Chronic gastric volvulus with diaphragmatic eventration: Case presentation.

INTRODUCTION AND IMPORTANCE: Gastric volvulus is a rare clinical entity which occurs due to the rotation of the stomach and can have life-threatening complications. This condition can have an acute or chronic presentation and its symptoms will vary according to the degree of obstruction and rapidity of onset. CASE PRESENTATION: We report a case of a 84-year-old male with history of frequent periods of constipation and lack of appetite who presented to the emergency room with left-sided abdominal pain and distension and persistent nausea, without the ability to vomit. Abdominal radiograph, computed tomography scan of the abdomen, contrast-enhanced examination and upper endoscopy were consistent with a gastric volvulus secondary to diaphragmatic eventration. The patient's symptoms resolved after nasogastric tube placement and fluid resuscitation. However, he was proposed to a laparoscopic anterior gastropexy to prevent symptom recurrence. He remains asymptomatic after 3 years of follow-up. CLINICAL DISCUSSION: The diagnosis of gastric volvulus is based mainly on clinical presentation and abdominal imaging. The main principles of surgical intervention include stomach decompression with volvulus reduction, followed by gastropexy and correction of any predisposing intra-abdominal factors. CONCLUSION: Definitive treatment of both acute and chronic gastric volvulus includes a surgical approach. Laparoscopic anterior gastropexy has been found to be a viable alternative in these patients.

Spontaneous retroperitoneal biloma in a patient with choledocholithiasis: Presentation of case.

INTRODUCTION AND IMPORTANCE: Spontaneous perforation of the biliary tree, resulting in retroperitoneal biloma in adults is an extremely rare condition, and may unfold to a potentially fatal outcome, particularly when the diagnosis and definitive treatment are delayed. CASE PRESENTATION: We report a case of a 69-year-old male who presented to the emergency room with abdominal pain, localized to the right quadrants, associated with jaundice and dark-coloured urine. Abdominal imaging including CT scan, ultrasound and magnetic resonance cholangiopancreatography (MRCP) revealed a retroperitoneal fluid collection, a distended gallbladder with wall thickening and lithiasis, as well as a dilated common bile duct (CBD) with choledocholithiasis. The analysis of the retroperitoneal fluid obtained by CT-guided percutaneous drainage was consistent with biloma. A combined approach of biloma percutaneous drainage and endoscopic retrograde cholangiopancreatography (ERCP)-guided stent placement in the CBD with biliary stones removal was successful in the management of this patient, despite the fact that the perforation site could not be detected. CLINICAL DISCUSSION: The diagnosis of biloma is based mainly on clinical presentation and abdominal imaging. If urgent surgical intervention is not indicated, pressure necrosis and perforation of the biliary tree may be avoided by timely percutaneous aspiration of the biloma and ERCP to remove the impacted stones in the biliary tree. CONCLUSION: Biloma should be considered in the differential diagnosis of a patient presenting with right upper quadrant or epigastric pain and an intra-abdominal collection on imaging. Efforts should be made in order to offer a prompt diagnosis and treatment to the patient.

Correlation between clinical outcomes and spinopelvic parameters in patients with lumbar stenosis undergoing decompression surgery.

PURPOSE: The aim of this study is to determine if there is a relation between preoperative sagittal alignment, based on radiographic parameters, and clinical outcomes, after lumbar decompressive procedures, in patients with lumbar spinal stenosis (LSS). METHODS: This study enrolled patients with LSS who underwent lumbar decompressive procedures, between January 2016 and December 2017. Preoperative spinopelvic parameters were measured, and patients were divided into radiological groups according to the median of the following variables: relative lumbar lordosis (measured minus ideal lumbar lordosis), relative pelvic tilt (measured minus ideal pelvic tilt) and sagittal vertical axis (SVA). Clinical outcomes were compared between these groups and included the Core Outcome Measures Index, EuroQoL Five Dimension Questionnaire (EQ-5D) and Oswestry Disability Index (ODI) scores before and 1 year after surgery. Further correlation statistics between sagittal radiological measurements and the postoperative outcome scores were performed. RESULTS: The study included 104 patients. We did not find any clinically important difference in clinical outcomes between radiological groups. However, in correlation analyses we found a significant but weak statistical correlation between relative lumbar lordosis and both preoperative and postoperative ODI, as well as a significant statistical negative correlation between SVA and postoperative EQ-5D. CONCLUSION: Preoperative spinopelvic parameters did not significantly correlate with clinical outcomes after decompression surgery for LSS on non-deformity patients. Patients had a comparable improvement after surgery, regardless of their preoperative sagittal alignment.