[Diagnostic laparoscopy in acute abdomen]

New insights in diagnostic laparoscopy

The basic concept of Diagnostic Laparoscopy (DL) is old but not old-fashioned. – Before the rise of tomography and ultrasound there was just the direct look into the abdomen and onto the affected organ available. As open surgery comes along with trauma, blood loss and infection, every effort have been made to improve the access strategies. Finally, due to innovation in optics, video technology and computer science, the look into the abdomen through a “keyhole” is a standard procedure today. – In this review we give an overview of history, implications and cost-effectiveness of DL, attempting an extrapolation of its future role.

Transmesenteric hernia: A rare cause of bowel ischaemia in adults

INTRODUCTION

Transmesenteric herniae are a rare cause of bowel ischaemia in adults with few reported cases in published literature.

PRESENTATION OF CASE

We report a rare case of a 26-year-old female with spontaneous transmesenteric hernia of jejunum and proximal ileum due to a congenital mesenteric defect resulting in bowel gangrene, presenting initially with no haemodynamic or biochemical abnormalities. The hernia was reduced, small bowel resected and primary side to side anastomosis performed, following which the patient made a good recovery and was discharged 5 days later.

DISCUSSION

The insidious onset of transmesenteric herniae and lack of specific radiological or laboratory investigations reaffirms the importance of surgeons maintaining a high index of suspicion for this critical surgical emergency.

CONCLUSION

Close monitoring of the patient's general condition in cases of non-specific abdominal pain is essential to identify the rare deteriorating patient for early surgical intervention and optimal outcome.