Background Pneumoperitoneum is defined as the presence of free air in the peritoneal cavity. It is a surgical emergency that represents in 90% of the cases with a hollow viscus perforation and its feared consequences of sepsis and death. On the other hand, spontaneous pneumoperitoneum is a benign surgical entity occurring in newborns that requires no surgical intervention. Cases presentation In this series, we report three cases of benign spontaneous pneumoperitoneum in neonates treated at Jordan University Hospital between 2004 and 2021. Two of them were treated by exploration laparotomy but no gross pathology could be identified; one case was successfully treated conservatively with observation alone. Conclusion This case series recognizes the presence of such entity which can be treated conservatively, eliminating the unnecessary burden of morbidity and mortality of surgery in such age group.

Objective We aim to assess the effect of low-pressure pneumoperitoneum on post operative pain and ten of the known inflammatory markers. Background The standard of care pneumoperitoneum set pressure in laparoscopic cholecystectomy is set to 12–14 mmHg, but many societies advocate to operate at the lowest pressure allowing adequate exposure of the operative field. Many trials have described the benefits of operating at a low-pressure pneumoperitoneum in terms of lower post operative pain, and better hemodynamic stability. But only few describe the effects on inflammatory markers and cytokines. Methods A prospective, double-blinded, randomised, controlled clinical trial, including patients who underwent elective laparoscopic cholecystectomy. Patients randomised into low-pressure (8–10 mmHg) vs. standard-pressure (12–14 mmHg) with an allocation ratio of 1:1. Perioperative variables were collected and analysed. Registered on ClinicalTrials.gov (NCT05530564/ September 7th, 2022). Results one hundred patients were allocated, 50 patients in each study arm. Low-pressure patients reported lower median pain score 6-hour post operatively (5 vs 6, p-value = 0.021) in comparison with standard-pressure group. Eight out of 10 inflammatory markers demonstrated better results in low-pressure group in comparison with standard-pressure, but the effect was not statistically significant. Total operative time and surgery difficulty was not significantly different between the two groups even in the hands of inexperienced surgeons. Conclusion low-pressure laparoscopic cholecystectomy is associated with less post operative pain and lower rise of inflammatory markers. It is feasible with comparable complications to the standard of care.

Esophageal atresia occurs in 1 out of 2500 to 4500 live births; an isolated variant occurs in 8% of the cases. In this case report and literature review, we present a rare case of isolated distal esophageal atresia happening just 2 cm above the diaphragmatic right leaflet with the connecting band between the two esophageal parts. The location raised the possibility of a direct vascular accident to that segment as a cause of the atresia. Post-operative ambu bagging may facilitate leak at the anastomosis site and should be done carefully, as well as, to introduce contrast with suckling not with jet injection for the same reason. We mentioned that to raise a wariness as this mishap may cause problems.

Background: Sleeve gastrectomy is a safe and feasible bariatric procedure, but it is debatable whether the resected gastric specimen should be sent for histopathological examination. This is based on whether examination would reveal any serious findings in the absence of suggestive clinical symptoms. In this study, we aim to look for the percentage of examined resected gastric specimens and identify the prevalence of various histopathological findings among patients who underwent sleeve gastrectomy, comparing our results to the literature. Materials and methods: A retrospective cross-sectional study. Histopathology reports were retrieved for patients who underwent sleeve gastrectomy between January 2015 and October 2019. Data was collected from their medical records and analysed. Results: A total of 810 patients underwent sleeve gastrectomy in the study period. The majority of them (88.9%, n = 720) had their specimens sent for pathological examination. Female patients were 585 (77.5%), their mean age was 36 ± 10.7 (mean ± SD) years and body mass index was 46 ± 7.5 (mean ± SD) kg/m2. Chronic gastritis was detected in 88.3% of the patients (n = 636), H. Pylori related gastritis was present in 50.3% of the patients (n = 362), intestinal metaplasia (2.2%, n = 16), gastric atrophy (0.4%, n = 3), and dysplasia (0.1%, n = 1), none had malignancy. Conclusion: This is the largest study in the area examining resected gastric specimens post sleeve gastrectomy. Most sleeve gastrectomy patients had chronic gastritis in their resected gastric specimens, and half of it is attributed to H. Pylori microorganism, only one had dysplasia. Highlights