Sleeve gastrectomy may not be an appropriate weight loss operation in patients with diffuse idiopathic skeletal hyperost
- PDF / 847,049 Bytes
- 4 Pages / 595.276 x 793.701 pts Page_size
- 35 Downloads / 186 Views
CASE REPORT
Sleeve Gastrectomy May Not Be an Appropriate Weight Loss Operation in Patients with Diffuse Idiopathic Skeletal Hyperostosis L. Alevizos, K.M. Stamou, K. Papiris, E. Samanda, M. Pattas, E. Menenakos, G.C. Zografos
Abstract Aim-background: Diffuse idiopathic skeletal hyperostosis (DISH) is a common disease among obese patients,
though not easily suspected in obesity surgery departments. Case report: We present the case of a 40-year-old woman with morbid obesity (BMI of 43kgr/m2) and undiagnosed
DISH who underwent a laparoscopic sleeve gastrectomy (LSG). Postoperatively, she presented serious dysphagia and failure to lose weight. Results: The patient complained of severe dysphagia postoperatively, for solid foods and cooked meals in particular.
A gastroscopy and upper gastrointestinal swallow radiographs did not show stenosis. Dysphagia led the patient to a high-calorie low-viscosity diet and inability to lose weight. Two years after the operation, the patient underwent radiography and MRI of the thoracic and lumbar spine due to chronic low back pain; the diagnosis of DISH was set by a rheumatologist. Conclusion: Patients with DISH may not be good candidates for restrictive bariatric operations. Patients presenting to morbid obesity surgical departments require a full investigation of all possible underlying causes of obesity, including DISH. Key words: Sleeve gastrectomy, diffuse idiopathic skeletal hyperostosis, weight loss
Introduction Diffuse idiopathic skeletal hyperostosis (DISH) is a musculoskeletal disease characterized by calcification and ossification of entheseal sites. The prevalence of DISH in adults over 50 years of age is around 25% for men and 15% for women, with an increased incidence in patients with obesity, gout or diabetes [1]. It was first described as senile ankylosing hyperostosis of the spine by Forestier and RotesQuerol in 1950 [2]. In the 1970s, Resnick et al [3] suggested the term DISH for this systemic entity. DISH is usually an asymptomatic condition and its diagnosis is based on characteristic findings in radiographs of the thoracic spine. Clinical manifestations may include pain, limited range of spinal motion and increased incidence of spinal fractures after trauma. Dysphagia is another common L. Alevizos, K.M. Stamou, K. Papiris, E. Samanda, M. Pattas, E. Menenakos, G.C. Zografos First Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School Greece, Greece Corresponding author: Alevizos Leonidas MD Pipinou 52, Athens, 11251 Athens, Greece. Tel: +30-2108230446, Fax: +30-210-7707574, e-mail: [email protected] Received 26 April 2013; Accepted 19 June 2013
Hellenic Journal of Surgery 85
symptom in DISH patients that may be caused by a variety of mechanisms, such as direct mechanical compression of the pharynx and oesophagus, cricopharyngeal spasm, disturbances of a normal epiglottis tilt over the laryngeal inlet by osteophytes at C3–C4 level, cricopharyngeal spasm and inflammation of the tissues around the oesophagus that could lead to fib
Data Loading...
