Surgery and considerations for the repair of Petersen's space hernia after mini gastric bypass

This paper reports a case of Petersen's space hernia after mini gastric bypass. This is an anecdotal post-operative complication in the mini gastric bypass technique, with an estimated rate of 1/5000 cases. Similar cases described in the literature were treated by the surgical hernia reduction and the closure of the mesenteric defect. Our patient had a unique management, performing a conversion to Roux-en-Y gastric bypass with dissection of the biliopancreatic limb at the anastomosis and creation of a variable foot-point anastomosis with excellent mid-term post-operative results. This should provide better long-term results as compared to simple mesenteric closure, avoiding the complications of mini gastric bypass technique

Hypercalcemia associated with adenosquamous pancreatic carcinoma: a reason to initiate palliative treatment

Background: hypercalcemia in patients with diagnosed carcinoma has predominantly a humoral basis mediated by parathyroid hormone-related protein (PTH-rP). Among the reported cases, hypercalcemia associated with the majority of abdominal malignancies indicates an advanced stage of disease. Case report: we present a case of a 78-year-old patient with an adenosquamous pancreatic carcinoma associated with humoral hypercalcemia mediated by PTH-rP. Conclusion: in this case, demonstration of unexpectantly rapid increase in calcium serum correlated with aggressive tumor growth led us to raise the hypothesis that PTH-rP could be a mediator of invasion and dissemination secreted by some tumors, and probably indicates the appropriate time to initiate palliative treatment

Posterior thoracotomy approach to aid resection of posterolateral anaplastic meningioma

Introduction: Meningiomas of the spinal column are tumors that can cause compression of the spinal cord with progressive paraplegia. Prognosis depends on a complete surgical resection. We propose surgical tips for these uncommon placed tumors in order to obtain free margins.   Presentation of the case: We present a patient with unusual presentation of an extensive anaplastic meningioma located posterolateral to the spinal cord with retroperitoneal and pleural invasion. An aggressive and extensive surgical approach was performed with retroperitoneal disection and limited posterior thoracotomy to achieve complete tumor resection. There were no signs of recurrence one year after the intervention.   Conclusions: We have presented an unusual case concerning its presentation and surgical management. With our management we got free margins and almost complete neurological recovery with no signs of recurrence one year after the intervention.Introducción: Los meningiomas espinales son tumores que producen clínica por compresión de la médula espinal, pudiendo debutar como una paraplejia progresiva. Su pronóstico depende de la realización de una resección quirúrgica completa. En este artículo proponemos algunos consejos quirúrgicos para la resección completa y con márgenes libres de estos tumores de localización atípica   Presentación del caso: Presentamos una paciente con una presentación clínica atípica por un meninguoma localizado en la zona posterolateral de la médula espinal dorsal, con invasión retroperitoneal y pleural. Se realizó un abordaje quirúrgico extenso, con disección retroperitoneal y una toracotomía posterior con el objetivo de realizar una resección tumoral completa. Al año de la intervención se encuentra asintomática y sin signos de recurrencia.   Conclusiones: Hemos presentado el manejo quirúrgico complejo de un caso raro e inusual. Con este abordaje hemos conseguido una resección quirúrgica completa, con márgenes libres y una recuperación neurológica prácticamente completa, sin signos de recurrencia al año de la intervención