OV13 LAPAROSCOPIC APPROACH IN EMERGENCY HERNIA SURGERY: MANAGEMENT OF ACUTE SMALL BOWEL OBSTRUCTION SECONDARY TO STRANGULATED OBTURATOR HERNIA

Aim Acute small bowel obstruction secondary to strangulated obturator hernia is a rare condition, with high rates of morbidity and mortality in the absence of prompt diagnosis and intervention. We aim to describe a case with the above presentation, managed using a minimally-invasive approach with positive outcomes. Material and Methods We describe a case of an 82-year-old female who presented with acute small bowel obstruction secondary to strangulated obturator hernia on cross-sectional imaging. Results The patient underwent emergency surgery using laparoscopic approach for repair of obturator hernia and assessment of obstructed small bowel. Our approach involved identification and reduction of small bowel loop. A transabdominal preperitoneal approach was made to obturator hernia and ischaemic sac was reduced followed by closure of defect with a plug of biologic mesh. A linear segment of ischaemic small bowel was oversewn. Total operative time was 90 minutes. Conclusions Minimally-invasive surgery is an important tool in the armamentarium of the acute care surgeon. A laparoscopic approach will reduce the insult of intervention in already physiologically deplete patients. This case demonstrates the feasibility of laparoscopy for small bowel obstruction secondary to strangulated obturator hernia in the acute setting, requiring advanced laparoscopic skill as demonstrated in this video.

Mesenteric lipoma: a rare cause of acute small bowel obstruction

Lipomas, also known as universal tumors, can be found almost anywhere in the human body. However mesenteric lipomas are rare entities, with less than 100 cases reported in clinical literature. Patients may present with chronic non-specific abdominal symptoms, or rarely acute intestinal obstruction. Multiple imaging modalities are available for pre-operative diagnosis. Surgical intervention is required for treatment of symptomatic mesenteric lipomas.

78 A Lockdown Dilemma; Ingestion of Magnetic Beads Presenting as Right Iliac Fossa Pain and Sub-Acute Small Bowel Obstruction

A 13-year-old girl presented with a three-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She represented six days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment as recommended by the radiology department. Intra-operative findings revealed 200mls of serous fluid in the pelvis, normal-looking appendix, dilated stomach, and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetized the laparoscopic instruments. A mini-laparotomy was performed with the extraction of fourteen magnetic beads and the repair of nine enterotomies. Foreign body ingestion is a known cause of abdominal pain, which in some cases might mimic or even be the cause of acute appendicitis. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.