Intestinal intussusception as a postoperative complication of gastric bypass.

The gold standard for bariatric surgery is the laparoscopic gastric bypass, which consists in forming a small gastric pouch and a Roux-en-Y anastomosis. We present the case of a 41-year-old female who underwent a laparoscopic gastric bypass 8 years prior to her admission to the emergency room, where she arrived complaining of severe and colicky epigastric abdominal pain. The abdominal computed tomography showed a jejuno-jejunal intussusception, for which the patient underwent urgent exploratory laparotomy with intussusception reduction. Intestinal intussusception is a possible postoperative complication of a Roux-en-Y gastric bypass.

El Método de referencia en la cirugía bariátrica es el bypass gástrico laparoscópico, que consiste en la creación de una bolsa gástrica pequeña, anastomosada al tracto digestivo mediante una Y de Roux. Presentamos el caso de una mujer de 41 años con el antecedente de un bypass gástrico laparoscópico realizado 8 años antes, quien ingresó al servicio de urgencias refiriendo dolor abdominal grave. La tomografía computarizada abdominal evidenció una intususcepción a nivel de la anastomosis yeyuno-yeyuno, por lo que se realizó una laparotomía exploradora con reducción de la intususcepción. Se debe considerar la intususcepción intestinal como complicación posoperatoria de bypass gástrico.

Two cases of complicated jejunal diverticulosis in a low-resource peripheral teaching hospital.

Jejunal diverticula, like other intestinal diverticula, can become complicated and present as acute abdomen. Diagnosis is difficult and management in complicated cases can be surgical as well as conservative. We present two cases of complicated jejunal diverticulosis that presented with acute abdomen and were managed surgically. Post-operative recovery was satisfactory. Jejunal diverticula is a diagnostic challenge in a low-resource peripheral hospital.

Multiple giant jejunal diverticulosis: A rare clinical presentation of a rarely encountered disease.

Jejunoileal diverticula have a four-fold greater risk of developing general complications and an 18-fold greater risk of perforation compared to duodenal diverticula. While resection is not preferred in asymptomatic cases, surgical intervention may be required in life-threatening conditions. In this case report, a 69-year-old male patient with multiple giant jejunal diverticulum presenting with long-standing and transient symptoms was presented. The patient had a history of appendectomy 15 years before application. During the patient's last admission to the emergency department, contrast-enhanced abdominal computed tomography was ordered and revealed jejunum segments with multiple giant diverticula which were treated by excision by open laparotomy. It was observed that the patient's complaints did not recur and he started to gain weight. In patients admitted to the emergency department with complaints of long-standing abdominal pain, weight loss, and bloating, in whom diagnosis cannot be made, it is recommended to consider diverticulum originating from the jejunum in the differential diagnosis, especially in the presence of abdominal surgery history.

Unusual radiological findings of pediatric jejunojejunal intussusception: A case report.

Intussusception is a common cause of intestinal obstruction in children, especially in those of age <5 years. The typical signs and symptoms of this condition is colicky abdominal pain, bloody mucous stool, and palpated abdominal mass, with a classic target sign finding on abdominal ultrasound. In older children, the symptoms may vary, which necessitates investigation of the cause of intussusception, as it is often caused by a pathologic lead point. We report here the case of a 14-year-old girl with total bowel obstruction, hematochezia, a very dilated reverse C-shaped bowel loop, and intestinal pneumatosis on abdominal X-ray. During laparotomy, we detected jejunojejunal intussusception caused by jejunal polyp. After bowel resection and anastomosis, the patient recovered well and had no other events during follow-up.

Jejunal diverticulitis as a rare cause of abdominal pain: a case report.

Jejunal diverticulitis is an uncommon and underdiagnosed condition. Due to the rarity of This disease, diagnosis is often difficult and delayed. Medical treatment is usually sufficient for jejunal diverticulitis without peritonitis. Surgery is required in case of generalized peritonitis or voluminous abscess complicating diverticulitis. We report the case of a 76-year-old woman who suffered from recent abdominal pain. Diagnosis of uncomplicated jejunal diverticulitis was based on computed tomography (CT) scan. The evolution was favorable after antibiotic treatment. Jejunal diverticulitis have to be evoked among the differential diagnosis of patients with abdominal pain especially in the elderly and it is important for clinicians and radiologists to have awareness about this disease.

Síndrome de Wilkie: caso clínico / Wilkie syndrome: case report

Resumen Introducción: El síndrome de Wilkie es una causa poco frecuente de obstrucción del tracto digestivo superior, se caracteriza por una disminución del ángulo aorto-mesentérico que resulta en compresión de la tercera porción del duodeno que produce síntomas obstructivos altos. Caso Clínico: Presentamos el caso de una mujer de 64 años, con historia de dolor abdominal, pirosis, saciedad precoz e intolerancia a la vía oral, en quien los estudios iniciales mostraron esofagitis, pero en quien los síntomas no mejoraron con el tratamiento clásico para enfermedad ácido péptica y en quien estudios imagenológicos adicionales sugerían el síndrome de Wilkie como causa de los síntomas. Discusión y Conclusión: Se trata de una patología que debe conocerse y considerar en paciente con historia de pérdida de peso, marcada intolerancia a la vía oral y falta de respuesta al manejo.

Introduction: Wilkie syndrome is a rare cause of upper gastrointestinal tract obstruction, it is characterized by a decrease in the aorto-mesenteric angle that results in a compression of the third portion of the duodenum causing high obstructive symptoms. Case Report: We present the case of a 64-year-old woman, with a history of abdominal pain, heartburn, early satiety, and intolerance to the oral route, in whom initial studies showed esophagitis, but in whom symptoms did not improve with the classic treatment for peptic acid disease, additional imaging studies suggested Wilkie syndrome. Discussion and Conclusión: It is a pathology that must be known and suspected in patients with a history of weight loss, marked intolerance to oral intake, and lack of treatment response.

Appendiceal carcinoid in a pediatric patient with Peutz-Jeghers syndrome: A case report and comprehensive literature review.

RATIONALE: Peutz-Jeghers syndrome (PJS), a rare autosomal dominant disorder, is characterized by mucocutaneous pigmentations, hamartomatous polyps in the gastrointestinal tract, and a high risk of developing various malignancies. To the best of our knowledge, only 1 case of appendiceal carcinoid associated with PJS has been previously reported in the pediatric population. PATIENT CONCERNS: We report a 7-year-old girl who was admitted for severe, intermittent abdominal pain and cramps, nausea, and vomiting. Multiple brown melanotic macules on the lips, buccal mucosa, and the tongue were noted. DIAGNOSIS: A plain abdominal X-ray in a standing position revealed dilated intestinal loops with multiple air-fluid levels. A computed tomography scan of the abdomen showing a "coffee bean" appearance of the jejunal loop with a transition point to the duodenal loop. Axial-contrast-enhanced computed tomography scan of the abdomen showing dilated jejunum loops, filled with fluid with the swirled appearance of mesentery typical for volvulus. The diagnosis of PJS was based on clinical findings along with the histopathologic confirmation of the hamartomatous polyps. INTERVENTIONS: An emergency laparotomy was performed, revealing a jejunojejunal intussusception starting 40 cm from the duodenojejunal flexure. Jejunotomy revealed that a lead-point intussusception was a necrotic hamartomatous polyp. After resecting the involved jejunal necrotic segment, including the polyp, end-to-end jejuno-jejunal anastomosis was performed. Further exploration revealed the presence of a jejunal mass 80 cm from the duodenojejunal flexure identified as another hamartomatous pedunculated polyp. The polyp was resected, and the enterotomy was then closed transversely. The grossly normal appendix was also removed. OUTCOMES: Clinical findings along with the histopathologically confirmed hamartomatous polyps were consistent with PJS. An appendiceal carcinoid (well-differentiated neuroendocrine tumor, European Neuroendocrine Tumor Society stage pT2) was incidentally detected during histological examination of the appendix. The patient and parents were counseled accordingly, focusing on active surveillance and control of symptoms. Two additional hamartomatous polyps (gastric and jejunal) were detected endoscopically and resected in the fourth postoperative week. A regular, 1-year follow-up and surveillance revealed no complications or recurrences. LESSONS: Unusual neoplasms can occasionally be encountered in well-defined syndromes such as PJS. Therefore, active follow-up and surveillance are mandatory for all patients with PJS.