Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA (Drs Wynn and Clapp)

ABSTRACT

Background: In the past, hormonal therapy was the primary treatment option for patients with gender dysphoria, but it has been supplemented in recent years by surgical treatments, termed sex reassignment surgery (SRS).

Case Report: A 41-year-old male-to-female patient presented with morbid obesity, hypertension, hyperlipidemia, obstructive sleep apnea, fibromyalgia, and osteoarthritis. She identified as a woman and planned to undergo gender confirmation surgery. She had already undergone bilateral orchiectomies and was enrolled in hormonal therapy. The patient underwent a laparoscopic Roux-en-Y gastric bypass without complication. At 1 year postoperation, the patient has experienced a 65% extra body weight loss, her body dissatisfaction has resolved, and she has undergone bilateral breast augmentation. She is now planning to finish her transition.

Discussion: This patient highlights an important consequence of weight loss surgery in an underserved segment of society that suffers from morbid obesity as well as gender identity issues. One study from 2016 found that up to 61% of the lesbian, gay, bisexual and transgender (LGBT) respondents were obese or overweight, and transgender individuals had the highest prevalence of obesity among the different groups of the LGBT community. With government insurances now funding SRS surgeries, bariatric surgeons will likely encounter patients undergoing gender confirmation surgeries more often.

Conclusions: Bariatric surgery can assist transgender patients with confirming their gender, without the risks associated with primary eating disorders. The transgender population remains an underserved sector of the morbidly obese population, and bariatric surgeons are more likely to see patients undergoing gender confirmation surgery.

Key Words: Bariatric Surgery, Gender Confirmation, Gastric Bypass.

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Department of Surgery, Montefiore Medical Center, Bronx, New York, USA (all authors).

ABSTRACT

Introduction: Hyperplastic inflammatory polyp (HIP) is an overgrowth of gastric mucosa associated with underlying chronic inflammation. Usually located in the gastric corpus and antrum, it has also been known to arise at the gastroesophageal (GE) junction

Case Description: We report a case of a large HIP located at the GE junction causing dysphagia in a patient who recently underwent a Roux-en-Y gastric bypass. The polyp was removed endoscopically with resolution of the patient’s symptoms.

Discussion: We present an unusual case of HIP, the first such case in our experience, and report the successful restoration of oral intake in the patient.

Key Words: Hyperplastic, Polyp, Obstruction, Gastric bypass.

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Wayne State University, Detroit, MI, USA (all authors).

ABSTRACT

Mesenteric fibromatosis poses a diagnostic and therapeutic challenge. We report a case of giant cell mesenteric fibromatosis tumor arising from the mesentery of the small intestine in a patient two years after a Roux-en-Y gastric bypass. A 47-year-old African-American female presented as a transfer from an outside institution with a large abdominal mass that was initially diagnosed as an intraabdominal cyst on computed tomography scan. The tumor was successfully excised surgically and the diagnosis of mesenteric fibromatosis tumor was confirmed on immunohistochemical analysis. To our knowledge, this is the only reported case of mesenteric fibromatosis tumor arising from the jejunojejunostomy anastomosis of the small bowel mesentery after Roux-en-Y gastric bypass surgery to treat morbid obesity.

Key Words: Mesenteric fibromatosis, Small bowel mesentery, Gastric bypass.

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