Background/aim of the study: The objective of the present study is to investigate the evolution of surgery in the 19th century in Greece. Material and methods: Medline and books on the subject were searched as well as 19th-century medical journals and books on surgery, and the Proceedings of the Medical Society of Athens (IEA) from 1835 to 1900. Results: Existential doctors treated patients and injured at the beginning of the 19th century and during the Greek revolution. The first political hospital, the "Municipal Hospital of Athens", started operating in 1842. The pain was abolished in the operating room due to the administration of ether in 1846 by W. Morton. Six months later, E. Treiber and N. Petsalis administered ether anesthesia for the first time in Greece. In February 1848, at the meeting of the Medical Society of Athens, V. Rezer and I. Olympios mentioned the first chloroform anesthesia. Despite these achievements, anesthesia was marginalized, and the number of surgical operations performed was negligible. When the experience was gained, and antiseptic was introduced into clinical practice, surgery was gradually extended to more serious and heavier surgeries in the 1880s and 90s, which laid the foundations for modern surgery. Conclusions: Although essential changes were made for surgery in the 19th century in Greece, the number of surgeries being performed remained small for a while. After the accumulation of experience of anesthesia with ether or chloroform and the introduction of antiseptic in the clinical practice, surgery thrived in the 1880s and 90s.

Εισαγωγή: Η εισαγωγή νέων φαρμάκων που στοχεύουν στο ανοσοποιητικό σύστημα φαίνεται να αλλάζει το τοπίο στην αντιμετώπιση του καρκίνου. Πέντε ανοσολογικά σημεία ελέγχου έχουν εντοπιστεί ως πιθανοί στόχοι της ανοσοθεραπείας: το μόριο του προγραμματισμένου κυτταρικού θανάτου PD-1 (programmed cell death), ο συνδέτης του PD-L1 (PD ligand), η πρωτεΐνη CTLA4, το γονίδιο LAG-3 και η IDO. Στόχος: Να μελετηθεί η έκφραση του μορίου PD-L1 σε παθολογοανατομικά δείγματα από γαστρικό και κολο-ορθικό καρκίνο. Μέθοδος: Η έκφραση του μορίου PD-L1 μετρήθηκε με ειδική ανοσοϊστοχημική μέθοδο και βαθμονομήθηκε σε ένα σύστημα τριών επιπέδων: α) έκφραση 50% (υψηλή έκφραση). Αποτελέσματα: Μελετήθηκαν 32 δείγματα ασθενών με κολο-ορθικό καρκίνο, 16 άνδρες και 16 γυναίκες, με μέση ηλικία 71,4 έτη (45-93). Ιστολογικά, τα περισσότερα νεοπλάσματα ήταν μέτριας διαφοροποίησης (24) και λιγότερα χαμηλής διαφοροποίησης (8). Η έκφραση του μορίου PD-L1 ήταν απούσα σε 21 ασθενείς (65,6%), χαμηλή σε 5 (15,6%) και υψηλή σε 6 ασθενείς (18,75%). Σε όλους τους ασθενείς με υψηλή έκφραση του PD-L1 ανευρέθηκε υψηλή μικροδορυφορική αστάθεια (MSI- high). Συμπεράσματα: Η έκφραση του μορίου PD-L1 ανευρίσκεται συνήθως αυξημένη στην υπο-ομάδα των ασθενών με κολο-ορθικό καρκίνο που έχει μικροδορυφορική αστάθεια.

Background: Hernias in cirrhotic patients with ascites may develop severe complications. Acute umbilical hernia rupture in cirrhotic patients is unusual but potentially life-threatening. of surgical and anesthetic stresses. Cirrhotic patients with ascites have reduced hepatic reserve and poor tolerance Patients and methods: A prospective randomized controlled study of cirrhotic patients with ascites presented with a spontaneously ruptured umbilical hernia who were equally subdivided into two groups. Group I: the peritoneum was closed separately by continuous Vicryl® 2-0 suture, then the sheath was closed by continuous Prolene® 0 suture in two layers. In group II: defect closure in two layers, the first layer was mass closure of the peritoneum and sheath by continuous Prolene® 0 suture, and the second layer was a continuous stitch to invaginate the previous layer. Results: Twenty-two cirrhotic patients with ascites presented with ruptured umbilical hernia were randomly subdivided into two groups each group of 11 patients. There were 7 males and 4 females with a mean age of 51.36±5.92 in group I, while in group II, there were 6 males and 5 females with a mean age of 49.9 ±5.7. operative time was longer in group I than in group II with p-value= 0.000066. There was no postoperative ascites leakage in group I, while there was leakage in 4 cases in group II. This was statistically significant with p-value of 0.027 Conclusion: Spontaneously ruptured umbilical hernia in cirrhotic patients can be managed safely under local anesthesia in well- selected patients. Separate closure of the peritoneum prevents the ascites leak through the repaired defect.

Aims and objectives: The primary aim of our study was to evaluate morbidity and mortality following feeding jejunostomy in pancreaticoduodenectomy compared to the control group. We also evaluated individual complications like delayed gastric emptying, post operative pancreatic fistula, superficial and deep surgical site infection. Material and Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2.the random-effects model was used. Results: Four studies including Total of 1639 patients were included in the analysis. Total 843 patients were included in Feeding jejunostomy group and 796 patients included in control group without feeding jejunostomy. Over all morbidity was significantly higher in feeding jejunostomy group. (p = 0.001).There was no significant difference in mortality between both groups. (p=0.07). Delayed gastric emptying was significantly higher in Feeding jejunostomy group. [p=0.021]. There was no significant difference in development of pancreatic fistula between the two group. Deep surgical site infection was significantly higher in feeding jejunostomy group. (p=0.013). Hospital stay was significantly more in feeding jejunostomy group (p0.0001). There was no significant difference between readmission, TPN requirement and time to start oral feed. Conclusion: Feeding jejunostomy seems to be associated with increased morbidity and increased length of stay.

Background: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a common and serious morbidity. Many scoring systems and biomarkers are used to predict POPF development in the preoperative period. In this study, we examined proinflammatory markers in the preoperative and postoperative early period and prognostic nutritional index in predicting PF development. Materials: A total of 39 patients, 27 male (69.2%), 12 female (30.8%), who underwent PD between 2016 and 2020, were included in the study retrospectively. Preoperative neutrophil lymphocyte ratio (NLR), preoperative platelet lymphocyte ratio (PLR), postoperative NLR (PNLR), postoperative PLR (PPLR), reticulocyte distribution volume (RDW), prognostic nutritional index (PNI) and postoperative first day drain amylase values were examined in predicting POPF and cut-off values were found. Results: Grade B and C POPF developed in 19 (48.7%) of 39 patients included in the study. In the study, NLR (p = 0.002), PLR (p = 0.006), PNLR (p 0.001), PPLR (p 0.001) and PNI (p 0.001) were statistically significant in predicting grade B and C POPF. To predict the development of Grade B and C POPF, the cut-off value of NLR was 2.76, the cut-off value of PLR was 157.4, the cut of value of PNLR was 11.89, the cut-off value of PPLR was 308, and the cut-off value of PNI was 31.8. On the first postoperative day, cut-off values were found 176 U / L in the drain amylase. Conclusion: In addition to the scoring system and biomarkers used to predict the development of POPF in patients undergoing pancreaticoduodenectomy, low cost and easily available markers that we evaluated in our study such as NLR, PLR, PNLR, PPLR, PNI can also help to predict pancreatic fistulas.

The aim of this study was to determine optimal regimes of antibacterial therapy on different stages of acute pancreatitis (AP) clinical course and susceptibility of causative agents, which cause AP infectious complications (IC), to antibiotics. 119 patients with severe and moderate AP were enrolled to the study. The I group was formed from 57 patients (treated during 2015-2016 years). The II group included 62 patient (treated during 2017-2018 years). Antibiotics from reserve group were used for infectious complications’ prophylaxis in the I group. Broad-spectrum antibiotics were administrated in the II group. There were no statistically significant difference in the arise of IC (I group – 24,5%; II group – 25,8%; p=1,0). Associations of microorganisms were found in 18,5% samples in the I group and 47,4% in the II. There were 23,8% antibiotics with sensitivity more then 50% in the I group and 19,2% in the II. 10,0% of IC causative agents produced extended spectrum beta lactamases (ESBL) in the I group. In the II group there were 29,6% ESBL-producing microorganisms. Causative agents of IC in patients with AP are in majority microorganisms, which are resistant to several antibiotics. This characteristic of microorganisms does not depend on type of drug, which is used for prophylactic antibiotic administration during early stages of AP clinical course. The increase of ESBL producing bacteria, Gram-negative bacteria and microorganisms’ associations among IC causative agents is observed. Administration of antibiotics from reserve group in case of IC occurrence is recommended.

Hemangiomas are the most common benign tumors of the liver. There are two main methods for surgical treatment of hepatic hemangiomas: liver resections of different sizes and enucleation. To date, there is no consensus on the surgical treatment of benign liver tumors, including hemangiomas. The aim of this study is to make a comparative analysis of the results obtained in the surgical treatment of LH, focusing on the two main methods of resection and enucleation.

Abstract: Using laparoscopic assisted surgery in management of rectal cancer, particularly, very low rectal cancer is still complicated due to technical difficulties owing to its anatomical location in the pelvis. Moreover, the approach of laparoscopic assisted intersphincteric resection as a recent management strategy of very low rectal cancer remains a controversial issue, due to few prospective studies about such issue, advantages, benefits and contraindications of such procedure is still not reaching a consensus. Aim of the present case study to evaluate both the short-and long-term surgical results of laparoscopic intersphincteric resection as a management surgical approach of low rectal cancer comparing such procedure with open intersphincteric resection. Patients and methods: we selected 90 patients with low rectal cancer, 60 patients underwent laparoscopic assisted intersphincteric resection and 30 patients underwent open intersphincteric resection. We compare between both groups regarding short and long term outcomes. Results: In the group of patients who were managed by laparoscopic approach the median time of surgery was significantly longer than the open approach (p=0.002) but the median amount of intra-operative blood loss and the median duration of post-operative hospital stay were significantly less than the open approach (p =0.011 and 0.043).In the group of patients who were managed by laparoscopic approach there is reduction of morbidity and complications which indicated a safe outcome of such procedure. Conclusions: laparoscopic approach has many advantages that it leads to less amount of intra-operative blood loss, a shorter duration of staying at hospital, less post-operative morbidity, less short term and long term complications than the open approach.

Background: Intracorporeal Anastomosis (IA) was found to be an alternative surgical approach which decreases Extracorporeal Anastomosis (EA), related technical problems. Recent studies have compared surgical and techniqual findings of laparoscopic right colectomy with EA or IA, but little information were known about outcomes of performing either laparoscopic left colectomy. Aim of the study was to compare between EA and IA in laparoscopic management of left sided CRC. Material and Methods: we performed a retrospective data analysis of 60 left sided CRC patients of whom we treated 38 (63%) patients by IA, and treated 22 (37%) patients by EA. Results: We found that operative time was shorter (p=0.006), abdominal incision was smaller (p=0.002), postoperative complications were less (p=0.049), in the AI group than that in the EA group. Days spent until occurrence of first flatus in the IA were less than in the EA group (p= 0.049). We found no significant differences between both groups regarding incidence of tumor recurrence, disease free survival rate and overall survival rate. Conclusion: performing a total laparoscopic assisted colectomy with IA for management of left-side cancer colon is technically safe, feasible, has better cosmetic results and faster recovery that EA. Additionally we did not find significant differences between IA and EA in recurrence of the disease, PFS or OS rates.

Objectives: Aim of this study is to determine the incidence, etiological factors, demographic profile, mechanism of injury, anatomical distribution, diagnostic methods, management and outcome of hollow viscus perforation due to abdominal trauma. Methods: This is a prospective study, including patients with abdominal trauma leading to hollow viscus perforation admitted to Dr. Ram Manohar Lohia hospital New Delhi, over a period of 3 years (January 2016 to December 2018). A total of 105 patients with hollow viscus injury due to abdominal trauma, who underwent laparotomy in our institute, were reviewed for various parameters. Results: Out of 105 patients, 88.5% were male, and 11.5% were female. The mean age of patients was 31 ± 14.12 years. The most common site of injury was jejunum (34.2%), followed by ileum (20%). Blunt trauma abdomen was the most common mechanism of injury (46.9%), followed by a road traffic accident (28.2%). Free gas under the diaphragm on erect abdomen radiography was seen in 80% of cases, while preoperative CT Abdomen was done in 45% of cases. Treatment consisted of simple closure of the perforation (58.2%), resection and anastomosis (21.8%) and stoma formation (14.2%). The major complications were burst abdomen (5.32%), stitch abscess (17.8%), sepsis (14.7) and anastomotic leak (2.9%). The average hospital stay was 13±6 days. The overall mortality rate was 22.8%. Conclusion: Early recognition of intestinal injuries from abdominal trauma is very important due to its great life-threatening potential. Age of the patient, associated injuries, anatomical site and time of presentation are probably the main prognostic factors in terms of morbidity and mortality.

Background: Lymphadenopathy is a common presentation in geriatric population due to various diseases including infections, inflammatory lesions and malignancies. Fine needle aspiration cytology (FNAC) is investigation of choice for lymphadenopathy evaluation. It is rapid diagnostic technique as it is simple, cost effective and minimally invasive. Aims & Objectives: To analyse the prevalence and to study the pathological spectrum of lymphadenopathy in geriatric population (more than 65 years) in tertiary health care centre. Material & methods: This retrospective study included geriatric patients (more than 65 years) of lymph node enlargement who underwent FNAC at our tertiary care institution during five year study period (January 2015 to December 2019) in whom aspirated material was adequate and satisfactory for evaluation. Results: The study group consisted of 196 cases. Among 196 cases metastatic tumors comprised of 150 patients (76.5%), tubercular lymphadenitis 25 patients (12.8%), pyogenic abscess 12 patients (6.4%) and 9 patients (4.3%) cases of Non Hodgkin lymphoma. Among metastatic tumors squamous cell carcinoma (79.5%) was the most common cause followed by poorly differentiated carcinoma (12%). Most common group of lymph nodes involved was cervical followed by axillary and inguinal lymph nodes. Conclusion: In our study most common cause of lymphadenopathy in geriatric population is metastatic tumors especially squamous cell carcinoma followed by tubercular lymphadenitis. Cervical group of lymph node is most commonly involved. Evaluation of lymph node enlargement can be done effectively by FNAC without the need for surgical biopsy.

Background/aim of the study: Lung is considered to be an organ generally resistant to ischemia-reperfusion injury due to its double perfusion and its highly oxygenated environment. Nonetheless, there are many studies that indicate that lung ischemia- reperfusion injury is an actual clinical problem, especially nowadays with the broad establishment of organ transplantation. The aim of this study is to examine the broad spectrum of lesions occurring in the ischemic lung, the progress of these lesions during reperfusion and the association of these lesions with possible molecular mechanisms that activate during ischemia – reperfusion. Materials and methods: 21 female Munich swines were submitted to cardiac arrest (CA) via a pacemaker, then cardiopulmonary resuscitation (CPR) was attempted. Animals were divided into two groups based on the return of spontaneous circulation (ROSC) or not. Resuscitated animals (ROSC, n=10) and not resuscitated animals (no ROSC, n=11). Lung tissue samples were obtained for histopathological and imuunohistological examination. Results: In both groups the lung specimens examined revealed various pathological lesions, more frequent and severe in the no- ROSC group. Optical microscopy revealed destruction of the alveolar architecture and accumulation of inflammatory cells within the alveoli, mainly lymphocytes. Electron microscopy findings indicated inflammation and apoptosis such as thickening of the alveolar membrane, increased number of plasmocytes, destroyed pneumocytes and apoptotic cells. TNFα was not expressed strongly apart from a few cases in the no-ROSC group, especially around the alveoli. The expression of IL-6 was stronger than the one of TNF-a and similarly more intense to the no-ROSC group especially inside the alveoli and the interstitial space. Conclusions: Despite extensive research, signaling pathways of lung ischemia reperfusion injury have not yet been fully identified and no special treatment exists. This multivariable phenomenon requires further studies so that targeted therapies can be developed.

Immunohistochemical localization of myoepithelial cells to differentiate invasive from non-invasive lesions of breast- nip the problem in the bud

Background: Breast cancer is considered the commonest cancer in Egyptian females. Established prognostic parameters of breast cancer patients are size, grade and stage of the tumor, presence of lymph nodes and distant metastasis in addition to assessment of hormonal receptors status. Aim of the current study was to assess ER, PR, Her2neu, Ki67 and AR status, to assess association between them, morphological and prognostic parameters in a large cohort of Egyptian females diagnosed with breast cancer. Patients and methods: This study was performed on 250 Egyptian female patients with breast cancer. All patients’ data were collected and statistically analyze all data for detection of the association between ER, PR, Her2-neu, Ki 67 labeling index, AR, clinicopathological and prognostic data. Results: we found an association between positive ER and positive PR, with low grade of the tumor, absence of lymphovascular invasion, little number of metastatic lymph nodes, early stage and absence of distant metastases, favorable survival rates and lower rate of recurrence and disease progression ( p0.001). We found an association between positive AR, positive Her2-neu, high ki67 labeling index with; higher grade of the tumor, large number of metastatic lymph nodes and presence of distant metastases, unfavorable survival rates and higher rate of recurrence and disease progression ( p0.001). Conclusion: expression of ER, PR and Her2neu could be considered other prognostic parameters for patients with breast cancer and must be routinely performed for all cases to detect the prognosis and expect progression of the tumor and survival rates. Keywords: Breast cancer, ER, PR, Her2neu, immunohistochemistry, Prognosis

Introduction: Biliary problems are high in old age. Advancement of laparoscopic that occurred in the last years made the use of laparoscopy is available in these cardiopulmonary risk patients. Aim: compare between Fundus-Calot cholecystectomy with low pressure pneumo-peritoneum VS open cholecystectomy in Emergency cases with cardiopulmonary risk patients as regard intraoperative data and postoperative complications. Patients and methods: This prospective randomized controlled study was conducted in emergency general surgery department on 374 cases with acute cholecystitis, biliary colic, mucocele, and gall bladder pyocele. Group A: Calot fundus (235 cases), group B (235 cases) and classic open approach Patients were divided into 2 groups. Results: This study included 374 cases with different ages mostly more than 40 years male diabetic obese patients with variable cardiopulmonary risks .In most cases of group A the operating time was up to 90 minutes, while in group B most cases were more than 90 minutes. In group B, intraoperative bleeding, visceral injury, and biliary injury were greater than in group A. As regards bleeding, biliary leakage and wound infections, postoperative sequelae were reported to be larger than in group B. Remote complications in Group B (23 %) were more pronounced for biliary rigidities than in Group A (2 %) Conclusion: In patients with cardiopulmonary risk, laparoscopic cholecystectomy with low pressure pneumoperitoneum with fundus-Callot approach is an excellent method and safe approach

Background& Aim: Several treatment forms have been utilized to remove the pain following laparoscopic cholecystectomy (LC), including nonsteroidal anti-inflammatory drugs, opioids and local anaesthetics, however none has elucidated harmonious effectiveness. So, this study aimed to estimate the effectiveness of intraperitoneal (IP) lidocaine with tenoxicam on relieving the pain and bowel recovery post LC. Methods: A prospective clinical trial was performed in the General Surgery department, Zagazig University Hospitals, Egypt, between March 2019-March 2020. Such study was done on 126 patients suffered from chronic calcular cholecystitis categorized into two groups: Group (A): patients underwent LC without IP lidocaine or tenoxicam and Group (B): patients underwent LC with IP lidocaine and tenoxicam. Results: There was no significant variations among both groups concerning demographic and clinical characteristics. Furthermore, there was no significant variations concerning operation time or anesthesia time. Pain control satisfaction score (PCSS) was significantly higher in Group B. Visual analogue scale (VAS) was significantly lower at Group B from two-six hours with no significant variation at eight & 12 hours at rest or movement. The time of 1st demanded analgesia was earlier in Group A and total analgesia dosage was significantly higher between Group A. Group B was significantly shorter concerning bowel sound/h, oral intake/h, ambulation/h, and hospital stay/day. The shoulder pain and nausea were significantly correlating with Group A and also vomit was higher in Group A but not statistically significant. Conclusions: IP lidocaine with tenoxicam administration is a viable alternative when seeking to alleviate postoperative pain among patients undergoing LC.

Background: Aim of our study was to analyse if we can accurately predict uneventful post operative course pre operatively in gastrointestinal and HPB surgery patients. Material and Methods: We retrospectively evaluated patients who have undergone gastrointestinal and hepatobiliary surgery at our institute in last 3 years and analysed 90 days mortality and morbidity rates among these patients. We described any 90 day morbidity and mortality as an “event”. We performed univariate and multivariate analyses for factors predicting an “event”. Then based on pre operative factors that predicted an “event” we formulated a score. Statistical analysis was done using SPSS version 23. Results: Total 264 patient operated for gastrointestinal and HPB surgeries between April 2016 to may 2019 were evaluated. Total 45 (17%) events occurred. On univariate analysis CDC grade, ASA score,Operative time,Blood products used, emergency surgeries and open surgeries predicted an event.We developed score based on pre operative factors like ASA score, CDC grade of surgery,open surgery and emergency surgeries included in the score.We proposed score grater than 2 was associated with 90 day event. This score had sensitivity of 77.78%, specificity of 81.65%. low positive predictive value of 46.67% but very high negative predictive value of 94.68%. AUROC showed AUROC of 0.797 (p 0.0001, 95% confidence interval 0.721- 0.874). Pre operative fitness score and Open Surgery independently predicted an “event” on multivariate analysis. (p =0.003 and 0.026 respectively. Conclusions: Pre-operative fitness score accurately predicts uneventful post operative course in gastrointestinal and hepatobiliary surgery.

Introduction: Pilonidal sinus disease is a chronic disease of the sacrococcygeal region, which commonly occurs in young adults. The male population is affected more than the female one. Many surgical techniques have been described in the literature for the treatment of this disease. No single technique was the preferred method in preventing the recurrence of this condition. Objectives: This study aimed to compare the modified Limberg flap technique with the open method in the treatment of pilonidal sinus disease. Patients and methods: Thirty-six patients with pilonidal sinus disease, attending GIT Unit, General Surgery Department, Zagazig University Hospitals, were included in this study. They were divided into two groups: the modified Limberg flap group and the open method group. Results: twenty-seven male and 9 female patients were included in this study. The mean operative time in the modified Limberg flap group and the open method group was 63.056 ± 6.673 and 29.167 ± 3.93 min, respectively. There was a significantly lower rate of wound infection in the modified Limberg flap group. Three patients (16.7%) showed recurrence in the open method group, whereas no patients had a recurrence in the modified Limberg flap group. The healing time and duration of work-off were significantly shorter in the modified Limberg flap group (P 0.001). Conclusion: modified Limberg flap technique showed earlier healing, shorter duration of work-off, and a lower rate of complications and recurrence compared with the open method technique.

Background: The present study aimed at evaluating the protective effects of curcumin against apoptosis on caspase- 3 apoptosis in experimental varicocele rats. Methods: 30 male Wistar rats were randomly divided into 5 groups: varicocele (V1, V2), treatment (T), sham (Sh), and control (C) groups. Varicocele was induced by partial ligation of the left renal vein. Serum levels of pro-oxidant-antioxidant balance (PAB) and Nitric oxide (NO) were evaluated in groups V1 and V2 at the 2nd and 4th months, respectively, after varicocele induction. Two months after varicocele induction, 100 mg/kg Curcumin) dissolved in 2 ml of corn oil (was orally administered to each rat of group T daily for 2 months, and in the Sh group, rats were administered 2 ml of corn oil only. Western blot and ELISA techniques were used to evaluate the various parameters in our study. Results: Our results show that T group, the significantly decreased level of expression of caspase-3, and the high plasma level of Testosterone confirmed that Curcumin had a significant effect on decreasing apoptosis in the treatment group. Conclusions: The anti-oxidant properties of Curcumin may be utilized in adjuvant therapies to reduce varicocele complication.

Hemosuccus Pancreaticus (HP) is a rare clinical entity yet potentially fatal. Patient usually present with occult gastrointestinal (GI) bleeding and imposed diagnostic dilemma to most physician. We discuss a case of young gentleman with alcoholic pancreatitis which later presented with upper GI bleeding. Initial endoscopic examination was negative. He deteriorated during observation thus warranted computed tomography (CT) scan imaging. There was bleeding from splenic artery which successfully managed surgically.

Mesenteric cysts are rare surgical condition and They may also come with complications such as are usually asymptomatic. Most of the cases are incidentally detected during physical or radiological examination. intestinal obstruction. We are presenting a case where a young man presented with acute intestinal obstruction secondary to infection, bleeding, torsion, rupture and internal herniation of small bowel into a ruptured mesenteric cyst. There is no similar documented case so far in literature.