We revealed that inflammation is an independent predictor of BDI occurrence during LC. Therefore, it would be advisable for surgeons to not hesitate to convert a LC to an OC in the presence of inflammation.

We report the case of a 22-year-old patient who presented to the emergency department with epigastric pain and vomiting. Haematological studies showed a rapid decrease in haemoglobin levels from 13.6g/dl to 4.9g/dl. Abdominal ultrasonography revealed the presence of fluid around the spleen and the patient was immediately referred for surgery. An intra-abdominal desmoid tumour presenting as a hemorrhagic shock has not previously been described. Given the relatively benign course of the disease and the young age at presentation, this clinical entity should not be overlooked as it has the potential to invade vessels and therefore be fatal. KEywORdSDesmoid -Aggressive fibromatosis -Hemorrhagic shock Case historyA 22-year-old woman presented to the emergency department with epigastric pain of 12 hours' duration and vomiting. On examination, the patient was afebrile with mild epigastric tenderness. Upper and lower abdominal ultrasounography was unremarkable. Initial haematological and biochemical parameters were normal except for leucocytosis (white blood count: 14,000 cells/mm 3 ). At the time of admission, the patient looked acutely ill, was pale and pulseless with severe epigastric and left upper abdominal quadrant tenderness. Serial haematological studies showed a rapid decrease in haemoglobin level from 13.6g/dl at presentation to 4.9g/dl one hour later. New abdominal ultrasonography was performed, which revealed the presence of fluid around the spleen. The patient was referred for surgery immediately. An area of bleeding behind the body of the pancreas was located. A splenectomy was performed as a lifesaving manoeuvre to maximise access to the bleeding area. Palpation revealed the presence of a 1.5cm x 0.5cm tumour strangulating the splenic artery and branches of the artery to the pancreas. Resection of the mass en bloc with a portion of the splenic artery was undertaken. Nine units of packed red blood cells and seven units of fresh frozen plasma were administered.The patient was discharged a few days later completely well. Follow-up magnetic resonance imaging at three months did not show any recurrence. It is noteworthy that the patient had no history of familial adenomatous polyposis syndrome.Histological examination revealed proliferation of myofibroblasts with a fasciculate and storiform growth pattern in a background of a mainly collagenous and focally myxoid intercellular matrix. The benign tumour entrapped part of the pancreas and infiltrated medium-sized arteries, replacing their smooth muscle cells (Fig 1). Recent haemorrhage between myofibroblasts was found with absence of haemosiderin laden macrophages, suggestive of a chronic haemorrhage. No pleomorphic, atypical or hyperchromatic nuclei were seen. Immunohistochemical staining showed granular cytoplasmic positivity and focal nuclear positivity for β-catenin. Immunohistochemistry for desmin, smooth muscle actin, CD117 and CD34 was negative. The proliferation marker Ki-67 stained approximately 2% of cells. These features were suggestive of dee...

TAPP repair is a technically demanding laparoscopic technique, but once mastered, is safe and effective with a high degree of patient satisfaction. Stapling the mesh is not necessary in most cases, thus resulting in a remarkably low cost. The rapid rehabilitation typically associated with laparoscopic surgery was seen in all our patients. The low recurrence rate (1% in our series) compares favorably to other tension-free techniques.