Qual o seu diagnóstico?

Abstract

0100-3984 © Colégio Brasileiro de Radiologia e Diagnóstico por ImagemWhich is your diagnosis? • Qual o seu diagnóstico? A female, Caucasian, 76-year-old patient reported the onset, approximately three weeks ago, of an intense, diffuse lumbar pain, irradiating over the lower limbs up to the knees. The pain did not decrease with rest and presented only a mild improvement with analgesic and non-hormonal anti-inflammatory drugs. The patient reported a previous history of rectal neoplasm treated with surgery and radiotherapy six months ago. At clinical examination, the patient presented pain at palpation and movement of the lumbar region, negative Lasègue's sign, with no motor or sensitivity deficit. Plain radiography (unshown), computed tomography ( Figure 1

Gastroesophageal Reflux Disease and Obesity

“…Laparoscopic sleeve gastrectomy (LSG) is another approach of bariatric procedure that has gained more attention, owing to less technical complexity as compare to laparoscopic Roux-en-Y gastric bypass (LRYGB), it showed lower incidence of postoperative complication, and leads to substantial weight loss [48]. The impact of LSG on GERD, however is still inconsistent in regards to the control of pre-existing reflux, development of de novo GERD after procedure, and several studies suggested that LSG is a refluxogenic procedure [49][50][51]. Another study showed that the main technical issues that determine the occurrence of postoperative GERD are relative narrowing of the sleeve and hiatal hernia [52].…”

“…Another study showed that the main technical issues that determine the occurrence of postoperative GERD are relative narrowing of the sleeve and hiatal hernia [52]. Ultimately, the baseline severity of reflux symptoms and mucosal injury is the key determinants of patient's feasibility to surgery [51]. Erosive esophagitis is considered as a relative contraindication to the surgery by the joint statement of ASMBS, SAGES, and ASGE [53].…”

“…Recently, the available management options for GERD after LSG include pharmacotherapy with PPI or repair with laparoscopic Roux-en-Y gastric bypass [52]. These available options should be openly discussed with the patients [51].…”