ABSTRACT
INTRODUCTION: Small bowel obstruction (SBO) is a common surgical emergency. Our report describes a case of a 61-year-old male who was found to have a PROLENE suture left in situ from a previous open appendectomy 22 years ago, over which a fibrous adhesive band had formed, resulting in a terminal ileal volvulus and subsequent SBO. CASE: A 61-year-old male presented with a 3-day history of severe lower abdominal cramps, nausea and constipation. A previous open appendectomy, performed 22 years ago, was the only significant detail in his medical history. A CT can with oral contrast was performed which showed dilatation of the terminal ileum and a complete absence of opacification of the cecum. Laparoscopy was then performed and a large adhesive band which formed over a suture from his previous open appendectomy was observed. On dissection of the adhesion, the bowel decompressed and returned to normal. Patient was discharged with no complications. DISCUSSION: This is quite a unique case due to the structure of the adhesive band that was formed and the resulting terminal ileal volvulus which is an uncommon occurrence. We could not find any similar reports in our search of the literature and believe our report is novel in this regard. CONCLUSION: We explored a novel etiology of adhesion formation over a foreign body left in situ and this should be considered by surgeons, especially when the clinical picture is uncommon such as a terminal ileal volvulus in this case.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Gastro-esophageal reflux disease (GERD) is frequently associated with obesity. Excess body weight, particularly central adiposity, with a concomitantly raised intra-abdominal pressure, leads to a reduced lower esophageal sphincter (LES) pressure and GERD. The lax LES essentially causes acid reflux in the lower esophagus. CASE PRESENTATION: We report a 44-year-old woman who presented to our surgical clinic with heartburn and acid reflux, associated with difficulty in weight management. The patient had a BMI of 35 kg/m2. The upper GI endoscopy showed a small hiatal hernia, with lax LES and grade A esophagitis. She was initially started on daily proton pump inhibitors (PPIs). All available management plans were discussed with the patient, and she did not prefer to continue with life-long PPIs. At the same time, the patient was also concerned about her weight and requested for a plausible weight management solution. CLINICAL DISCUSSION: The patient was planned for a single-stage Transoral Incisionless Fundoplication (TIF) and laparoscopic sleeve gastrectomy for her GERD and obesity, respectively. TIF was performed by two experienced endoscopists, one controlling the EsophyX device and the other ensuring continuous direct visualization of the field of work with the endoscope. Following the procedure, laparoscopic sleeve gastrectomy was performed during the same session. The patient had an uneventful recovery. CONCLUSION: Eight months after surgery, the patient reported resolution of her GERD symptoms and a weight loss of 20 kg.
