Laparoscopic transgastric resection of gastroduodenal intussusception due to gastric leiomyoma

@#part of the duodenum is a rare complication. We report herean 80-year-old woman who presented at the SarawakGeneral Hospital, Kuching, Sarawak, Malaysia with earlysatiety and epigastric fullness for 3 months. She had noprior medical or surgical history other than an uneventfulopen cholecystectomy. Upper endoscopy showed a largesubmucosal mass in the first part of duodenum with pyloricconverging gastric folds. Computed tomography scan of theabdomen showed a gastroduodenal intussusception with a4x6cm mass at the junction between the first and secondpart of duodenum. Laparoscopic transgastric resection wasperformed. Histopathological examination of the resectedspecimen confirmed leiomyoma. She remained well at 43months follow-up.

A case of laparoscopic resection of myxoid liposarcoma of the greater omentum

@#Primary omental liposarcoma is a rare clinical entity with less than 20 cases being reported in the literature. Laparotomy has been the traditional approach for resection, with no reports of laparoscopic resection. A 39-year-old lady presented at the Sarawak General Hospital, Kuching, Malaysia with a history of a progressive, painless left upper quadrant abdominal swelling for a year. CT scan showed a well-defined heterogeneously enhancing cystic mass measuring 7.5x7.5x8.1cm with a poor plane with the adjacent greater curvature of stomach and transverse colon. Upper and lower endoscopy was normal. The tumour was completely dissected from the adjacent transverse colon and removed laparoscopically. Histopathological examination of the resected specimen revealed a myxoid liposarcoma. She had an uneventful recovery and was discharged well on the third postoperative day. She subsequently underwent adjuvant chemotherapy and was well at 1-year follow-up with PET CT showing no evidence of recurrence or metastases.

Epiphrenic oesophageal diverticulum managed via laparoscopic transhiatal approach

@#Epiphrenic oesophageal diverticulum is a rare disorder affecting the distal oesophagus. Surgical techniques for this condition evolve over time from open transthoracic and trans-abdominal approaches to minimally invasive surgery. We report a case of an 82-year-old male who presented with symptomatic epiphrenic oesophageal diverticulum over the last 1 year. He underwent laparoscopic transhiatal diverticulectomy, myotomy and anterior partial fundoplication and was discharged well. He remains asymptomatic after a follow-up of 6 months.

Acute Lower Gastrointestinal Haemorrhage Secondary to Small Bowel Ascariasis

Acute lower gastrointestinal haemorrhage secondary to small bowel ascariasis is extremely rare. A high level of suspicion should be maintained when dealing with acute gastrointestinal haemorrhage in migrants and travellers. Small bowel examination is warranted when carefully repeated upper and lower endoscopies have failed to elicit the source of bleeding. Appropriate test selection is determined by the availability of local expertise. We present a case of acute lower gastrointestinal haemorrhage secondary to jejunal ascariasis and a literature search on lower gastrointestinal haemorrhage associated with jejunal infestation with Ascaris.

Two Different Surgical Approaches for Strangulated Obturator Hernias

Obturator hernia is a rare condition that may present in an acute or subacute setting in correlation with the degree of small-bowel obstruction. Pre-operative diagnosis is difficult, as symptoms are often non-specific. A high index of suspicion should be maintained for emaciated elderly women with small-bowel obstruction without a previous abdominal operation and a positive Howship–Romberg sign. When diagnosis is in doubt, computed tomography scan of the abdomen and the pelvis (if available) or laparotomy should be performed immediately, as high mortality rate is related to the perforation of gangrenous bowels. We present 2 cases of strangulated obturator hernia, managed differently with both open and laparoscopic approaches. The diagnostic accuracy of computed tomography scan is highlighted followed by a brief literature review with an emphasis placed on surgical management.

Stomach gastrointestinal stromal tumours (GIST) intussuspected into duodenum: A case report

Gastrointestinal stromal tumours (GIST) are tumours of gastrointestinal tract and mesentery. The commonest site of its occurrence is the stomach. Patients with GIST are usually asymptomatic but they can present as abdominal pain, bleeding and rarely gastric outlet obstruction. In this particular case, the patient presents with symptoms of anaemia, partial gastric outlet obstruction and intermittent epigastric pain. Laparotomy was performed and a diagnosis of gastroduodenal intussusception secondary to gastrointestinal stromal tumour was made.