Laparoscopic anterior gastropexy for chronic recurrent gastric volvulus: a case report

<p>Abstract</p> <p>Introduction</p> <p>Gastric volvulus is an uncommon clinical entity, first described by Berti in 1866. It is a rotation of all or part of the stomach through more than 180°. This rotation can occur on the longitudinal (organo-axial) or transverse (mesentero-axial) axis. This condition can lead to a closed-loop obstruction or strangulation. Traditional surgical therapy for gastric volvulus is based on an open approach. Here we report the case of a patient with chronic intermittent gastric volvulus who underwent a successful laparoscopic treatment.</p> <p>Case presentation</p> <p>A 34-year-old woman presented with multiple episodes of recurrent upper abdominal pain associated with retching and vomiting, treated unsuccessfully with intramuscular metoclopramide. Endoscopic examination of the upper digestive tract showed a suspected rotation of the stomach, and a chronic recurrent gastric volvulus was revealed by barium meal. The patient was operated on successfully, with an anterior laparoscopic gastropexy performed as the first surgical approach.</p> <p>Conclusion</p> <p>Experience with laparoscopic anterior gastropexy is limited only to a few described cases. Our patient was clinically and radiologically followed-up for 2 years with no evidence of recurrence, either radiological or symptomatic. Based on this result, laparoscopic gastropexy can be seen and considered as an initial 'gold standard' for the treatment of gastric volvulus.</p

Rabies

International audienceRabies is a zoonotic disease caused by viruses of the Lyssavirus genus (in the family Rhabdoviridae of the order Mononegavirales) that was first described in the 4th century BC 1. Rabies virus (RABV), the proto type virus of the Lyssavirus genus (TABLE 1), is by far the most common causative agent of rabies 2 and is most readily transmitted by the bite of an infected mammal (FIG. 1). Dogtransmitted rabies causes >99% of the human cases reported. Both animal and human rabies are entirely preventable through vaccination, and the first efficacious rabies vaccines for human use were developed in the 19th century. However, in the 21st century, the virus is still enzootic (that is, endemic in animals) in many regions of the world, and human rabies remains one of the most serious and distressing diseases and an important threat to public health 3. Indeed, when an individual with rabies develops symptoms, the disease is nearly always fatal 4. Rabies is often considered a disease of poverty, ignorance and, in some circumstances, misinformation 5. RABV enters peripheral nerves at the synapse level at the site of the bite and is transported to neurons in the central nervous system (CNS); the virus then replicates and causes cerebral damage. Rabies can manifest in two classical forms (furious and paralytic) with a range of symptoms, but ultimately leads to coma and death. The priority for reducing the burden of human rabies is con trolling dog rabies, especially in freeroaming commu nity dogs 6-9. Rabies elimination was achieved in domesti