Small intestinal diverticula induced by malignant mesenchymal tumors are extremely rare clinical entities. We present the case of a 46-year-old female who reported a one-week history of worsening generalized abdominal pain accompanied by constipation. A computed tomography (CT) scan of her abdomen revealed an ulcerative mass at the proximal/midjejunal junction, suggestive of jejunal diverticulitis. She initially underwent diagnostic laparoscopy, which was converted to an open procedure for resection of the jejunal mass and side-to-side anastomosis. The final histopathological examination revealed features consistent with a gastrointestinal neuroectodermal tumor.
The coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams.The current study is a subset analysis of the GENEVA study which was an international cohort study between 01/05/2020 and 31/10/2020. Data were specifically analysed regarding the timing of BMS suspension, patterns of service recovery, and precautionary measures deployed.A total of 527 surgeons from 439 hospitals in 64 countries submitted data regarding their practices and handling of the pandemic. Smaller hospitals (with less than 200 beds) were able to restart BMS programmes more rapidly (time to BMS restart 60.8 ± 38.9 days) than larger institutions (over 2000 beds) (81.3 ± 30.5 days) (p = 0.032). There was a significant difference in the time interval between cessation/reduction and restart of bariatric services between government-funded practices (97.1 ± 76.2 days), combination practices (84.4 ± 47.9 days), and private practices (58.5 ± 38.3 days) (p < 0.001). Precautionary measures adopted included patient segregation, utilisation of personal protective equipment, and preoperative testing. Following service recovery, 40% of the surgeons operated with a reduced capacity. Twenty-two percent gave priority to long waiters, 15.4% gave priority to uncontrolled diabetics, and 7.6% prioritised patients requiring organ transplantation.This study provides global, real-world data regarding the recovery of BMS services following the COVID-19 pandemic.
Pancreas transplantation is currently the curative treatment for type 1 diabetes mellitus. It aims at providing physiological insulin replacement therapy in type 1 diabetes mellitus. The goal is thereby also to prevent secondary complications of diabetes. Long term control of glucose metabolism has only been achieved by pancreas transplantation. As a result of improvements in the surgical techniques and the efficacy of immunosuppression, the patient and graft survival rates have improved dramatically over the last 2 decades. As a result, pancreas transplantation, as part of simultaneous pancreas and kidney transplantation, pancreas after kidney transplantation, and exceptionally pancreas transplantation alone, became the standard therapeutic option for patients with type 1 diabetes mellitus with end-stage renal disease. In this article we review the pancreas transplantation methods, indications, techniques, and the short as well as the long outcomes of treatment.
Obesity is associated with erectile dysfunction in many studies. This study aims to inspect the impact of weight-loss surgery on the erectile function in the Saudi male population.Forty-two consecutive male patients who underwent weight-loss surgery during a period from February 2013 to July 2016 were included in the study. Unmarried patients were excluded from the study. A designed questionnaire includes the short version of the International Index of Erectile Function (IIEF), usage of phosphodiesterase inhibitors, overall satisfaction before and after the intervention, marriage duration, and fertility postsurgery. All the participants were contacted through phone in July 2018, and then the questionnaire was mailed to them. All the data were analyzed and compared to a control group of married obese patients, who were waiting for the bariatric surgeries, using specific statistical tests.Thirty patients responded and completed the survey. Their mean age was 41.9 years (range 26-62), and the mean preoperative body mass index (BMI) was 46.3 ± 7.5, with a significant reduction in the BMI postoperatively to a mean of 30 ± 5.5. The IIEF score improved, and the overall satisfaction and feelings were better (76.7%). Only 16.7% of cases needed PDEI before and after the operation. Thirteen (43.3%) patients got children after the surgery. Univariate and multivariate analysis showed that age was a significant factor in association with both erectile function and fertility after bariatric surgeries (P = 0.02). Fertility was better in patients who underwent laparoscopic sleeve gastrectomy than gastric bypass surgery (P = 0.01).The weight-loss surgeries have a significant effect on erectile function, and they improve patient sexual satisfaction. Most of these patients feel better sexual function after bariatric surgeries. Fertility outcome seems to have a positive correlation with this type of surgery. However, a larger sample size and more elaborate studies are warranted to substantiate this claim.
Enteritis cystica profunda (ECP) is a rare benign condition characterized by mucin-filled cystic spaces in the submucosal layer of the small intestine. It is often associated with inflammatory conditions, such as Crohn's disease. This case report describes a 47-year-old male with a history of diabetes and hypertension who presented with flank pain and dysuria. Imaging revealed a mesenteric mass, which led to a differential diagnosis that included malignancies. Despite extensive evaluations, including computed tomography (CT) scans, positron emission tomography (PET) scans, and colonoscopies, the mass showed no significant changes over time. Six months after the initial presentation, the patient returned with acute abdominal pain and signs of bowel obstruction. Surgical intervention revealed a cauliflower-shaped mass at the root of the mesentery, necessitating resection of the small bowel and cecum. Histopathological analysis confirmed ECP. Postoperatively, the patient developed abdominal collections but responded well to treatment, including antibiotics and interventional radiology. This case underscores the diagnostic challenges of ECP, particularly its potential to mimic malignancies, complicating its management in patients with underlying gastrointestinal (GI) diseases. Enhanced awareness and understanding of ECP are crucial for timely diagnosis and appropriate surgical intervention to prevent complications. Continued research is necessary to refine management strategies for this rare condition.
Pulmonary complications after bariatric surgeries are rare but usually serious. They often occur early after surgery but the presentation might be delayed for several months. Gastropleural fistula after bariatric surgery is extremely rare and has been reported in a very small number of patients post sleeve gastrectomy and gastric bypass. A 37-year-old lady presented with left sided pleural effusion and empyema 2 years post single anastomosis gastric bypass surgery. She was found to have a large gastropleural fistula and was managed by surgical repair of the fistula with conversion to gastric bypass and decortication of the affected pleura. That resulted in significant clinical improvement and resolution of the empyema. Gastropleural fistula is a very rare complication of bariatric surgeries and should be considered in patients who present with chronic or recurrent pulmonary infections.