Rectal gastrointestinal stromal tumours (GISTs) are uncommon and pose technical challenges due to their deep pelvic location and proximity to the anal sphincter complex. Radical resections, although traditionally preferred, often result in significant morbidity. We describe two cases of rectal GIST successfully managed by transanal minimally invasive surgery (TAMIS). One patient received neoadjuvant imatinib to downsize the tumour before excision. Full-thickness transanal tumour excision was achieved without rupture in both cases, with primary rectal wall closure. At 5 and 4 years of follow-up, respectively, both patients remain recurrence-free with full continence. TAMIS represents a safe, oncologically sound, organ-preserving approach for selected rectal GISTs.

Herlyn-Werner-Wunderlich syndrome, also known as obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome, is a rare congenital Müllerian duct anomaly, occurring in approximately 1 in 1,000,000 females. It is characterised by a triad of uterine didelphys, obstructed hemivagina and ipsilateral renal agenesis. Patients typically present with chronic pelvic pain, dysmenorrhea and endometriosis, which can lead to diagnostic bias and the misattribution of all pelvic pain to their underlying gynaecological condition. We present the case of a 19-year-old female with a known diagnosis of OHVIRA syndrome who presented with acute right iliac fossa (RIF) pain and raised inflammatory markers. Despite her complex gynaecological background, imaging confirmed a diagnosis of acute appendicitis with impending perforation. She underwent a successful laparoscopic appendicectomy. The patient had experienced multiple prior episodes of RIF pain, previously attributed to her gynaecological condition, without further surgical evaluation. This case underscores the importance of maintaining a broad differential diagnosis in patients with complex gynaecological anomalies and highlights the risk of diagnostic overshadowing. A comprehensive assessment for acute surgical pathology should always be considered in this cohort to avoid delays in diagnosis and treatment.

Subcutaneous emphysema (SE) is a rare and usually self-limiting complication of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. We report a 74-year-old man who developed massive SE after a short, technically uncomplicated 32-min TEP repair, despite the absence of major modifiable technical risk factors - working pressure ≤12 mmHg, open (Hasson) entry, single absorbable tack and no peritoneal breach. An abrupt rise in end-tidal carbon dioxide (EtCO 2) from a stable baseline (34-36 mmHg) to 60 mmHg was the earliest warning sign and preceded clinical detection. Post-operative computed tomography revealed SE extending to the neck, thorax, abdominal wall, back and both upper and lower extremities, surpassing all categories of the Aghajanzadeh classification. The patient was managed conservatively with manual decompression and an intentionally open trocar site, with complete resolution. This case illustrates an anatomical distribution extending beyond the territories included in conventional SE grading and underscores EtCO 2 monitoring as a valuable early warning tool.

Brunner's gland hamartoma (BGH) is an extremely rare benign duodenal tumour (<0.01% incidence), often asymptomatic but occasionally presenting with dyspepsia, bleeding or obstruction. Small lesions can be managed endoscopically, whereas broad-based masses require surgical resection. We report the first video article describing robotic-assisted segmental duodenectomy for a giant BGH. A male in his early 40s presented with dyspepsia and intermittent melena with anaemia. Endoscopy and contrast-enhanced computed tomography revealed a 7-cm broad-based lesion arising from the first part of the duodenum, provisionally diagnosed with gastrointestinal stromal tumours. Robotic segmental duodenectomy with stapled antecolic loop gastrojejunostomy was performed using the da Vinci Xi system. Operative time was 156 min with negligible blood loss. Histopathology confirmed BGH. Recovery was uneventful and the patient remained symptom-free at 2 months. Robotic segmental duodenectomy is safe, feasible and ensures adequate margins with enhanced recovery.

We describe a standardised 14-step technique for pilonidal sinus tract ablation using a radial 1470-nm diode laser. The protocol incorporates systematic tract identification, methylene blue staining, pit excision and sequential curettage, followed by a dual curettage-dual ablation cycle with ice-cold saline cooling. Laser ablation is a safe, minimally invasive, day-case procedure offering rapid recovery, minimal post-operative pain and acceptable recurrence rates.