Bezoars have different compositions and can be subdivided into trichobezoar, phytobezoar, pharmacobezoar, lactobezoar and food bolus. The reported incidence of bezoar is 0.4% with phytobezoar being the commonest. Rapunzel syndrome is an extremely rare complication when trichobezoar crosses the pylorus to enter the duodenum, ileum and colon. We present the case of a 29-year-old female with a oneweek history of abdominal pain, anorexia, nausea, vomiting, constipation, lethargy and a one-year history of increasing abdominal mass. Physical examination revealed a 20 cm palpable mass extending from the left upper quadrant to the umbilicus. Laboratory investigations demonstrated iron deficiency anemia and CT showed two well-defined foci within the gastric lumen consistent with trichobezoars. She was managed conservatively during her hospital stay and discharged home with a plan for elective laparotomy. We present this case to discuss the management of trichobezoars and to highlight the importance of early recognition of recurrence to avoid severe complications.

Gallbladder volvulus (GBV) is an extremely rare disease, which presents similarly to acute cholecystitis. It has an incidence of less than 0.1% among urgent cholecystectomies and one in 356,000 hospital admissions. We report the case of a 92-year-old female with a three-day history of abdominal pain that had acutely worsened and localized to the right upper quadrant over the past 24 hours. Physical examination revealed a tender palpable mass in the right upper quadrant. Laboratory investigations demonstrated elevation of the white cell count and liver enzymes while CT abdomen showed a thick-walled gallbladder with an abrupt cutoff of the cystic duct suggestive of gallbladder volvulus. A laparoscopic cholecystectomy revealed a massively distended gangrenous gallbladder which has volved on the hepatocystic ligament. We present this case to demonstrate the radiological and intraoperative findings of GBV and to highlight the importance of early intervention to avoid life-threatening complications.

Herniation of a gravid uterus through an abdominal wall incisional hernia with overlying skin necrosis is exceptionally rare. A 29-year-old multiparous K30 + 4/40 pregnant female presented with a 1-month history of worsening abdominal wall skin changes. Magnetic resonance imaging of the abdomen and pelvis confirmed herniation of the gravid uterus into the hernia sac. A lower uterine segment caesarean section and hernia repair were performed by the general surgical and obstetrics team in view of the potential maternofoetal complications. This case highlights the importance of early recognition and the difficulties in managing gravid uterus herniation.

Mesh migration mimicking sigmoid diverticulitis Case reportA 59-year-old female presented to the emergency department with a 4-day history of left lower quadrant pain, loose stools, and nausea. Her past medical history was significant for type 2 diabetes mellitus, and obesity. She had a past surgical history significant for laparoscopic appendicectomy, laparoscopic cholecystectomy and a total abdominal hysterectomy with bilateral salpingo-oophorectomy. She had undergone an incisional paraumbilical hernia suture repair with novofil in 1995 and a repair via laparotomy for multiple midline incisional hernias in 2003, where a large preperitoneal nylon mesh was secured with 1-0 single loop nylon suture. Physical examination revealed a soft abdomen with tenderness in the left lower quadrant.