Gastric mucocele after conversion of open butterfly gastroplasty to Roux-En-Y gastric bypass - A case report with a review of the literature.

INTRODUCTION: There has been a significant increase in the prevalence of morbid obesity across the globe. Various non-surgical weight loss options have shown limited long-term efficacy, leading to the popularity of surgical treatment alternatives with long-term efficacy. PRESENTATION OF CASE: This case report describes the development of a gastric mucocele in a 51-year-old female patient. The patient initially underwent open butterfly gastroplasty in August 2016. Seven years later, she presented with severe symptoms of gastroesophageal reflux disease (GERD). After further diagnostic evaluations, laparoscopic Roux-en-Y bypass surgery was performed. However, the patient experienced complications including fever, abdominal pain, and fluid collection around the stomach. Conservative management initially helped, but persistent symptoms led to laparoscopic exploration, which revealed a distended remnant stomach forming a gastric mucocele. Severe adhesions hindered attempts to remove the remnant stomach, resulting in the need for gastro-gastric anastomosis. Following the surgery, the patient had no symptoms, could eat solid food, and was discharged in good condition. DISCUSSION: Although various non-surgical weight loss options such as diet modifications, lifestyle changes, and drug therapy have been used for weight loss, they have demonstrated limited long-term efficacy. Surgical treatment has demonstrated long-term efficacy in such patient groups. In recent years, there has been an increased popularity of Roux-en-Y gastric bypass (RYGBP) due to long-term weight loss. However, in some cases, complications have also been reported. CONCLUSION: This case emphasizes the challenges in managing complications from open butterfly gastroplasty and Roux-en-Y gastric bypass. Surgeons should be aware of the possibility of gastric mucocele development and consider appropriate management strategies.

A plastic bezoar causing bowel obstruction: A case of table cover ingestion.

INTRODUCTION AND IMPORTANCE: A bezoar is an indigestible food or other material within the gastrointestinal tract. It can be ingested intentionally or accidentally. The small bowel bezoar prevalence ranges between 0.4 % and 4 %, and the prevalence is less than 0.5 % for gastric bezoars. There are different types of bezoars, but the mention of a plastic bezoar rarely appears in the literature. To our knowledge, this is the first reported case of a plastic bezoar in the Kingdom of Saudi Arabia. CASE PRESENTATION: A 58-year-old woman was admitted for acute kidney injury, and while working her up, it was discovered that she had a possible foreign body on computerized tomography scan. As a result, she underwent exploratory laparotomy with the findings of plastic foreign objects identified 90 cm from the ileocecal valve and other objects identified in the stomach. CLINICAL DISCUSSION: The impaction of these materials often occurs in narrow areas such as the lower esophagus, duodenum, ileocecal valve or even the anus. In this unique case, two points of impaction were noted: the first was in the small bowel and the second point in the stomach. The approach to such cases could be Endoscopic versus surgical or even chemical dissolution as a choice of treatment is dependent on multiple factors. CONCLUSION: The approach to these cases is multidisciplinary and depends on the availability of services and resources at the treating hospital. Reporting such cases helps in managing challenging situations. Additionally, a psychiatric assessment is a crucial step.

Filiform polyposis presenting with rapid growth and severe anemia case report.

INTRODUCTION: Giant inflammatory polyposis (GIP) is a rare manifestation of inflammatory bowel disease (IBD), and it is described as a worm-like projection of 1.5 cm or more in diameter with unclear pathogenesis. GIP may be related to the severity of IBD. GIP presents with a wide range of symptoms, including crampy abdominal pain, anemia, and intestinal obstruction. The histopathology of GIP is a polyp lined by normal colonic mucosa with superficial ulceration that may show mild crypt distortion. CASE REPORT: Our case reports a patient with ulcerative colitis diagnosed via colonoscopy and histopathology 10 months before presenting with severe anemia due to lower gastrointestinal bleeding. Colonoscopy showed GIP obstructing the descending and sigmoid colon, and total colectomy showed the entire colon full of worm-like polyps up to 14 cm the longest polyp. DISCUSSION: Giant inflammatory polyposis which is seen in 17 % of UC with active colitis, as seen in our patient, the histopathology component was acute in addition to chronic, which formed within 6 months. According to the data in the literature, the average duration reported for formation since diagnosis with UC is approximately 3 to 276 months. With a length up to 16 cm, the sigmoid colon is the most common site. CONCLUSION: Surgical intervention is indicated for filiform polyposis (FP) if it is complicated, such as bleeding or obstruction, which is reported in a few cases. However, there are no clear guidelines for surgical intervention for complicated FP, but the safest method is to tailor the management according to the guidelines for each underlying disease.

Comparison of two approaches to lateral nasal osteotomy in Saudi patients

BACKGROUND: Nasal deformity is an abnormality in the appearance of the nose due to either congenital defect or trauma. In traumatic cases, patients often present with combined functional and cosmetic complaints. Therefore, otolaryngologists take into account both breathing and aesthetic nasal issues. OBJECTIVES: To evaluate the changes in the nasal dorsum and base; compare breathing and aesthetic satisfaction scores between two approaches to lateral nasal osteotomy: low-to-low and low-to-high. DESIGN: Comparative observational; data gathered retrospectively and prospectively. SETTING: Head and Neck and Skull Base Center, King Abdullah Medical City, Makkah, Saudi Arabia. PATIENTS AND METHODS: Patients who received hump reduction rhinoplasty from 2013 to 2016 met the inclusion criteria. MAIN OUTCOME MEASURE(S): The differences in dorsal (DW) and ventral (VW) widths with a fixed interpupillary distance (IPD). Satisfaction scores for both cosmetic perspective and breathing functionality. RESULTS: We included 46 patients; 28 patients underwent low-to-low osteotomy and 18 patients underwent low-to-high osteotomy. With both approaches, there were statistically decreases from preoperative to postoperative ratios of VW/IPD and DW/IPD. However, differences in DW/IPD ratio and VW/IPD ratio (pre- versus post-op) were significantly higher in the low-to-low group (P < .0001). All showed breathing satisfaction postoperatively regardless of the operative approach. Patients with a low satisfaction level for aesthetic sensibility (neutral and dissatisfied) underwent low-to-high osteotomy. CONCLUSION: Both types of osteotomy showed a satisfactory outcome in both objective and subjective measures. However, low-to-low osteotomy was superior in pre- to post-operative differences in DW/IPD and VW/IPD ratios. LIMITATIONS: Sampling was by convenience. The study was conducted in a single tertiary center and was a small sample.