Weight reduction after bariatric surgery - Do results correlate with postoperative visit frequency?

Background: Consistent follow up after a bariatric surgery is considered vital to adequate and sustained weight reduction. This study examined the strength to which compliance with postsurgical appointments predicted an increase in total body weight loss percent (TBWL%) and change in body mass index (BMI) in a cohort of Illinois based surgical center patients. Methods: Participants (n = 78) were patients with obesity who underwent bariatric surgery between 2019 and 2021. Patient preoperative weight and BMI, and postoperative weight and BMI at 3-month intervals for one year, and the number of visits were collected from chart review to calculate TBWL%, and change in BMI. Relationship between these factors and postoperative visit compliance were evaluated using linear regression to assess if it was a significant predictor of success. Results: Follow up visit compliance had a weak positive association with increased TBWL% (Model R2 = 0.134, B = 0.011, p = 0.004) and a minimally stronger association with increased change in BMI (Model R2 = 0.229, B = 0.015, p = 0.0001). Conclusions: Adherence with follow up visits was weakly related to improved weight reduction outcomes after bariatric surgery. Future investigations should consider how follow up visits can better influence a patient's success in sustaining achieved weight reduction.

Cutaneous Metastases in Progressive Prostate Adenocarcinoma: A Case Report and Literature Review.

Prostate cancer has an indolent progression course and commonly metastasizes to the vertebrae bone and regional lymph nodes. We report a patient with prostate cancer who has developed cutaneous metastases in multiple regions, including the right infraclavicular and abdominal area, as well as the left supraclavicular region. It presented as isolated, prominent nodules that were microscopically proven to be of prostate adenocarcinoma when biopsied. This rare presentation is a marker of an advanced disease course with a poor prognosis in castrate-resistant prostate cancer. Thorough clinical examination to rule out metastasis from the prostate and other dermatological conditions is paramount as well as ensuring early detection and optimizing patient outcomes.

Eight-Centimeter Gallbladder Stone Post-Roux-en-Y Gastric Bypass: A Case Report.

Cholelithiasis occurs when a stone forms in the gallbladder; when symptoms develop, the condition is termed symptomatic cholelithiasis. The correlation between bariatric surgery and post-operative symptomatic cholelithiasis has long been established. Presented is a case of a 56-year-old female status post-Roux-en-Y gastric bypass who developed symptomatic cholelithiasis and subsequently underwent cholecystectomy with the removal of an 8-centimeter (cm) gallbladder stone. This case report explores the benefits and limitations of watchful waiting versus prophylactic concomitant cholecystectomy among bariatric surgery patients, noting the difference between the bariatric sleeve and bypass anatomy for managing biliary complications.

Perforated Duodenal Ulcer Post-Roux-en-Y Gastric Bypass: A Case Report.

Obesity is a growing health concern worldwide, with bariatric surgeries such as gastric bypass providing an effective treatment choice. However, a rare complication of gastric bypass is a duodenal ulcer. Currently, there is no exact incidence of this complication, and only a few case reports have been published in the literature. Presented is a case of a 32-year-old patient, eight years status post gastric bypass, who was evaluated for surgical repair of a large anterior perforated duodenal ulcer. This case report explores the relationship between patient history and gastric bypass surgery in the case of duodenal ulcer formation and perforation, as well as the diagnostic difficulty and modalities for duodenal ulcers in post-gastric bypass patients.

Unresectable Mesenteric Mass Causing Small Bowel Obstruction.

Small bowel obstruction (SBO) has a variety of etiologies, including but not limited to adhesions, malignancy, hernia, and inflammatory bowel diseases. Treatment for SBO may be nonoperative or operative, depending on the underlying condition and clinical symptoms. Clinical judgment and radiological findings cooperate in formulating an appropriate assessment and treatment plan. Mass effect due to malignancy is an indication for surgical intervention, as tumor resection is a mainstay of treatment. However, patient safety and chances of vascular compromise must be considered when determining if the tumor is resectable. Reported is a case of a 65-year-old female with severe abdominal pain, nausea, vomiting, and obstipation due to a malignant neuroendocrine tumor within the mesentery adjacent to the aortic bifurcation. Management included surgical intervention to alleviate bowel obstruction and biopsy of the tumor.

Right Foot Trans Metatarsal Amputation Following COVID-19 Infection.

A 60-year-old male patient with a prior coronavirus disease 2019 (COVID-19) pneumonia diagnosis presented with a right foot ulcer. The ulcer progressed to osteomyelitis of his right fifth metatarsal with eventual amputation and resection of the affected digit. The infection recurred two months later and spread to the right fourth metatarsal and gangrene, leading to the amputation and partial metatarsal head resection of the fourth toe. A month later, the infection recurred for a second time and a decision to perform a right trans metatarsal amputation of the foot was evaluated to avoid further progression of the infection and the need for more invasive surgical intervention.

Atypical Small Bowel Obstruction Caused by Perforated Cecum: A Case Report.

Acute onset of abdominal pain with emesis and lack of stool or flatus is an alarming presentation for possible small bowel obstruction (SBO). SBO should be high on the differential diagnosis due to concomitant signs and symptoms that are highly sensitive in diagnosing SBO. These include diffuse tenderness on palpation of the abdomen, abdominal distention, hypotension, vomiting, and lack of flatus or stool. In this report, we present a 67-year-old African American male, who presented to the emergency department with the above-mentioned signs and symptoms and decreased oral intake for four days, ultimately undergoing surgical exploration to relieve the SBO caused by an idiopathic cecal perforation. This case report calls attention to the decision-making, standard protocol, and surgical intervention of a patient with SBO.

Intussusception in the Geriatric Population: A Case Report.

Recurrent abdominal pain in the adult population is a complex symptom with a broad spectrum of diagnoses. The diagnosis of intussusception in the elderly is considerably rarer than in the younger population. High clinical suspicion is required, and imaging is needed for confirmation. Here, we present and discuss the clinical course and management of an 82-year-old female who underwent small bowel resection following recurrent intussusception that was confirmed by imaging and at the time of surgery. The patient was known for having a history of polyps, and the pathology report described a large tubulovillous adenoma found on the resected small bowel specimen. The patient was discharged after surgery with complete remission. This case report intends to explore the importance of surgical intervention versus conservative management in a patient with a similar clinic presentation. This report also intends to highlight the importance of surgical intervention to prevent intussusception-related complications and reduce patient mortality further.

Management of Spontaneous and Pruritic Keloids: A Case Report.

Spontaneous chest wall keloid scars can occur without any history of trauma and are rare. Some keloids present with intense pruritus or paresthesia, prompting patients to seek treatment. Currently, many treatment options are available in medicine. However, for this case report a less invasive treatment modality is evaluated. This clinical case report will present Kenalog-40 injections as a treatment option to treat a spontaneous keloid scar. Observation of this treatment option has illustrated a reduction in size and improvement in pruritus, paraesthesia and discoloration.

Diffuse Nickel Hypersensitivity Reaction Post-cholecystectomy in a Young Female.

Nickel, a silvery-hard metallic element used in corrosion-resistant alloys, is widely used in the medical field. Nickel has aided in medical advancements; however, it has been known to cause hypersensitivity reactions. Retained foreign bodies due to surgical procedures may cause postoperative complications such as allergic reactions. This case involves a 30-year-old female presenting with non-specific symptoms involving multiple organ systems, notably with abdominal pain. Due to chronic symptoms, the patient was tested for metal allergies and diagnosed with hypersensitivity reactions to nickel surgical clips that were previously inserted during cholecystectomy. Subsequently, the patient had surgical removal of the foreign bodies, which led to significant improvement of her symptoms immediately. This case demonstrates a delayed hypersensitivity reaction to a foreign body involving multiple body systems and vague symptoms making the diagnosis challenging. It is important to carefully evaluate the patient's past medical history including history of any allergies. It also brings attention to the necessity of performing metal skin patch tests preoperatively for individuals with a history of any type of allergies.

Delayed Titanium Hypersensitivity and Retained Foreign Body Causing Late Abdominal Complications.

Titanium is a known metal used widely in the medical field and can cause allergic reactions with complications. Our case is about a 28-year-old female presenting with a spectrum of abdominal symptoms with a complicated medical history. The abdominal pain is associated with titanium allergy reaction from previously inserted titanium-based surgical clips. This patient is concurrently found to have a retained pigtail catheter in the cecum discovered incidentally through radiology. We discuss the presentation, investigations, and treatment of this unusual case. The case also unfolds rare differential diagnoses to keep in mind when encountering a patient with abdominal pain and associated nonspecific symptoms.

Cholecystoduodenal Fistula Evading Imaging and Endoscopic Retrograde Cholangiopancreatography: A Case Report.

Cholecystoduodenal fistulas are a type of internal biliary fistula that occur due to chronic inflammation of the gallbladder/biliary tree; if left untreated, perforation and necrosis can occur. Cholecystoduodenal fistulas are often difficult to diagnose due to their non-specific signs and symptoms. Since the widespread use of techniques such as magnetic resonance cholangiopancreatography and imaging modalities such as computed tomography, the frequency of reports describing intraoperative cholecystoduodenal fistula has reduced dramatically. Here, we report the case of a 54-year-old female who presented with a two-day history of non-radiating epigastric abdominal pain, initially diagnosed with acute cholecystitis and choledocholithiasis. Upon undergoing laparoscopic cholecystectomy, she was found to have extensive fibrosis of the gallbladder, adhesions, and an impacted gallstone in the wall of the gallbladder. Imaging and endoscopic retrograde cholangiopancreatography performed prior to surgery did not detect a cholecystoduodenal fistula that was discovered intraoperatively. She was treated successfully with laparoscopic cholecystectomy and repair of the duodenum.

Acute Genital Edema during Peritoneal Dialysis: A Review for Surgeons.

Acute genital edema (AGE) is an infrequent but disruptive complication in patients on continuous ambulatory peritoneal dialysis. It is a common manifestation of dialysate leakage caused by inguinal, umbilical, femoral, or incisional hernias; peritoneal tears; leaks around the dialysis catheter; trauma; fluid overload; and malignancy. The evaluation of AGE begins with a history and physical exam. However, the physical exam in these patients is often indeterminate. Several diagnostic measures exist to evaluate and guide management of AGE occurring during continuous ambulatory peritoneal dialysis but little agreement exists on an optimum method. We have conducted a review of the literature on the evaluation and management of AGE and present a summary of the data. CT peritoneography and peritoneal scintigraphy have been used extensively to evaluate AGE although no comparative studies exist. MRI peritoneography has also been described. CT peritoneography offers more anatomical detail but may not be as sensitive as peritoneal scintigraphy in detecting a peritoneal fluid leak as the cause for AGE. CT is also more costly and subjects the patient to more radiation. MRI is a noncontrast study without radiation risk, but has not been studied to the same degree. If testing is equivocal or bilateral hernias are suspected, diagnostic laparoscopy is helpful and can be combined with hernia repair. Whether the etiology is a leak or tear, low-volume peritoneal dialysis (PD) or cessation of PD for two to four weeks will allow closure. However, hernias almost always require operative repair with mesh usually without disrupting PD.

Marchiafava-Bignami disease in a trauma patient.

Marchiafava-Bignami disease (MBD) is a rare pathological condition affecting the corpus callosum (CC), characterized by progressive demyelination and necrosis. While usually found in patients with chronic alcoholism, it has rarely been characterized in non-alcoholics. We describe a trauma patient with an unknown mechanism of injury, who was found to have MBD after remaining comatose for a prolonged period of time. Magnetic resonance imaging (MRI) demonstrated restricted diffusion involving the genu, body, and splenium of the CC. The patient eventually awoke but was non-communicative and uncomprehending prior to discharge to a nursing facility. We reviewed the literature and report here the first case of MBD encountered in a trauma patient. In conclusion, MBD is an extremely rare condition in non-alcoholic patients, and the use of MRI is crucial for its identification.

Laparoscopy to evaluate scrotal edema during peritoneal dialysis.

BACKGROUND: Acute scrotal edema is an infrequent complication in patients who undergo continuous ambulatory peritoneal dialysis (CAPD), occurring in 2% to 4% of patients. Inguinal hernia is usually the cause, but the diagnosis is sometimes confusing. Imaging modalities such as computed tomographic peritoneography are helpful but can be equivocal. We have used diagnostic laparoscopy in conjunction with open unilateral or bilateral hernia repair for diagnosis and treatment of peritoneal dialysis (PD) patients with acute scrotal edema. TECHNIQUE AND CASES: Three patients with acute scrotal edema while receiving CAPD over the span of 7 years had inconclusive results at clinical examination and on diagnostic imaging. All patients underwent diagnostic laparoscopy that revealed indirect inguinal hernia, which was concomitantly repaired using an open-mesh technique. RESULTS: Diagnostic laparoscopy revealed the etiology of the scrotal edema 100% of the time, with no complications, and allowed concomitant repair of the hernia. One patient had postoperative catheter outflow obstruction, which was deemed to be unrelated to the hernia repair. CONCLUSION: Diagnostic laparoscopy is helpful in confirming the source of acute scrotal edema in CAPD patients and can be performed in conjunction with an open-mesh repair with minimal added time or risk.