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The authors present the case of a 43-year-old women who underwent a laparoscopic gastric bypass in 2003 for morbid obesity.
They report that 2 years later, she had maintained significant weight loss, but had developed acute abdominal pain, followed
by nausea and emesis. In the emergency room, she had diffuse tenderness, tachycardia, and leukocytosis. After initial resuscitation,
a computed tomography was performed, which showed free air above the liver and thickened small bowel loops. She was brought
emergently to the operating room for laparoscopy. At surgery, turbid fluid and inflamed small bowel loops were seen. A perforated
marginal ulcer was discovered in the Roux limb, approximately 2 cm distal to the gastrojejunal anastomosis. The perforation
was oversewn primarily and patched with omentum. The repair was tested by intraoperative endoscopy. A gastrostomy tube also
was placed within the gastric remnant for enteral access. The patient did extremely well postoperatively, and had an uneventful
postoperative course. She was discharged on postoperative day 4. The gastrostomy tube was removed at 1 month, and at this
writing, she remains well since surgery. An upper endoscopy at 2 months was completely normal, and the Helicobacter pylori test results were negative. The gastric pouch had not significantly enlarged since initial surgery, as indicated by both
endoscopy and barium study. Marginal ulcer is reported to be 0.6% to 16% after laparoscopic gastric bypass [1]. Etiologies include gastrogastric fistula, excessively large gastric pouch containing antral mucosa, H. pylori infection, nonsteroidal antiinflammatory use, and smoking [2]. Unfortunately, none of these applied to the reported patient. Because her exact etiology remains unknown, she at this writing
continues to receive proton pump inhibitor therapy.
Electronic supplementary material The online version of this article (doi: ) contains supplementary material, which is available to authorized users. 相似文献
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Pyomyositis: characteristics at CT and MR imaging 总被引:9,自引:0,他引:9
7.
AJ Larner MRCP 《International journal of clinical practice》1994,48(5):272-274
SUMMARY A case is reported of pseudohyperphosphataemia in association with a monoclonal gammopathy of undetermined significance. 相似文献
8.
Daniel M. Herron 《Journal of gastrointestinal surgery》2004,8(4):406-407
Conclusion In the year 2003 there is no “one best bariatric operation” for every severely obese patient. The choice of operation must
be tailored to each individual patient’s needs and wishes. For the superobese patient, the patient diagnosed with intestinal
metaplasia of the stomach, and for those patients who do not wish to undergo the severe dietary restrictions imposed by the
RNY-GB, the BPD-DS is a valuable surgical option. 相似文献
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D De AJ Kanwar S Handa 《Journal of the European Academy of Dermatology and Venereology》2006,20(7):853-859
BACKGROUND: Diagnosis of atopic dermatitis (AD) depends on clinical features because no definitive diagnostic test exists. Criteria proposed by Hanifin and Rajka (Acta Derm Venereol (Stockh) 1980; Suppl 92: 44-47) were acceptable for hospital-based studies but were found not to be suitable for field studies. A UK working party formulated clinical diagnostic criteria that could be used in both hospital and epidemiological settings. Validation studies of the criteria showed widely variable results, probably due to different clinical settings and ethnicity. AIM AND OBJECTIVE: This study was undertaken to validate Hanifin and Rajka's criteria and to assess the comparative efficacy of their criteria and the UK working party's diagnostic criteria in the diagnosis of AD in a hospital setting in North India. SUBJECTS AND METHODS: This study serially included 101 patients with AD and 48 controls of paediatric age group. The study period was from July 2003 to December 2004. RESULTS: Hanifin and Rajka's criteria (sensitivity 96%, specificity 93.75%, positive predictive value 97% (PPV) and negative predictive value (NPV) 91.84%) had a statistical advantage over the UK working party's diagnostic criteria (sensitivity 86%, specificity 95.83%, PPV 97.75% and NPV 76.67%), with a P-value < 0.005. 相似文献