Introduction. Gastric leak after laparoscopic sleeve gastrectomy (LSG) is a severe complication that may lead to sepsis and even death. Early diagnosis and treatment are critical. The aims of this prospective study are to establish normal amylase levels and investigate elevated amylase levels, especially in the drain, for detecting anastomotic leakage following LSG. Material and Methods. One hundred sixty-one patients who underwent LSG during 1 year at Rambam Health Care Campus were included prospectively in the study. Demographic and medical background, peri- and postoperative complications, and laboratory data including amylase levels in blood, urine, and drain were evaluated. Univariate and multivariate analyses were performed to examine independent variables that can predict increases in amylase values. Results. Thirty-five (21.8%) patients had high levels of amylase in blood, urine, and/or drain and 126 (78.2%) normal values of amylase until discharge. No significant differences were found in operation duration, length of hospitalization, or occurrence of complications. One patient had a staple-line leak diagnosed in the third postoperative day that was treated conservatively with endoscopic approach. His amylase levels in the blood and drain were normal, with only a slight hyperamylasuria. Conclusions. High amylase levels after LSG does not necessarily indicate a major complication such as staple-line leak, and in the vast majority of cases, it seems to have no clinical relevancy. Therefore, it should not automatically lead to a full investigation in the absence of further clinical signs. It is suggested that there is no clinical justification to test amylase routinely after LSG.

Introduction:The wandering spleen is a very rare cause of acute abdominal pain, occurring mostly in children and females of reproductive age. It is characterized by weakness or absence of one or more of the ligaments that hold the spleen in its normal location at the left upper quadrent of the abdomen. Herein, we present a rare case of wandering spleen in a patient with intestinal malrotation and history of an unknown abdominal surgery in the left upper quadrant. Case Presentation:A 37-year-old female patient, presented to our Emergency Medicine department with acute abdominal pain. She was diagnosed with a wandering spleen and intestinal malrotation. Prompt laparotomy was performed, and the patient underwent splenectomy, appendectomy and intestinal fixation.

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