Median Arcuate Ligament Syndrome (MALS) is a rare condition caused by external compression of the coeliac artery by the median arcuate ligament (MAL), leading to postprandial abdominal pain, nausea, vomiting, and weight loss. This study aims to compare outcomes of robotic (RMALR) and laparoscopic (LMALR) MAL release. A systematic search of PubMed/MEDLINE, Scopus, and Embase databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to compare perioperative and postoperative outcomes of LMALR versus RMALR. Comparative studies including adult patients undergoing either approach were included. Outcomes assessed were conversion to open surgery, resolution of pain, length of admission, postoperative complications, symptom recurrence and time to recurrence. Five retrospective comparative studies comprising 158 patients were included. No differences were found between laparoscopic and robotic approaches in conversion to open, resolution of pain, postoperative complications, length of admission, or overall time to recurrence. However, RMALR showed a significantly longer time to symptom recurrence (9.04 months, 95% CI 4.18-13.89; p = 0.0003). Both LMALR and RMALR are safe and effective for MALS, with comparable perioperative and postoperative outcomes. The longer symptom-free interval after robotic surgery may reflect greater precision in dissection around the coeliac axis. However, further prospective studies with standardised follow-up are needed to validate these findings.

A healthy 69-year-old man presented to the cardiovascular surgery outpatient department with a 20-year history of right leg swelling and varicose veins (Figure A). He denied experiencing resting pain and had no bad habits such as smoking or alcohol consumption. His vital signs were normal. On physical examination, a palpable vein was noted with no redness, heat, or pain. Peripheral sonography revealed engorgement of the great saphenous vein. The laboratory results showed no significant findings except for a Para-Bombay blood group type A. Due to concerns about abdominal vessel disease, a computed tomography scan was performed, identifying an aneurysm in the abdominal aorta (Figure B) and common iliac artery? (Figure C), along with compression of the inferior vena cava and right common iliac vein.

Splenic cysts are rare and are often detected incidentally or until the cyst reaches a certain size, causing clinical symptoms. They are classified into primary (true) and secondary (false) splenic cysts. False cysts often pose diagnostic and therapeutic challenges due to their nonspecific clinical presentation and overlapping imaging features with true cysts. Here, we present the case of a 36-year-old female who presented with symptoms of intermittent left-sided abdominal pain, nausea, loss of appetite, and low-grade fever. Clinical examination revealed a palpable mass in the left hypochondrium. Contrast-enhanced computed tomography showed a large, well-defined cystic lesion arising from the inferior pole of the spleen. Based on clinical, serological, cytological, and radiological findings, a nonparasitic splenic cyst was suspected preoperatively. As the cyst was large (>8 cm) and involved >75% of the splenic parenchyma, a total splenectomy was performed. Histopathological examination revealed the absence of an epithelial lining, confirming a nonparasitic secondary (false) splenic pseudocyst. The postoperative course was uneventful. A systematic diagnostic workup and total splenectomy remain safe and effective options for splenic cysts with significant size and rupture risk. Histopathological examination continues to be the gold standard for definitive diagnosis.

An elderly woman with vascular risk factors presented with postprandial abdominal pain. CT showed ileal edema with the target sign but no vascular occlusion. Surgical resection confirmed ischemic enteritis. This case highlights a rare cause of chronic abdominal pain.

Teratomas are germ cell tumors, with ovarian teratomas being the most common type. However, extragonadal teratomas are extremely rare. Omental teratomas are the most common type of extragonadal teratomas. Most patients with omental teratomas are asymptomatic, making preoperative diagnosis challenging. Imaging studies, such as CT scans, can provide valuable information, but a definitive diagnosis requires histopathological examination. In this case, a 65-year-old Iranian woman presented with mild abdominal pain and a normal physical examination. A preoperative abdominopelvic CT scan revealed a calcified pelvic mass with fat components, suggesting a connection to the right fallopian tube. However, during surgery, the mass was found to be in the greater omentum, with no adnexal involvement. Histopathological examination confirmed a mature teratoma. Treatment for mature teratomas typically involves surgical excision, which was successfully performed in this case, resulting in a smooth postoperative recovery.

Clip migration into the common bile duct (CBD) represents a rare yet severe complication after laparoscopic biliary surgery. Herein, we report a case of a 75-year-old male patient who previously received simultaneous laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) with T-tube drainage. The patient was admitted with upper abdominal pain and jaundice. Elevated inflammatory indicators and liver function enzymes indicated biliary obstruction complicated by cholangitis. Abdominal computed tomography (CT) revealed CBD stones and two intraductal high-density foreign bodies, highly suggestive of migrated surgical clips. After empirical antibiotic administration, the patient underwent emergent reoperative LCBDE and T-tube reinsertion on hospital day 2. Intraoperative exploration confirmed complete clearance of biliary stones, with one Hem-o-lok clip and one titanium clip embedded in the stones. The patient had an uneventful postoperative course and was discharged with a favorable prognosis. This case report combined with literature review further clarifies the etiological characteristics of clip migration, and provides practical references for the early prevention and individualized management of such rare biliary complications.

Irritable bowel syndrome (IBS) is one of the most common functional gut disorders affecting the global population, characterized by chronic abdominal pain and altered bowel habits in the absence of structural disease. The brain-gut-microbiota axis, a bidirectional network integrating central nervous system processing, enteric and autonomic function, immune signaling, and gut microbial ecology, provides a mechanistic framework that helps explain the substantial symptom heterogeneity and variable treatment response observed across patients. Artificial intelligence (AI) and machine learning (ML) approaches offer the ability to model complex, nonlinear relationships across high-dimensional biological datasets generated from this axis, including microbiome composition profiles, resting-state functional MRI connectivity matrices, multiomics data layers, and psychological and clinical feature sets. This narrative review evaluated primary human studies applying AI and ML to brain-gut axis data in IBS, identified through structured searches of PubMed/MEDLINE and Scopus supplemented by citation chaining, with literature included up to April 2026. Across microbiome profiling, neuroimaging, multiomics integration, and psychological feature modeling, ML approaches have demonstrated proof-of-concept performance for IBS classification and, in a smaller number of studies, for prediction of clinically meaningful outcomes, including cognitive behavioral therapy (CBT) response. A notable early signal is the integration of baseline microbiome and brain features to predict CBT response, with high reported discrimination, although these results are derived from small, single-center cohorts with only internal validation and should be regarded as hypothesis-generating. The current evidence base is limited by small single-center cohorts, reliance on internal validation, healthy-control comparators, limited external replication, and substantial overfitting and data-leakage risk in high-dimensional small-sample settings. AI and ML applications in IBS are promising but remain exploratory and are not yet suitable for routine clinical use. Clinical translation will require larger multicenter datasets, harmonized preprocessing pipelines, external validation, calibration reporting, and evaluation against clinically realistic comparators and decision points.

Choledocholithiasis after cholecystectomy is a clinically significant cause of recurrent biliary symptoms and may result from retained stones, recurrent stone formation, or calculi within the cystic duct remnant. Although uncommon, cystic duct stump calculi can present several years after surgery and may be associated with chronic inflammation, adhesions, and, rarely, biliary fistula formation. We report the case of a 48-year-old female with a history of open cholecystectomy who presented with recurrent right upper abdominal pain, intermittent jaundice, clay-colored stools, and high-colored urine. Magnetic resonance cholangiopancreatography (MRCP) revealed choledocholithiasis with proximal biliary dilatation, along with a cystic duct stump calculus. The patient was planned for choledochoduodenostomy; however, intraoperative findings included dense adhesions, a cystic duct remnant-common bile duct (CBD) fistula, and an impacted stump stone, making the planned procedure unsafe. The surgical approach was modified, and CBD exploration with stone extraction and T-tube drainage was performed. The postoperative course was uneventful, and a T-tube cholangiogram confirmed satisfactory ductal clearance. The patient remained asymptomatic on follow-up, with normalization of liver function tests. This case highlights the importance of considering cystic duct stump pathology in post-cholecystectomy patients with recurrent biliary symptoms and underscores the need for individualized surgical decision-making in complex reoperative biliary surgery.

Open total abdominal hysterectomy is associated with substantial postoperative pain. We compared ultrasound-guided transversus abdominis plane block with ilioinguinal-iliohypogastric nerve block for postoperative analgesia. We conducted a randomised, parallel-group trial in patients undergoing elective open total abdominal hysterectomy under general anaesthesia, allocating participants 1:1 to bilateral transversus abdominis plane block or ilioinguinal-iliohypogastric nerve block. The primary outcome was time from end of surgery to first rescue nalbuphine within 24 hours. Secondary outcomes included 24-hour nalbuphine consumption, pain scores at rest (0-10 numerical rating scale), haemodynamics, postoperative nausea and vomiting and complications. Forty-two participants were randomised (21 per group). Time to first rescue nalbuphine did not differ significantly between groups (log-rank p = 0.87; hazard ratio [95% CI] 1.06 [0.45-2.50], p = 0.89). Rescue nalbuphine was required by 11/21 (52%) versus 10/21 (48%) participants (p = 1.00). Total 24-hour nalbuphine consumption did not differ significantly between groups (median difference [95% CI] 0 [0-3] mg; p = 0.63). Cumulative pain burden over 24 hours was lower with transversus abdominis plane block (median difference [95% CI] -15.3 score [-21.7 to -8.6]; p = 0.0006). Haemodynamic differences were limited to the end of surgery and 5 minutes in the post-anaesthesia care unit; no significant difference was found in postoperative nausea and vomiting, and no block-related complications were observed. In summary, transversus abdominis plane block and ilioinguinal-iliohypogastric nerve blocks did not differ in time to first rescue nalbuphine; the study was likely underpowered for this endpoint, and equivalence cannot be inferred. A secondary analysis suggested lower cumulative pain burden with transversus abdominis plane block.

IgA vasculitis (IgAV), previously known as Henoch-Schönlein purpura, is a small-vessel vasculitis that may involve the skin, joints, gastrointestinal tract, and kidneys. While purpura is a key clinical feature, presentations without rash at onset can occur and may lead to diagnostic uncertainty. We report the case of a two-year-old boy who presented with a three-day history of acute right knee pain, swelling, and reduced weight-bearing ability following a recent febrile respiratory illness. Ultrasound of the knee demonstrated mild periarticular fluid, and a provisional diagnosis of transient synovitis was made. No rash or systemic features were present at initial presentation. Two days later, the child developed a progressive rash over the lower limbs with erythematous lesions and evolving purpuric features, along with right elbow swelling and intermittent abdominal pain. These findings prompted further evaluation and led to a clinicoradiological diagnosis of IgAV. Abdominal ultrasound excluded intussusception and demonstrated mesenteric lymphadenitis. Laboratory investigations showed mild inflammatory changes and reactive thrombocytosis, while renal function and serial urinalysis remained normal. The patient was managed conservatively with close monitoring and safety-netting, without corticosteroid therapy. Symptoms gradually resolved, and no renal involvement was identified during follow-up. This case highlights an atypical presentation of IgAV in which isolated monoarthritis preceded the development of purpura, emphasizing the importance of diagnostic vigilance and serial clinical reassessment.