ABSTRACT
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common operations performed for morbid obesity. Some of the known surgical complications include anastomotic leaks and small bowel obstructions due to internal hernias. Diaphragmatic hernias are common in the general population, and repair of symptomatic hernias is generally recommended. Diaphragmatic hernia after a prior LRYGB is markedly less common. Diaphragmatic hernias can occur via a hiatal defect or rarely a parahiatal defect that is found lateral to the hiatus. We present two cases of incarcerated diaphragmatic hernias after a LRYGB with vastly different presentations. The first patient presented with a giant defect containing incarcerated jejunum after a prior LRYGB. The second patient presented with a parahiatal defect with an incarcerated remnant stomach. The first patient was successfully managed laparoscopically by reinforcing the defect with a mesh after defect closure. The second patient required an open operation due to the inability to reduce the tightly incarcerated stomach and defect approximated with sutures without the need for mesh reinforcement. Both patients did well postoperatively and remain symptom-free.
ABSTRACT
Benign multicystic peritoneal mesothelioma (BMPM) is a rare neoplasm of the abdominal mesothelium (i.e., peritoneum, mesentery, and omentum). We present the case of a 74-year-old male who presented with a right paracolic gutter fluid collection and cystic mass. The patient underwent diagnostic laparoscopy with resection of the mass. The final pathology revealed BMPM. The pathogenesis may have been related to longstanding diverticular disease, which could prove to be an underrecognized risk factor for the development of BMPM. Therefore, this case suggests a broadened differential diagnosis to include BMPM in specific cases of pre-operatively diagnosed colonic masses. The patient is disease-free 11 months post-operatively.
