ABSTRACTS POSTERS WETENSCHAPSDAG SFG 2012 Anamnestisch bleek patiënte bij drukverhogende momenten vocht aan onderzijde te verliezen: vaginaal of urethraal. Aanvullend onderzoek toonde een blaasretentie van 320cc en een CT-abdomen liet een gedeeltelijk gevulde blaas zien met een kleine verkalking passend bij een blaassteen. In verband met deze opmerkelijke bevinding werd de uroloog in consult gevraagd. Cystoscopie toonde een blaasempyeem op basis van een rubberen corpus alienum. Deze werd verwijderd en na het spoelen van de blaas werd gentamicine achtergelaten. Bij nadere bestudering bleek het te gaan om een stukje van een oude blaascatheter. Patiënte bleek twintig jaar geleden voor de laatste keer gecatheteriseerd was. DIAGNOSE: Blaasempyeem op basis van oud stukje blaascatheter bij een anefrische- hemodialyse patiënte. Haemodynamic instability following bariatric surgery: an unusual complication? M. Zigenhorn1 AP Rietveld1 , S. van de Poll2 , G. Mannaerts3 Departments of Internal Medicine1 Rotterdam , J. Wiebolt1, JWF Elte1 , M. Castro Cabezas1 , Cardiology2 , and Surgery3 , Sint Franciscus Gasthuis, INTRODUCTION: Bariatric surgery (BS) is a popular and effective method in the treatment of morbid obesity. In the majority of patients BS results in significant weight loss. Symptoms and signs of orthostatic hypotension following rapid weight loss have been described especially in starvation, but may also occur after BS. We describe three patients with severe orthostatic intolerance after BS. Case report: Three patients (two males and one female; mean age 44.3 ±2.9 years) who had undergone BS and developed clear symptoms of orthostatic intolerance and were admitted to the hospital. On average they lost 54.0 ± 20,2 kg body weight (representing 37.4 ±9.9 % of their original body weight). Their initial BMI was 42.2 ±3.2 kg/m2 which decreased after laparoscopic sleeve resection to 26.1 ±2.9 kg/m2. All three subjects developed new-onset syncope, near-syncope and dizziness within a mean term of 13.3 ±8.1 months after surgery. Their mean systolic blood pressure decreased from 132.5 ±10.6 mmHg to 117.5 ±24.7 and their heart rate decreased from 81.0 ± to 55.5 ±14.8 bpm. ECG, electrocardiography and 24 hrs holter registration were normal. None of the patients had deficiencies of vitamins or minerals and there were no other biochemical abnormalities responsible for their symptoms. Based upon these results all three patients were diagnosed with (postural) orthostatic hypotension following excessive weight loss. DISCUSSION: BS is an effective method to treat (morbid) obesity. Orthostatic hypotension can be a severe side-effect of BS and has been described previously. Its exact incidence and etiology is unknown. The likely mechanism of orthostatic failure is autonomic insufficiency combined with reverse course of obesity-related hypertension. In general, the orthostatic hypotension disappears if the patient regains weight. As BS is getting more popular in the Netherlands, more people presenting with orthostatic intolerance following rapid weight loss are expected. Further investigations will be necessary to determine the exact incidence of orthostatic intolerance and to identify those patients at greater risk for developing orthostatic intolerance following BS. 126 WETENSCHAPPELIJK jaarverslag 2012 Pagina 125
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