ABSTRACT
INTRODUCTION AND IMPORTANCE: We present a case of Congenital fibular dimelia or fibula duplication with tibial hypoplasia, talar duplication and diplopodia with two complete pre-axial rays. This association has not been published in the literature to our knowledge. We discuss the unique features and surgical management of this rare condition. CASE PRESENTATION: The patient is a 3 year old child with congenital unilateral fibular dimelia, tibial hypoplasia, talar duplication and diplopodia who presented to us with leg length discrepancy and progressive equinovarus deformation of the right foot and ankle. She was surgically treated by excision of the medial two rays, cuneiforms, navicular, duplicate talus, os calcis and medial accessory fibula with reconstruction of the ankle joint capsule and foot reconstruction. DISCUSSION: Due to the rarity of the condition there is no described treatment protocol. It was decided to do resection taking in consideration of the disabling and unsightly progressive deformity. CONCLUSION: The case presented is a very rare of type of duplication deformity which we believe to be unique. The surgical treatment has been performed due to progressive deformity based on principles of management. Future follow up to observe growth and development of the lower limb joints, especially the ankle, as well as treatment for leg length equalization will be required.
ABSTRACT
Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic procedure with many studied complications. We are presenting a rare complication of ERCP in choledocholithiasis: gallstone dislodging into the airway upon retrieval. The patient is a 37-year-old female admitted with obstructive jaundice. She was evaluated, and her management plan included a referral for an ERCP to extract the impacted common bile duct stones. Upon retrieval of the gallstone, it fell out the basket and lodged into the airway which was confirmed on bronchoscopy and successfully retrieved. This report describes successful management of a rare but potentially dangerous complication of ERCP to remove impacted CBD stones. The possible complications of delayed removal or inability to remove gallstones from the airway have yet to be studied and reported but are likely to include recurrent chest infections, bronchiectasis, and empyema of the lung.
ABSTRACT
BACKGROUND: Internal hernia rate after Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is variable (0.5%-9%). METHODS: We retrospectively reviewed all patients who underwent diagnostic laparoscopy for possible internal hernia after RYGB from 2009 to 2016. All internal hernia defects were closed. RESULTS: We performed 574 RYGB cases between 2013 and 2016, 33 diagnostic laparoscopies were performed (6 after RYGB done at our institution & 27 after RYGB done at outside institutions). Diagnostic laparoscopies after RYGB done at our institution showed internal hernia in 3/6 (50%), none at Petersen space, none had incarcerated small bowel or were converted to open. While 20/27 (74%) of diagnostic laparoscopies after RYGB done at outside institutions had an internal hernia, 18/20 (90%) at Petersen space, 15/27 (55%) had incarcerated small bowel and 3.7% needed small bowel resection or were converted to open. Our internal hernia rate after RYGB was 0.5%. Computerized Tomography (CT scan) was falsely negative in 44-50% of patients with laparoscopy after RYGB. CONCLUSION: Diagnostic laparoscopy is more accurate than CT scan in evaluating patients with abdominal pain after RYGB.
