No abstract

Transmesenteric hernia is a rare cause of bowel obstruction and strangulation. It can be due to iatrogenic injury, trauma, inflammatory and less likely congenital. We present a case of true congenital transmesenteric hernia in a 26-year-old male with no previous surgical history or trauma. The patient presented acutely with no prior symptoms. Investigations provided limited information towards the diagnosis of the hernia, but suggestive of mid-gut volvulus. Emergency laparotomy was performed to find >75% of small bowel herniating through a proximal jejunal mesenteric defect leading to incarceration and early strangulation. No resection was required and patient recovered well. This case presents yet another rare pathology and highlights the importance of keeping a low threshold for operative intervention in uncertain cases.

Background Patients with typical biliary pain, no gallstones on ultrasound and low gallbladder ejection fraction (GBEF) on cholescintigraphy (gallbladder dyskinesia) may be considered for a laparoscopic cholecystectomy. However, some studies have suggested that symptoms alone are an adequate indication for laparoscopic cholecystectomy. The aim was to determine the role of cholescintigraphy in predicting outcomes of cholecystectomy in patients with typical and atypical biliary symptoms and normal biliary ultrasound. Methods Meta‐analysis using Preferred Items for Systematic reviews and Meta‐Analysis (PRISMA) guidelines of published literature using several electronic databases. Results Twenty‐four articles were selected with a total of 1710 patients. The majority (n = 1633, 94.4%) of patients had typical biliary symptoms. A total of 1047 patients with typical symptoms and a reduced GBEF had a cholecystectomy with 852 (81.4%) having complete resolution of symptoms. A total of 148 with typical symptoms and normal GBEF had a cholecystectomy with 103 (69.5%) having complete resolution, which was significantly less than those with a reduced GBEF (odds ratio 1.65, confidence interval 1.08–2.05, P = 0.01). Forty‐five patients with atypical symptoms and a reduced GBEF had a cholecystectomy with 31 (68.9%) having complete resolution of symptoms, which is significantly lower than those with typical symptoms (odds ratio 1.97, confidence interval 0.95–3.90, P = 0.05). Conclusion Cholescintigraphy improved the predication of outcome of cholecystectomy in biliary dyskinesia by 10%. However, the presence of typical symptoms does predict an effective response in 70% of patients. Atypical symptoms predict a poorer response.

Endoscopic sleeve gastroplasty (ESG) is a new obesity control modality. Limited data are available to describe post ESG findings and approaches to surgically revise this procedure. Two female patients with persistent obesity despite multiple ESG procedures underwent laparoscopic sleeve gastrectomy (LSG). Pre- and post-ESG, LSG body mass index (BMI), weight, and excess weight loss percentage (EWL%) were recorded. Endoscopic findings and revisional LSG technique were carefully documented. Pre-ESG BMI of the patients were 44 and 52 kg/m2. Pre-LSG BMI were 44.6 and 50 kg/m2. Pre-LSG gastroscopy and laparoscopy revealed complete dehiscence of ESG sutures with full-thickness invasion of these sutures and titanium clips through the gastric wall and some intraperitoneal adhesions. At 7-month follow-up, BMI are 40.3 and 35.7 kg/m2 and EWL% are 39 and 43%, respectively. This is the first study reporting LSG following failed ESG. ESG can lead to significant complications. LSG is achievable post-ESG and has superior results to it.