Acute post sleeve surgery bleeding as rare cause of acute renal failure: a case report.

BACKGROUND: Bariatric surgeries have been considered as one of the most important treatment procedures in recent years. Being aware of the side effects of this surgery will lead to better results after the surgery. CASE PRESENTATION: A 37-year-old Iranian male patient presented one day after sleeve surgery with symptoms of weakness, lethargy, and shortness of breath, which hospitalization and workup to were done to rule out pulmonary embolism. Because of the high creatinine and anuria, we couldn't perform computed tomography angiography. A bedside ultrasound was done for the patient and showed a mild to moderate amount of fluid around the spleen and some blood clots. Due to the progressive clinical findings and suspected internal bleeding, the patient was a candidate for laparoscopic revision procedure. Gradually, after performing the surgery, removing the blood clot and reducing the compressive effect of that on the inferior verna cava which was the main reason of renal failure, the patient was able to urinate afterwards and was discharged in good general condition. CONCLUSION: Surgeons should be aware of the management of rare surgical complications after bariatric surgeries. To be best of our knowledge, this was the first case report of a patient with acute renal failure after bariatric surgery and the rare cause of clot compression on inferior vena cava and raised abdominal compartment pressure.

Case report of multidisciplinary approach to post single anastomosis sleeve jejunal bypass (SASJ) surgery refusal to eat.

INTRODUCTION AND IMPORTANCE: Bariatric surgeries are introduced as novel procedures in the whole world. Among the most important side effects after these surgeries is malnutrition. One of the reasons for suffocation can be the patient's psychological problems (such as depression). Paying attention to these symptoms can be effective in managing post-surgical complications. CASE PRESENTATION: A 36-year-old female patient who was operated with SASJ BYPASS surgery method presented three weeks after the surgery with symptoms of weakness, lethargy, nausea, vomiting, and PO (Per OS) intolerance, which did not respond to outpatient treatment. Barium swallow imaging and abdominopelvic CT scan was done for the patient and findings were normal. During conservative treatment and total parenteral nutrition (TPN) the patient underwent psychiatric consultation and took psychiatry medications. Gradually after these consultation sessions the patient had a good PO tolerance, no edema and no weakness and was discharged in a good condition. She was advised to continue psychologic consultation sessions besides other post-surgical follow ups. CLINICAL DISCUSSION: After complete assessment of malnutrion etiologies after bariatric surgeries it was advised to ensure that the patients demonstrate an understanding of the bariatric surgical procedure, necessity of changes in eating habits. Any existing psychological issues should be identified and treated the patient should be educated to make a commitment to multidisciplinary care after these surgeries. CONCLUSION: With continued communication, support, and multidisciplinary monitoring, nutritional complications can be minimized among patients undergoing bariatric surgeries. LEVEL OF EVIDENCE: V.