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HighlightsIntercostal hernias are rare, usually acquired hernias.They most commonly are associated with stab wounds and present late.They require surgical treatment for correction.Open repair is well established but laparoscopic surgery has tremendous advantages in fixing these hernias.

Gossypibomas are generally retained surgical sponges, and are usually a rare occurrence. They are diagnostic dilemmas with an incidence ranging from 1 in 8000 to 1 in 18,000 surgeries. However the incidence of this problem is on the rise and the clinician needs to have a high index of suspicion to make an accurate diagnosis. We reported the case of a 50-year-old male patient who presented with a 6-month history of vague epigastric discomfort, early satiety and nausea. Further investigation revealed an intra-abdominal cyst that proved to be secondary to a retained laparotomy sponge and was treated laparoscopically. This is usually an unanticipated surgical misadventure which is often preventable, with significant associated stigma for the surgical professional involved. Unfortunately it leads to extensive and often unnecessary surgical intervention. The condition can be managed conservatively or surgically. Our case report demonstrates the use of laparoscopy for the successful management of intra-abdominal gossypibomas and represents the first reported case of laparoscopic management of a gossypiboma in the Caribbean setting. It also demonstrates both the acute and delayed presentations of gossypibomas in the same patient.

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The presentation of a massive upper gastrointestinal bleed (UGIB) due to an aortoenteric fistula (AEF) is a rare occurrence. A high index of suspicion is required to rapidly make the diagnosis and execute prompt surgical management. Despite the many surgical options described, the survival rate continues to be low. Conventional surgical management is associated with a high morbidity and mortality. However, in emergencies, patients are unsuitable for major vascular surgery and may benefit from the less invasive staged procedure. This is a case report of a secondary aortoenteric fistula (SAEF) presenting as a massive UGIB, two years after an abdominal aortic aneurysm repair using a Dacron graft. Due to a lack of endovascular service in our setting, we proceeded with an upper gastrointestinal endoscopy followed by exploratory laparotomy. A damage control approach was chosen for our patient, i.e., local repair of the graft and aorta, as our patient was on double inotropes on the table. The patient died within 24 hours as a result of massive blood volume loss.