A hernia is defined as a protrusion of an organ or its fascia through a sac of its containing cavity. The presentation of an inflamed appendix inside an incarcerated femoral hernia is termed de Garengeot's hernia. Almost exclusively seen in the female patient, this type of hernia like all others can undergo strangulation leading to complications including appendicitis with or without perforation. Management as described in literature usually comprises open or laparoscopic approach, followed by appendectomy and repair of the femoral hernia with or without mesh. We describe a case of a female patient who presented with an irreducible groin swelling, found to have a femoral hernia containing the inflamed appendix intraoperatively and how it was managed surgically through a laparoscopic approach with a small mesh and closure of defect. Literature review on this rare form of hernia is discussed thereafter.

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Introduction: Laparoscopic assisted colonoscopic polypectomies have been well described in the literature and are well established in surgical practice, for removal of large, inaccessible, or flat based polyps. Laparoscope allows the endoscopist a serosal viewpoint and thus clear indication of perforation, in addition to enhancing endoscopic positioning through colonic mobilisation, facilitating polypectomy. We describe a previously rarely published technique, in which the colonoscope directs the surgeon to polyps and laparoscopy enables wedge resection of benign polyps using Endo GIA staplers. Using this method, the colonoscope provides an intra-luminal view ensuring adequate excision with margins whilst the laparoscope provides intra-peritoneal access for the wedge resection. Methods: This is a case series of 12 patients with large tubulovillous adenomas, found and biopsied at colonoscopy. Under a general anaesthetic, an on table colonoscopy was performed to identify and reassess the polyp, whilst a laparoscopy was performed to excise the polyp via wedge resection, using the endoscopic view as guidance. Results: The polyp was identified and completely resected in our 12 patients. All patients were discharged on the first post-operative day. Of the polyps excised, a focus of adenocarcinoma was detected in one and an adjacent endocrine tumour was found in another patient in histology along with tubulovillous adenoma. Rest were all tubulovillous adenomas only. Conclusion: We propose that this technique should be regarded as an alternative to Right hemicolectomies and difficult endoscopic mucosal resections for large adenomas, and be regarded as a definitive and safe procedure in its own right.

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Intraperitoneal stent migration should also be considered in any individual with no clinical success post stent insertion. KeywordsColonoscopy, colorectal cancer, colorectal diseases, colorectal pathology, colorectal surgery.Question: Can you identify the unique complication of SEMS?Answer: Intraperitoneal stent migration. This 80-year-old male with known primary colonic pathology required laparotomy for small bowel obstruction. He initially underwent through the scope satisfactory self-expanding metal stent (SEMS) placement for palliation of advanced sigmoid cancer. The main tumor was located at 18 cm from anal verge. DIAGMED, noncovered colorectal stent with 140-mm total length and 122-mm usable length was used in that particular case. The distance from anal verge to inferior end of stent was 16 cm. He had no bowel activity and subsequently developed small bowel obstruction without peritonitis. At laparotomy, he was found to have intraperitoneal stent migration without any fecal soiling and perforation. The span time from insertion to surgery was only 1 week. The gentleman underwent small bowel resection with end ileostomy and had uneventful recovery from operation.