Diabetes mellitus brings together several syndromes, all burdened by a high complexity and with the potential to generate vital impairment. The large number of complications result from the association of high blood glucose level with vascular damage, neuropathy, poor healing and overall increased atherosclerosis process. The clinical manifestation of these complications involves a wide range of manifestations from simple lesions to complex pathology, many of them requiring surgical treatment. Surgical implications of diabetes mellitus include diabetic foot syndrome, soft tissue infections, renal impairment and abdominal pathology.

Introduction: Identifying left aberrant hepatic artery during gastrectomy for cancer is occasional. In case of replaced left hepatic artery, its ligation can lead to hepatic injury or ischemia, while preserving it can cause difficulties during lymphadenectomy. In literature there is no consensus regarding preserving replaced left hepatic artery during gastrectomy for cancer. A recent study, analysing adverse effects of ligating an aberrant left hepatic artery, shows in pacients with over 5 times elevated transaminase levels, increase in hospital length and postoperative complications. On the other hand, there are studies that consider ligation of aberrant left hepatic artery safe, the only inconvenient being postoperative transient elevation of transminase levels, when ligated artery diameter is over 1.5 mm. Matherial and methoods: We report the case of a 65 years old male, known with myocardial infarction, admitted for epigastric pain, nausea, vomiting, dysphagia for solids and important weight loss. Upper gastrointesinal endoscopy with biopsy and computed tomography showed eso-gastric tumoral mass, signet ring cell carcinoma, no metastases. Intraopertive, we found replaced left heaptic artery arising from left gastric artery, close to the celiac trunk, its diameter being approximately 1 cm. Total radical D2 gastrectomy with mechanical eso-jejunal Roux-en-Y anastomosis was performed. Postoperative evolution was favourable surgically, but the patient had SarsCov2 infection during hospitalisation The final pathology report showed 18 lymph nodes examined, 5 being with adenocarcinoma metastases. Conclusions: Preserving replaced left hepatic artery during gastectomy for cancer is preferable, lyphadecnectomy not being affected. Potential postoperative complications resulted from ligation of replaced left hepatic artery could have chanced the prognosis.

Esophagectomy is the best therapy for the patients with locoregionally advanced esophageal cancer, but carries serious risks of associated morbidity and mortality. Esophageal anastomotic leak is a severe post-operative complication with a rate of mortality that can reach 60%. Clinical presentations of esophageal anastomotic leaks varies from asymptomatic to severe sepsis and death. The prognosis depends on the duration to diagnosis and the severity of contamination. An anastomotic esophageal leak has a great impact on the length of hospitalization, morbidity, stricture formation and dysphagia. The management of intrathoracic anastomotic leaks include conservative, surgical or endoscopic treatment, but the indication between these options of treatment remains controversial. [...]