Management of blunt splenic injury remains controversial. The decision to pursue non-operative management rather than splenic conservation or splenectomy depends on the individual merits of each case. There is an increasing trend towards splenic conservation, particularly in younger, stable patients with single organ injury.

Femoral hernias can be difficult to diagnose and are at high risk of strangulation. This report is of a rare case of an irreducible femoral hernia containing caecum and appendix presenting as an emergency. To the authors' knowledge, there have only been three cases reported, the first described by Duari. This case was incorrectly diagnosed preoperatively as an inguinal hernia, so the CT diagnosis of femoral hernias is reviewed, in particular demonstrating the radiological use of the femoral vein compression sign.

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A 50-year-old female presented with a 3-day history of fevers and myalgia on a background of 2 weeks abdominal pain that progressed to severe epigastric pain and vomiting postprandially. Twelve years earlier, she had undergone laparoscopic adjustable gastric band (LAGB) insertion that had been complicated by slippage and adjustment 12 weeks after insertion. At the adjustment, an extra length of port tubing was added to the original tubing. The patient had no history of infection of the band including the port tubing and port. Although 2 weeks prior to presentation, her band had been deflated because of a leak. On examination, she had a fever to 38°C and a soft abdomen with epigastric tenderness. A chest X-ray revealed an appropriately positioned gastric band. A computed tomography scan revealed oral contrast passing through to the duodenum but that the gastric band tubing appeared to traverse the ascending colon -as shown in Figure 1. At laparoscopy, there were dense adhesions along the length of the band tubing that were released and the original length of tubing was found to enter the ascending colon. The operation was converted to laparotomy with the LAGB being removed and the colon defect being repaired.The patient made an unremarkable recovery and was discharged home 4 days post surgery.LAGB surgery has been performed in Australia since 1994 and has been the most common form of bariatric surgery in Australia. Recently, there has been a trend away from LAGB. In an Australian study by Bardsley and Hopkins, 1 greater than 13% of patients undergoing LAGB surgery required re-operation because of complications. The more common reasons for re-operation being band slippage, tubing or balloon leakage, failure of weight loss, band erosion and port revision.LAGB port tubing is considered to be inert and there are very few cases of complications arising from erosion of the tubing. The most likely mechanism leading to tubing erosion is bacterial colonization of the tubing as previously proposed by Sneijder et al. 2 Of the few cases of tubing erosion reported in the literature, all were associated with port infection.Although the number of LAGBs being inserted in Australia is decreasing, there is still a significant number of patients with bands in situ that will continue to develop complications in the future and it is important to keep this in mind when these patients present in the acute setting. This case demonstrates that although complications from LAGB tubing erosion are extremely rare, they are possible in the setting of tubing infection, and should be kept in mind. References Bardsley S, Hopkins H. Laparoscopic revision of gastric band surgery.ANZ J. Surg. 2010; 80: 350-3. 2. Sneijder R, Cense A, Hunfeld M, Breederveld R. A rare complication after laparoscopic gastric banding: connecting-tube penetration into the hilus of the kidney.

Background: The early experience in correction of simple transposition of the great arteries (TGA) involved redirection of atrial inflow to re-establish systemic and pulmonary blood flow, the basis of the Senning and Mustard operations. Since 1984, however, the arterial switch operation (Jatene) has been increasingly used. It appears that with experience the peri-operative mortality rate for arterial repair is comparable to that for atrial repairs, while the late morbidity rates have generally favoured arterial repair, with sequelae such as obstruction of venous inflow, dysrhythmias, systemic atrioventricular valve dysfunction and impaired systemic ventricle function being more common following atrial repairs. Methods: A retrospective review of patients surgically treated for TGA at the Prince Charles Hospital. Results: Between April 1973 and July 1994, 103 patients with simple TGA underwent surgical correction using one of three standard approaches currently advocated (arterial switch/Jatene, Senning or Mustard operations). Fifty-one Jatene, 3 1 Senning and 2 1 Mustard operations were performed. Associated procedures included closure of ventricular septal defect, right and left ventricular outflow tract resection and pulmonary artery band removal. The coronary artery anatomy was found to be suitable in all except two patients when the Jatene operation was planned; both these patients had a Senning procedure without mortality. There were nine perioperative deaths (4 Jatene, 2 Senning, 3 Mustard), and five late deaths ( I Jatene, l Senning, 3 Mustard). Follow-up was maintained to a mean time of 60.5 months (range, 9 days to 203 months). In the Jatene group there were five anastomotic stenoses (all involving the neo-pulmonary artery), three cases of arryhthmias (two postoperative supraventricular tachycardia and one nodal rhythm) and two pulmonary valve stenoses. In the Senning group there were four anastomotic stenoses (three involving pulmonary vein and one causing superior vena cava (SVC) inlet obstruction) and four cases of arryhthmias (with one requiring permanent pacemaker insertion). In the Mustard group there were two cases of SVC obstruction and two permanent pacemaker insertions for bradycardia. Conclusions: These early and midterm results suggest that the arterial switch operation has comparable overall mortality to, and less morbidity than, the atrial repairs for TGA with the retention of left ventricle to systemic arterial connection, which may provide improved long-term results.