We present four patients with vasculitis manifesting with unusual clinical or pathological features, generating surgical problems. Two cases presented with pulmonary hypertension, with investigations and radiological evidence prompting clinical suspicion of pulmonary thrombo-embolic disease. First case, with an antecedant history of Wegener's granulomatosis (WG), demonstrated following "embolectomy", WG involving the large pulmonary elastic arteries. The second case of inoperable "pulmonary thrombo-embolic disease" was subsequently found at limited post mortem to have giant cell arteritis, which affected widespread small peripheral pulmonary arterial vessels. The other two cases were of aortitis occurring in the background of immune-mediated disease, which had been treated with aggressive immunosuppression regimens. The first of these was a case of Cogan's syndrome complicated by descending aortitis, a rarely reported phenomenon, with co-existent acute endocarditis of the aortic valve leaflets. Most cases of endocarditis in this context occur secondary to and in continuity with ascending aortitis. That this case, and a case of ascending aortitis occurring in the context of relapsing polychondritis occurred in the face of aggressive immunosuppression with an apparent clinical response, underscores the need to not accept a clinical picture at face value. This has implications for clinical management, particularly in the follow-up of surgical prosthetic devices such as grafts which may be used in these cases. All four cases emphasise the continued importance of histology and the post-mortem examination in elucidating previously undetected or unsuspected disease.

Aims: Fully Laparoscopic living donor left lateral hepatectomy is standardized, anatomically well-defined which is routinely performed for cancer surgery and occasionally for living donor hepatectomy for transplantation. There are a few liver transplant programs actively performing this type of donor surgery. We describe our experience at the Organ Transplant Center of King Faisal Specialist Hospital & Research Center, Riyadh in terms of techniques and immediate outcome on the series between May 2013 and July 2014. Methods: We performed 21 fully laparoscopic left lateral hepatectomy for living donors for pediatric liver transplantation from May 2013 to July 2014 at the Organ Transplant Center. The living donors were carefully selected and investigated according to established criteria and guideline. Demographic data, operative time, cold and warm ischemia times, conversion rate, blood loss, blood transfusion, hospital stay, post-operative complications, pain scale according to the Adult Communicative Pain Score assessment were retrospectively reviewed and analyzed. Results: The procedure was performed for 6 adult females & 15 males who voluntarily donated to their relatives. Donor mean age was 28.7 years, range18e42 years. Mean BMI was 22.6, BMI range 15.3e31.6. Mean operative time was 5.1 h, range 3.5 he6.5 h. 2 cases were converted. Mean blood loss of 105 ml and range of 50e500 ml was documented without blood transfusion. Mean hospital stay was 4.3 days, range 2.4e12 days. One donor developed segment 4 infarction (grade II, according to modified Clavien et al. grading system described by Broering et al.). Conclusions: Fully laparoscopic left lateral hepatectomy is a safe procedure with minimal blood loss, low post-operative morbidities and a better cosmetic outcome compared with open procedure. The procedure has evolved to be a standard procedure for left lateral living donor hepatectomy at our center and donors are requesting for it.