Adult Intestinal Malrotation With Congenital Transverse Meso-Colic Internal Hernia: An Infrequent Cause of Small Bowel Obstruction.

Adult intestinal malrotation along with congenital transverse-mesocolic internal hernia causing small bowel obstruction is extremely rare. Most of these patients don't have any obvious clinical symptoms. Only a few cases have been documented in the English literature. We present the unique case of a 43-year-old male without any prior surgical history who presented with nonspecific abdominal pain and was diagnosed with malrotation of the small intestine by computed tomography (CT) scan and underwent exploratory laparotomy found to have internal herniation through the transverse-mesocolon. The patient underwent an emergency laparotomy; a Ladd's procedure and repair of the hernial orifice were performed. This case highlights the association of adult intestinal malrotation with internal hernias and small bowel obstruction; it also explores the importance of timely diagnosis and adequate management of this condition.

Clinical yield of screening colonoscopies in Jamaica.

There is still no organised national screening programme for colorectal cancer in Jamaica. We sought to evaluate the detection of colorectal cancer precursor lesions in patients who underwent opportunistic screening over three years. Patients with colorectal polyps were selected for further study. In 431 procedures, there were 84 (19.5%) patients with colorectal polyps identified at screening colonoscopy, which gave a 19.5% sensitivity to identify patients with polyps at risk of developing colorectal cancer, 9.5% being <50 years of age. At the time of examination, 16.7% had already developed invasive adenocarcinoma. We conclude that it is time for policy makers to develop a national colorectal cancer screening programme to diagnose patients early and improve their therapeutic outcomes.

Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice.

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.