The use of staple line buttress may be associated with shorter hospital stay in RYGB patients. However, buttress use also associates with higher hospital cost in our analysis cohort.
mL). Left heart catheterization showed non-obstructive coronary artery disease. Right heart catheterization showed elevated pulmonary artery pressures and filling pressures with cardiac index of 1.28. He was started on dobutamine infusion. His deranged LFT and liver failure was related to hypoperfusion of liver. His necrotic toes were thought to be secondary to decreased peripheral perfusion and redistribution to vital organs in the setting of acute heart failure after normal arteries were visualized in computed tomography angiography of chest/abdomen/pelvis and Doppler ultrasound of legs. Discussion: Diagnosis should be suspected in patients with bluish discoloration of extremities and elevated lactate levels. Various infective and noninfective factors are responsible for development of SPG. Among them, cardiac conditions like myocardial infarction, myocardial infarction with coronary artery bypass graft and ventricular septal defect repair, ball-valve thrombus with mitral stenosis, paroxysmal ventricular tachycardia, ventricular pseudoaneurysm and severe heart failure have been associated with SPG. Conclusion: SPG is associated with significant mortality and morbidity with an alarmingly high rate of amputation in survivors. Awareness of this condition and association with low flow state can help diagnose this condition early with prompt treatment for early recovery.
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