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INTRODUCTION AND IMPORTANCE: Laparoscopic sleeve gastrectomy is a prevalent bariatric surgery for managing morbid obesity. Despite its efficacy, complications can arise, particularly from intraoperative devices such as esophageal thermometers and orogastric tubes. These devices, if misplaced or inadequately monitored, can migrate and become entrapped or sectioned during surgery, leading to significant morbidity. CASE PRESENTATION: A 49-year-old female with morbid obesity underwent LSG. During surgery, an esophageal thermometer migrated into the stomach and was inadvertently sectioned during the stapling process. This required additional surgical intervention to remove the severed segments and repair the damage. Postoperative recovery was uneventful after corrective measures were taken. CLINICAL DISCUSSION: This case underscores the critical importance of ensuring the proper placement and continuous monitoring of intraoperative devices, such as esophageal thermometers, to prevent similar preventable complications in future surgical procedures. CONCLUSION: The reviewed cases demonstrate that complications from intraoperative device migration and entrapment during bariatric surgery, while rare, are significant and preventable. Adherence to strict protocols, continuous device monitoring, and enhanced team communication are essential to improve patient safety and surgical outcomes. Implementing these measures can prevent avoidable complications and enhance the efficacy of bariatric surgeries. EVIDENCE BASED MEDICINE RANKING: Level IV.
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INTRODUCTION AND IMPORTANCE: Biliary ileus is a rare yet significant cause of mechanical intestinal obstruction, which occurs when a gallstone enters the gastrointestinal tract through a bilioenteric fistula, leading to intestinal blockage. This condition primarily affects elderly patients and is associated with high morbidity and mortality if not diagnosed and treated promptly. CASE PRESENTATION: We present the case of a 94-year-old female with a history of hypertension and chronic venous insufficiency. The patient was admitted with severe abdominal pain, nausea, and vomiting, with clinical findings suggestive of intestinal obstruction. Computed tomography revealed Rigler's triad, confirming the diagnosis of biliary ileus. An exploratory laparotomy was performed, identifying three gallstones in the small intestine. The patient underwent enterotomy for stone extraction and had a favorable immediate postoperative outcome. CLINICAL DISCUSSION: Biliary ileus presents a diagnostic challenge due to its nonspecific symptoms. While Rigler's triad (pneumobilia, intestinal obstruction, and ectopic gallstone) is diagnostic, it is not always apparent in imaging. Surgical intervention remains the standard of care for resolving the obstruction, though appropriate preoperative management and timely surgery are crucial for improving outcomes. CONCLUSION: This case emphasizes the importance of considering biliary ileus in the differential diagnosis of intestinal obstruction, particularly in elderly patients. Early surgical intervention is essential to prevent severe complications. Evidence based medicine ranking: Level IV.
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INTRODUCTION AND IMPORTANCE: Congenital transmesenteric hernia is a rare form of hernia and intestinal obstruction. Autopsy studies report an incidence of 0.2-0.9 % of internal hernias, causing intestinal obstruction in 4.1 % of all cases. CASE PRESENTATION: A 35-year-old female patient, with no surgical history, presented with severe abdominal pain in the right hemiabdomen, nausea, and vomiting. She was initially unsuccessfully treated for gastritis. Upon admission to our unit, she had stable vital signs but severe abdominal pain. An acute abdomen was diagnosed, and a diagnostic laparoscopy converted to open surgery revealed an internal transmesenteric hernia with partial intestinal obstruction. A right hemicolectomy with ileotransverse anastomosis was performed. CLINICAL DISCUSSION: Diagnosing this condition is challenging due to nonspecific symptoms and signs, and radiological investigations may not provide sufficient information. The clinical features of a transmesenteric hernia can mimic more common causes of acute abdominal pain, such as appendicitis, complicating early identification. Computed tomography (CT) is the most useful imaging modality, but even with CT, the diagnosis can be difficult due to the rarity of the condition and the lack of specific signs. CONCLUSION: Early intervention and surgical correction in this case were crucial to preventing mortality associated with internal hernias. EVIDENCE BASED MEDICINE RANKING: Level IV.
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INTRODUCTION AND IMPORTANCE: Polybrachysyndactyly is the combination of malformations and is considered a congenital anomaly that is very difficult to treat. In addition to presenting as a disabling entity, it is a reason for little acceptance under the aesthetic standards established by society. CASE PRESENTATION: 6-year-old male patient with polybrachysyndactyly in all 4 extremities. The parents rejected surgery at a younger age, however, the social/aesthetic pressure exerted on the patient at school and the child's inability to perform activities in a common way, motivated them to make a new decision. CLINICAL DISCUSSION: Different surgical techniques were used on all four extremities. A soft tissue technique was performed on the pinkies of both feet and ray cuts to correct syndactyly of both thumbs of the feet and middle fingers of both hands, and excision. Extirpations were obtained: one thumb of the right foot, one thumb of the left foot and two middle fingers (one of each hand). He was discharged after recovery from surgery. CONCLUSION: Cases of polysyndactyly are considered extremely rare, the first thing to evaluate is the presence of other signs that could be part of a syndromic association in order to proceed with surgical intervention that allows the patient to lead a life as far away from aesthetic stigmas that could damage his mental health. EVIDENCE BASED MEDICINE RANKING: Level IV.