Intestinal malrotation is the name for a variety of intestinal attachments and rotation abnormalities that ranged from a mobile cecum to a complete non-rotation of the intestine with or without an associated volvulus of the midgut and reversed rotation. Patients present with midgut volvulus as a complication of intestinal malrotation during the 1st year of life, mostly within the first sevenNewborns with intestinal malrotation mostly present with a scaphoid abdomen and bilious vomiting which is associated with midgut volvulus, which leads to serious outcomes in case of a delay in diagnosis and treatment [2]. Ladd in 1938 described a surgical approach for management and is still the main line of management of malrotation [3]. Ladd's procedure could be performed either by

BACKGROUND Hepatobiliary manifestations occur in ulcerative colitis (UC) patients. The effect of laparoscopic restorative proctocolectomy (LRP) with ileal pouch anal anastomosis (IPAA) on hepatobiliary manifestations is debated. AIM To evaluate hepatobiliary changes after two-stages elective laparoscopic restorative proctocolectomy for patients with UC. METHODS Between June 2013 and June 2018, 167 patients with hepatobiliary symptoms underwent two-stage elective LRP for UC in a prospective observational study. Patients with UC and having at least one hepatobiliary manifestation who underwent LRP with IPAA were included in the study. The patients were followed up for four years to assess the outcomes of hepatobiliary manifestations. RESULTS The patients' mean age was 36 ± 8 years, and males predominated (67.1%). The most common hepatobiliary diagnostic method was liver biopsy (85.6%), followed by Magnetic resonance cholangiopancreatography (63.5%), Antineutrophil cytoplasmic antibodies (62.5%), abdominal ultrasonography (35.9%), and Endoscopic retrograde cholangiopancreatography (6%). The most common hepatobiliary symptom was Primary sclerosing cholangitis (PSC) (62.3%), followed by fatty liver (16.8%) and gallbladder stone (10.2%). 66.4% of patients showed a stable course after surgery. Progressive or regressive courses occurred in 16.8% of each. Mortality was 6%, and recurrence or progression of symptoms required surgery for 15%. Most PSC patients (87.5%) had a stable course, and only 12.5% became worse. Two-thirds (64.3%) of fatty liver patients showed a regressive course, while one-third (35.7%) showed a stable course. Survival rates were 98.8%, 97%, 95.8%, and 94% at 12 mo, 24 mo, 36 mo, and at the end of the follow-up. CONCLUSION In patients with UC who had LRP, there is a positive impact on hepatobiliary disease. It caused an improvement in PSC and fatty liver disease. The most prevalent unchanged course was PSC, while the most common improvement was fatty liver disease.

Background: Spleen is the most common intra-abdominal organ injury in blunt abdominal trauma. Splenectomy (open or laparoscopic) is the role in treatment of severe injuries of spleen or after failure of conservative treatment.Aim of the work: Compare the outcomes between open versus laparoscopic in high grade splenic injuries.Methods: This study includes 70 patients with various grades of splenic injuries in abdominal trauma. The patients were 15 years and older. They were categorized into two groups: open splenectomy group (35 patients) and laparoscopic splenectomy group (35 patients). The study was performed from January, 2012 to July 2017. Variables included demographics data, splenic injury graded by computerized tomography, duration of operation (in minutes), intra-operative blood loss (in ml), and intraoperative blood transfusion, length of hospital stay (in days), complications and mortality.Results: There was no significant difference or association between groups as regard age, sex and causes of splenic injury (p=0.374, 0.41, 0.38).Most cases were under 35 years old male patients exposed to motor car accidents. As regard intraoperative data, no statistically significant difference between both groups except for blood loss and transfusion that were statistically significant to the open group (p=0.039*).In the laparoscopic group, operational time was longer than open but no statistically significant (p=0.11).as regard conversion, we found that 14% of laparoscopic group (5 cases) had conversion. Most cases operated by laparoscopic approach were in grade III, IV with no cases tried in grade V (p=0.06). No statistically significant difference between both groups as regard postoperative variables except Pain (p=0.0003), and hospital stay(p=0.00) that were significantly longer among open group.The immediate postoperative complications showed that Wound infection, Missed injuries, pancreatic fistula and ileus were significantly higher among open group (p=0.00, 0.006, 0.02, 0.0004).The delayed postoperative complications where Incisional hernia (p=0.001) and Adhesive intestinal obstruction (p=0.00) were significantly associated with open group.Conclusion: In high-grade splenic injuries patients, this study found that laparoscopic splenectomy is safe.

Objectives: This study sought to determine the commonest causes of acute abdominal pain (medical, surgical, and oncological) during the COVID-19 pandemic. Methods: From May 1, 2020, to February 28, 2022, 910 adult patients > 18 years of age of both sexes were admitted to the emergency department or already admitted but complaining of an acute abdomen and diagnosed with COVID-19. Results: The mean age of the studied group was 48.13±11.97 years, with male predominance (66%). Medical causes of the acute abdomen were in 34% of cases, and 66% were surgical causes. Gastric causes of the acute abdomen were the most common medical causes. Referred pain from COVID-19 pneumonia was the cause of abdominal pain in 20.8% of cases. Acute appendicitis was the commonest surgical cause of acute abdomen (42.4%), mostly Grade V, followed by acute cholecystitis (11%) and biliary colic (9.8%). Acute pancreatitis was the cause in 12.7% of cases, and its causes were mainly idiopathic (48.7%). Conclusions: Surgical causes of acute abdominal pain were more common than medical causes. The commonest medical causes of the acute abdomen during COVID-19 were gastric causes, while acute appendicitis, gallbladder diseases, and intestinal ischemia were the commonest surgical causes. Idiopathic acute pancreatitis was more common than gallstone pancreatitis, and most cases were mild. Surgery is the most common cause of death from the acute abdomen, followed by respiratory failure caused by COVID-19 and then medical causes of acute abdomen. Trial registration: It was approved by the institutional review board (IRB) for all parts of this study by ZUMEC 152020-23.Clinical trial registration: NCT05295251.Retrospective registered.

Background:The numbers of elderly persons have greatly increased worldwide due to improvement of medical health. Elderly complains of cardiopulmonary diseases and the incidence of emergent gall bladder diseases increase with age. Laparoscopic cholecystectomy is the usual approach in dealing with cholithiasis that greatly replace open approach even in acute emergency gall bladder diseases.Aim: compare between initial Fundus first cholecystectomy followed by Calot dissection VS Calot first cholecystectomy in Emergency laparoscopic cholecystectomy with low pressure pneumo-peritoneum in cardiopulmonary risk patients as regard intraoperative data and postoperative complications.Patients and methods:This prospective randomized controlled study was carried out in the Department of Emergency General Surgery on 470 cases with acute cholecystitis, biliary colic, mucocele and pyocele of gall bladder. The patients were divided into two groups, Group A: fundus-Calot group (235cases) and Group B (235cases): classical Calot first approach.ResultsIn most cases of group A, the operating time was up to 90 minutes, while in group B, most cases were more than 90 minutes. Intraoperative bleeding, visceral injury and biliary injury were higher in group B than in group A and therefore the conversion was higher in group B than in group A (14% vs. 4%). Postoperative sequelae were reported to be greater than in group B in regard to bleeding, biliary leakage and wound infections. Remote complications were more pronounced for biliary restrictions in Group B (14%) than in Group A (2%)Conclusion:Laparoscopic low-pressure pneumoperitoneum cholecystectomy with initial Fundus first method is an excellent and safe approach in treating acute gallbladder diseases in cardiopulmonary risk patients.