A 44-year-old male, who has sex with men, presented with proctalgia and peri-anal lesions. In addition, he had inguinal lymphadenopathy and ulcerated papules on his extremities, trunk, and face. On polymerase chain reaction testing, a diagnosis of monkeypox was made. Given the current prevalence, monkeypox should be considered in patients with new peri-anal lesions.

A 60-year-old woman presented with abdominal pain, distension, and constipation. A computed tomography scan showed small bowel obstruction. At laparotomy, the small bowel was found to be obstructed by a fallopian tube. The fallopian tube band was released and right-sided salpingectomy performed.

A 69-year-old man presented with right lower quadrant abdominal pain and fever. His medical history was notable for erectile dysfunction treated with an inflatable penile prosthesis. A computed tomography scan showed caecal ischaemia. Diagnostic laparoscopy (Video File) found the caecum had lodged in the empty reservoir of the penile prosthesis, causing ischaemia.

A 55-year-old woman with a prior history of laparoscopic uterine myomectomy presented with an incisional hernia. Preoperative computed tomography reported calcified lymph nodes in the mesentery. At laparotomy, multiple tumours of up to 8 cm were found. An ileocaecal resection and omentectomy were performed. Following histopathological assessment, a diagnosis of Peritoneal Leiomyomatosis was made.

A 73-year-old male presented with abdominal pain and progressive ascites. Cytological assessment of the ascites found no abnormality. An exploratory laparoscopy was performed, which was converted when miliary seeding was identified. Histopathological examination demonstrated peritoneal tuberculosis.

A 56-year-old man presented with a 2-day history of severe abdominal pain, anuria, and absolute constipation. Abdominal CT showed a large foreign body in the rectum, which compressed the prostatic urethra, causing urinary retention. A coconut was removed from the rectum via exploratory laparotomy.

A 46-year-old woman presented with abdominal pain. A computed tomography scan found colonic intussusception. She underwent a laparoscopic colectomy at which a giant lipoma was found.

Aortic coarctation is a localized narrowing in the thoracic aorta which is rarely diagnosed in adulthood. This image shows an aortic coarctation in a 70-year-old male. This was approached by left thoracotomy. The segment of coarctation was successfully resected while on the left-sided cardiac bypass and replaced by an interposition graft.

A 25-year-old gentleman, with chronic calcific pancreatitis and bilateral medullary nephrocalcinosis caused by hypercalcaemia, was found to have a 3.2×3.6 cm right inferior parathyroid adenoma. Contrast-enhanced computed tomography of the neck showed an enlarged well-defined cystic right inferior parathyroid gland located posterior to the right lobe of the thyroid with retrosternal extension. He underwent focused parathyroidectomy under the cervical block with the removal of a brown coloured cyst.

An 80-year-old man presented as an emergency with a pneumoperitoneum. He was noted to have seborrhoeic keratoses on his chest bilaterally, his right axilla, and pubic regions that had developed in the month before admission. He was found to have metastatic sigmoid adenocarcinoma with liver metastases. The Leser–Trélat sign describes the eruption of multiple seborrhoeic keratoses secondary to disseminated malignancy.

A 37-year-old female patient was referred with a widespread itchy rash, weight loss, and new-onset diabetes mellitus. Blood glucagon hormone measurement was >500 pg/ml. Laparoscopic distal pancreatectomy and splenectomy was performed. Her complaints disappeared afterwards. Surgery is the mainstay of treatment for glucagonoma disease and associated symptoms.

A 38-year-old man with a history of recurrent pancreatitis of undetermined origin was re-admitted with vomiting and epigastric pain. A decision was made to perform a laparoscopic cholecystectomy. At the laparoscopy, pancreatic tissue completely wrapped around the duodenum was found. A gastrojejunostomy was performed to treat the gastric outlet obstruction caused by the obstructive annular pancreas.

While performing the jejuno-jejunal anastomosis during a laparoscopic Roux-en-Y gastric bypass to treat morbid obesity, a yellowish filamentous structure appeared from the bowel lumen. It was removed, and subsequent microbiological analysis reported it to be a Taenia saginata (a tapeworm).

A 66-year-old man who had recently undergone aorto-mesenteric bypass presented with haematemesis. An upper gastrointestinal endoscopy found that the graft had fistulated into the lumen of the duodenum.

A 50-year-old male receiving peritoneal dialysis was admitted with abdominal pain. At exploratory laparotomy, small bowel ischaemia was found. In addition, the remaining small bowel was brown, hard, and like a plastic hose in keeping with early-stage encapsulating peritoneal sclerosis.

During a laparoscopic right inguinal hernia repair, the patient’s appendix was found in an indirect hernia sac. This finding is called an Amyand’s hernia.

This intraoperative image shows an intact calcified plaque removed by endarterectomy. The plaque had caused a long occlusion of the superficial femoral artery. Superficial femoral artery endarterectomy should be considered when the saphenous vein is unavailable.

A 53-year-old patient with a history of Crohn’s disease had experienced painful bleeding from colostomy granulomas for 7 years. Repeat biopsies diagnosed a stomal adenocarcinoma; multiple previous biopsies had been negative for malignancy. A left colectomy was performed. Definitive histopathology showed a mucinous pT2N0 adenocarcinoma with a complete resection.

A 62-year-old patient presented with multiple episodes of haematochezia, abdominal pain, nausea, and vomiting. Computed tomography demonstrated an 11 cm colo-colic intussusception with a lead point. Intraoperative and pathological findings found a benign 8.2 cm polypoid submucosal lipoma with ischaemic changes, ulceration, and necrosis of the surrounding colonic mucosa.

During laparoscopic surgery for a right inguinoscrotal hernia in an adult male patient, the patient’s testicle was seen in the hernia sac (Fig. 1). The presence of a testicle in an indirect hernia sac is not uncommon, especially in congenital hernias. Surgeons should be aware of this condition to avoid injury during repair.

A 23-year-old woman presented with symptoms of obstruction. At laparotomy a gastroduodenal trichobezoar was removed from her stomach and duodenum. Trichobezoar are concretions of swallowed hair bundles and can be associated with Rapunzel syndrome. Endoscopy may be helpful in early cases; however, surgery remains the mainstay for late presentation.

A 22 year-old male patient underwent laparoscopic cholecystectomy for recurrent biliary colic. Multiple macroscopic pale lesions were noted on the liver surface. Histopathology confirmed non-caseating granulomas. Serum angiotensin-converting enzyme was elevated. These findings were suspicious for extrapulmonary manifestations of sarcoidosis. Up to 10 per cent of all liver biopsy specimens are granulomas. Of these, 22 per cent are due to sarcoidosis. This is mostly asymptomatic. Up to 40 per cent of patients however present with biochemical derangement or hepatomegaly.

A 76-year-old male with a known left diaphragmatic hernia presented with acute shortness of breath, vomiting and diarrhoea for five days. A chest computed tomography was performed. What is the diagnosis?

A 55-year-old man presented acutely with small bowel obstruction. What is shown in the intraoperative photograph?

A 60-year-old man presented with acute epigastric pain and diarrhoea. His medical history included chronic obstructive pulmonary disease with recent exacerbation for which he was taking glucocorticoid therapy. What is the name of the clinical sign found on CT scan and correlated intraoperatively?

A 25-year-old man, treated one year previously for a signet ring mid-rectal adenocarcinoma, presented with facial swelling and multiple nodular swellings on the neck and back. What is the diagnosis?

A 17-year-old woman presented with a 3-year history of an abdominal mass that was increasing in size. On abdominal examination there was a 20-cm mobile pelvic mass. What is shown in the intraoperative photograph?

A 14-year-old female patient presented with progressive abdominal distension and constipation. An MRI scan was performed and the patient was taken to the operating theatre. What is the diagnosis from these intraoperative images?

A 32-year-old woman presented with pain and numbness in the right leg. Radiological imaging and subsequent core biopsy diagnosed a large sciatic notch dumbbell-shaped lipoma measuring 17 cm. What is the surgeon doing and why?