A delayed acute complication: Gastric remnant hemorrhagic ulcer after mini-gastric bypass

Mini-gastric bypass is a common procedure for bariatric surgery. This procedure creates and excluded gastric remnant and this part can’t be accessed easily. Some complications of this gastric remnant has been reported but there is not a reported case of acute bleeding from there. Our report presents and 37 year old woman who had undergone bariatric surgery 6 years ago. Mini-gastric bypass was performed to this patient. The patient comes to the emergency service with signs of upper gastrointestinal bleeding. After hospitalization, examinations showed us that the patient was bleeding from the remnant stomach. The remnant stomach and the first part of the duodenum were resected with laparoscopic surgery. At 6 months followup, the patient has had no further episodes of gastrointestinal hemorrhage. Keywords: Gastric remnant; Hemorrhagic ulcer; Mini-gastric bypass; Red blood cell scintigraphy.

Peritoneal Dialysis Exit Site Pyoderma Gangrenosum: A Case Report

Background: Pyoderma gangrenosum (PG) is a rare, chronic inflammatory condition exhibiting mucopurulent or hemorrhagic exudates. The majority of cases are associated with inflammatory bowel disease, rheumatological diseases, and hematological malignancies. In the absence of typical serological markers and specific histopathological changes, the diagnosis is often clinical. Being rare, it is frequently misdiagnosed, which leads to a delay in instituting appropriate therapy. Case Presentation: We present a 53-year-old male of Aboriginal descent with end-stage renal disease due to diabetes who underwent insertion of a peritoneal dialysis (PD) catheter. Five weeks after PD catheter insertion, he started to notice a painful ulcer surrounded by a bed of erythema. The lesion eventually progressed to a purulent, hemorrhagic ulcer surrounded by a raised, irregular, violaceous border along the entirety of the PD catheter tunnel. There was no history of underlying systemic diseases commonly associated with PG. The catheter was removed, and an elliptical biopsy was taken, which ruled out infection, malignancy, and vasculitis. The changes were felt to be consistent with PG. The patient underwent treatment initially with topical corticosteroids, followed by oral prednisone, which unfortunately worsened his diabetic control; due to this, he was transitioned to cyclosporine, with complete resolution. Conclusions: Lesions at the PD catheter exit site are usually treated for infections. However, for ulcers that are painful, rapidly expanding, nonhealing, and unresponsive to antibiotics, PG should be considered as a differential diagnosis. This is the first reported case of PG occurring at the exit site of a PD catheter.

Host-parasite relationship during Epistylis sp. (Ciliophora: Epistylididae) infestation in farmed cichlid and pimelodid fish

The objective of this work was to describe the host-Epistylis sp. relationship during infestation on farmed fish. Five Nile tilapia (Oreochromis niloticus) and ten hybrid surubim catfish (Pseudoplatystoma reticulatum x P. corruscans), all diseased, were used for in vivo morphological analysis of sessile peritrichs by contrast microscopy. Fragments of infected tissues were subjected to histological processing and scanning electron microscopy. Epistylis sp. caused hemorrhagic ulcer disease, and cichlids were more prone to develop infestations throughout the body surface due to the attachment of the colonies to the scales, which did not occur with pimelodids. Multifocal granulomatous dermatitis was observed, associated with the hydropic degeneration of the epithelium and to ulcerative areas of necrosis. Microscopic examination showed the presence of bacterial microflora associated to Epistylis sp. peduncles. Therefore, this species can be considered a portal of entry for opportunistic bacteria.