Meckel's diverticulum is the most common congenital abnormality of the small intestine that results from incomplete closure of the vitelline (omphalo-mesenteric) duct. This true diverticulum, ~2 ft from the ileocecal valve commonly found on the anti-mesenteric border of the ileum, is benign and majority asymptomatic. Diagnosis challenges arise when it became inflamed or presented in following ways, for example, haemorrhage (caused by ectopic pepsin—and hydrochloric acid—secreting gastric mucosa), intestinal obstruction (secondary to intussusception or volvulus) or the presence of diverticulum in the hernia sac (Littre's hernia). We report a case of a 59-year-old male who was admitted under the surgical service at Blackpool Victoria Hospital with suspected appendicitis that turned out to be a Meckel's diverticulitis, a rare presentation of an acute abdomen. We discuss the issues involved in his investigation and management as well as perform a literature review comparing different surgical approaches.

Despite a special interest in laparoscopic colorectal surgery of the two colorectal units who provided the data for this study, fewer than half (96/205; 47%) of the patients in this consecutive unselected series who were undergoing major colorectal resection had the procedure completed laparoscopically.

Anastomotic bleeding from a stapled anastomosis in laparoscopic left-sided colorectal surgery is an infrequent complication and it may be more common with preservation of the inferior mesenteric artery. In the majority, bleeding is self limiting and will settle with nonoperative means. Endoscopic procedures may be useful for confirmation of bleeding and for therapeutic intervention, and may avoid the need for surgical intervention.

The rate of stoma reversal after Hartmann procedure is low, principally because of the technically demanding nature of the reversal procedure and preexisting comorbid disease frequently present in this patient group. Laparoscopic reversal of Hartmann procedure is an attractive alternative that can reduce perioperative morbidity but the feasibility of completing the procedure laparoscopically is often limited by extensive adhesion formation present after the initial open operation. We describe a technique for laparoscopic reversal of Hartmann procedure where the stoma is mobilized externally and a pneumoperitoneum established through this preexisting defect. Results for the first 7 cases show a median operative duration of 132 minutes and length of hospital stay of 6 days with no conversions. Insertion of the operating ports under direct vision and a more limited dissection to facilitate the anastomosis represents an alternative operative strategy that can be performed successfully, even in patients with comorbid disease.