Perforation of a duodenal ulcer (DU) into the retroperitoneal space presenting with clinical features of acute appendicitis is known as Valentino's syndrome. Post duodenal perforation, the gastric and duodenal fluids tend to settle in the right paracolic gutter causing peritonitis and clinically mimicking acute appendicitis. Only three cases of Valentino's syndrome have been reported till date in the published literature and there is only one previous report of its preoperative imaging diagnosis. To our knowledge, this is the first reported case of preoperative imaging diagnosis in a surgically confirmed case of Valentino's syndrome. In most cases, patients with undiagnosed Valentino's syndrome are operated for acute appendicitis, and on finding a normal appendix, search is made for the cause of peritonitis, which then leads to retroperitoneal perforation of duodenum. The diagnosis of Valentino's syndrome by computed tomography (CT) imaging is easy and can help in avoiding the surgery or directing the surgeon directly to the repair of the duodenal perforation. It is, therefore, essential for emergency physicians, surgeons, and radiologists to know about this entity and consider it in the differential diagnosis.
This retrospective study evaluated the effectiveness and safety of laparoscopic adjustable gastric banding as a means of treatment of morbid obesity in Qatar. Methods: Seventy-one patients (59 females; mean age 32 years, range 18 to 60) underwent laparoscopic adjust-able gastric banding for morbid obesity. Their mean weight was 134.6 Kg (range 90 to 200) and mean preoperative body mass index was 49.8 Kg/m2 (range 36.5 to 70). Results: All patients were followed-up for a mean du-ration of 8.6 months (average 1 to 27). The mean excess weight loss was 27% (range 0 to 84). The operation time showed a marked reduction with a mean duration of 149 minutes in the first ten cases reaching to a mean of 81 minutes in the last ten cases. The commonest early com-plication was chest infection seen in 3 patients (4.1%). Late complications were seen in 5 cases (6.9%) most commonly related to swallowing. One case developed band infection severe enough to necessitate removal of the band. There was no operative related mortality. Conclusion: Laparoscopic adjustable gastric banding is relatively an effective means for control of morbid obe-sity with a low rate of complications.
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