We present the case of a 43-year-old multiparous female patient presenting with post-coital haemoperitoneum secondary to a ruptured uterine fibroid. This is a rare case demonstrating the need to elicit full gynaecological history in patients presenting with an acute abdomen.
Laparoscopic gastric bypass is becoming a frequently performed bariatric operation for patients with obesity. However, bariatric surgery has inherent risks and complications, which are further potentiated by the high risk nature of bariatric patients. These complications can be either site specific i.e. anastomotic leaks, or systemic i.e. venous thromboembolism, however they can intimately related. We present the case of one patient undergoing routine gastric bypass complicated postoperatively by recurrent intra-abdominal collections and sepsis, and aortic thrombosis with distal embolisation.
A sixty-one year old man was referred with a history of progressive dysphagia, vomiting and weight loss with some back pain. Upper gastrointestinal endoscopy and biopsies revealed a gastro-oesophageal junction adenocarcinoma. Despite the absence of metastatic disease on computed tomography, positron emission tomography demonstrated multiple vertebral and sternal deposits. He was reviewed in an ENT clinic with a sudden onset of hearing loss accompanied by dizziness, but no focal neurology. Magnetic resonance imaging identified bilateral 2cm lesions at the internal auditory meatus, consistent with a diagnosis of bilateral acoustic neuromas. The patient subsequently died of carcinomatosis and, because of the potential familial significance of bilateral acoustic neuromas, a limited post-mortem examination was carried out. Unexpectedly, this revealed bilateral adenocarcinoma metastases infiltrating the internal auditory meatus affecting the acoustic nerves. The authors believe this a very rare presentation of metastatic gastric disease.
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