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Pseudomyxoma peritonei is due to diffuse involvement of the peritoneal cavity with mucinous material. Four patients were found in two major general hospitals in Riyadh. All patients were male. Cardinal clinical features were abdominal distension, pain and weight loss. Computed tomography was helpful preoperatively. Laparoscopy or laparotomy were performed to arrive at a correct diagnosis.

AIm: Evaluation of the laparoscopic assisted revision of the ventriculoperitoneal shunt as an alternative technique to the traditional laparotomy. mAterIAl and methOds: Out of 1181 elective neurosurgical procedures have been done from January 2009 to December 2010. There are 98 (8.2%) ventriculoperitoneal shunt procedures. New shunt insertion was performed 41 times (41.9%) and shunt revision performed 57 times (58.1%). Shunt-related infection was detected in 11 cases (11.22%) while mechanical failure was found in 46 cases (46.9%), proximal obstruction was diagnosed in 26 cases (26.5 %) while 20 patients (20.4%) suffered from distal obstruction. Out of the 20 patients with distal obstruction, 12 patients were treated with laparoscopic assisted revision of the peritoneal end.results: Intra operative finding revealed peritoneal adhesion in 83.3% of cases and cerebrospinal fluid pseudo cyst in 16.6% while extra peritoneal tube was found in one case. Intraoperative management included adhesiolysis in 10 patient, evacuation and marsupialization of the cyst in two cases in addition to tube repositioning in all cases. There was no procedure-related complications.COnClusIOn: Laparoscopic assisted revision of the peritoneal catheter is an alternative technique to traditional laparotomy in the revision of ventriculoperitoneal shunt.

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Background: Chronic complications of symptomatic gallstone disease such as Mirizzi's syndrome are rare. The importance and implications of these conditions are related to their associated surgical complications which are potentially serious such as bile duct injury and to the modern management when encountered during laparoscopic cholecystectomy. Objectives: This research offers a technique to avoid surgical complications in Mirizzi's syndrome cases during laparoscopic cholecystectomy. Patients and Methods: Between November 2012 and February 2015, 17 patients (12 females and 5 males) with mean age of 51 years (between 29 and 57 years) suffering from Mirizzi's syndrome underwent the divided cholecystectomy. In this technique the gall bladder was divided into two parts above the gall bladder infundibulum. The distal part was dissected for short distance and used to push liver up. The proximal part of gall bladder was cleared from all its contents and reevaluated from inside. Management was achieved according to the stage of disease. Results: The mean operative time was 70 minutes (between 60 and 90 minutes). No biliary tract obstruction or leakage or stenosis was recorded in this patient group during the period of follow up (18 months). Conclusions: Divided laparoscopic cholecystectomy is a safe and effective technique to face the unusual gallstones complications (Mirizzi's syndrome).