Antiphospholipid syndrome (APS) is one of the many causes of hypercoagulability which often presents with vascular thrombosis in the presence of antiphospholipid antibodies. Symptoms vary depending on the location of the thrombosis. Gastrointestinal symptoms such as paralytic ileus is one of the rare symptoms in APS. The main therapy for APS is use of anticoagulants, but this becomes difficult when there is ongoing bleeding. We report a successful but challenging treatment of a 42-year-old patient who presented with paralytic ileus due to APS with cofounded on-going renal bleeding caused by renal angiomyolipoma.

Superior mesenteric artery syndrome (SMAS) is an uncommon condition which is difficult to diagnose due to non-specificity of symptoms. The most common causes of SMAS are severe weight loss secondary to severe medical conditions, surgical history, and cancer. A 31-year-old male with a history of ulcerative colitis status-post proctocolectomy with ileal pouch-anal anastomosis 10 years prior, presented with progressively worsening weight loss and abdominal pain. Radiographic imaging was consistent with SMAS, which was subsequently confirmed intraoperatively during an emergency surgery in which a Roux-En-Y gastrojejunostomy was performed. Clinicians should be aware that SMAS is a rare but possible complication of ileal pouch-anal anastomosis. Although rare, there should be a low threshold for this diagnosis when obstructive symptoms present.

Citations

• Superior mesenteric artery syndrome following colorectal surgery: a systematic review
  Nourah Alsaleh, Waed Yaseen, Renad Abo Alshamat, Raghad Aljurushi, Basem Alshareef
  Annals of Medicine & Surgery.2025; 87(5): 2763.     CrossRef

Rapunzel syndrome is a very rare condition. The trichobezoar, in cases of Rapunzel syndrome, extend from the stomach into the duodenum and small bowel. Trichobezoars are usually encountered in young women with psychiatric problems, such as trichotillomania, trichophagia, or mental retardation and pica. Large trichobezoars, which are associated with Rapunzel syndrome, are removed during open surgery which requires large incisions. This Case Report describes 2 girls who had Rapunzel syndrome where the trichobezoars reached the jejunum and laparoscopic surgery was successful in the removal of the trichobezoars. Laparoscopic removal of a trichobezoar can be considered as a treatment option for children with Rapunzel syndrome.

Citations

• Endoscopic Treatment of Gastric Bezoars: A Report of Three Cases
  Younghee Choe, Joon Sung Kim, Byung-Wook Kim
  The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2024; 24(3): 286.     CrossRef

Bariatric patients are at risk of diverse complications, such as bowel obstruction, internal hernia, and mesenteric thrombosis, which can result in massive small bowel resection with short bowel syndrome (SBS) as a consequence. In this study a case of an internal hernia after childbirth in a 36-year-old patient with a history of laparoscopic Roux-en-Y gastric bypass surgery is reported. An emergency laparotomy revealed an internal hernia in Petersen’s space with volvulus, causing extensive small bowel infarction and necrosis. SBS is a complicated multifaceted syndrome which requires a multidisciplinary approach, such as medical, nutritional, and pharmaceutical therapies, to optimize fluid and nutrient absorption over long-term monitoring and with revisions of the care plan. To reduce the morbidity and mortality associated with an internal hernia and volvulus, clinicians must be acutely aware of a potential SBS diagnosis and not delay surgical exploration, even if the vital signs, laboratory results, and imaging studies are normal.