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A 71-year-old woman was admitted to the hospital after consuming food due to acute malnutrition and abdominal pain. Reduced patency of all jejunoileal branches and the superior mesenteric artery was observed in the abdominal computed tomography scan. Abdominal angina was caused by atherosclerosis, the frequent use of triptans for recurrent migraines, the JAK2 mutation, and a high platelet count. The patient’s complete parenteral nutrition was not spared, despite the development of a collateral circulation preventing fatal acute ischemia.

A 71-year-old woman was admitted to the hospital after consuming food due to acute malnutrition and abdominal pain. Reduced patency of all jejunoileal branches and the superior mesenteric artery was observed in the abdominal computed tomography scan. Abdominal angina was caused by atherosclerosis, the frequent use of triptans for recurrent migraines, the JAK2 mutation, and a high platelet count. The patient's complete parenteral nutrition was not spared, despite the development of a collateral circulation preventing fatal acute ischemia. [ABSTRACT FROM AUTHOR]

Mesenteric ischemia is a group of disorders requiring prompt identification, supportive care, and treatment. Chronic mesenteric ischemia can develop into acute mesenteric ischemia, which has high mortality. Acute mesenteric ischemia can be occlusive (caused by arterial embolism, arterial thrombosis, or mesenteric venous thrombosis) or nonocclusive, with treatment depending on the underlying cause. [ABSTRACT FROM AUTHOR]

Chronic mesenteric ischemia (CMI) is a rare vascular disease. Unlike acute ischemia with a sudden onset, CMI is characterized by permanent or episodic intestinal hypoperfusion, usually due to atherosclerotic vascular lesion. Despite the high prevalence of atherosclerosis of mesenteric arteries in the general population, clinical manifestations of CMI may be absent up to the end-stage disease, which is due to the formation of extensive collateral circulation and the presence of residual fetal circulation. CMI not only worsens the quality of life, but also increases the risk of acute ischemia against the background of chronic. This problem is relevant, since the incidence and related mortality do not tend to decrease. The article presents the case report of CMI in a patient with an atypical abdominal angina. The etiopathogenesis, clinical picture, diagnosis and treatment methods are described in relation not only to the presented report, but also to literature data. This improves understanding and management strategy of this rare life-threatening pathology.

A 77-year-old woman who had experienced postprandial abdominal pain for four years was admitted to our institution presenting sudden and severe abdominal pain. Contrast-enhanced computed tomography (CECT) demonstrated complete short-segmented occlusion in the orifice of the superior mesenteric artery (SMA), and saccular aneurysms in the right hepatic artery and the anterior superior pancreaticoduodenal artery. She was diagnosed with abdominal angina due to occlusion of the SMA. The SMA was recanalized by stenting, and a CECT scan confirmed naturally shrunk aneurysms after eight months. The patency of the SMA was maintained at five years after endovascular treatment. [ABSTRACT FROM AUTHOR]

Background: Mesenteric ischaemia is often a manifestation of severe vascular disease involving the superior mesenteric artery (SMA). Endovascular revascularization is challenging in a chronic total occlusion (CTO) of SMA. Case presentation: A-73-year-old male patient was referred to our hospital because of a 2-year history of post prandial abdominal angina. Computed tomography (CT) images revealed a heavily calcified CTO in the ostium of SMA and three-dimensional CT (3D-CT) detected pancreaticoduodenal arcade with filling from the celiac artery. Then, endovascular procedure was attempted; however, angiography did not show the collateral route suitable for transcollateral approach. As demonstrated on the CT, we were successful in passing a guidewire through the SMA-CTO via the celiac trunk transcollateral route. After pull-through of the guidewire, two balloon-expandable stents were deployed in the ostium of SMA. During 3 months after stent implantation, the patient had no further episodes of abdominal angina on dual-anti-platelet therapy. Conclusion: We demonstrate a case of a heavily calcified SMA occlusion successfully treated with endovascular stenting employing a transcollateral approach, guided by 3D-CT. [ABSTRACT FROM AUTHOR]

Introduction: Buerger disease or thromboangiitis obliterans (TAO) is non-atherosclerotic segmental inflammatory and occlusive vessel disease of unknown etiology. It affects small and medium-sized arteries and veins of the limbs, typically occurring in young male smokers. Involvement of visceral arteries is rare. The diagnosis relies on clinical presentation, radiological findings and exclusion of other clinical entities. The main treatment approach is smoking cessation1-3. Case report: 34-year-old-man, smoker, was admitted to due to recent abdominal pain, mainly postprandial, without signs of peritonitis. During the period of several weeks he has lost about 5 kg. He noticed a spontaneous appearance of small wounds on his big toes that did not heal and reported intermittent claudication for the last couple of years that now progressed to rest pain. Upon physical examination, we observed a lividity on the soles of both feet and small areas of necrosis on big toes. Distal arterial pulsations were absent. Computed tomography angiography (CTA) of abdominal aorta branches showed a thrombotic occlusion of the celiac trunk and the proximal section of the lienal artery without intestinal infarction while CTA of leg arteries revealed a segmental occlusion of both-sided peroneal and tibial arteries (Figure 1 and 2). No significant abnormality was found in blood tests, thrombophilia screening was negative, while potential cardioembolism was ruled out. Considering the patient’s history of smoking, younger age, clinical presentation and angiographic findings of segmental occlusions of the lower leg arteries along with the presence of corkscrew collateral vessels, we made a diagnosis of TAO. The patient has immediately been started on heparinization and antiaggregation, statins, analgesics and a customized diet plan. Balloon angioplasty of both legs was performed in two stages. During follow-up, we observed favorable outcomes: reduction in leg and abdominal pain, spontaneous recanalization of the splenic artery and stable body weight (Figure 3). Due to involvement of the splanchnic circulation, the patient was maintained on warfarin. Abdominal angina in young smokers should raise suspicion of TAO. Anticoagulants in visceral involvement could improve the prognosis of TAO patients. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Gastroenterología del Perú is the property of Sociedad de Gastroenterologia del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Middle age patient was presented in emergency department with complains of acute abdominal pain, vomiting and diarrhea. On clinical examination there was board like rigidity and tender abdomen. Initial labs were unremarkable. Filling defect was seen in an anomalous channel, hepato-spleno-mesenteric trunk that was seen as a supply of liver, spleen, small bowel and part of large bowel on contrast enhanced computed tomography. The left gastric artery was seen arising separately from aorta. Emergency exploratory laprotomy was done. Patchy discoloration and cyanosis with friability was seen in liver and spleen representing ischemia. Gangrene of small bowel and proximal large bowel (till the splenic lexure) was seen. The patient expired few days after presentation. No other surgical intervention was done. This was an unusual case of abdominal angina due to thrombosis of a rare arterial variation of gastrointestinal vascularity. The hepato-spleno-mesenteric trunk was seen thrombosed which happens to be the only artery supplying the midgut and its embryological visceral derivatives in the subjects it occur in. However, in cases like these there is a possibility of collateral supply from esophageal, phrenic and inferior mesenteric arteries.

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Copyright of Revista Latinoamericana de Hipertension is the property of Revista Latinoamericana de Hipertension and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Key Clinical Message: Mesenteric ischemia and antiphospholipid syndrome is a rare combination but should be suspected as a differential diagnosis. This may be presented as diffuse abdominal pain typically after food intake, diarrhea, and weight loss. Early recognition is warranted, and nutrition, stenting, and anticoagulant treatments are indicated. [ABSTRACT FROM AUTHOR]

Background/Aim. Despite a huge success in decrease rate of recurrences of inguinal hernia in mesh and "plug in" techniques, a new problem appears such as chronic pain and other complications. The aim of this paper was to present the original modification of bilayer patch device (Prolene Hernia System®, Ethicon) insertion in "non-plugged" fashion and 11-year experience with this open technique for the indirect hernia repair in a male. Methods. This retrospective study included 96 male patients with 103 indirect unilateral and bilateral inguinal hernias, operated due to a primary or recurrent hernia in an 11-year interval (2004-2015). In all operation an extended Prolene Hernia System® (PHS) bilayer patch device was inserted medially of inferior epigastric vessels through a small incision in Hasselbach's triangle, thus avoiding plug component of device connector into the internal ring. All data were taken from the medical records, operative protocols, and telephone questionnaire. Results. Non-plugged technique of bilayer patch device insertion was presented in details. Mean age of patients was 59 years. There were 3 (2.91%) patients with procedure-related complications, two patients with postoperative seroma and one with scrotal ecchymosis. There were 86 (89.6%) patients who answered on the questionnaire. During 11 years of following, recurrence of a hernia occurred in 1 patient, one had funiculocele and only one had chronic pain during 6 months. Almost all patients (97.68%) were satisfied with the procedure and results of hernia surgery. Conclusion. Nonplugged insertion of bilayer patch device is a safe technique for solving the primary and recurrent indirect inguinal hernias. The low incidence of the recurrence and chronic pain many years after the operation justifies this technique even in hospitals not specialized for the hernioplasty. [ABSTRACT FROM AUTHOR]

Middle age patient was presented in emergency department with complains of acute abdominal pain, vomiting and diarrhea. On clinical examination there was board like rigidity and tender abdomen. Initial labs were unremarkable. Filling defect was seen in an anomalous channel, hepato-spleno-mesenteric trunk that was seen as a supply of liver, spleen, small bowel and part of large bowel on contrast enhanced computed tomography. The left gastric artery was seen arising separately from aorta. Emergency exploratory laprotomy was done. Patchy discoloration and cyanosis with friability was seen in liver and spleen representing ischemia. Gangrene of small bowel and proximal large bowel (till the splenic flexure) was seen. The patient expired few days after presentation. No other surgical intervention was done. This was an unusual case of abdominal angina due to thrombosis of a rare arterial variation of gastrointestinal vascularity. The hepato-spleno-mesenteric trunk was seen thrombosed which happens to be the only artery supplying the midgut and its embryological visceral derivatives in the subjects it occur in. However, in cases like these there is a possibility of collateral supply from esophageal, phrenic and inferior mesenteric arteries. [ABSTRACT FROM AUTHOR]

The article presents the results of examination of patients with chronic abdominal ischemia with hemodynamically significant unpaired visceral branches of the abdominal aorta lesion. Functional classes of chronic abdominal ischemia are defined. It allows to estimate clearly the disease progress in patients with intravazal and extravasal stenosis and to justify further treatment strategy.

Introduction. Abdominal angina, also known as chronic mesenteric ischemia or intestinal angina, is a rare disease caused by intestinal flow reduction due to stenosis or occlusion of mesenteric arteries. A case of successful treatment of a patient with abdominal angina by percutaneous transuliminal angioplasty of high-grade superior mesenteric artery and coeliac trunk stenosis was presented. Case Outline. A 77-year-old male patient was admitted at our Clinic for severe postprandial abdominal pains followed by frequent diarrhoeas. Extensive gastrointestinal investigations were performed and all results were normal. Multislice computerized (MSCT) arteriography was indicated which revealed ostial celiac trunk and superior mesenteric artery subocclusion. Percutaneous transluminal angioplasty of the superior mesenteric artery and coeliac trunk was done with two stents implantation. Just a few hours following the intervention, after food ingestion, there were no abdominal pains. Six months later, the patient described a significant feeling of relief after food ingestion and no arduousness at all. Conclusion. High-grade visceral arteries stenoses in patients with intestinal ischemia symptoms can be treated by either surgical procedures or percutaneus transluminal angioplasty. In cases when a low operative risk is anticipated, surgical treatment is recommended due to a better anatomical outcome, while percutaneus angioplasty is advised to elderly patients in whom increased operative risks can be expected.

Unstable angina, characteristic of coronary artery disease, is caused by in-situ clot formation complicating ruptured atheromatous plaque. Abdominal angina, however, usually reflects chronic mesenteric ischaemia, caused by multi-vessel stable plaques involving mesenteric arteries. Herein, we describe a patient with new-onset abdominal pain caused by a ruptured atheromatous plaque at the superior mesenteric root. The diagnosis was based on an evident reversible epigastric bruit and high-degree eccentric stenosis caused by a non-calcified atheroma. Symptoms and bruit resolved within 3 weeks on aspirin and statins with regression of the stenotic lesion. Although the condition is likely common, this is the first clear-cut report compatible with 'unstable' abdominal angina, resolved by conservative treatment., Learning Points: Resembling unstable angina pectoris, ruptured atheromatous plaque in mesenteric vessels can develop, clinically manifested by new-onset abdominal angina.This condition may be reversible under treatment with antiplatelet medications and statins.Searching for abdominal bruit is invaluable in the assessment of unexplained abdominal pain., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2023.)

A 74-year-old woman who was diagnosed with chronic mesenteric ischemia was under hemodialysis maintenance and had previously undergone axillobifemoral bypass surgery because of abdominal aortoiliac occlusion. Endovascular and antegrade or retrograde surgical revascularizations from the aortoiliac artery were contraindicated because of a severely calcified arteriosclerotic lesion, which included aortoiliac occlusion. During median laparotomy, revascularization consisting of bypass grafting from a previous prosthetic graft to the mesenteric arteries was performed using saphenous vein grafts. Although extra-anatomical bypass for chronic mesenteric ischemia is challenging, it provides a feasible option in cases where conventional endovascular or surgical revascularization is contraindicated., Competing Interests: Disclosure StatementAll authors have no conflict of interest., (© 2023 The Editorial Committee of Annals of Vascular Diseases.)

Pulmonary sequestration (PS) is a rare congenital malformation of the lower respiratory tract and is commonly complicated by recurrent infections and presents with respiratory failure. We report an atypical clinical presentation of postprandial abdominal pain and cramps in a patient with intralobar PS.

Takayasu's arteritis is a rare disease involving inflammation in the walls of the largest arteries in the body: the aorta and its main branches. The disease results autoimmunity which causes inflammation in the arterial wall. Patient symptoms are usually non-specific and include fever, malaise and myalgia. The patient was admitted with abdominal angina and weight loss. We were able to detect a pulse only in the upper extremities. Magnetic resonance angiography (MRA) revealed stenosis of the descending aorta and mesenteric artery. We diagnosed the patient with Takatasu's arteritis. This case is presented as an example of this rare condition. [ABSTRACT FROM AUTHOR]

Aims: Smartphone technology and downloadable applications (apps) have created an unprecedented opportunity for access to medical information and healthcare-related tools by clinicians and their patients. Here, we review the current smartphone apps in relation to hernias, one of the most common operations worldwide. This article presents an overview of apps relating to hernias and discusses content, the presence of medical professional involvement and commercial interests. Methods: The most widely used smartphone app online stores (Google Play, Apple, Nokia, Blackberry, Samsung and Windows) were searched for the following hernia-related terms: hernia, inguinal, femoral, umbilical, incisional and totally extraperitoneal. Those with no reference to hernia or hernia surgery were excluded. Results: 26 smartphone apps were identified. Only 9 (35 %) had named medical professional involvement in their design/content and only 10 (38 %) were reviewed by consumers. Commercial interests/links were evident in 96 % of the apps. One app used a validated mathematical algorithm to help counsel patients about post-operative pain. Conclusions and opportunities: There were a relatively small number of apps related to hernias in view of the worldwide frequency of hernia repair. This search identified many opportunities for the development of informative and validated evidence-based patient apps which can be recommended to patients by physicians. Greater regulation, transparency of commercial interests and involvement of medical professionals in the content and peer-review of healthcare-related apps is required. [ABSTRACT FROM AUTHOR]

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Background: median arcuate ligament syndrome is a rare condition that causes abdominal angina; detecting it is a diagnostic challenge. For years, angiography was considered the only method of obtaining anatomic information for diagnosis; however, advances in tomographic techniques of multiplanar reconstruction and 3D volume rendering have made this non-invasive method a means for precise detection of this condition. Presentation of the case: female patient, 55 years of age, with history of chronic postprandial abdominal pain, associated with hyporexia, weight loss, and episodes of intermittent diarrhea. Computed tomography images clearly showed an area of anterior focal compression at the origin of the celiac trunk, with dilation of the distal segment to stenosis and collateral conduit vessels. Discussion: angiotomography plays a very important part in diagnosis of median arcuate ligament syndrome; its symptoms are potentially reversible by means of surgical treatment and detection is of vital importance in patients identified as candidates for surgery who require supra-selective arterial catheterization or liver transplant. [ABSTRACT FROM AUTHOR]

The article presents guidelines for the use of laparoscopy in patients with ventral and incisional abdominal wall hernias, which was released by the International Endohernia Society. Topics discussed are the use of mesh technology and adhesions after laparoscopic ventral hernia repair (LVHR), insertion during laparoscopic intraperitoneal onlay meshes (IPOM) and the role of biological meshes in LVHR. Studies supporting the efficacy of mesh technology are cited.

Abstract: Systemic childhood polyarteritis nodosa (C-PAN) is a rare primary vasculitis involving medium or small sized arteries. Abdominal angina is an important and serious complication of PAN, occurring usually 15 to 30min after food intake, and particularly in adult patients. However, to our knowledge, this involvement as the first manifestation of C-PAN was not described. Therefore, we reported herein two C-PAN cases that fulfilled the new criteria for this vasculitis. These patients were young boys that had malignant arterial hypertension and recurrent post-prandial cramping with acute abdomen. Both of them were submitted to laparotomy that revealed multiple and diffuse intestinal necrosis. One of our cases had a severe post-prandial cramping, even after drinking water, and the laparotomy evidenced multiple intestinal perforations. In spite of use of antihypertensive therapies, immunosuppressive agents (corticosteroids, cyclophosphamide and/or methotrexate) and intravenous immunoglobulin, they died possibly due to severe and disseminated activity disease. In conclusion, we described herein the first two fatal cases of C-PAN that presented severe abdominal pain as initial manifestation. We suggest that the diagnosis of PAN should be considered in patients under acute abdominal angina with no apparent etiology. [Copyright &y& Elsevier]

Background and aims: Chronic mesenteric ischemia in older patients is a challenge for the physician because it coincides with a vague and non-specific clinical presentation with abdominal pain. It can frequently cause diagnostic errors and lead to legal consequences. The aim of this work was to evaluate the literature on chronic mesenteric ischemia and focus on the limited data concerning the geriatric population. Methods: This research focused on observational studies, randomized controlled trials, and clinical reports (excluding case reports and reviews) dealing with patients at least 65 years old with a clinical or instrumental diagnosis of chronic intestinal ischemia, published between 2000 and 2010. The search was conducted in PubMed using the following key words: chronic ischemia splanchnic disease, chronic mesenteric ischemia, angina abdominis, chronic abdominal angina, intestinal ischemia. Results: We selected 925 articles with the key words as follows: chronic mesenteric ischemia in 355 cases; chronic is- chemic splanchnic disease in 46; angina abdominis in 4; abdominal angina in 242; and chronic intestinal ischemia in 278. We then excluded articles judged scarcely pertinent, case reports, reviews, works concentrating only on diagnostic, methodological, instrumental and surgical approaches, and articles based on animal or experimental models. This selection left us with 13 articles (after excluding duplicates), only three of which were considered valid for our purposes. Conclusions: Our review indicates that there is a shortage of useful literature on chronic intestinal ischemia disease diagnosed in the older adults, and the appropriate geriatric management of these patients is consequently not well established. [ABSTRACT FROM AUTHOR]

A surgical sponge left in abdominal cavity following completion of the operation (Gossypiboma) is a rare entity. They may not only cause aseptic reactions without significant symptom, but they may also lead to exudative reaction which is manifested in the early phase with non-specific symptoms or they may manifest in the late phase with abscess and palpable mass symptoms. Surgical gauze pad will initiate a granulomatous reaction and it may appear as a large intra-abdominal mass. This condition is referred as gossypiboma. Gossypiboma should be considered in patients who have abdominal pain and intraabdominal abscess symptoms particularly in patients had abdominal operation previously. In this study, we present radiological findings of a 37-years old male patient who referred to our clinic with complaints of abdominal pain and fever and diagnosed as gossypiboma. [ABSTRACT FROM AUTHOR]

Introduction. Valve calcification is highly prevalent and an important predictor for all cause mortality in haemodialysis (HD) patients. Abdominal fat deposition is linked to inflammation and protein-energy wasting and it is also associated with increased mortality risk. An association of inflammation and malnutrition with cardiac VC is reported, similar to that of atherosclerosis. We evaluated the possible relationship between abdominal fat deposition, inflammation markers and valve calcification (VC) in patients on maintenance haemodialysis (HD). Methods. The data of 69 haemodialysis patients were analysed. There were 41 (59.4%) males, mean age 51.39± 12.72 yrs and mean time on therapy 54.3±39.9 months. The presence of cardiac valve calcification was assessed by standard bi-dimensional echocardiography. Abdominal fat deposition was assessed by conicity index (Ci). Fibrinogen and C-reactive protein (CRP) were measured to assess the presence of inflammation. Results. The prevalence of valve calcification was 58%. Significantly higher fibrinogen level [446±100.84 vs 356 ±109.01 (p=0.037)], conicity index [1.45±0.13 vs 1.33±0.08 (p= 0.002)] and lower s-albumin (3.8±0.32 vs 4.04±0.29 (p=0.045)] were observed in the group with valve calcification compared to the group without valve calcification. Patients were divided into groups according to tertiles of Ci distribution. There were statistically significant differences in fibrinogen, VC and BMI between Ci groups, with significantly higher fibrinogen (p= 0.001), valve calcification (p=0.01) and BMI (p=0.043) in high Ci group. Significant difference between Ci groups was found for CRP. A significant relationship between presence of valve calcification with Ci and fibrinogen and inversely with serum albumin was found [(r= 0.414, p= 0.002); (r=0.224, p= 0.043); (r= -0.274, p= 0.045) respectively]. Conclusions. We found that abdominal adiposity was frequent in HD patients, and it was associated with inflammatory markers, both being risk factors for heart valve calcification. HD patients must be encouraged to decrease the abdominal fat, even when they are not overweight. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the relation between fat distribution in subcutaneous and visceral area with other variables in patients suffered for stable angina. Methods: This cross sectional study was done on 40-60 years patients with stable angina. CT scan was determined subcutaneous (deep and superficial) and visceral fat. Body mass index, waist circumference, and blood pressure measurement were calculated by standard protocols. Sugar, triglyceride, total cholesterol, LDL-c, HDL-c, Leptin and apolipoproteins A and B were recorded. Data was entered in SPSS15 and analyzed by Student-t and correlation test. Finding: Sixty-six men and 88 women were studied. The mean of BMI, apo A, Leptin, lipids variables were significantly different in two sexes. Total variable fat accumulation in women was greater than men (P < 0.05). The correlation was significant between weight, BMI, WC and Leptin level in both sexes. Conclusion: Relation of fat distributions and other risk factors was different in both sexes, but BMI and WC had significant correlation with CT scan variables. [ABSTRACT FROM AUTHOR]

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Intimal angiosarcoma is a most unexpected cause of aortic occlusion. We present the case of a 74-year-old woman with intimal angiosarcoma that manifested with the triad of congestive heart failure, acute renal failure, and abdominal angina. A review of the literature and discussion of postoperative outcomes follows. [Copyright &y& Elsevier]

Aim: To evaluate the sensitivity and specificity of eight previously reported computed tomography (CT) signs in diagnosing internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Materials and methods: Preoperative CT images of nine patients with surgically proven internal mesenteric hernia as a complication of gastric bypass surgery and 10 matched control patients were reviewed in a blinded fashion by three radiologists. The presence of eight previously reported signs of internal mesenteric hernia was assessed: mesenteric swirl sign, hurricane eye sign, mushroom sign, small bowel obstruction, clustered small bowel loops, small bowel other than duodenum located behind the superior mesenteric artery (SMA), presence of the jejunal anastomosis to the right of the midline, and engorged mesenteric lymph nodes. The sensitivity and specificity were calculated for each sign, as well as inter-observer reliability in recognizing these signs. Results: Mesenteric swirl was the most predictive sign of internal hernia (sensitivity 78–100%, specificity 80–90%). Other CT signs showed good specificity (70–100%), but sensitivities were low (0–44%). The presence of a small-bowel obstruction and engorged mesenteric nodes was found to be 100% specific in predicting the presence of an underlying hernia. There was substantial inter-observer agreement in detecting mesenteric swirl sign (κ=0.48–0.79), but agreement was relatively poor for all other signs. Conclusion: Mesenteric swirl is an easily recognized CT sign, and is the best indicator of internal hernia following Roux-en-Y gastric bypass surgery. Other reported CT signs are diagnostically insensitive. The presence of small-bowel obstruction with engorged mesenteric nodes is highly specific in diagnosing internal mesenteric hernia. [Copyright &y& Elsevier]

The article provides information on the fibromuscular dysplasia (FMD). It notes that FMD is a non-atherosclerotic, non-inflammatory vascular disease of pathogenesis which mainly affects the renal and cerebral arteries. It mentions that patients having FMD can be asymptomatic or present with hypertension, stroke, abdominal angina, claudication, or other signs of vascular insufficiency.

The article presents a clinical study on the important determinant of outcome of high-grade blunt hepatic trauma in Switzerland. It states that a study on retrospective single-centre was conducted to inquire the safety of non-operative management of liver injury and the impact of concomitant intra- and extra-abdominal injuries on clinical outcome. It also notes that immediate laparotomy was required by 35 patients, owing to extrahepatic intra-abdominal injury in 21 cases.

Summary: Objective: Little data exist about the optimal management of the rare coccygeal hernia. A novel method of repair is reported. Methods: A 46-year-old woman presented with a symptomatic coccygeal hernia after resection of the coccyx for a tumour. She had previously been reconstructed with an on-lay polytetrafluorethylene (PTFE) mesh but subsequently developed a hernia. A de-epithelialised vertical rectus abdominis musculocutaneous flap was elevated and passed through the hernia defect. The de-epithelialised dermis was secured to the levator ani and to the periosteum of the sacrum via access through a posterior approach. The gluteal skin was closed primarily over the inset flap. Results: The de-epithelialised rectus abdominis musculocutaneous flap is a viable option for the treatment of coccygeal hernia. Relevance: The de-epithelialised rectus abdominis flap has several advantages over other techniques including mesh repair and anterior or posterior flap repairs of the coccygeal hernia. The transposed muscle blocks herniation through the pelvic floor and does not create the dead space that is associated with posterior flap repairs such as the bilateral gluteal advancements. It also has the advantages of the posterior approach mesh repair, as the de-epithelialised dermis provides significant strength when secured like mesh to healthy local tissue. [Copyright &y& Elsevier]