No abstract

Appendiceal metastasis from primary gallbladder cancer is rare. Here we report the case of a 62-year-old female with stage IV gallbladder cancer who presented to the ED four months after initiation of her cancer treatment. Diffuse abdominal pain was her only presenting symptom and contrast-enhanced CT imaging revealed findings consistent with acute appendicitis. Prompt surgical treatment with laparoscopic appendectomy was initiated. Surprisingly, the histologic analysis was consistent with gallbladder primary metastatic adenocarcinoma to the appendix rather than primary adenocarcinoma of the appendix.

Obesity is estimated to affect more than one and a half billion adults. Laparoscopic Roux-en-Y gastric bypass (LRYGB) has become one of the preferred weight loss procedures. However, complications can occur. Strictures at the gastrojejunal anastomosis lead to clinical symptoms such as vomiting, dysphagia, and patient discomfort. The stricture rate has been correlated with the size and type of stapler used. A retrospective review of the clinical records of patients who underwent LRYGB was performed between 2003 and 2010. A comparison was made between a 21-mm circular stapler technique and a 25-mm linear stapler technique. The stricture rate for the 21-mm circular stapler group was 7.12% and comparable to the national average. Using the 25-mm linear stapler, this complication rate significantly decreased to 1.09% (<0.0004; odds ratio 6.5; [95% confidence interval 1.96-33.83]). Stricture after LRYGB is a serious complication. This study found that with a change in technique, this complication can be decreased considerably.