Late Complications after Laparoscopic Longitudinal Gastrectomy - Case Report.

INTRODUCTION: Bariatric surgery is now widely regarded as the most effective treatment for morbid obesity. It aims to enhance patients' health by achieving long-lasting weight loss, reducing associated comorbidities, and improving their quality of life. CASE REPORT: The case involves a 51-year-old female patient who underwent sleeve gastrectomy eight years ago to address morbid obesity (Body Mass Index (BMI) = 43). Subsequently, the patient developed gastric obstructive syndrome, leading to diagnostic investigations including repeated upper digestive endoscopies and native computed tomography. These examinations revealed the presence of a hiatal hernia. In 2021, the patient underwent fundoplication type Dor with anterior hemivalve. However, post-surgery, the patient's condition did not improve, with persistent symptoms including regurgitation, heartburn, difficulty ingesting food, sensation of gastric fullness, and epigastralgia. Further exploratory procedures, including upper digestive endoscopy, abdominal computed tomography with contrast substance, and barium transit with contrast substance, led to the diagnosis of mediogastric stenosis postgastrectomy longitudinal, necessitating surgical intervention. This finding prompted a surgical approach involving distal gastric resection and restoration of digestive tract continuity through Hoffmeister-Finsterer gastro-jejunal anastomosis. Following the surgery, the patient's postoperative symptoms showed improvement. DISCUSSION: Several other studies have demonstrated that the incisura angularis is the most common site of obstruction, as was observed in our study. This particular location appears to be more prone to narrowing, likely attributable to its angular shape. The linear staple line in this area can create a locus minoris resistentiae for kinking, as well as increase the risk of true stenosis if stapling is performed too close to the incisura angularis. CONCLUSIONS: Bariatric surgery should not be considered as the initial treatment option. However, in cases where it becomes necessary, postoperative monitoring is essential to prevent complications or address them promptly.

Cough-Induced Multiple, Bilateral, Asymmetrical Rib Fractures in a Scoliosis Patient: A Case Report.

Cough-induced rib fractures represent infrequent complications of strenuous and prolonged coughing, mostly provoked by respiratory tract infections, with localized chest pain being the most indicative component of the clinical picture. This paper reports a case of a 27-year-old female patient who presented with four cough-induced rib fractures following the contraction of an upper respiratory tract infection. The unique character of this case is provided by the young age of the patient, the presence of multiple and bilaterally located rib fractures, and the absence of predisposing factors related to her bone physiology. Furthermore, three of the four fractures were revealed on the left side, where a scoliotic sinistro-convex thoracic curvature is described. Following conservative treatment, the patient experienced a complete resolution of symptoms and favorable clinical outcomes. Even in the seemingly low-risk category, the diagnosis of cough-induced rib fractures should be taken into consideration, and their correlation to pre-existing rib deformities, such as the ones secondary to scoliosis, should be thoroughly investigated.