A 52-Year-Old Woman with Abdominal Pain and Vomiting.

A 52-Year-Old Woman with Abdominal Pain and VomitingA 52-year-old woman presented for evaluation of abdominal pain, nausea, and vomiting after consuming a large calzone. How do you approach the evaluation, and what is the diagnosis?

Pulmonary Hypertension and Transbronchial Lung Biopsy: Does It Increase the Risk of Hemorrhage?

Background Bronchoscopy with transbronchial lung biopsy (TBLB) is commonly used as a diagnostic tool for pulmonary disease. Hemorrhage is a major complication of TBLB. While pulmonary hypertension (PH) is considered a risk factor, evidence supporting this is limited. In this study, we compare complications of TBLB in patients with PH to those without PH. Material and methods We performed a retrospective review of patients who underwent TBLB in our institution from January 2010 to May 2016. PH and non-PH groups were compared with respect to patient demographics, biopsy guidance, number of lobes biopsied (single or multiple), positive pressure ventilation, pre- and post-procedure diagnoses, and complications. Complications were defined as major hemorrhage, prolonged intubation, and reintubation within 72 hours from TBLB. Results The PH group had 45 patients with a mean age of 71 ± 14 years, and the non-PH group had 349 patients with a mean age of 63 ± 14 years. There were no significant differences with regards to gender, pre-procedure anticoagulation and antiplatelet agents, biopsy guidance, or number of lobes biopsied (p > 0.371). There was no significant difference in the occurrence of major hemorrhage between the two groups (p = 0.491). Prolonged intubation occurred more frequently in the PH group (p = 0.007). Conclusions There appears to be no increased risk of post-procedure hemorrhage with TBLB in patients with mild PH. There is, however, an increased risk of post-procedure prolonged intubation in these patients.

Venous thromboembolism after laparoscopic or robotic biliopancreatic diversion with duodenal switch. Ninety-days outcome of a 10 years' experience.

BACKGROUND: Venous thromboembolism (VTE) is a feared complication after bariatric surgery. Biliopancreatic diversion with duodenal switch (BPD-DS) is a complex bariatric procedure that is offered typically to super morbidly obese patients. Scarce data exist in reporting VTE outcome and identifying the risk factors associated with it after BPD-DS. OBJECTIVE: To determine the risk factors for VTE after BPD-DS at 90-day follow-up. SETTING: A nonprofit regional referral center and teaching hospital in Pennsylvania. METHODS: A retrospective chart review was performed on prospectively collected data over 10 years, between January 1, 2006 and December 31, 2016. Patients who underwent laparoscopic or robotic BPD-DS were included. Preoperative variables, selected risk factors, and methods of VTE prophylaxis were analyzed. RESULTS: A total of 662 patients who underwent BPD-DS were identified. The mean age was 44.7 ± 10.4 (20-72) years; 474 patients were female (71.7%), and the mean body mass index of the cohort was 50.5 ± 7.5 (34-98) kg/m2. Overall, 16 patients (2.4%) experienced VTE complication at 90-days follow-up post-BPD-DS with 100% follow-up rate; deep vein thrombosis was experienced by 10 patients (1.5%), and 6 patients (0.9%) experienced pulmonary embolism (1 patient experience both). None of those patients had a previous history of VTE. Only operative time (P value = .009) and length of stay (P value ≤ .001) were associated with VTE events. Other factors such as age, sex, body mass index, previous history of VTE, preoperative heparin injection, preoperative inferior vena cava filter insertion, intermittent compressive device use, interval heparin time, and postoperative chemical prophylaxis did not show a statistical association. A logistic regression analysis showed a statistically significant increase of VTE outcome with length of stay; odds ratio of 1.161, (95% confidence interval, 1.048-1.285), P value = .004. CONCLUSION: With proper preoperative evaluation and aggressive VTE prophylaxis protocol, the risk of VTE post-BPD-DS is comparable to other bariatric procedures. Every effort should be adopted to shorten the length of stay, and thus reduce VTE risk.