Vertebral Artery Dissection After Sleeve Gastrectomy: a Case Report
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LETTER TO THE EDITOR
Vertebral Artery Dissection After Sleeve Gastrectomy: a Case Report Seyed Nooredin Daryabari 1 & Fahimeh Haji Akhoundi 2 & Ebrahim Aghajani 3 & Mohammad Kermansaravi 1,4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Introduction Present day sees obesity manifest itself as an immense global health challenge. Accordingly, surgical treatment for morbid obesity has gained growing popularity worldwide. Over the last years, sleeve gastrectomy has captured remarkable surgical interest mainly because this technique does not require a gastrointestinal anastomosis or intestinal bypass. The most common complications of sleeve gastrectomy are bleeding, staple line leak, early and late stenosis, GERD, incisional hernia, wound infection, and even nutrient deficiencies [1]. Vomiting, being one of the more frequent issues following laparoscopic sleeve gastrectomy (LSG), is mostly selflimiting if not due to technical problems. At times, this can lead to dangerous and unexpected complications. The incidence of postoperative nausea and vomiting following bariatric surgeries, who did not receive antiemetic prophylaxis, is high almost 70–80% [2]. Vertebral artery dissection is a rare condition that may follow mild neck trauma. The annual incidence of vertebral
* Mohammad Kermansaravi [email protected]; [email protected] Seyed Nooredin Daryabari [email protected] Fahimeh Haji Akhoundi [email protected] Ebrahim Aghajani [email protected] 1
Minimally Invasive Surgery Research Center, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Niyayesh Ave, Sattarkhan St, Tehran, Iran
2
Neurology Department, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
3
Department of Surgery, Aleris Hospital, Fredrik Stangs gate 11-13, 0264 Oslo, Norway
4
Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e-Rasool Hospital, Tehran, Iran
artery dissection is estimated at 1 to 1.5 per 100,000 and occurs in 0.01–1% of patients sustaining head and neck trauma. The typical mechanism for vertebral artery dissection involves hyperextension or rotation of the neck [3]. The most common ophthalmologic findings include diplopia, nystagmus, blurred vision, and visual field defect [4]. Here, we present a 33-year-old woman with history of LSG, who was admitted due to nausea and vomiting, and neurologic symptoms that occurred later. Following investigations, a rare etiology, vertebral artery dissection, was confirmed.
Case Presentation A 33-year-old woman with body mass index (BMI) of 43 kg/ m2 with a history of LSG 20 days prior arrived at the clinic with fatigue, nausea, and vomiting. These symptoms began a few days after surgery. She denied having had any fever, abdominal pain, or other associated symptoms. At admission, the patient’s vital signs were stable (T, 36.8; PR 100/min; and BP, 100/56 mmHg). She was dehydrated and looked ill. In physical examination, the abdomen was soft, without tenderness. Intravenous (I
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