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INTRODUCTION: It has been demonstrated that certain technique endpoints are key to the success for the OAGB and RYGB procedures but only a few texts in which post-operative complications are documented. PRESENTATION OF CASE: 42-year-old male patient admitted to the emergency department for presenting abdominal pain located in the epigastrium for 4 days, melenic evacuations and syncope on one occasion. Two years prior to admission, the patient underwent a single anastomosis bypass for grade III obesity.Gastric bypass mini revision surgery was performed an antecolic and antegastric gastrointestinal anastomosis was made with a 3 cm latero-lateral anastomosis; an intestinal-intestinal anastomosis was performed 60 cm from the gastric anastomosis. The length of the biliopancreatic loop (120 cm) and the feeding loop (60 cm) are reviewed. DISCUSSION: Performing an "en bloc" resection of the anastomosis is essential since bile reflux is one of the irritation mechanisms of the anastomosis but not the only one. The size of the gastric pouch directly influences the frequency of marginal ulcers, so during the OAGBP revision, the gastro-jejunal junction must be resected to remodel it, reducing the size of the gastric reservoir that allows to perform the new anastomosis in less inflamed tissue. Roux-en-Y reconstruction should be performed once the length of the biliopancreatic loop is verified and it does not exceed 150 cm and a short alimentary loop to avoid nutritional complications.Complications arising from bariatric procedures are varied, infrequent in well-trained surgeons, but severe in inexpert hands, leading to an increase in mortality rates. CONCLUSIONS: We propose the laparoscopic conversion of OAGB to RYGB as a safe method, and feasible in hemodynamically unstable patients.
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INTRODUCTION: Acute abdomen due to midgut volvulus with intestinal malrotation is rare event with only only few cases in the literature Butterworth et al. (2018). Intestinal malrotation presented in the adulthood is reported in 0.2-0.5 %, of cases; with only 15 % f them presenting as midgut volvulus Butterworth et al. (2018). Intestinal malrotation is casued by an alteration in embryonic development between 10-12 weeks of gestation. The main alteration is anomalous position of the bowel with the small intestine residing on the right side of the abdomen, while the colon and cecum remain on the left side due to malposition of the Treitz ligament. Additionally, the ascending colon remains attached to the abdominal wall by fibrous peritoneal bands known as Ladd bands, this being a cause of midgut volvulus and intestinal obstruction. PRESENTATION OF CASE: We present a 25-year-old male with failure to thrive who arrives at the ED with clinical signs and symptoms of intestinal occlusion and acute abdomen, initial resuscitation is made in ED and is transferred to OR, an exploratory laparoscopy evidencing intestinal malrotation with cecal volvulus and a Ladd procedure is made openly without PO complications. DISCUSSION: The gold standard for diagnosis of intestinal malrotation is the upper gastrointestinal series. However, in patients with acute abdomen associated with this pathology where is suspected intestinal ischemia and hemodynamic instability, it is essential that an emergency laparotomy be performed. CONCLUSIONS: The diagnosis of intestinal malrotation is difficult, since many patients are asymptomatic in adulthood or present with variable GI symptoms. Therefore, it is imperative to have a high index of suspicion in patients with compatible clinical characteristics in order to perform the best therapy in time and manner.
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INTRODUCTION: Liposculpture procedures have a complication rate of 5%, with the majority being minor complications. Infections in isolated liposuction procedures are as low as 0.1 % of cases. Necrotizing infections can occur after major traumatic injuries, as well as after minor breaches of the skin or mucosa. Here we present a case of a 53-year-old female patient who underwent cosmetic surgery and developed a necrotizing soft tissue infection and we will discuss the importance of early diagnosis, risk factors and preventive measures, treatment options and our management of this particular case. PRESENTATION OF CASE: 53-year-old female patient with a history of multiple cosmetic surgeries, with no significant past medical history, she presented fever and disabling pain at the surgical site with extensive bullae formation; during her fourth post operative day, she presented septic shock that required vasopressor support and mechanical ventilation, accompanied by acute renal failure which required admission to the intensive care unit. The patient's relatives requested air transportation to bring the patient to our center. The patient remained hospitalized for 42 days in which 15 surgical interventions were performed including multiple surgical wound cleansing and debridement as well as placement of a negative pressure wound therapy system, flaps advancement, lesions reconstruction, graft procurements and insertions. DISCUSSION: Antibiotic prophylaxis is recommended preferably with a second-generation cephalosporin, one hour prior to surgery and should be continued for 5-6 days afterwards. Likewise, prophylaxis with Flucloxacillin or gentamicin is recommended in the case of liposuction and or abdominoplasty. The microorganisms most frequently isolated in post-liposuction infections are Staphylococcus aureus, Streptococcus group A, Streptococcous pyogenes, and synergistic infections with anaerobes and facultative pathogens. Among the most severe complications of liposuction is necrotizing soft tissue infection (NSTI), which is an infection of the subcutaneous tissue that spreads to the underlying dermis and sometimes beyond including the fascia and muscle. CONCLUSION: Rapid recognition of NSTI is life-saving and urgent, extensive debridement and prophylactic antibiotics are the mainstay treatment for this condition, multiple debridement procedures may be necessary for successful treatment.