Laparoscopic repair of pericardio-diaphragmatic rupture: A case report

Diaphragmatic rupture following blunt trauma is a common pathology which has good outomes when discovered early and treated. The common practice has been to manage these patients with either a laparotomy or thoracotomy, with some reports showing the safety of laparoscopy. We present a case of a patient who presented with a pericadio-diaphragmatic rupture who was managed successfully using laparoscopy

Small bowel obstruction secondary to paravesical hernia

Background: Bowel obstruction in the setting of the unscarred abdomen can be due to a wide variety of causes. Internal hernias are a rare cause of bowel obstruction with paravesical hernia being exceedingly rare. Paravesical hernia should form part of the differential diagnosis in the patient presenting with bowel obstruction. Prompt management and reduction of the incarcerated bowel are essential. This will prevent further complications especially related to bowel ischemia. Case summary: The patient presented with a classical history of small bowel obstruction. Abdominal X-ray revealed distended loops of small bowel and absence of air in the rectum. An exploratory laparotomy revealed a paravesical internal hernia. A loop of terminal ileum had incarcerated and was the cause of the bowel obstruction. The defect was repaired after reducing the bowel and the patient made an uneventful recovery. Conclusion: Internal paravesical hernia although extremely rare should form part of the differential diagnosis in the patient presenting with small bowel obstruction especially in the previously unscarred abdomen. If the obstruction is complete then prompt exploration via laparotomy or laparoscopy is required. Delays in definitive management may result in marginally viable bowel becoming ischemic and requiring bowel resection