The term intussusception refers to invagination of a segment of the gastrointestinal tract into the lumen of an adjacent segment. This is a rare entity and it is more prevalent in children and less common in adults. The diagnosis of intussusception in adults is difficult as a result of the nonspecific signs and symptoms. As there are many common causes of acute abdomen, intussusception should be considered when more frequent etiologies have been ruled out. The laparoscopic approach offers both a diagnostic option and a therapeutic one for intussusception in adults. We report a forty-one year old male patient, who presented to our Emergency Department complaining of peri-umbilical pain associated with nausea and vomiting for 1 day. Diagnosed with transient small bowel intussusception without any obvious underlying pathology. This report is the first to present an intra-operative video showing the small bowel intussuscepting and reducing spontaneously. Furthermore, the authors present a review about this rare condition, including previously reported similar cases in literature. Transient intussusception is extremely rare and is a challenging condition. Imaging techniques, especially CT scan, are helpful in the diagnosis of intussusception. However, laparoscopy offers the advantage of distinguishing transient intussusception from persistent intussusception.

Meckel’s diverticulum is the most common congenital malformation of the gastrointestinal tract, and it represents a persistent remnant of the omphalomesenteric duct. Although it mostly remains silent, its infrequent occurrence is mirrored by the paucity of large series of data on it in the literature. Hemorrhage, obstruction and inflammation are most common complications of Meckel’s diverticulum. Perforation of Meckel’s diverticulum is considered very rare. We present the case of a 17-year -old male, who presented to the emergency department with 1-day history of lower abdominal pain. CT of the abdomen suggested a perforated Meckel’s diverticulum, which was confirmed later at the exploratory laparotomy. Perforation was due to progressive inflammation and presence of gastric and pancreatic tissue found on histopathology. Perforation of Meckel’s diverticulum is rarely suspected. Complications of Meckel’s diverticulum can be difficult to diagnose, and early recognition with timely operative intervention must occur in order to provide the best outcome for these patients. This is an interesting and unusual case of Meckel’s diverticulum perforation that highlights the importance of considering Meckel’s diverticulum as a differential diagnosis in every patient presenting with acute abdomen.

Boerhaave’s syndrome involves a sudden elevation in the intraluminal pressure of the esophagus, causing a transmural perforation. It is associated with high morbidity and mortality. Its treatment is challenging, and early surgical intervention is the most crucial prognostic element. We present a case of a 32 year-old male who presented after severe emesis with an acute onset of epigastric pain. He was diagnosed with Boerhaave’s syndrome. Displaying signs of shock mandated immediate surgical exploration with laparoscopic primary repair. The golden period of the first 24 hrs of the event still applies to cases of esophageal perforation. The scarcity of these cases makes a comparison between the various treatment methods difficult. Our data support the use of laparoscopic intervention with primary repair as the mainstay of treatment for the management of esophageal perforation.

Introduction: Schwannoma is a benign encapsulated tumor of the peripheral nervous system which is mainly located in the head and neck. However, axillary Schwannoma is rare. In this article, the author presents an interesting case of a right axillary Schwannoma, where the diagnosis was preoperatively made on a Tru-cut biopsy. Case presentation: We report a case of an enlarged right axillary swelling in a sixty-year-old male. Proper radiologic workup was performed. Furthermore, a Tru-cut biopsy was taken which revealed evidence of schwannoma. Having such symptomatic lesion, operative excision was done with the use of a nerve stimulator, which aided in preserving nerve function. Conclusion: With such non-specific presentation, axillary Schwannoma may be easily missed and mismanaged. A Tru-cut biopsy may provide great help in expert hands, aiding operative planning; likewise in the case we are presenting. Furthermore, utilizing an intraoperative nerve stimulator will facilitate nerve preservation. Highlights:

Meckel's diverticulum is the most common congenital anomaly of the small intestine. Common complications related to Meckel's diverticulum include hemorrhage, intestinal obstruction and inflammation. Acute large bowel obstruction is a rare complication of Meckel's diverticulum and in the presented case it is caused by volvulus. We report a 39 year old female who presented with the diagnosis of a large bowel obstruction occurring as a result of cecal volvulus caused by adhesions of a perforated diverticulum. The reported case presents one of the rare complications of MD, which is volvulus. The case described above presented with signs and symptoms suggestive of acute intestinal obstruction and radiological findings suggestive of cecal volvulus. The patient was taken to the operation room for exploration and we discovered the presence of a perforated MD. The main treatment of such case is to perform diverticulectomy in all symptomatic patients. MD is mostly identified intraoperatively. Knowledge of the pathophysiologies by which MD can cause complications such as volvulus is important in order to plan management.

The burden of obesity in Saudi Arabia is partly addressed with Laparoscopic Sleeve Gastrectomy (LSG), a bariatric surgical option, but perioperative complications and prolonged hospital stays persist. Enhanced Recovery After Surgery (ERAS) aims to improve postoperative outcomes. To compare the peri-operative LSG outcomes among patients receiving ERAS and conventional bariatric procedures (non-ERAS). A prospective cohort study design involving patients receiving conventional LSG care (non-ERAS) (n = 50) and those receiving ERAS protocol (n = 44) at International Medical Centre, Jeddah, Saudi Arabia. The ERAS protocol consisted of preoperative, intraoperative, and postoperative components, including patient education, fluid management, early mobilization, and pain management. Outcomes were compared between the two groups in terms of length of stay, postoperative ambulation, Clavien-Dindo graded postoperative complications, 30-day readmission, mortality and healthcare costs, followed by a five-year follow-up. In total the number of participants was 94 patients. The ERAS group had a slightly shorter length of stay (2.05 days vs. 2.20 days) and significantly lower healthcare costs (SAR43,337 vs. SAR46,040, p < 0.05) compared to the non-ERAS group. The ERAS group had a lower incidence of postoperative Clavien-Dindo-graded complications, including wound infection, atelectasis, and pneumonia. The total length of the surgical procedure did not differ significantly (p < 0.05). Remarkably, 100% of patients in the ERAS group were out-of-bed on postoperative day (POD) zero compared to only 25% in the non-ERAS group. On the day of the operation, a greater percentage of patients in the ERAS group (58%) began oral intake than in the conventional care group (42%). There were no observable statistical differences in analgesic benefits in both groups (p = 0.543), 6 h after discharge from the post-anaesthesia care unit and at POD 1 (p = 0.08). At 5-year follow-up, the ERAS group had a better prognosis with fewer complications. At 5-year follow-up, a higher percentage of the ERAS group did not report any complication compared to the non-ERAS group (61% vs. 51%). Implementation of ERAS in LSG improved postoperative outcomes, including shorter length of stay, better mobilization, lower healthcare costs, and fewer complications. This demonstrates the effectiveness of ERAS in LSG and provides valuable insights for improving perioperative bariatric care practices.