Primary internal hernias are extremely rare in adults. They are an important cause of small intestinal obstruction and lead to high morbidity and mortality if left untreated. Clinical presentation of internal hernia is nonspecific. Imaging has been of limited utility in cases of acute intestinal obstruction; moreover, interpretation of imaging features is operator dependant. Thus, internal hernias are usually detected at laparotomy and preoperative diagnosis in an emergency setting is either difficult or most of the time not suspected. We report herein a case of a 45-year-old male who presented with acute intestinal obstruction which was attributed later to a very rare type of internal hernia on exploratory laparotomy. A loop of ileum was found to enter the retroperitoneum through a hernia gate which was located lateral to the sigmoid colon in the left paracolic gutter. The segment of intestine was reduced and the hernial defect was closed. Our finding represents an extremely rare variant of retroperitoneal hernias.

Introduction: Gastrointestinal anastomosis is one of the most common procedures being performed in oesophagogastric, hepatobiliary, bariatric, small bowel and colorectal surgery; however, the safety and efficacy of single layer or double layer anastomotic technique is still unclear.Aim: To assess and compare the efficacy, safety and cost effect iveness of single layered versus double layered intestinal anastomosis.

A 26-year-old, gravida 2 abortion 1, unbooked case, presented to the labour ward at 36+5 weeks gestational age in active labour. Two years back, she had an induced abortion at 6 weeks of gestation by medical methods. During her present pregnancy, she had irregular antenatal check ups at a local hospital with no followup in the third trimester. She had no known history of any medical illnesses, drug intake or addiction. On examination, her pulse rate was 42/minute, while blood pressure was 110/80 mmHg. Cardiorespiratory system examination was unremarkable. Obstetric examination revealed term size uterus with fetus in longitudinal lie and cephalic presentation. There were regular uterine contractions, fetal heart rate was 140 beats/minute. On per vaginal examination, cervix was fully effaced, os was 4 centimetres dilated, vertex station was at -2 and membranes were intact.Cardiologist's opinion was sought in view of persistent bradycardia. Electrocardiogram (ECG) was done which showed sinus bradycardia with narrow QRS complexes suggestive of congenital Complete Heart Block (CHB) [Table/ Fig-1]. Echocardiography was normal. Routine blood investigations were within normal limit. Pulse rate settled to 70-76/minute with intravenous injection atropine. Plan was to proceed with temporary pacing if heart rate did not increase after injection atropine or any deterioration in haemodynamic status occurred.Labour was augmented with injection oxytocin. In the meantime, thick meconium stained liquor was detected on artificial rupture of membranes and cardiotocograph showed non-reassuring fetal heart rate pattern. The woman was taken up for caesarean section under emergent conditions without temporary pacing. However, injection isoprenaline and temporary pacemaker was kept on standby. She was preloaded with 750 mililitres of Ringer's lactate solution prior to spinal anaesthesia. Two mililitres of hyperbaric 0.5% Bupivacaine was injected into subarachnoid space at L3-L4 level with the woman in left lateral position. A sensory level upto T8 was achieved. A late preterm vigorous male baby with birth weight of 2400 grams (appropriate for date) was delivered. The average estimated total blood loss was approximately 600 mililitres. Monitoring included continuous ECG, pulse oximeter and both invasive and noninvasive blood pressure. During surgery, heart rate dipped to 50/minute once; it responded to atropine [Table/ Fig-2]. Intraoperative haemodynamics remained stable and surgery proceeded uneventfully.Postoperatively, continuous monitoring was done with pulse oximeter and invasive blood pressure. The woman's heart rate remained steady at 54-64 beats/minute. Analgesia was achieved with injection diclofenac 75mg intravenous 8 th hourly. Postpartum period was uneventful; she was discharged on the seventh postoperative day. The neonate did not have any rhythm disturbance. She was doing well on follow up at 6 weeks. She was prescribed progesterone only pill (desogestrel 75μg) for 3 months and advised to continue follow-up in cardiology. M...

Isolated mesenteric vascular injury following blunt abdominal trauma as a result of road traffic accidents is rare. Delay in reaching hospital, delay in diagnosis, or late operative intervention could lead to increased morbidity, prolonged hospital stay and even mortality. We herein report a case of such injury with subsequent massive segmental small bowel infarction. The patient was referred to our institute ten hours after the alleged accident. Resection of the infarcted bowel segment with end-to-end anastomosis was done. We highlight the various techniques for timely diagnosis and management of isolated mesenteric injuries. A high index of suspicion, early detection and prompt surgical intervention is required when there are minimal symptoms and signs, which might avert adverse outcome.

Serous psammocarcinoma is a rare variant of serous carcinoma arising from either ovary or peritoneum, characterized by massive psammoma body formation, low grade cytologic features, and invasiveness. Its clinical behavior is similar to serous borderline tumors with relatively favorable prognosis. We report herein a case of a 60-year-old postmenopausal woman who presented with abdominal distension. Contrast enhanced computed tomography (CECT) revealed calcified pelvic masses with ascites. Elevated serum CA-125 (970 U/mL) suggested malignant ovarian neoplasm. Patient underwent exploratory laparotomy with primary debulking surgery. Histopathology showed bilateral serous psammocarcinoma of ovary with invasive implants on omentum. Adjuvant chemotherapy was advised in view of advanced stage disease, although its benefits are poorly defined due to rarity of the tumor. However, patient opted out of it and is now on follow-up.