A Case Report of Intussusception After Gastric Bypass.

Intussusception is a rare cause of late complication after gastric bypass. We report the case of a 53-year-old woman having a gastric bypass in 2011. The patient presented to the emergency department with abdominal pain and vomiting. The diagnosis of intussusception was made by CT scan. Laparoscopy found an invaginated intestinal segment at the level of the jejuno-jejunal anastomosis without necrosis. Adhesiolysis and revision of the anastomosis were performed. The post-operative course was favorable. The diagnosis of intussusception was made by CT scan.

Pneumoscrotum, pneumomediastinum, pneumothorax, and pneumorrhachis following colon surgery.

We report the case of an 80-year-old man who developed a colocutaneous fistula as a complication of anastomotic leakage following segmental colonic resection. The patient presented with an abscess of the abdominal wall, subcutaneous emphysema, pneumomediastinum, pneumothorax, pneumorrhachis, and pneumoscrotum. We discuss the possible mechanisms for these unusual clinical presentations of extraperitoneal air following anastomotic leak.

Role of laparoscopy in the management of visceral injuries following abdominal stab wounds.

BACKGROUND: Laparoscopy offers several advantages in the treatment of abdominal stab wounds. In this paper, we report our experience during 2004, where hemodynamically stable patients with stab wounds were managed laparoscopically. PATIENTS AND METHODS: Between January and December 2004, 8 hemodynamically stable patients (7 men, 1 woman) underwent laparoscopy for anterior abdominal stab wounds. Median age was 28.5 years (range, 17-55). All patients underwent an abdominal computed tomography (CT) prior to the laparoscopy. RESULTS: Exploration of the wound under aseptic conditions, carried out as a part of the physical examination, confirmed peritoneal penetration in 7 of the 8 cases. Abdominal CT revealed positive findings in 7 (87.5%) cases. Laparoscopy was performed after a median time of 60 minutes (range 30-90). Laparoscopic exploration evidenced peritoneal penetration in 100% of the cases and visceral lesions in 87.5% of the cases. All visceral injuries were managed laparoscopically. Median operative time was 135 minutes (range, 45-200). Operative mortality was 0% and early morbidity was 12.5%. Median hospital stay was 5 days (range, 1-11). After a median follow-up of 12 months (range, 1-28), 1 patient complained of persistent chest pain and a ventral hernia at the site of the abdominal stab wound was diagnosed in another patient. CONCLUSIONS: Laparoscopy should be included in management algorithms in patients with anterior abdominal stab wounds who are hemodynamically stable. In addition to its diagnostic ability, this study demonstrates that laparoscopy can be an effective management modality with minimal morbidity and no mortality.

Accuracy of MDCT in predicting site of gastrointestinal tract perforation.

OBJECTIVE: The purpose of this study was to prospectively evaluate the accuracy of MDCT for preoperative determination of the site of surgically proven gastrointestinal tract perforations and to determine the most predictive findings in this diagnosis. SUBJECTS AND METHODS: We prospectively studied 85 consecutive patients with extraluminal air on MDCT who had surgically proven gastrointestinal tract perforations. All patients underwent surgery within 12 hours after MDCT was performed. Two experienced radiologists, blinded to the surgical diagnosis, reached a consensus prediction of the site of the perforation using the following eight MDCT findings: concentration of extraluminal air bubbles adjacent to the bowel wall, free air in supramesocolic or inframesocolic compartments, extraluminal air in both abdomen and pelvis, focal defect in the bowel wall, segmental bowel-wall thickening, perivisceral fat stranding, abscess, and extraluminal fluid. MDCT imaging results were compared with surgical and pathologic findings. Logistic regression analyses were performed to assess the significance of the different radiologic criteria. RESULTS: Analysis of MDCT images was predictive of the site of gastrointestinal tract perforation in 73 (86%) of 85 patients. Logistic regression showed that concentration of extraluminal air bubbles (p < 0.001), segmental bowel wall thickening (p < 0.001), and focal defect of the bowel wall (p = 0.007) were strong predictors of the site of bowel perforation. CONCLUSION: MDCT is highly accurate for predicting the site of gastrointestinal tract perforations. Three of eight CT findings significantly correlate with surgical diagnosis.

Intragastric band erosion after laparoscopic adjustable gastric banding for morbid obesity: imaging characteristics of an underreported complication.

OBJECTIVE: Our purpose was to describe the imaging findings of intragastric band erosion, an underreported complication after laparoscopic adjustable gastric banding for the treatment of morbid obesity. In this long-term complication, the gastric band fastened around the upper stomach to create a small proximal gastric pouch gradually erodes into the stomach wall and can extend into the gastric lumen. We present three cases of patients with band erosion in whom findings on an upper gastrointestinal series and CT established the diagnosis. CONCLUSION: Diagnosis of intragastric band erosion after gastric banding is usually made with endoscopy. However, the radiologic appearance of band erosion when visualized on an upper gastrointestinal series is pathognomonic and allows initial imaging diagnosis. In patients with extraluminal air or prosthesis infection, CT findings also are suggestive of this postoperative complication.

Intrathoracic migration of the wrap after laparoscopic Nissen fundoplication: radiologic evaluation.

OBJECTIVE: The purpose of our study was to evaluate the different types of postoperative herniation of the wrap into the thorax after laparoscopic Nissen fundoplication, to propose a clear radiologic definition, and to establish their respective frequencies. SUBJECTS AND METHODS: Two hundred twenty-six consecutive patients who underwent laparoscopic Nissen fundoplication were studied prospectively. All patients underwent an upper gastrointestinal series before surgery and on the first postoperative day. Radiologic follow-up performed yearly after surgery in 148 patients (65%) consisted of a double-contrast upper gastrointestinal series. Intrathoracic migration of the wrap was diagnosed on radiography when the intact fundoplication wrap herniated partially or entirely through the esophageal hiatus of the diaphragm. The kappa statistic was used to assess interobserver agreement. RESULTS: Of the 148 upper gastrointestinal series, 44 intrathoracic migrations (30%) were diagnosed. These examinations were reviewed and allowed us to differentiate two types of migrations. Type I (31 patients) consists of a paraesophageal hernia of a portion of the wrap through the esophageal hiatus with the esogastric junction remaining below the diaphragm. Type II (13 patients) is diagnosed when the entire fundoplication herniates through the hiatus with the gastroesophageal junction located at or above the level of the diaphragm. CONCLUSION: Intrathoracic migration is an important complication of laparoscopic Nissen fundoplication. Most migrations are small and asymptomatic. We propose a simple and reproducible radiologic definition of two different types of intrathoracic migration of the wrap observed after laparoscopic Nissen fundoplication.