Primary spontaneous bacterial peritonitis (SBP) is a rare cause of acute abdomen in previously healthy patients, even more unusually caused by a group A Streptococcus (GAS) (also known as Streptococcus pyogenes) infection. We report a young, otherwise healthy female who presented with generalized abdominal pain that was initially managed conservatively as gastroenteritis, with a computed tomography (CT) scan showing a ruptured corpus luteal cyst. Upon subsequent readmission with worsened pain and symptoms, a repeat CT scan showed worsened free fluid with signs of peritonitis. A diagnostic laparoscopy confirmed primary peritonitis with an unknown infection source and causative pathology, as the appendix, ovaries and bowels were healthy-looking. Fluid cultures returned positive for GAS Pyogenes, while blood and urine cultures were negative. The discussion reviews the challenges in diagnosis and treatment of GAS primary peritonitis, highlighting the need for clinical suspicion, early diagnosis via laparoscopy or laparotomy and prompt antibiotic therapy as the current standard for treatment.

Laparoscopic ventral hernia mesh repair (LVHR) is gaining popularity possibly due to reduced complications, reduced hospital stay, early return to work and better cosmesis. In intra-peritoneal onlay method (IPOM) a dual layer composite mesh with an absorbable barrier on the visceral surface is used for minimising bowel adhesions. Three most popular prosthetic mesh scaffolds are polypropylene (PP), polyester and expanded polytetrafluoroethylene (ePTFE). A new generation of monolayer condensed polytetrafluoroethylene (cPTFE) Omyra® mesh, which theoretically has better tissue integration with parietal tissue and possibly lesser adhesions with visceral organs is now available for use. The aim of our study is to assess the safety and efficacy of Omyra (cPTFE) mesh versus other mesh types in LVHR. We retrospectively collected data from 62 patients who underwent LVHR using cPTFE, as well as other mesh types from January 1, 2011 to December 31, 2020. Patient demographics, Hernia Characteristics, perioperative events, postoperative results and complications were documented and analysed. Among the 62 patients studied, there were 27 (43.55 %) in the Omyra group and 35 (56.45 %) in the other synthetic meshes group. The mean age of the Omyra group was 53.19 (31-85) and 55.03 (22-81) for the other synthetic meshes group. There were no differences in terms of patient demographics and major comorbidities. At presentation, the indication was more commonly for recurrence (p = 0.043), and patients were more symptomatic (p = 0.0034) in the Omyra group than the other synthetic meshes group. There were no differences in mean operating time, post-operative recovery and complications, as well as early (30 days) complications during follow up. The use of cPTFE (Omyra™) mesh yielded comparable operative characteristic compared to other synthetic meshes for LVHR. The rate of perioperative complications and early recurrence was similar between Omyra and other synthetic meshes group.

Superior mesenteric artery (SMA) syndrome is a rare, unusual cause of proximal intestinal obstruction. It is characterized by compression of the third part of the duodenum secondary to narrowing of the anatomical space between the SMA and the aorta due to a loss of the intervening mesenteric fat pad. This case highlights the challenge in obtaining a pre-operative radiological diagnosis in an extreme case of gastric outlet obstruction in SMA syndrome, fatally complicated by ACS and bilateral lower limb ischemia. It demonstrates that SMA syndrome remains important to exclude especially in patients with rapid weight loss and cardinal symptoms of intestinal obstruction, often requiring a high index of clinical suspicion.