Cases reported "Obesity, Morbid"

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1/34. Neurologic deficits after cervical laminectomy in the prone position.

    New neurologic deficits are known to occur after spine surgery. We present four patients with cervical myeloradiculopathy who underwent cervical laminectomy, fusion, or both in the prone position, supported by chest rolls. Three patients were intubated and positioned while awake, whereas the fourth patient was positioned after induction. Surgeries were successfully carried out, except for transient episodes of relative hypotension intraoperatively. On recovery from anesthesia, all patients were noted to have new neurologic deficits. Immediate CT myelography or surgical reexploration was unremarkable. All patients improved gradually with administration of high-dose steroids and induction of hypertension. Use of the prone position with abdominal compression may compromise spinal cord perfusion and lead to spinal cord ischemia. The use of frames that prevent abdominal compression, as well as avoidance of perioperative arterial hypotension, is important in maintaining adequate spinal cord perfusion during and after decompressive spinal cord surgery.
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keywords = chest
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2/34. intestinal obstruction following biliopancreatic diversion.

    In our opinion biliopancreatic diversion patients require particular care, especially in the emergency room setting. Due to the changes in anatomy following surgery, there are many changes in physiology. These changes result in different clinical manifestations than in the general population. Therefore, the combined use of clinical and laboratory findings, abdominal ultrasound and CT scan are invaluable assets in obesity surgery patients presenting with acute abdominal pain.
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ranking = 78.047809297566
keywords = abdominal pain
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3/34. Gastric perforation in an obese patient with an intragastric balloon, following previous fundoplication.

    BACKGROUND: The Bioenterics Intragastric Balloon (BIB) has been a safe and effective method used in treatment of moderate obesity. Gastric perforation is a rare complication, and its possible sequelae are dangerous. methods: A 52-year-old women (BMI 37 kg/m(2)), with hiatal hernia, moderate hypertension and dyspnea, 1 year ago underwent laparoscopic fundoplication. She now underwent positioning of a BIB filled with 500 cc of saline. After 8 days, 6 kg weight loss occurred and her clinical condition was satisfactory. On day 11, severe abdominal pain and vomiting occurred, which spontaneously regressed in the following 6-8 hours. Ultrasound confirmed the correct position of the BIB, and showed widespread abdominal meteorism. On day 18, acute abdomen with paralytic ileus occurred. On admission, CT scan documented hydropneumoperitonitis. At operation, a large perforation of the lesser curvature was found, with undigested food in the abdomen. She underwent peritoneal lavage, removal of the BIB, and suture of the gastric laceration. RESULTS: She was discharged in good condition after 11 days. CONCLUSION: According to our experience, fundoplication represents an absolute contraindication to positioning of a BIB.
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ranking = 78.047809297566
keywords = abdominal pain
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4/34. Treatment of a celiac artery aneurysm with endovascular stent grafting--a case report.

    As a result of more sophisticated and more commonly performed investigative procedures, aneurysms of the visceral abdominal vasculature, including celiac artery aneurysms, are increasingly recognized. Traditional therapy for visceral artery aneurysms has been limited to open aneurysmectomy or aneurysmorrhaphy to prevent catastrophic aneurysmal rupture. However, these procedures are associated with significant postoperative morbidity and mortality despite technical successes. High complication rates are likely related to poor preoperative conditions among the patient population typically presenting with these visceral artery aneurysms. This report introduces an alternative therapy for visceral artery aneurysms and highlights the potential for catheter-based interventions. This case report depicts a 61-year-old morbidly obese woman diagnosed with a 10-centimeter celiac artery aneurysm during investigation of upper abdominal pain. Given the patient's poor medical condition, punctuated by hemodynamic instability, open operation was avoided, and percutaneous embolization was not feasible owing to a large aneurysm neck. Therefore, inflow to the celiac artery aneurysm was excluded by placing a modular stent graft component within the abdominal aorta at the celiac artery orifice. During the intervening 12 months since stent graft deployment, the aneurysm sac diameter has steadily decreased, as determined by serial computed tomography scans. This report underscores the potential for catheter-based techniques to offer new therapeutic options for patients with visceral artery aneurysms. Careful individualization is required given the highly variable size, location, and character of such lesions.
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ranking = 78.047809297566
keywords = abdominal pain
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5/34. Ruptured appendicitis after laparoscopic Roux-enY gastric bypass: pitfalls in diagnosing a surgical abdomen in the morbidly obese.

    A recent gastric bypass can mask the symptoms of an acute abdomen. physical examination is generally unreliable and subtle clinical symptoms or signs should alert clinicians to a significant postoperative problem. In morbidly obese patients, the presence of overt peritoneal findings is usually ominous, leading to sepsis, organ failure and death. We report a case of ruptured appendicitis following a laparoscopic Roux-en-Y gastric bypass. The patient developed tachycardia, fever, and leukocytosis in the absence of abdominal pain or positive upper GI contrast studies. Eventually, a CT scan revealed a large pelvic abscess and inflammation. A subsequent exploratory laparotomy confirmed a perforated appendicitis with pelvic peritonitis. Her recovery was rapid and uneventful. This case highlights the pitfalls in promptly diagnosing an unrelated acute surgical abdomen postoperatively in the morbidly obese patient. The need for extreme vigilance and a low threshold for aggressive intervention in the period after bariatric surgery is emphasized.
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ranking = 78.047809297566
keywords = abdominal pain
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6/34. Gastro-clip gastroplasty: a very long-term complication.

    For most surgeons, the gastro-clip gastroplasty is an unfamiliar operation. It was performed during the mid 1980s as an alternative to more complex bariatric operations. However, the device had problems. Because of its rigid nature, it occasionally eroded into the stomach and chest. Many of these devices required removal. However, patients may occasionally present with delayed complications. We present a patient with a Gastro-clip gastroplasty, who presented years after the procedure with a functional gastric outlet obstruction.
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keywords = chest
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7/34. Gastric wall necrosis following late prolapse after laparoscopic banding.

    A 20-year-old female, who had suffered from morbid obesity with a BMI of 41.2, was admitted 3 years after undergoing laparoscopic gastric banding. 3 days before her present admission, she began suffering from abdominal pain without vomiting. On admission investigation, gastric prolapse was diagnosed with complete obstruction of passage through the band. Emergency laparoscopy was performed, which showed devitalization of the stomach above the band. At the operation, the band was removed, and conservative treatment was begun with nasogastric aspiration, total parenteral nutrition, and close observation.
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ranking = 78.047809297566
keywords = abdominal pain
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8/34. Mesenteric venous thrombosis after gastric bypass.

    A 43-year-old man presented 10 days after a Roux-en-Y gastric bypass with abdominal pain radiating to the back. Investigation revealed a thrombus in the superior mesenteric vein. The patient was found to have a hypercoagulable state. He responded successfully to anticoagulant therapy.
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ranking = 79.230034039315
keywords = abdominal pain, back
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9/34. Incomplete reversal of enoxaparin toxicity by protamine: implications of renal insufficiency, obesity, and low molecular weight heparin sulfate content.

    The use of low molecular weight heparin (LMWH) is increasing throughout north america and europe for a number of reasons: 1). ease of use; 2). predictable dose response; 3). less heparin associated thrombocytopenia. However, aside from increased costs, LMWH has significant potential drawbacks: 1). poor reversibility; 2). tendency to accumulate in renal insufficiency; 3). less experience in subset patient groups such as morbid obesity. We report a case of a postoperative morbidly obese patient who developed enoxaparin toxicity secondary to acute renal failure that did not reverse with protamine sulfate infusion. In addition, we review the use of LMWH in renal insufficiency, dosing in obese patients,and the importance of sulfate content in the efficacy of protamine sulfate as a reversing agent for LMWH.
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ranking = 1.1822247417486
keywords = back
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10/34. diagnosis and management of acute gastric distention following laparoscopic adjustable gastric banding.

    Laparoscopic adjustable gastric banding (LAGB) is commonly performed for weight reduction in the morbidly obese population. Morbidly obese patients often suffer from many co-morbid conditions including diabetes. Diabetic patients may suffer from symptomatic or asymptomatic gastric dysmotility resulting in intermittent gastric distention. Following gastric banding, in the early postoperative period, patients may be unable to decompress trapped air in the stomach and may develop severe acute distention with associated risk for catastrophic results. We present the case of a diabetic patient who underwent an uneventful LAGB but returned to the hospital with severe abdominal and back pain. Following the diagnosis of acute gastric distention using an abdominal roentgenogram, the stomach was decompressed using a naso-gastric tube. Following initiation of promotility agents, the patient was successfully discharged home without symptoms. A high index of suspicion, prompt diagnosis and appropriate management can prevent complications of acute gastric distention in this patient population.
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ranking = 10.636803852304
keywords = back pain, back
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