Transmesocolon internal hernia masking as simple sigmoid volvulus.

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.

Vaginal evisceration of small bowel.

Evisceration of bowel through the vaginal vault is an extremely rare condition and is considered to be a surgical emergency. We present the case of an 83-year-old female who was brought to the emergency department with a vaginal prolapse complicated by evisceration of small bowel. A midline laparotomy was performed for reduction of the bowel with a subsequent vaginal repair. We present this case due to its rarity and high-reported mortality rate.

New method of abdominoplasty for morbidly obese patients.

INTRODUCTION: We report two cases of morbidly obese patients with huge infected abdominal aprons who underwent apronectomies at Alice Springs Hospital, Northern Territory, Australia. We describe a novel technique which to date has not been described in the available literature. Patients afflicted by morbid obesity with large aprons can be incapacitated by immobility as well as suffer from recurrent infections. Apronectomy in this situation can be difficult because of the heavy weight of the apron. METHOD: This technique involves the use of a small crane and large orthopaedic K-nails. Two K-nails were inserted into the apron and attached to a small crane. This facilitated the elevation and manipulation of the apron during surgical dissection. The abdominal tissue removed from the female and male weighed 30 kg and 64 kg, respectively. The wounds were closed primarily and drained by three large bore suction drains. RESULTS: The female patient had a largely uneventful postoperative course with a minor wound infection that resolved with conservative treatment. The other patient required a more protracted course of antibiotics for his more severe infection. Mobility was markedly improved in both individuals. CONCLUSION: This novel technique can be used successfully for severely morbidly obese individuals and can significantly reduce the surgeon's and assistants' difficulty in manipulating and handling a heavy apron during dissection.