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Late complications involving the site of the jejunojejunal (J-J) anastomosis are uncommon after laparoscopic Roux-en-Y gastric bypass. We present a case of a perforation at the J-J anastomosis complicated by the formation of an abscess 6 months after surgery. Following clinical and radiological evaluation, the patient underwent an exploratory laparoscopy which had to be converted to an open technique because of technical difficulties. The abscess was drained, the anastomosis was resected, and a new anastomosis was undertaken. When the surgical specimen was inspected, a perforation was found at the site of the previous J-J anastomosis. The patient had an uneventful recovery. To our knowledge, this is the first report of the formation of an abscess due to a perforation at the site of the J-J anastomosis after laparoscopic Roux-en-Y gastric bypass surgery. This complication, although rare, should be taken into account in patients with abdominal pain and systemic inflammatory response syndrome after bariatric surgery.
Traumatic diaphragmatic rupture represents a diagnostic challenge to any physician dealing with polytraumatized patients. This uncommon injury must be suspected in certain types of accidents, making knowledge of trauma mechanisms vital for its diagnosis. In this paper we present a case of traumatic diaphragmatic rupture with intrathoracic herniation of abdominal contents, which was surgically repaired. We also present a review of the clinical characteristics, diagnosis and treatment of this entity, emphasizing the importance of keeping a high index of suspicion in order to achieve a correct diagnosis.
A 44-year-old woman presented to our hospital after noticing an enlarging mass in her neck for the previous 2 months. She complained of pain, orthopnoea, stridor, hoarseness and weight loss. Physical examination revealed a solid mass with ill-defined borders and intrathoracic extension. Pulses were present in the right arm, but absent in the left arm and both legs. A chest X-ray and magnetic resonance imaging with angiography were ordered, revealing an intrathoracic mass arising from the thyroid gland ( Fig. 1). Fine needle aspiration of the mass showed an anaplastic thyroid carcinoma. The patient was discharged home with palliative measures, and she died a few days later.Anaplastic thyroid carcinoma is a rare and very aggressive tumour that accounts for 1-2% of all thyroid cancers. 1 It usually presents in women in the sixth or seventh decades of life and is characterized by a rapidly enlarging neck mass. Symptoms are related to the compression of adjacent structures and include dyspnoea, stridor, dysphagia and hoarseness. 2 Invasion of vascular structures is uncommon. Most patients have metastases at the time of diagnosis, with the most common sites being regional lymph nodes and the lungs. Treatment is highly unsatisfactory and mean survival after diagnosis ranges from 3 to 8 months. 3
References1 Smallridge RC, Marlow LA, Copland JA. Anaplastic thyroid cancer: molecular pathogenesis and emerging therapies.
Figure 1Chest X-ray (A) revealed a mass (arrow) that displaced the heart and trachea, with elevation of the left hemidiaphragm (arrowheads). Magnetic resonance imaging revealed a tumour arising from the thyroid gland with invasion of the mediastinum (C and D, arrows) and the left hemithorax (D, arrowhead). Magnetic resonance angiography showed an interruption of the left carotid artery (B, arrow) and the aortic arch (B, arrowhead).
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