhesions is very rare in the absence of precipitating trauma. However, the trauma can be trivial. Rupture of intra-abdominal adhesions has been described after sexual intercourse or mobilization of the patient under general anesthesia. Disruption of adhesions by insufflation or mobilization of organs under laparoscopy also is reported. The transperitoneal approach to laparoscopic treatment of inguinal hernia can be responsible for late intestinal obstruction caused by intra-abdominal adhesions, but late hemorrhagic complication has not yet been reported.