Laparoscopic Salvage of Percutaneous Endoscopic Gastrostomy Tract Dehiscence Following Blind Reinsertion: A Case Report Percutaneous endoscopic gastrostomy (PEG) is a commonly performed and generally safe method for long-term enteral nutrition. Nevertheless, accidental dislodgement is a well-recognised complication, and premature or unguided reinsertion may result in severe morbidity. We described a 60-year-old man with a history of cerebrovascular accident who developed peritonitis following blind reinsertion of a dislodged PEG tube. Diagnostic laparoscopy revealed partial tract dehiscence and intraperitoneal contamination, necessitating laparoscopic refashioning and peritoneal lavage. His postoperative course was complicated by recurrent dislodgement and stomal stenosis, successfully managed with endoscopic reinsertion under direct visualisation. Blind reinsertion of PEG tubes carries significant risk even in apparently mature tracts. Laparoscopy provides both diagnostic confirmation and therapeutic control in cases of tract dehiscence or peritonitis. Image-guided or endoscopic techniques should be prioritised to minimise recurrence and ensure safe re-establishment of enteral access. Early recognition and image-guided management are essential to prevent peritonitis and preserve long-term enteral access. Laparoscopy remains the preferred modality for both diagnosis and salvage in complex PEG-related complications.

Primary omental liposarcoma is a rare clinical entity with less than 20 cases being reported in the literature. Laparotomy has been the traditional approach for resection, with no reports of laparoscopic resection. A 39-year-old lady presented at the Sarawak General Hospital, Kuching, Malaysia with a history of a progressive, painless left upper quadrant abdominal swelling for a year. CT scan showed a well-defined heterogeneously enhancing cystic mass measuring 7.5x7.5x8.1cm with a poor plane with the adjacent greater curvature of stomach and transverse colon. Upper and lower endoscopy was normal. The tumour was completely dissected from the adjacent transverse colon and removed laparoscopically. Histopathological examination of the resected specimen revealed a myxoid liposarcoma. She had an uneventful recovery and was discharged well on the third postoperative day. She subsequently underwent adjuvant chemotherapy and was well at 1-year follow-up with PET CT showing no evidence of recurrence or metastases.

Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity from infection and possible loss of renal function. A successful repair is related to the timing of diagnosis, site of injury and method of repair. This study was a retrospective review of outcomes of iatrogenic ureteric injury and factors contributing to successful operative repair. Twenty consecutive cases referred to the Urology Unit of the UKM Medical Center during an 11-year period from 1998 to 2009 were reviewed. Thirteen patients were diagnosed intraoperatively and underwent immediate repair. Seven patients had delayed diagnosis but also underwent immediate repair. In our series, there was no significant difference in outcome between injuries diagnosed intraoperatively versus injuries with delayed diagnosis. There was significant difference in the outcomes between methods of ureteric repair where ureter reimplantation via psoas hitch or Boari flap yielded better results than primary end-to-end anastomosis Three patients suffered loss of renal function from unsuccessful ureter repair. We conclude that all iatrogenic ureteric injury should be repaired immediately in the absence of overt sepsis. Ureter reimplantation using a Boari flap or psoas hitch is preferred to the end-to-end anastomosis especially when there is delayed diagnosis