Common bile duct MALT lymphoma: case report and review of the literature.

We report a rare case of common bile duct mucosa-associated lymphoid tissue (MALT) lymphoma treated with pancreatico-duodenectomy with a partial gastrectomy. MALT lymphoma involving the biliary tree is extremely rare. Diagnosis is difficult and treatment options are controversial. Even though Helicobacter pylori treatment is effective in the early stages of the disease, surgery is still helpful especially when obstruction, perforation, or bleeding is present.

Postoperative rhabdomyolysis with bariatric surgery.

Rhabdomyolysis has been reported in all postoperative patients including those in prone, supine, lithotomy and lateral decubitus positions. Only a few reports suggest that bariatric surgical patients are at risk for rhabdomyolysis. We describe a male (BMI 69 kg/m2) who underwent an uneventful open Roux-en-Y gastric bypass for weight reduction lasting 5 hours. Postoperatively the patient suffered oliguria. Evaluation included subjective pain in both hips, a normal temperature and physical examination, creatinine increase to 3.5 mg/dl, CPK levels as high as 41,000 IU/L, and urinalysis showing a large amount of occult blood with 5-7 RBCs/HPF. Intravenous hydration with 0.9% normal saline, bicarbonate, and mannitol demonstrated initial success, but the patient eventually developed renal failure, respiratory distress, and tachycardia leading to cardiac arrest. Prior to his death, intraoperative evaluation demonstrated intact anastomoses. Obese patients undergoing bariatric surgery should be considered at risk for rhabdomyolysis, especially in view of prolonged surgeries, difficult physical examination, low volume status, and larger or immobile patients.