Clinica Gastrobese

Patient: Female, 40-year-oldFinal Diagnosis: ObesitySymptoms: ObesityClinical Procedure: —Specialty: SurgeryObjective: Unusual clinical courseBackgroundMetabolic and bariatric surgeries (MBS) are effective treatments for obesity and related comorbidities, such as diabetes and hypertension. In patients with morbid obesity and challenges like hepatomegaly, conventional procedures may increase risks. Staged MBS was developed to address these issues, enhancing safety. This report highlights the successful use of isolated intestinal transit bipartition with duodeno-ileal anastomosis, preserving the duodenum, as the first stage of the duodenal switch.Case ReportA 40-year-old woman with a BMI of 40.2 kg/m2 was booked for MBS. Severe hepatomegaly impaired safe access to the esophagogastric junction, leading to the performance of only the intestinal stage of the duodenal switch. A duodeno-ileal anastomosis was created 250 cm from the ileocecal valve, preserving the stomach and partial duodenal function. Without the gastric stage, the patient achieved 50 kg of weight loss (equivalent to 78.7% excess weight loss) over 19 years, without requiring additional surgery. Minor complications included occasional diarrhea, meteorism, and difficulties with vitamin supplementation, all managed effectively through dietary adjustments and nutritional guidance. A benefit was increased satiety.ConclusionsIsolated intestinal transit bipartition with duodeno-ileal anastomosis is an approach that may be used in exceptional cases, such as with this patient. Despite the favorable long-term follow-up results, further studies are necessary to better understand this approach. This method demonstrated sustained weight loss and long-term metabolic control, potentially representing a promising initial treatment option for patients with lower BMIs, including those with type 2 diabetes.

BACKGROUND Sleeve gastrectomy (SG) is widely used in obesity treatment, although it is associated with new onset of gastroesophageal reflux disease (de novo GERD) and weight regain. Roux-en-Y gastric bypass (RYGB) is the standard revisional procedure for GERD, though it offers limited additional weight loss. Ileal-based procedures have demonstrated superior outcomes regarding weight loss but have uncertain results in GERD. This study presents preliminary findings on gastric bipartition with functional duodenal exclusion (GBp-FDE) as a revisional approach following SG in this scenario. CASE REPORT A retrospective data analysis was conducted on 10 patients who underwent GBp-FDE due to de novo GERD and obesity recurrence after SG (mean BMI: 37.2±3.2 kg/m²). Nine patients presented with hiatal hernia and 8 with sleeve dilation. GERD was assessed pre- and postoperatively using a validated questionnaire, endoscopy, and contrast radiology. The surgical technique involved a pre-pyloric antroileostomy in Roux-en-Y configuration using a 40% proportion biliopancreatic limb. One-year postoperative findings included pyloric spasm (endoscopy), very preferential contrast flow to the ileum (radiology), and endoscopic access preservation to the duodenum. GERD symptoms resolved in 90% (P=0.0059) and esophagitis healed in 80% (P=0.008), likely due to gastric decompression. Mean percent total weight loss and percent excess weight loss were 35.2±6.6 and 108.0±11.14, respectively. CONCLUSIONS GBp-FDE seems to be a promising surgery for managing de novo GERD and obesity recurrence after SG, through SG pouch decompression and ileal stimuli, promoted by the antroileostomy. Further controlled studies with extended follow-up are necessary to validate these findings.

Granulomatous colitis, or ulcerative colitis, is an infectious and inflammatory disease that primarily affects the colon and occasionally extends to the ileum, particularly in young Boxer and French Bulldogs. Unlike typical chronic colitis in small animals, the early onset of the disease suggests a genetic predisposition. The condition is characterized by the overgrowth of Escherichia coli, specifically the enteroinvasive variant, which displaces beneficial gut bacteria, contributing to its infectious nature. Secondary dysbiosis and chronic-active inflammation involving histiocytes and other leukocytic infiltrates are prominent features. Clinical manifestations include chronic diarrhea with blood and mucus, frequent tenesmus, and pain, with variable degrees of weight loss depending on disease severity. The final diagnosis is based on clinical history (chronic diarrhea with hematochezia), macroscopic findings from colonoscopy (edema, ulcers, and wall hyperplasia), histopathology (presence of histiocytes), and Escherichia coli growth in culture from a colon fragment. Treatment is guided by colon antibiograms, which often require prolonged antibiotic therapy. Fecal microbiota transplantation (FMT) has emerged as a potential treatment, either as a primary intervention or adjunctive therapy, for conditions such as acute enteritis (e.g., canine parvovirus), dysbiosis, and chronic enteropathies. However, its application to modulate the microbiota and reduce inflammation in granulomatous colitis, potentially leading to longer intervals between relapses, remains an area of ongoing investigation. This is a case report of a French Bulldog diagnosed with ulcerative colitis accompanied by dysbiosis and refractory to standard treatments but sensitive and partially responsive to amikacin. The patient achieved control and sustained improvement in fecal scoring following fecal transplantation. This approach prevented the need for additional antibiotic therapy, ensuring clinical amelioration alongside microbiome restoration.

Bochdalek hernia is the most common congenital diaphragmatic hernia. Its symptoms are normally diagnosed and treated during the neonatal period. Conversely, in adults it is usually asymptomatic and, as a consequence, this group is misdiagnosed. A case of a 64-year-old female patient with an uncommon incarcerated right-sided diaphragmatic hernia formed three years after a Roux-en-Y gastric bypass and a significant weight loss is reported. The importance of this abnormality as a complication of the bariatric surgery should be considered.