Background: Portal vein gas is an ominous radiological sign, which indicates a serious gastrointestinal problem in the majority of patients. Many causes have been identified and the most important was bowel ischemia and mesenteric vascular accident. The presentation of patients is varied and the diagnosis of the underlying problem depends mainly on the radiological findings and clinical signs. The aim of this article is to show the clinical importance of portal vein gas and its management in emergency surgery.

Perforated appendicitis can be managed effectively and safely using a laparoscopic technique. Timing of intervention and operative technique which includes four abdominal quadrants copious irrigation is important to prevent postoperative intra-abdominal abscesses.

Background: Complicated diverticular disease of the colon imposes a serious risk to patient's life, challenge to surgeons and has cost implications for health authority. The aim of this study is to evaluate the management outcome of complicated colonic diverticular disease in a district hospital and to explore the current strategies of treatment.

The rarity and variable presentation of primary hyperparathyroidism can make its diagnosis a challenge - especially in the developing world where malnutrition may mask hypercalcaemia. Our case report is of a 25-year-old Yemeni woman who presented at AL Buraihi General Hospital with a pathological fracture of the right femur and a past history of multiple limb fractures. The diagnosis of primary hyperparathyroidism was suspected after full history and examination. It was then confirmed biochemically by raised PTH and serum calcium levels, and radiologically by ultrasonography of the patient's neck, which demonstrated a right inferior parathyroid adenoma. The patient underwent open reduction and internal fixation of her right femoral fracture but suffered a fracture of her left femur which was treated conservatively so as not to delay parathyroidectomy. Post-operatively, the patient suffered from transient hypocalcaemia, which was treated medically, and eventually went on to make a full recovery.

Zusammenfassung. Grundlagen: Um die Größe von Hautinzisionen zu minimieren, hat sich die minimal invasive Chirurgie in den letzten Jahren weiterentwickelt. Der faszinierendste Schritt ist nun Natural Orifice Tranlumenal Endoscopic Surgery (NOTES), also endoskopische Chirurgie über natürliche Körperöffnungen. In dieser Arbeit wird der derzeitige Stand von NOTES evaluiert.Methodik: Ü bersicht zu NOTES. Ergebnisse: NOTES wird derzeit an Tiermodellen optimiert und findet auch schon Anwendung am Menschen. Die technische Herausforderung besteht in der Entwicklung von neuen, flexiblen, multifunktionalen Endoskopen und Instrumenten, um NOTES sicher, rasch und flexibel zu gestalten.Schlussfolgerungen: NOTES ist vielversprechend und wird die chirurgische Routine durch minimales operatives Trauma und schnelle Genesung revolutionieren. Die Zukunft wird ideale Anwendungen für NOTES zeigen.Schlüsselwörter: NOTES, Endoskopie, Chirurgie, minimal invasiv, Hybrid-Eingriff.Summary. Background: Surgeons are striving to minimize the surgical incisions. Minimal invasive surgery is progressing over the years. The most exciting move is Natural Orifice Transluminal Endoscopic Surgery. The aim of this article is to evaluate the current evolution and future prospects of natural orifice transluminal endoscopic surgery.Methods: Medline search was used for the published articles through March-May 2008 relevant to natural orifice transluminal endoscopic surgery. About 147 articles were published and 85 papers were selected for this review.Results: Extensive activities are on to study NOTES on animal models, to try NOTES on human beings, and to provide training, research and scientific meetings. Technical refinement to produce an ideal flexible scope and access closure devices is continuing to make NOTES procedures quick, safe and practical.Conclusions: The current NOTES situation is promising .We expect NOTES to refine current surgical practice to provide minimal operative and postoperative trauma and rapid recovery through useful clinical applications in the near future.Keywords: Natural orifice transluminal endoscopic surgery (NOTES), hybrid procedure, state of the art, minimal invasive surgery, endoscopy.