An approach to accurate computed tomography imaging interpretation in penetrating neck trauma.

Penetrating neck injury can have potentially devastating consequences due to the many vital structures contained within the neck. In patients who do not require immediate surgery, computed tomography angiography of the neck is the test of choice to characterize the injury. A systematic approach to assessment will ensure a thorough evaluation and give the reporting radiologist the best chance of identifying the significant findings, which can often be subtle. Clear communication with the trauma team at both the time of request and after the imaging has been evaluated to relay any significant findings is vital to ensure the best outcome for the patient.

Management of staple line leaks following sleeve gastrectomy.

BACKGROUND: Leaks after laparoscopic sleeve gastrectomy (LSG) are not very frequent but are a difficult complication that can become chronic. Various treatment options have been suggested but no definitive treatment regimen has been established. The aim of our study is to report leak complications after LSG, their management, and outcomes. METHODS: Between June 2008 and October 2013, a total of 539 patients underwent laparoscopic and robot-assisted laparoscopic sleeve gastrectomy at our institution. A retrospective review of a prospectively collected database was performed for all LSG patients, noting the outcomes and complications of the procedure. RESULTS: Fifteen (2.8%) patients presented with a leak after LSG. The diagnosis was made at a mean of 27.2±29.9 days (range, 1-102) after LSG. Eight (53.3%) patients underwent conservative treatment initially and 6 (75.0%) of these patients required stenting as secondary treatment. Although leaks from 3 patients resolved with stenting, the other 3 required restenting and 2 eventually underwent conversion to gastric bypass. Five (33.3%) patients underwent endoscopic intervention, closing the leak with fibrin glue (n=3) or hemoclips (n=2). Two (13.3%) patients who were diagnosed with a leak immediately after LSG before discharge had their leak oversewn laparoscopically with an omental patch. Leaks in 9 (60.0%) patients did not heal after the first intervention, and the mean number of intervention required was 2.3±1.7 times (range, 1-7) for the treatment of this condition. CONCLUSION: Management of leaks after LSG can be challenging. Early diagnosis and treatment is important in the management of a leak. However, it can be treated safely via various management options depending on the time of diagnosis and size of the leak.