Percutaneous gastric remnant gastrostomy following Roux-en-Y gastric bypass surgery: a single tertiary center's 13-year experience.

PURPOSE: The purpose of the study is to evaluate the indications, techniques, and outcomes for percutaneous gastrostomy placement in the gastric remnant following Roux-en-Y gastric bypass (RYGB) in bariatric patients. MATERIALS AND METHODS: Retrospective chart review and summary statistical analysis was performed on all RYGB patients that underwent attempted percutaneous remnant gastrostomy placement at our institution between April 2003 and November 2016. RESULTS: A total of 38 patients post-RYGB who underwent gastric remnant gastrostomy placement were identified, 32 women and 6 men, in which a total of 41 procedures were attempted. Technical success was achieved in 39 of the 41 cases (95%). Indications for the procedure were delayed gastric remnant emptying/biliopancreatic limb obstruction (n = 8), malnutrition related to RYGB (n = 17), nutritional support for conditions unrelated to RYGB (n = 15), and access for endoscopic retrograde cholangiopancreatography (ERCP, n = 1). Insufflation of the gastric remnant was performed via a clear window (n = 35), transhepatic (n = 5), and transjejunal (n = 1) routes. Five complications were encountered. The four major complications (9.8%) included early tube dislodgement with peritonitis, early tube dislodgement requiring repeat intervention, intractable pain, and upper gastrointestinal bleeding. A single minor complication occurred (2.4%), cellulitis. CONCLUSION: Patients with a history of RYGB present a technical challenge for excluded gastric remnant gastrostomy placement. As the RYGB population increases and ages, obtaining and maintaining access to the gastric remnant is likely to become an important part of interventional radiology's role in the management of the bariatric patient.

Temporal neocortical origin of pilomotor seizures in association with an infiltrating glioma: a case confirmed by intracranial electroencephalography monitoring.

Patients with seizures occasionally present with autonomic symptoms. Pilomotor seizures are uncommon and usually accompanied by other manifestations of complex partial seizures of limbic origin. Activation of the central autonomic network appears to be necessary for the development of ictal goose bumps. Pilomotor seizures have been reported to originate in the temporal lobe and other medial limbic structures. Ictal piloerection can arise due to a variety of brain pathologies. Isolated pilomotor seizures are very rare. The authors present the first case in which intracranial electroencephalography monitoring was used to confirm pilomotor seizures of temporal neocortical origin in association with an infiltrating tumor.