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Blunt cerebrovascular injuries, defined as blunt injuries to the internal carotid or vertebral arteries, are uncommon and usually occur in victims of high-speed deceleration motor vehicle crashes. A blunt cerebrovascular injury after an equestrian accident is an extremely unusual presentation. In recent years, advances in screening and treatment with pharmacologic anticoagulation before the onset of neurologic symptoms have improved outcomes for these patients. Endovascular stenting and embolization, although unproven, offer a new potential approach for these complex injuries. We present a unique case of four-vessel blunt cerebrovascular injuries after a horse-riding injury that required multidisciplinary management.

HighlightsA rare case of laparoscopic Roux-en-Y gastric bypass on a patient with situs inversus totalis (SIT).SIT is a rare congenital condition, but surgeons in general do encounter those patients throughout their career.SIT should not solely be an indication for an open approach as minimally invasive surgery is safe and should still be considered the standard of care.Gastric bypass can be safely performed in SIT without the need for major adjustment to the surgeon’s position, trocar placement or instruments used.

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Highlights Jejunoileal bypass is a surgery of the past however still affects patients being see by surgeons today.The pathophysiology is complicated and it should be known these patients suffer from chronic kidney disease, liver failure, chronic diarrhea and many vitamin deficiencies.Bypass reverseal can help preserve kidney function but may not reverse damages already done.From our experience, Bypassed bowel incorporation back into enteric tract can produced a immune response causing functional obstruction only relieved by removal of this bowel.