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Stenosis due to lumbar degenerative disease is associated with aging and often requires surgical treatment to provide decompression of the neural elements and alleviation of the symptoms. We present an 83-yo female patient, with neurological claudication and bilateral L5 paresis, treated with undercutting and bilateral flavectomy at the level L4-L5 without fusion. With this case we would like to illustrate the decision-making problem for or against fusion and the operative approach for adequate decompression without causing further instability. We discuss the indications of undercutting and the evidence against routinely performing fusion and compare our presentation to the current literature.

Background: Meckel’s diverticulum is a common congenital abnormality of the gastrointestinal tract encountered in about 1–3% of the general population. Although most patients remain asymptomatic, a minority will experience serious complications such as acute abdomen, haemorrhage or obstructive ileus. Of all patients presenting with symptoms of obstruction due to Meckel’s diverticulum 7–18% is due to volvulus. Case Report: A 39-year-old male with multiple previous episodes of obstructive ileus presented with an acute abdomen. An exploratory laparotomy was performed in order to reveal the cause of the obstruction. An internal hernia with ileal volvulus and a Meckel’s diverticulum was found, which was later confirmed by histopathological examination. Conclusion: Meckel’s diverticulum is a rare cause of acute abdomen and obstructive ileus which should be considered when the symptoms date back to childhood. The difficulty of preoperative diagnosis dictates the need for exploratory laparoscopy or laparotomy as diagnostic tools.