Background. Complications at the gastrojejunal anastomosis after laparoscopic Roux-en-Y gastric bypass (LRYGB) are challenging in terms of diagnosis, therapy, and prevention. This study aims at identifying these complications and discussing their management. Methods. Data of 228 patients who underwent a LRYGB between October 2008 and December 2011 were reviewed retrospectively to evaluate the frequency and treatment of complications such as stenoses, marginal ulcers, perforated marginal ulcers, or anastomotic leaks related to the operation. Results. Follow-up information was available for 209 patients (91.7%) with a median follow-up of 38 months (range 24–62 months). Of these patients 16 patients (7.7%) experienced complications at the gastrojejunostomy. Four patients (1.9%) had stenoses and 12 patients (5.7%) marginal ulcers, one of them with perforation (0.5%). No anastomotic leaks were reported. One case with perforated ulcer and one with recurrent ulcers required surgical revision. Conclusion. Gastrojejunal anastomotic complications are frequent and occur within the first few days or up to several years after surgery. Stenoses or marginal ulcers are usually successfully treated nonoperatively. Laparoscopic repair, meanwhile, is an appropriate therapeutic option for perforated ulcers.

Harlequin syndrome is a rare autonomic disorder referring to the sudden development of flushing and sweating limited to one side of the face. Like Horner syndrome, associating miosis, ptosis, and anhidrosis, Harlequin syndrome is caused by disruption of the cervical sympathetic pathways. Authors of this report describe the case of a 55-year-old female who presented with both Harlequin sign and Horner syndrome immediately after anterior cervical discectomy (C6–7) with cage fusion and anterior spondylodesis. They discuss the pathophysiology underlying this striking phenomenon and the benign course of this condition. Familiarity with this unusual complication should be of particular interest for every specialist involved in cervical and thoracic surgery.

Eine 24-jährige Patientin stellt sich mit seit einem Tag bestehenden diffusen krampfartigen abdominalen Schmerzen, Appetitverlust, Nausea und Emesis sowie Diarrhö auf der Notfallstation vor. In der kör-perlichen Untersuchung können epigastrische Druckschmerzen ohne peritoneale Reizung erhoben werden. In der laborchemischen Untersuchung finden sich normwertige Leukozyten bei erhöhtem C-reaktives-Protein(CRP)-Wert (94,4 mg/l). Es war 28 Monate zuvor bei morbider Adipositas [initialer Body-Mass-Index (BMI) 41,5 kg/m 2 ] die Durchführung eines laparoskopischen antekolischen, antegastrischen Roux-en-Y-Magenbypass (RYGBP) mit anisoperistaltischer Seit-zu-Seit-Jejunojejunostomie erfolgt. Bisher war der Verlauf komplikationslos, und die Patientin hatte ihr Übergewicht um 95,1% reduziert (aktueller BMI 25,8 kg/m 2 ). ComputertomographieIn der kontrastmittelgestützten Computertomographie des Abdomens (Abdomen-CT) kann ein "target sign" im Bereich der nutritiven Schlinge nachgewiesen werden (. Abb. 1). Die Bezeichnung beruht darauf, dass bei der Einstülpung eines Dünndarmabschnitts in einen anderen, beim axialen Schnittbild beide konzentrischen Dünndarmwände in Form einer "Zielscheibe" dargestellt werden.

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Laparoscopic finding showing a tapeworm in the intestinal lumen during the creation of the jejuno-jejunal anastomosis.