A study was made of 45 patients with diaphragmatic herniation after penetrating trauma. In 29 the diagnosis was established during the first admission (early presentation) and in 16 during a subsequent admission (delayed presentation). The mortality rate in the early presentation group was 3 per cent compared with 25 per cent in the delayed presentation group. The presence of gangrenous or perforated abdominal viscus in the chest cavity was the single most common and severe aggravating factor. The need for diagnosis of diaphragmatic herniation during the initial admission is emphasized. As isolated diaphragmatic injuries provide few helpful clinical features to aid diagnosis, appropriate investigations and good follow-up are of paramount importance in preventing late herniation of intra-abdominal viscera through a penetrating diaphragmatic injury.

Two cases of gluteal artery aneurysm following penetrating trauma to the buttock are presented. Both cases were misdiagnosed as abscesses and were incised in the casualty area, resulting in massive haemorrhage. The surgical exposure for this pathology is discussed. Case reports Case IA 35-year-old man was seen in the casualty department 2 weeks after being stabbed in the right buttock. The buttock was swollen, inflamed, and painful. The diagnosis of an infected haematoma was made and an incision was performed over the pointing area. Torrential arterial bleeding followed and the systolic blood pressure dropped t o 60 mmHg within minutes. The bleeding was partly controlled by direct compression over the wound and the patient was taken to the operating theatre. A ruptured false aneurysm arising from the main trunk of the superior gluteal artery was found. Suture ligation of the feeding vessei was performed from inside the aneurysm. The patient was transfused intra-operatively with 6 units of blood. The postoperative recovery was uneventful.Case 2 A 22-year-old man was seen 3 weeks after a penetrating injury of the right buttock. The affected area was swollen, inflamed and painful. The lesion was thought to be an abscess and it was incised under local anaesthesia. Massive arterial bleeding followed and the blood pressure became unrecordable within minutes. Attempts to control the bleeding by direct compression over the buttock were unsuccessful. The wound was then extended and the cavity was tightly packed with a large swab. This manoeuvre was successful and the patient was taken to theatre where a ruptured aneurysm of the superior gluteal artery was found and the vessel was sutured-ligated. The patient was transfused with 5 units of blood intra-operatively. The postoperative recovery was uneventful.

BackgroundLaparoscopic sleeve gastrectomy (LSG) has gained popularity over the years as a standalone procedure. In 2014, it was the most rapidly growing bariatric procedure. The aim of this study was to describe the outcomes of LSG at a single bariatric unit in Johannesburg, South Africa, using the Bariatric Analysis and Reporting Outcome System (BAROS) standardised scoring.MethodsA retrospective record review and analysis was carried out using data collected from patients who had LSGs. The information obtained included patient demographics, comorbidities, preoperative weight and height, operative technique, time and complications, postoperative gastrografin swallow results, hospital stay, and weight at 6 months postoperatively. The percentage of excess body mass index (BMI) loss (%EBMIL) was calculated at 6 months, and included in the BAROS questionnaire completed by the patients at the 6-month follow-up visit. Statistical significance was set at p < 0.05.ResultsA total of 103 patients were included in the study; of these, 85.4% were female and 14.6% were male. The mean preoperative BMI was 42.1 kg/m2; additionally, 77.7% of the patients in the study had comorbidities prior to the procedure. The mean operative time was 104.3 min, with a mean hospital stay of 2.5 days. No mortalities occurred, and a complication rate of 7.7% was encountered. At the 6-month follow-up, the mean %EBMIL was 65%. When followed up at 6 months, all 103 patients demonstrated no failures according to the BAROS assessment. It was found that 96.1% had good, very good or excellent outcomes. In total, 9.7% of the patients had an excellent outcome.ConclusionsLSG was shown to produce an adequate %EBMIL loss at 6 months, resulting in a significant improvement in the quality of life (QoL), coupled with good BAROS outcomes. The results of this research are comparable to other studies of LSGs, and the low complication rate supports the use of the procedure and accounts for no observed mortality.