No abstract

Patient: Female, 32Final Diagnosis: Gastro bronichial fistulaSymptoms: DyspneaMedication: —Clinical Procedure: —Specialty: SurgeryObjective:Unusual clinical courseBackground:Bariatric operations have been gaining more ground over the past decade. The most commonly used bariatric operation is the laparoscopic sleeve gastrectomy. A complication of laparoscopic sleeve gastrectomy is gastric leak; which can rarely cause a primary subphrenic abscess and a secondary diaphragm rupture that will lead eventually to a gastrobronchial fistula.Case Report:We present the case of a 32-year-old patient who started having symptoms suggestive of gastrobronchial fistula at 2 months following laparoscopic sleeve gastrectomy.Conclusions:The treatment of a gastrobronchial fistula is controversial as this complication is rarely covered in published studies. Our expert opinion for this patient case was to opt for a surgical approach seeing that the complexity and severity of the fistula had a low chance of subsiding after only conservative measures.

Patient: Male, 27Final Diagnosis: AppendicitisSymptoms: Abdominal discomfortMedication: —Clinical Procedure: —Specialty: SurgeryObjective:Rare diseaseBackground:Left-sided acute appendicitis, although well described in the literature, is still an easily missed diagnosis. Midgut malrotation and situs inversus are 2 known leading conditions that contribute to misdiagnosis of appendicitis.Case Report:Here is the case of a 27-year-old male without any previous medical history, who presented with left lower quadrant tenderness and was misdiagnosed with gastroenteritis as an outpatient and sent home; the patient presented the next day to the emergency department where he was found to have acute appendicitis with situs inversus. He underwent laparoscopic appendectomy where a phlegmon was identified. Pathology came back as peri-appendiceal mucocele with no signs of malignancy.Conclusions:This case report aimed to revisit the idea of left-sided acute appendicitis and discuss the management of a perforated appendiceal mucocele contained by a phlegmon.

Patient: Male, 30Final Diagnosis: Duodenal obstruction caused by a looped appendix due to intestinal malrotationSymptoms: Post postprandial vomitingMedication: —Clinical Procedure: Improved after unwinding of the looped appendix and subsequent appendectomySpecialty: SurgeryObjective:Congenital defects/diseasesBackground:Bowel obstruction is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Intestinal malrotation is one of the rarest causes of mechanical bowel obstruction. In adults, the incidence rate is 0.2%, and 15% of all patients with confirmed diagnosis remain asymptomatic throughout life. Surgery is generally required when the patient is symptomatic.Case Report:A 30-year-old man with multiple admissions for chronic intermittent colicky abdominal pain since childhood, was admitted for symptoms suggestive of proximal small bowel obstruction. Tomographic imaging identified a midgut malrotation and a duodenal obstruction by a non-diseased displaced appendix. Laparoscopic liberation of the duodenum and the terminal ilium was done successfully.Conclusions:Intestinal malrotation is infrequently encountered in the adult population, but it should be kept in mind as a differential diagnosis whenever a case of acute intestinal obstruction in an adult presents without any significant past surgical history.

IntroductionLaparoscopic sleeve gastrectomy (LSG) has become one of the most commonly performed weight loss procedures due to its simpler technique and lower complication rate as compared to the Roux-en-Y gastric bypass and duodenal switch. However, weight regain is seen in patients with a large gastric fundus. In these cases, a revision laparoscopic sleeve gastrectomy (reLSG) aiming at resecting the excess pouch is a promising option for correction.MethodsFrom April 2013 to March 2016, six patients underwent a reLSG for a failure of weight loss after the demonstration of a large gastric fundus on the upper gastrointestinal (UGI) series.ResultsOne patient out of six (16.7%) suffered from a gastric leak and was lost to subsequent follow-up. The rest (83.3%) had a smooth recovery and were followed up for a mean of 18 months. Mean excess weight loss (EWL) was 68%, with a minimum of 48% and a maximum of 75%.ConclusionreLSG is a promising option for failed weight loss after LSG in patients who demonstrate the presence of a large gastric pouch. It carries a higher complication rate than the initial procedure. Further trials and meta-analyses are needed to prove the efficacy of this procedure.