Pneumatosis intestinalis (PI) is a radiographic finding which refers to the presence of gas within the wall of any part of the gastrointestinal tract. While in some cases it is an incidental finding which usually represent its benign nonischemic etiology, it may indicate a catastrophic intra-abdominal condition and distinctly characteristic of ischemic enterocolitis. Herein, we discuss the clinical signs and symptoms, the radiological features, the surgical management and outcome of an extremely rare concurrent triad of PI, gastric outlet obstruction, and the sigmoid volvulus based on a case of a patient who underwent surgery in our hospital, which, we think, can emphasize the mysterious concept of PI's mechanical etiology.

Objective: The aim of this study is to investigate the practice of laparoscopic gastric plication (LGP) in Syria with particular emphasis on efficacy and complications, and to explore the concept of bariatric surgery in times of crisis with its related issues and concerns. Materials and Methods: A prospective cohort study included all patients who underwent LGP between February 2011 and September 2014. The main outcome was the percentage of excess weight loss (%EWL). Secondary outcomes included operative time, hospital stay, postoperative complications, and improvement of related comorbidities. Results: Of the 129 patients who underwent LGP in the study period, 96 patients were included in the final analysis. The mean body mass index was 39.5 kg/m (32–49 kg/m). No cases of conversion to laparotomy, leak, intraabdominal infection, or mortality were seen. Vomiting was the most common postoperative complaint, which was encountered in 91.6% of patients. Two patients required operation reversal because of protracted vomiting. Mean %EWL was 60%, 65%, 70%, 67%, 66% and 65% at 6, 12, 18, 24, 30 and 36 months respectively. Obesity-related comorbidities were present in 33 patients (34.4%), and they showed considerable improvement or complete Original Research Article Hammadieh et al.; BJMMR, 19(3): 1-9, 2017; Article no.BJMMR.30714 2 resolution in 57-100% of cases. Weight regain was seen in 7 patients (7.3%) after 36 months, three of whom (3.1%) requested reoperation. Conclusions: LGP is a feasible and safe operation for the treatment of morbid obesity, and it is comparable to other restrictive bariatric operations with fewer rates of serious complications. It is an appropriate technique in times of crisis due to low cost and ease of follow-up.

The most common pattern of esophageal cancer metastases (ECM) is to the lymph nodes, lung, liver, bones, adrenal glands, and brain. On the other hand, unexpected metastasis (UM) spread to uncommon sites has increasingly reported and consequently affected the pathway of diagnosis, staging, and management. Using the PubMed database, a systematic search of the following headings "Esophageal" and "Metastasis" or "Metastases" was performed, 10049 articles were identified, and the articles were included if they demonstrated unexpected ECM. 84% of cases were men with an average age of 60.7 years. EC was located in the lower third in 65%. Two-thirds of the UM originated from the lower esophagus, and the two major histological types were adenocarcinoma 40% and squamous cell carcinoma 60%. Metastases were disseminated toward five main anatomical sites: the head and neck (42%), thoracic (17%), abdomen and pelvis (25%), extremities (9%), and multiple skin and muscle metastases (7%). The EC metastases were found to be synchronous 42% and metachronous 58%, isolated in 53.5% and multiple in 46.5%. The overall survival rate was 10.2 months. Since distant metastases are responsible for most EC-related deaths, understanding of ECM dissemination patterns needs more extensive studies. These critical data are the cornerstone of optimal cancer approach and treatment.

Background: Portomesenteric vein thrombosis (PMVT) is considered an uncommon complication in general surgery; nevertheless, with the growing popularity of sleeve gastrectomy (SG) as a bariatric procedure we have seen an increase in the occurrence of this complication.Objectives: To elucidate the question if it is a procedure-related complication and explore the modalities of prevention and treatment of this complication, a systematic review of available literature regarding PMVT events after SG was conducted.Methods: Our systematic review yielded 28 studies enclosing 89 patients. Perioperative data was collected from each study and analyzed.Results: The incidence of PMVT after SG ranged from .37% to 1%, 65% of the patients were female, and the mean body mass index was 41.63 kg/m(2). Perioperative co-morbidities including hypertension, diabetes, and dyslipidemia were recorded in 39.7%, 41.63%, and 38.23% of cases respectively. Tachycardia and fever were reported only in 23.9% and 20.89%, respectively, and hereditary thrombophilia studies were positive in 30.43% of cases. The rate of acute major complications after PMVT was 14.6% (13 cases), and mortality was reported in 3 cases (average 3.37%).Conclusion: PMVT seems to be an uncommon multifactorial disease, with unpredictable symptoms and varieties of the treatments options, but additional studies are required to further define optimal management and prevention algorithms. (Surg Obes Relat Dis 2017;13:1422-1433.) (C) 2017 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Esophagus cancer metastases often involve locoregional lymph nodes, lung, bone, liver, and brain. Metastatic involvement of the breast from esophagus cancer is uncommon, but if it happened, it usually presents as a part of multiple organ distal metastases. Here we report a case of the largest metastatic esophagus cancer of the breast and the chest wall, and we review the similar reported cases.

Situs ambiguous is an extremely rare syndrome with an overall incidence of 4 per 1 million live births [ [1] Lee S.E. Kim H.Y. Jung S.E. et al. Situs anomalies and gastrointestinal abnormalities. J Pediatr Surg. 2006; 41: 1237-1242 Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar ]. This syndrome involves a long list of malformations but can be classified into 2 main subgroups: right-sided isomerism with asplenia and left-sided isomerism with polysplenia. Several successful and safe laparoscopic weight loss surgeries were previously reported in morbidly obese patients with situs inversus [ 2 Catheline J.M. Rosales C. Cohen R. et al. Laparoscopic sleeve gastrectomy for a super-super-obese patient with situs inversus totalis. Obes Surg. 2006; 16: 1092-1095 Crossref PubMed Scopus (29) Google Scholar , 3 Samman M. Ratnasingham A. Pittathankal A. Hashemi M. Laparoscopic adjustable gastric banding for morbid obesity in a patient with situs inversus totalis. Obes Surg. 2008; 18: 898-901 Crossref PubMed Scopus (22) Google Scholar ]. However, to the best of our knowledge, no such cases in patients with situs ambiguous are available in the published literature. We herein present a case of laparoscopic vertical sleeve gastrectomy in a patient with situs ambiguous and review the distinctive technical difficulties related to the malposition of the stomach and the management of multiple spleen infarctions present during surgery.

Duodenal duplication is a rare developmental abnormality which is usually diagnosed in infancy and childhood, but less frequently in adulthood. We report a case of a 16-year-old female with a duplication cyst in the third part of the duodenum. The patient presented with symptoms of gastric outlet obstruction, including severe anorexia and weight loss. The diagnosis was made preoperatively by CT scan and upper endoscopy. The cyst was successfully treated by marsupialization on the duodenum using a GIA stapler. Duodenal duplication presents with a wide variety of symptoms. Although illusive, many cases can be properly diagnosed preoperatively by using the appropriate imaging modalities. Treatment choices are tailored according to the size and location of the cyst, in addition to its relation to adjacent structures. The outcomes are favorable in the majority of patients.