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1.
Obes Surg ; 33(6): 1955-1956, 2023 06.
Artículo en Inglés | MEDLINE | ID: covidwho-2319400

RESUMEN

BACKGROUND: GERD and Achalasia are two known complications after sleeve gastrectomy. Treatment towards each of these complications varies and requires a tailored approach. METHODS: We present a 55-year-old female with class II obesity and a previous history of sleeve gastrectomy who developed significant gastroesophageal reflux disease refractory to medical management. After a covid infection in fall of 2020, she began to report new symptoms of dysphagia that progressed from solids to liquids. She underwent extensive workup including upper endoscopy, upper GI barium swallow, manometry, pH impedence, and EndoFlip leading to a diagnosis of Achalasia type II as well as a paraesophageal hernia. RESULTS: Given these findings, she underwent a combined paraesophageal hernia repair with conversion of sleeve gastrectomy to Roux-en-Y gastric diversion and an intra-operative peroral endoscopic myotomy. Intraoperatively, she was noted to have significant lower abdominal adhesions leading to performing the Roux-en-Y reconstruction through a supramesocolic defect in a retrocolic fashion. CONCLUSIONS: While the development of heartburn and achalasia after sleeve gastrectomy is rare, it requires interventions dedicated towards each etiology. This case demonstrates treatment of both these symptoms is feasible in a single operation.


Asunto(s)
COVID-19 , Acalasia del Esófago , Derivación Gástrica , Reflujo Gastroesofágico , Hernia Hiatal , Laparoscopía , Miotomía , Obesidad Mórbida , Femenino , Humanos , Persona de Mediana Edad , Derivación Gástrica/efectos adversos , Hernia Hiatal/cirugía , Hernia Hiatal/complicaciones , Obesidad Mórbida/cirugía , Acalasia del Esófago/cirugía , Acalasia del Esófago/complicaciones , Laparoscopía/efectos adversos , Reflujo Gastroesofágico/etiología , Gastrectomía/efectos adversos , Miotomía/efectos adversos , Estudios Retrospectivos
2.
BMJ Case Rep ; 14(11)2021 Nov 12.
Artículo en Inglés | MEDLINE | ID: covidwho-1515265

RESUMEN

Acute oesophageal necrosis, black oesophagus (BE) or Gurvits syndrome (GS) is a rare form of severe oesophagitis appearing as a striking circumferential discolouration of distal mucosa with various proximal extensions abruptly terminating at the gastro-oesophageal junction. It is most commonly associated with acute exacerbations of medical comorbidities, while associations with altered gut anatomy are rare. We present a unique constellation of BE, Cameron ulcers (CU), and gastric volvulus from a large paraesophageal hiatal hernia. Our patient recently recovered from COVID-19 and was malnourished and frail, while the expanding paraesophageal hiatal hernia turned into an acute organoaxial gastric volvulus with accompanying outlet obstruction. In low-flow post-COVID coagulopathic states, compensatory mechanisms may lack against gastric stunning and sudden massive reflux on the oesophagus. We additionally performed a systematic review and discovered additional cases with coexistent volvulus and paraesophageal hernia, although there are no previous reports of BE with CU, which makes this study the first.


Asunto(s)
COVID-19 , Esofagitis Péptica , Hernia Hiatal , Vólvulo Gástrico , Unión Esofagogástrica , Hernia Hiatal/complicaciones , Hernia Hiatal/diagnóstico por imagen , Humanos , SARS-CoV-2 , Vólvulo Gástrico/complicaciones , Vólvulo Gástrico/diagnóstico por imagen , Vólvulo Gástrico/cirugía
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