RESUMO
Key Clinical Message: This report emphasizes the significance of acknowledging infrequent yet severe complications such as bowel perforation and transanal protrusion post ventriculoperitoneal shunt (VPS) surgery. VPS patients should be observed for atypical indicators and manifestations that could suggest the presence of such complications, even in the lack of traditional clinical signs of peritonitis or bowel perforation. Abstract: Placing an intracranial shunt, may be a reasonable approach to decrease the complications of hydrocephalus and it can be done either simultaneous to cranioplasty or not. Ventriculoperitoneal shunts were first proposed in 1905 and has been used since. Similar to any other procedure, there are different complications to this surgery. Abdominal complications, including peritoneal pseudocysts, intestinal volvulus, protruding in hernial sac or extrusion through vagina, scrotum, umbilicus or gastrointestinal tract, are rare but according to previous studies happen in 5%-47% of cases. Bowel perforation is a rare complication and can happen in 0.01%-0.07% of patients. It's also worth mentioning that only 25% of patients with bowel perforation experience the classic clinical symptoms of peritonitis or bowel perforation. This particular complication should not be overlooked since it can cause a high mortality rate of 15%. Here we present a case of transanal protrusion of ventriculoperitoneal shunt after an asymptomatic bowel perforation, in an adult who has undergone surgery after a traumatic brain injury. The patient has undergone surgery and lastly the shunt was manually removed from anus. He was monitored for 3 days and eventually discharged.
RESUMO
INTRODUCTION: GIST tumors are the most common mesenchymal tumors in the alimentary tract but are rather rare compared to other GI tract tumors and are usually found incidentally. Studies about cases of GIST tumor in bariatric surgery are scarce and there is no specific guideline for treatment. Most of previous cases were managed by sleeve gastrectomy due to their location which were usually in the body and greater curvature. METHODS: This patient had a GIST on lesser curvature and therefore underwent laparoscopic Roux-en-Y bypass. The follow-up was done with imaging studies and CT scan since the location of the tumor was no longer accessible to endoscopy after the gastric bypass. RESULTS: The post-operative course was uneventful and after 2 years the patient is still in good health and had no other complications. The patient has been followed up by imaging studies. DISCUSSION: There are pros and cons to this compared with sleeve gastrectomy. The most important advantage for this approach is that we have the stomach preserved; thus, our operation has the reversibility potential in case of any complication which requires revision operations. However, on the flip side, the limitation of such intervention is that we are not able to use the EGD to monitor and follow up our patient. Based on the relevant literature, for following up and monitoring the postoperative condition of these patients with relatively small GISTs, imaging studies specially abdominal computed tomography scan (CT scan) would be highly beneficial. It is also worth of mentioning that performing a EGD before a bariatric surgery, which is well noted in IFSO position statements and is well explained and discussed in other literature, had a major role in diagnosing this patient's GIST tumor and is proved to be beneficial and essential, once again.