Laparoscopic surgery with situs inversus may pose particular challenges to the surgeon. We discuss a case of undiagnosed situs inversus totalis in a morbidly obese patient undergoing laparoscopic adjustable gastric banding (LAGB). The patient was a 29-year-old male with a body mass index (BMI) of 56. There was no prior knowledge of his situs inversus totalis, which was only discovered during laparoscopy at the time of surgery. The operative challenges are discussed. LAGB was performed successfully without complication. Postoperative imaging confirmed dextrocardia and situs inversus totalis, as well as correct gastric band position. However, there has been subsequent gastric band erosion and eventual band removal. We discuss the appropriateness of LAGB in this group of patients.

Surgical emphysema in the abdominal wall is an indicator of retroperitoneal perforation, and its presence should be excluded before the possibility of perforation is dismissed. This may be of especial value in younger age groups amongst whom perforation may be less clinically obvious.

Although the incidence of breast cancer is increasing in the UK, mortality is decreasing thanks to significant achievements in the organisation and delivery of breast cancer care, with multidisciplinary working at its centre. Copyright © 2010 Wiley Interface Ltd

The presence of superficial bruising, no abnormal signs on abdominal examination and a negative FAST scan of the abdomen may not be enough to rule out intra-abdominal pathology. We report on the usefulness of CT in diagnosing a post-traumatic abdominal wall hernia.

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