RESUMO
A patient with a history of a laparoscopic gastric bypass presented with a perforated duodenal ulcer. The ulcer was laparoscopically oversewn, and an omentoplasty was performed. Postoperatively, a broad spectrum antibiotic and a proton pump inhibitor were administrated. Several questions arise regarding the diagnosis and treatment of duodenal ulcers after gastric bypass. What are the diagnostic tools to detect a duodenal ulcer, and how should Helicobacter pylori be diagnosed after gastric bypass? The key question is whether the bypassed stomach should be resected as a definitive treatment for complicated duodenal ulcers.
Assuntos
Úlcera Duodenal/complicações , Derivação Gástrica , Úlcera Péptica Perfurada/etiologia , Complicações Pós-Operatórias/cirurgia , Adulto , Feminino , Derivação Gástrica/métodos , Humanos , Laparoscopia , Omento/transplante , ReoperaçãoRESUMO
A patient with a history of coronary artery bypass grafting was admitted with severe hemoptysis. Bronchoscopy showed recent bleeding with clot formation in the lingular bronchus, but no tumor was visualized. Several biopsies of the underlying mucosa were negative. Coronary angiography showed patent venous and arterial bypass grafts. Selective angiography of the left internal mammary artery revealed one large and two smaller aberrant bronchial side branches, which probably caused the lingular hemorrhage. We performed embolization of the largest aberrant branch. After a follow-up of 3 months, hemoptysis had not recurred.