Adjustable gastric banding (AGB) was a previously popular bariatric procedure, but adverse events such as erosion have surfaced as common complications. We present an interesting case of an AGB causing biliary obstruction after eroding into the stomach.
Small Bowel Volvulus (SBV) is an uncommon cause of Small Bowel Obstruction (SBO), which can be difficult to diagnose. However, it is very important to recognise and intervene in a timely manner due to the high risk of bowel ischemia. Unfortunately, SBV does not always have clinical features that differentiate it from other causes of mechanical obstruction. The most reliable investigation appears to be Computed Topography (CT) scan with around 50% of patients displaying the classic 'whirl' sign on CT. However, many remain undifferentiated SBO patients. Any of these patients who have any clinical or radiological suspicion of bowel ischemia, should be considered for surgery, as delays in diagnosis of bowel ischemia are associated with an increased risk of morbidity and mortality. In this case reported, author detailed a 55year female who presented with SBV had a CT scan which showed the classic 'whirl' sign and thus had timely surgical intervention and an uncomplicated recovery. Her history was significant for a subtotal colectomy, and a Rouxeny gastric bypass. This case highlights the importance of early recognition of SBV and also carries a reminder to consider rare causes of abdominal pain in patients who have had previous bariatric surgery. They have altered anatomy and thus are at increased risk of internal hernia and volvulus including SBV.
Appendicitis typically presents with right sided pain, but some patients present with left sided symptoms. This is most commonly due to anatomical abnormalities such as intestinal malrotation or Situs Inversus. In this case study I present a case where an anatomically normal patient presented with Left Upper Quadrant (LUQ) pain. I hypothesize that the reason for this is incorrect interpretation of visceral nociceptive afferents by the Central Nervous System (CNS). I review the literature in regard to the "visceral homunculus." I also review the literature with regards to left sided abdomical pain and Appendicitis. This case highlights the importance of considering Appendicitis in LUQ pain.
Complications arising from revision bariatric surgery can be complex due to altered anatomy. This is especially the case in a bariatric patient who becomes pregnant. I present an interesting case of a female patient who suffered a gastric volvulus during pregnancy after having had revision gastric bypass surgery 3 years prior, secondary to an internal hernia. This case highlights that revision bariatric surgery attracts a higher rate of complication, both preoperatively and long term, as well as highlighting the need for a high degree of suspicion for rare causes of abdominal pain in patients post bariatric surgery. Pregnancy is also an added risk factor for these patients.
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