Laparoscopic management of massive spontaneous external haemorrhage from the umbilical varix due to recanalisation of the paraumbilical vein in a patient with 'Child's Class A' liver cirrhosis.

Spontaneous external haemorrhage from the umbilical varix is an extremely rare complication of portal hypertension. Bleeding is usually into the peritoneal cavity and the treatment involves urgent laparotomy and ligation of the bleeding varices. We describe a cirrhotic 38-year-old man who presented with spontaneous external haemorrhage from the umbilical varix which was successfully managed laparoscopically by in-situ distal clipping and proximal transcutaneous ligation of the recanalised paraumbilical veins. We therefore feel that laparoscopy can be safely and effectively employed to control external haemorrhage from the umbilical varix associated with liver cirrhosis. This novel technique can help avoid a laparotomy and also help preserve the umbilicus.

Incarcerated Gastro-thorax: a rare and delayed presentation of diaphragmatic injury due to multiple stab wounds.

Diaphragmatic injuries due to thoraco-abdominal penetrating trauma may often go unnoticed at the initial admission, especially in patients who are asymptomatic, with stable hemodynamic and respiratory parameters. Such occult diaphragmatic perforations can result in latent morbidity and mortality due to delayed trans-diaphragmatic herniation of the abdominal viscera leading to incarceration, strangulation and perforation. Here we report a case of an initially asymptomatic patient who had sustained multiple truncal stab injuries and presented two months later with a trans-thoracic incarceration of the stomach which was accurately diagnosed and successfully repaired at the time of surgery. This case report highlights the importance of exploring thoraco-abdominal penetrating injuries even in the absence initial clinical and radiological signs, so as to promptly identify occult and isolated diaphragmatic perforations and prevent delayed catastrophes. The clinical features, radiological findings, diagnostic difficulties and surgical options are discussed along with review of relevant literature.

Spontaneous Perforation of the Colon and Hypothyroidism: Report of a Case and Review of Literature.

Spontaneous perforation of the colon is a well documented but rare clinical entity commonly found to occur in the elderly and associated with chronic constipation. Hypothyroidism is known to be associated with intestinal motility disorders ranging from chronic constipation to more serious conditions like mega colon and pseudo obstruction. The case described here is that of a 35 years old hypothyroid male who presented with perforation peritonitis due to spontaneous perforation of the rectosigmoid. A thorough search of literature shows only one report of spontaneous perforation of the colon associated with hypothyroidism, to date. This case gives an opportunity to review the literature and discuss such unusual and dangerous presentations of hypothyroidism associated colonic motility disorders.