HighlightsPatient’s condition was further compounded by splenic rupture.Recovery was complicated by post-op sepsis and intraabdominal abscesses.Constipation may be missed due to encopresis and the analgesic effects of opioids.

No abstract

Subclavian steal syndrome is an uncommon entity diagnosed with angiography after neurologic symptoms occur during activity with the upper extremity. Cardiac symptoms or silent ischemia have been described in patients who have undergone cardiac bypass using the ipsilateral internal mammary artery. Our patient presented with acute chest pain radiating to the left upper extremity and a diminished pulse. Angiography to rule out an acute embolus instead revealed subclavian artery occlusion. As atherosclerosis is the most common cause, the ipsilateral subclavian artery should be carefully evaluated, particularly in cardiac patients undergoing coronary angiography. Recognition of coexisting subclavian artery occlusion could prevent cardiac complications that may occur with use of the ipsilateral internal mammary artery during coronary artery bypass surgery.

An extensive Medline search revealed no documentation in the literature regarding staple-line disruption of a vertical banded gastroplasty after blunt abdominal trauma. A 41-year-old woman with a past surgical history significant for a vertical banded gastroplasty 13 months ago was admitted to our hospital one week after an episode of blunt trauma to the abdomen. The patient presented with complaints of nausea, vomiting, and anorexia after the incident. The suspected diagnoses were stenosis of the stoma due to hematoma after the blunt trauma as well as staple-line dehiscence. A partial disruption of the vertical staple-line was identified by esophagogastroduodenoscopy and barium swallow.