OBJECTIVES:Bariatric surgery is considered as the most effective therapy for morbid obesity. But, each procedure carries both short-and long-term complications. And, it remains unclear if the late occurrence of gastric adenocarcinoma could be linked to bariatric surgery. We described a case of a female who developed a gastric adenocarcinoma after a silastic ring vertical gastroplasty (SRVG).METHODS:A 54-year-old female presented with postprandial vomiting, poor appetite, dysphagia and weight loss 10 year after a SRVG. A gastroscopy with biopsy disclosed a juxta-pyloric adenocarcinoma. No distant metastasis was found. After 3 cycles of neoadjuvant chemotherapy, a subtotal gastrectomy with Roux-en-Y anastomosis was performed.RESULTS:After the surgery, a minor anastomotic leak was treated conservatively and a parietal abscess was drained. The pathological studies demonstrated a T2bN1 adenocarcinoma with negative margins. Adjuvant chemotherapy was administered. At the last work up, the patient is disease-free.CONCLUSION:The association between a gastric adenocarcinoma and a bariatric procedure such as a SRVG is difficult to assess without a case-control or a cross-sectional study. Nevertheless, when new upper digestive tract complaints occur in any patient with an otherwise unremarkable bariatric surgery follow-up, the diagnosis of gastric cancer should be bear in mind.

A 76-year-old woman presented with recurrent right lower quadrant pain associated with decreased appetite and weight loss. An abdominal computed tomography (CT) scan without contrast injection (iodine allergy) showed a thickening of the cecal wall with infracentimetric regional lymph nodes ([Fig. 1]).

BACKGROUND:Due to the organ shortage, marginal donors are increasingly used in liver transplantation (OLT). These grafts may be safely used in less critical recipients but, the real influence of extended donor criteria (EDC) remains uncertain when graft-recipient matching is not applied. Our study analyzed the impact of EDC on initial graft function within the Eurotransplant patient-driven allocation system.PATIENTS AND METHODS:We reviewed 70 OLT performed between 2004 and 2006. The impact of the following EDC were analyzed: age > 60; intensive care unit (ICU) stay > 4 days; peak serum Na(+) > 160 mEq/L; body mass index (BMI) > 30; cardiac arrest with cardiopulmonary resuscitation, and high doses of vasopressors. Early graft function, as defined according to peak transaminase level and spontaneous prothrombin time within the first 5 posttransplant days, was compared between the donors with none or one criterion (group A = 39) and those with >1 criterion (group B = 31).RESULTS:The most frequent EDC were high vasopressor use, ICU stay > 4 days and BMI > 30, were present in respectively 44%, 27%, and 16% of the donors. No EDC were present in 13 donors, one in 26, three in eight, and four in three. Demographics and origin and severity of the liver disease were similar in both groups. We failed to observe significant differences in initial graft function.CONCLUSION:The presence of EDC did not significantly affect early graft function in a population where donor and recipient were not matched. While this observation must be confirmed in a multicenter analysis, it tends to support the use of marginal liver grafts, even in patient-driven allocation systems.