HighlightsDe Garengeot hernia is a rare type of femoral hernia that involves an appendix within the hernia sac.Diagnosis is clinically difficult. Imaging may assist in pre-operative diagnosis.There are various surgical methods in the approach to repair of femoral hernia. A recently published surgical method is described in this report.

HighlightsIntestinal malrotation is a congenital rotational anomaly that occurs as a result of an arrest of normal rotation of the embryonic gut, said to occur in 1 in 6000 live births. Once thought to be a disease of infancy, is now more prevalent in older ages.Cases of left sided appendicitis with previously undiagnosed intestinal malrotation therefore becomes more challenging to diagnose, and often time’s definitive surgical management is delayed. A varied list of differential diagnosis needs to be considered.This case presentation shows the difficulties encountered and the variation in presentation that lead us down a different path prior to attaining a formal diagnosis.CT abdomen was required to confirm the diagnosis, and in a paediatric age group, radiation exposure is always weighed upon risk-benefit ratio.Definitive management is surgical intervention.

IntroductionSuperior mesenteric artery (SMA) syndrome is a relatively rare aetiology of proximal intestinal obstruction. This is caused by narrowing of vascular angle of SMA and aorta compressing the third part of the duodenum (D3). Predisposing factors may include precipitous weight loss, corrective spinal surgery or repair of an aortic aneurysm.Presentation of caseA 53 year old male presented to our department with worsening post-prandial vomiting and epigastric pain for last three months. One examination, epigastric region was distended with succussion splash on abdominal auscultation. History did not include any predisposing factor. CT scan showed narrow angle of 12.77° between SMA and aorta owing to the compression of D3. Since onset of vomiting and resultant poor oral intake, he had lost 11 kg of his usual body weight. After gastric decompression, nasojejunal enteral feeding was started. Diet was progressed to oral feedings gradually and following return to his baseline weight, he continued to be free of symptoms in follow-up visits.DiscussionAlthough there are recognised predisposing factors but sometimes aetiology remains idiopathic. SMA syndrome should initially be managed non-operatively with gastric decompression, correction of water and electrolyte imbalance, and hemodynamic instability. Regaining weight helps increasing vascular space between SMA and D3 thus relieving obstruction. Persistence of symptoms beyond 3–4 weeks warrants surgical intervention.ConclusionNon operative management with nutritional supplementation remains the first line of therapy.

There is a subgroup of patients with MA who are young females with have low Alvarado scores, have non-diagnostic imaging, and may represent almost one-fifth of appendicectomy specimens. This study supports the probability that MA is a pathological entity.

Complications like anastomotic leakage (AL) after colorectal procedures are associated with significant morbidity. Subclinical AL can be misleading due to clinical behaviour and hence poses a diagnostic dilemma. Sometimes Radiological investigations are adjunct but may be detouring in diagnostic progression. We present a case of subclinical AL where near-miss in diagnosis led to unfavourable outcomes. In susceptible patients, diagnostic results need to be interpreted with caution in background of clinical scenario. Surgeons and radiologists need to be well familiarised of different presentations of postoperative complications after lower gastrointestinal surgery and their manifestations on imaging.