Lesser sac herniation: a rare cause of acute abdomen and bowel perforation.

Lesser sac herniation is a rare phenomenon, where the bowel protrudes through the epiploic foramen into the lesser sac. We describe the case of a 55-year-old male who presented with acute abdominal pain and in whose case the subtle findings of lesser sac herniation were missed during CT scan reporting. Re-review of the images after the patient's condition deteriorated found evidence of herniation, and re-scanning at that point demonstrated progression of the herniation, with bowel obstruction and perforation. The findings of lesser sac herniation complicated by basculetype caecal volvulus were confirmed during laparotomy. The patient underwent right hemicolectomy with primary ileocolic anastomosis.

Balloon-Expandable Transcatheter Aortic Valves Can Be Successfully and Safely Implanted Transfemorally Without Balloon Valvuloplasty.

OBJECTIVES: To assess the necessity for balloon aortic valvuloplasty (BAV) during transfemoral transcatheter aortic valve implantation (TAVI) when using balloon-expandable valves. BACKGROUND: BAV is a usual part of TAVI procedures, prior to valve implantation. However, the benefits and necessity of this are unknown and recent evidence in self-expanding valves suggests it may not be necessary. METHODS: Retrospective single-center study of 154 patients undergoing first-time, transfemoral TAVI for native aortic valve stenosis, with (N = 76), and without (N = 78), BAV as part of the procedure. Data collected included demographic, procedural, and outcome data. RESULTS: BAV did not alter VARC-2 defined procedural success or early safety compared to not performing a BAV, including mortality, degree of aortic regurgitation, or need for post-TAVI balloon dilatation, although there was a strong trend to reduced stroke when not performing a BAV. There was a significantly reduced procedural time (P = 0.01) and fluoroscopic time (P < 0.001) without performing a BAV. There were no differences in cerebral embolization (solid, gaseous, or total emboli) noted between the 2 groups, as measured on transcranial doppler (TCD). CONCLUSIONS: TAVI can be effectively and safely performed without a BAV and this results in reduced procedural and fluoroscopic times, although embolization to the brain is not reduced. There is a trend toward reduced stroke risk. (J Interven Cardiol 2016;29:319-324).