Two cases of diverticulosis and lipomatosis of the small intestine have been reported'.'. One of these cases had a small bowel volvulus. We report a further case that includes a volvulus. Case reportA 56-year-old man presented with a 4-month history of bouts of postprandial epigastric pain, with intermittent swelling in the right hypochondrium. Pain occurred on eating; he had lost 10 kg in weight. On examination, he was tender in the epigastrium and right hypochondrium.An abdominal ultrasound was normal. Gastroscopy revealed a small area of non-specific superficial gastritis; the barium enema was normal, as was colonoscopy. A small bowel enema showed multiple diverticula and intraluminal polyps throughout the jejunum and ileum (Figure 1 ). At laparotomy, there was a 360" clockwise volvulus of the small bowel, without evidence of vascular compromise. After derotation a length of abnormal small bowel was noted. It began 50cm from the duodenojejunal flexure and extended to 90 cm from the ileocaecal valve. It was thickened and dilated throughout its length. There were numerous large diverticula, up to 7cm in diameter, on both the mesenteric and antimesenteric borders. Multiple polyps could be palpated in this segment, one of which was producing an intussusception. The whole of the affected segment was resected and end-to-end anastomosis was performed. He made an uneventful postoperative recovery.At histological examination multiple discrete submucosal lipomata were found, some at the base of a diverticulum. DiscussionThe occurrence of the diverticulosis and lipomatosis together could occur by chance. The incidence of small bowel diverticulosis is generally reported as being between 1 and 1.5 per cent. Benign small bowel tumours are relatively rare, although lipomata are one of the more common types3. However, the lipomata may have caused a n intermittent or incomplete obstruction encouraging the development of pulsion Volvulus is a recognized complication of small bowel diverticulosis5. The abnormal weight distribution of the bowel may be a factor in its occurrence. We suggest that diverticulosis, lipomatosis and small bowel volvulus are linked, with lipomatosis being causative in the development. 3. References 4.5 .

A stapling device has been used to disconnect the lesser curve of the stomach during highly selective vagotomy in a consecutive series of ten patients. This modification renders the operation technically easier and quicker to perform. Postoperative recovery was uneventful in all patients, and in the subsequent follow-up period of 7-15 months, no problems relating to the technique were encountered.

statement as to the indication for operation would be helpful. If the indication was hypertension, the difference between the elective and emergency caesarean section groups is explained. If the indication was 'repeat' caesarean section, then the cause could be lack of labour contractions. Without such clarification there may be a reaction against elective caesarean section which is safer to the mother for both. the anaesthetic and obstetric considerations. Sincerely ROBERT HODGKINSON

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