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The identification of small neoplasms or areas presenting lesions associated with previous endoscopic polypectomy is one of the major problems in laparoscopic colonic resection. The aim of our study was to evaluate the effectiveness of tattooing with Indian ink to identify the area of the colon that is the site of the lesion in order to be able to perform colonic resections with oncologically correct margins. Eighty-four patients were observed with polypoid lesions or diagnosed as presenting lesions associated with endoscopic polypectomy for which colonic resection had been recommended. Marking was performed during preoperative colonoscopy by injecting 1 ml of Indian ink solution with a sclerotherapy needle into each of the four quadrants of the colon wall. This method, which is simple to execute, invariably allowed easy identification of the site of the neoplasm and laparoscopic colon resection with correct oncological margins. In the 84 cases, we recorded only one complication (1.1%) due to a paucisymptomatic microperforation discovered during the operation. The identification of small colon lesions can be performed easily using Indian ink. It is a simple, quick method which, if performed properly, always allows the site of the lesion to be identified and is associated with a negligible rate of complications.

Para-oesophageal hiatus hernia, a condition in which the fundus and part of the body of the stomach wrapped in a peritoneal sac herniate into the mediastinum, is a relatively uncommon entity. It tends to grow progressively and may become so large as to lead to symptoms of intrathoracic organ compression. In some exceptional cases, the entire stomach together with other abdominal viscera might herniate through the hiatus into the thorax. Paraesophageal hiatus hernias are characterised clinically by vague symptomatology, absent gastro-oesophageal reflux, and possible onset of gastric volvulus, generally without consequent incarceration of the portion of the herniated organ. Such an event is uncommon but dangerous and life-threatening. These cases often require resection of the incarcerated viscera, followed by hiatoplasty and Nissen fundoplication. The authors report on the case of a patient presenting with acute abdomen as a result of incarcerated and perforated para-oesophageal hiatus hernia.