Herpes Zoster as a Rare Etiology of Abdominal Pain After Sleeve Gastrectomy: a Case Report
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LETTER TO THE EDITOR
Herpes Zoster as a Rare Etiology of Abdominal Pain After Sleeve Gastrectomy: a Case Report Reza Karami 1 & Mohammad Kermansaravi 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Background Nowadays, obesity has become a serious health problem worldwide. Surgical treatment for morbid obesity is gaining global popularity. Laparoscopic sleeve gastrectomy (LSG) is now the most commonly performed bariatric procedure [1]. Abdominal pain occurring after LSG is an important sign, which should be investigated using abdominopelvic CT scan with intravenous and oral contrast to define the pain etiology. Accordingly, the pain etiology can be considered a sign of several complications such as staple line leakage, portal vein thrombosis, splenic ischemia, and trocar site hernia. However, a percentage of the patients suffering from unexplained abdominal pain after surgery and its reason may be remained as unidentified [2]. A rare differential diagnosis of abdominal pain is a mysterious pathology called herpes zoster (HZ) or shingles, which is caused by varicella zoster virus (VZV), should be considered an unjustifiable pain reason [3]. Varicella zoster virus (VZV) is an exclusively human virus belonged to the α-herpesvirus family. VZV is highly infectious and is present worldwide. Its clinical symptoms consist of dermal lesions such as papules, vesicles, and crusted lesions. HZ most often represents as a painful vesicular rash involving ≤ 2 adjacent unilateral dermatomes. Accordingly, it can be seen more frequently in the immunocompromised
* Mohammad Kermansaravi [email protected]; [email protected] Reza Karami [email protected] 1
Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Rasool-e-Akram Hospital, Niyayesh Ave, Sattarkhan St., Tehran, Iran
2
Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e-Rasool Hospital, Tehran, Iran
patients. The rapid diagnosis is determined by polymerase chain reaction (PCR) and serologic tests [4]. Here, we reported a 65-year-old female underwent LSG 3 weeks ago, who was admitted to our department due to an unrecognized abdominal pain for further evaluations.
Case Presentation A 65-year-old female with BMI of 44 kg/m2 and no significant past medical history underwent LSG. She was discharged on the first day after surgery by tolerating clear liquids regimen, with no problem. Afterward, she was routinely administered PPI, antiemetic agent (Ondansetron), and multivitamin. She had no history of past drug history, and after 3 weeks, she complained of a new-onset abdominal pain in the left flank and left abdomen with no other gastrointestinal complaint. She was visited outpatient in the clinic, and had normal vital signs with no fever, tachycardia, or tachypnea. In the physical exam, mild tenderness was found in the left abdomen as well as in the left flank. The pain was non-positional, with radiation to groin and hypogastrium. She had 9 kg weight los
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