A man of 57 suffering from nephroureterolithiasis was treated by ESWL (6 sessions) both in the prone and supine positions. Several hours after the last treatment (prone position) the patient complained about increasing abdominal pain which we found to be caused by an intra-abdominal perforation. In an emergency laparotomy we detected a perforation on the ventral wall of a small bowel loop, which was fixed at the colon ascendens on the rear side. Histological examination provided no evidence of previously existing intestinal disease. Thus, we suggest that this case is a rare major complication of ESWL.

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Internal abdominal hernias are rare and often are first seen when causing ileus. Three different internal hernias were operated on laparoscopically: a patient with a hernia duodeno-jejunalis causing recurrent pain in the upper bowel, vomitus and ileus; two patients with an intersigmoidal hernia and pelvic hernia causing ileus without prodroma. Each case was operated on laparoscopically during or short after ileus. In all cases the hernia could be assured and treated by retracting the gut into the abdominal cavity and either wide opening of the hernia's entrance or closing it by suture. It is concluded that internal hernias can be diagnosed and treated laparoscopically as well as in conventional operation techniques.

In order to reveal sonographic accuracy in imaging gut wall lesions transcutaneous ultrasonic findings in 78 colonic wall tumours (6 polyps sized more than 1 cm, 68 colonic carcinomas, 1 pancreatic carcinoma, 1 gallbladder carcinoma and 2 benign diverticulitis tumours) were staged according or similar to TNM classification from 1987 and compared to histologic findings. 62 ultrasonic stagings were correct, sensitivity and specificity of U/T1 to U/T4 stagings ranged from 0.64 to 0.89 resp. 0.7 to 1.0. Thus, in the example of colonic tumours (of either dignity) ultrasound not only shows quality differences as gut wall lesions, but also images depth of invasion as a quantitative feature in gut wall lesions with acceptable accuracy.