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A 36-year-old morbidly obese female with BMI 66 kg/m2, scheduled for elective laparoscopic sleeve gastrectomy. Prior to the surgery patient had symptoms of mild dyspnea, vague abdominal discomfort. CAT scan of thorax and abdomen revealed a right-sided large morgagni diaphragmatic hernia containing omentum and portion of the transverse colon. Patient elected to undergo Laparoscopic sleeve gastrectomy and concomitant morgagni diaphragmatic hernia repair. The post-operative course was uneventful and the patient was discharged on post-operative Day 2. This case is an extremely rare case of super obese patient with Morgagni hernia who desires bariatric surgery and found to have incidental finding of morgagni hernia. This kind of combination can safely undergo concomitant laparoscopic hernia repair with mesh and sleeve gastrectomy.

Background There seems to be a general consensus in the current published literature on postponing elective, non-urgent surgery on COVID-19-positive patients. But so far no recommendations have been published on when and how to start carrying out elective, non-urgent surgery on COVID-19-negative patients after the epidemic peak. Objective:  to determine the best approach for reintroduction of elective procedures during COVID-19 based on their preoperative screening by the respiratory scoring system.  Methodology: retrospective chart review of patients who underwent bariatric surgery between March to June  in  2020, during the  pandemic of Covid 19. The study was conducted in Riyadh, Saudi Arabia in two  different health institutions.  Results: The total number of patients were 90. The mean age of the patients was 32.73 ± 7.81 years. Moreover, (n=36; 40.0%) of the patients presented with comorbidities. Only (n=1; 1.1%) of the patient was tested for Covid19 by RT-PCR before surgery and tested  negative.  Majority of the patients (n=80; 88.9% ) underwent Lap sleeve gasterecomy. Post surgery no patients developed any complications and none of them were admitted to the ICU. Post surgery only (n=2; 2.2%) of the patient were  tested for Covid19 by  RT-PCR and 100%  tested  negative. Conclusion: During COVID-19 pandemic before considering patients for elective surgery they should be screened. If  their respiratory score is  ≤ 3 indicating low risk of respiratory illness, elective procedures should continue. Strict precautionary measures should be followed and limited number of surgeries should be performed.

HighlightsSmall bowel obstruction is a common surgical condition with diversity of causes.Meckel’s diverticulum is the most common congenital anomaly causing bowel obstruction.Complicated Meckel’s diverticulum in adults infected with parasitic infection is rare.

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