Transmesocolon internal hernias are very rare causes of bowel obstruction. Transmesenteric internal hernias normally associated with small bowel. It can be challenging to diagnose transmesocolon internal hernia hence we present a 93-year-old patient who was misdiagnosed with simple sigmoid volvulus on CT abdomen. She underwent endoscopic colonic decompression. Patient continued to deteriorate in the ward, and CT abdomen was repeated; it revealed the cause of the sigmoid volvulus was due to a defect through transverse mesocolon resulting in internal hernia. Patient was diagnosed with transmesocolic internal hernia with sigmoid volvulus. Patient underwent emergency laparotomy and Hartmann procedure. Transmesocolic internal hernia can be easily missed and needs to be considered when diagnosing patients with large bowel volvulus or obstruction.

Fistulating cholecystocutaneous abscess is a known rare complication of chronic gallstones disease. In these modern days, this complication is exceedingly rare due to early diagnosis with radiological imaging, use of broad spectrum antibiotics and early surgical management of biliary tract disease. Here we present a case of an 89-yearold with cholecystocutaneous abscess that was mistaken for simple subcutaneous abscess. The management include initial control of subcutaneous abscess and use of antibiotics followed by definitive surgical excision of gall bladder and the fistula tract.

Chronic abdominal pain is often a diagnostic dilemma. We present a 59-year-old female with chronic generalized colicky abdominal and altered bowel habits. She was investigated with colonoscopy and CT abdomen. Patient has a history of recurrent diverticulitis and insertion laparoscopic adjustable gastric band. The colonoscopy revealed a tubular foreign body and diverticular disease. The tubular structure was confirmed to be gastric band tubing on CT abdomen, also showing simultaneous gastric and colonic erosions. She denies any gastric band port related infection or previous issues with gastric band. This case suggest that the cause of the erosion is due to recurrent episodes diverticulitis. She underwent wedge resection of large bowel and laparoscopic removal of gastric band. She had uneventful post-operative recovery.

In the past few decades, laparoscopic adjustable gastric banding is one of the most common bariatric procedures performed to treat morbid obesity. Device-related complication such as connection-tubing problem is rare. Here we present a case of gastric band tubing complication during pregnancy. This case illustrates the need to maintain high index of suspicion of gastric band device-related complication during pregnancy and early referral for bariatric surgical assessment is recommended.

Inguinal hernia is a common general surgery presentation. Large inguinoscrotal hernias can contain large bowel, omentum, small bowel, Meckel’s diverticulum but rarely ureter and bladder. Ultrasound can further clarify contents of inguinal hernia, and for this patient, it showed a cystic structure in the hernia contents. This was further investigated and found to be the left ureter with moderate to severe hydronephrosis. The patient underwent left inguinal hernia repair without any complication because of the anticipated anatomical anomaly. This case is to raise awareness that a simple inguinoscrotal hernia repair could be complicated by ureteric injury if not investigated thoroughly in the preoperative stage.