Colonic cancer invading appendicectomy incision: a case report and literature review
by I. Uchendu, A. Hotouras, S. Jonalagadda, K. Osman, A. Mandal and D. Mathur
We report the case of a 62-year-old man who presented with puckering and tethering of his appendicectomy scar; he was found to have an underlying caecal carcinoma. We review the literature regarding this uncommon presentation of caecal cancer. (Specialties General Surgery; Colorectal Surgery: 1st October 2008) More...
Acute hepatic necrosis in a case of acute cholecystitis
by Jason A. Bolton, Bijendra Patel and Hannah Simms
A 73-year-old Asian gentleman was admitted via the Accident and Emergency Department with upper abdominal pain, jaundice, fever and rigors. Past history included non-insulin dependant diabetes, asthma, psoriasis and alcoholism. His drug history included methotrexate. A diagnosis of acute cholecystitis was made and ultrasound findings were consistent with this. The patient started to improve but on day 8 of his admission he suddenly deteriorated and arrested. The post mortem revealed complete hepatic necrosis as an unexpected cause of death. There are a number of factors which may be contributory in this case. The fact that our patient expired so rapidly with complete hepatic necrosis was not in keeping with the typical chronic course one might expect. We should always bear in mind the potential for fatal hepatic injury in patients presenting with hepatobiliary symptoms with a past history of alcohol abuse and methotrexate therapy. (General Surgery: 8th June 2008) More...
Gastrocutaneous fistula: case report and literature review
by Alex Hotouras, Adhip Mandal, Veera Karri and Aarti Varma
We report the case of a 91-year-old lady who presented with a gastrocutaneous fistula in the absence of any recent surgery. We review the literature and discuss this uncommon surgical problem. (Breast Surgery, Gastroenterology; General Surgery: 28th February 2008) More...
Anuria due to bilateral ureterolithiasis after appendectomy in a child
by A.J. Roeth, C.J. Krones, J. Conze, K.M. Ruhl, G. Steinau and V. Schumpelick
We report on a boy who presented with acute renal failure and bilateral ureteral obstruction 5 days after an uneventful appendectomy. In contrast to the few cases described in the literature, bilateral ureterothiasis was the pathogenesis of ureteric obstruction. The clinical signs and diagnostic findings, and an overview of the literature are presented. The severity of permanent renal damage in a child underlines the importance of this report. (General surgery; Paediatric surgery: 28th February 2008) More...
Midgut malrotation as a rare cause of chronic abdominal pain: a case report and review of literature
by A. Bajwa, H. Sheth and F. Hughes
Abnormalities in midgut rotation occur during the physiological herniation of the midgut between the 5th and 10th week of gestation. The most significant abnormality is a narrow small bowel mesentery which is prone to volvulus. This occurs most frequently in the neonatal period. Less commonly, midgut malrotation presents in adulthood with either acute volvulus or chronic abdominal symptoms. It is the latter group that represents a diagnostic challenge. We report a case of a 31-year-old female patient who presented with a 6-year history of non-specific gastro-intestinal symptoms. After extensive investigation the patient was diagnosed with midgut malrotation following an upper gastro-intestinal series. The patient was treated with a laparoscopic Ladd�s procedure and at 3 months was gaining weight and had stopped vomiting. A laparoscopic Ladd�s procedure is an acceptable alternative to the open technique in treating symptomatic malrotation in adults. (General surgery; Laparoscopic surgery: 16th November 2007) More...
Early port site hernia causing small bowel obstruction after laparoscopic appendicectomy
by M.R.E Abdel-Halim, S.M Higgs and M.H Niayesh
Laparoscopic appendicectomy is increasingly performed. We report a case of small bowel obstruction caused by early port/drain site hernia diagnosed on the 6th day following laparoscopic appendicectomy. (General surgery; 25th July 2007) More...
An unusual case of ‘collapse query cause’
by A Barclay and C Weaver
A 60-year-old woman attended A&E following an unwitnessed ‘collapse query cause’. Over 4 months she recalled involuntary movement of her eyes and head to the left and, on one occasion, complete rotation of her body. She had subtle neurological signs. Imaging identified the cause of these adversive seizures. (Accident and Emergency Medicine and Surgery (including Trauma); Neurology; 13th June 2007) More...
Clopidogrel and intraocular surgery: complicated or uncomplicated?
by Tahrina Salam and M.F. Raines
This case series of 16 patients demonstrates the postoperative complications associated with continued clopidogrel use and intraocular surgery. No intraocular or postoperative complications were noted but a 25% risk of subconjunctival haemorrhage following subtenons anaesthesia was noted. (Ophthalmology, General practice, Surgery; 13th June 2007) More...
Acute idiopathic mesentero-axial gastric volvulus in adolescence: a rare occurrence
by N Srinivasaiah, A Nichanametla, R Kasaraneni, D Tennant, K Seymour and L Horgan
Gastric volvulus is a rare entity first described in 1866. Gastric volvulus in neonates, infants and younger children accounts for 5�15% of the total. Acute idiopathic mesentero-axial gastric volvulus is a rare sub-type and there are only a few cases reported in children. There is a paucity of reports of its occurrence in adolescents. We present the first one of its kind, matching the classical description. (General Surgery; 13th June 2007) More...
Torted intra-abdominal testicular tumour mimicking an appendix mass
by Weiliang Chua, Alec Engledow, Dimitri Raptis and Austin Obichere
Torted intra-abdominal testicular tumours are rare. While the commonest diagnosis of a right iliac fossa mass is an appendix mass, rarer causes should not be disregarded, thus avoiding sub-optimal management and enabling the best possible clinical outcome. (General Surgery; 17th May 2007) More...
Ingested fishbone mimicking a gastric submucosal tumour
by A. Bajwa, H. Seth and F. Hughes
Gastric complications following unintentional foreign body ingestion are extremely rare. We report the case of a 48-year-old lady who presented with a right upper quadrant mass and was diagnosed with a likely submucosal tumour of the stomach. After surgical resection she was found to have an impacted fishbone mimicking a gastric tumour. (General Surgery; 14th May 2007) More...
Parathyroid incidentalomas: case report and literature review
by A. Hotouras and P. Sinha
We report the case of a 60-year-old woman with a multinodular goitre who underwent total thyroidectomy and was found intraoperatively to have a parathyroid �incidentaloma�. The surgical approach to the management of patients with incidental parathyroid disease is discussed and a review of the literature is presented. (ENT/Head Neck Surgery, General Surgery, Endocrinology; 14th May 2007) More...
Large bowel obstruction due to gallstone: �gallstone coleus�
by S. Doddi, N. N. Basu, T. Kamal, T. W. Hennigan and P. Sinha
We report the case of an 82-year-old lady who presented with large bowel obstruction. The computed tomography scan revealed an obstructing gallstone in the sigmoid colon. At colonoscopy the stone was seen in the sigmoid colon proximal to a diverticular stricture. After balloon dilatation of the stricture under general anaesthesia, the stone was removed. This approach should be the treatment of choice; only if this fails should surgical treatment be considered. (General Surgery; 19th April 2007) More...
A perforated jejunal diverticulum
by Jaimini Cegla, Puja Chudasama, Tushar Agarwal and Shahid Chaudhary
A 65-year-old lady presented with a 5-day history of watery diarrhoea and right-sided abdominal pain. Overnight she developed localised peritonitis in the left iliac fossa. An abdominal computed tomography scan revealed free fluid in the abdominal cavity, free air in the retroperitoneum and a small bowel perforation. An emergency laparotomy was carried out which revealed multiple jejunal diverticula, one of which had perforated. Jejunal diverticula have a prevalence of approximately 1% in the general population. Perforation of a jejunal diverticulum is a rare complication. Clinically, this diagnosis may be easily confused with other causes of an acute abdomen. In an elderly person, especially if known to have jejunal diverticulosis, one must have a high index of suspicion for perforation. (General Surgery; 20th February 2007) More...
Differential diagnosis of an incarcerated inguinal hernia: extraperitoneal endometrioma of the round ligament
by Jack J. K. Ku, Michael Marfan, Michael O�Shea, Adam Louie, John Lynch and Anthony Griffin
General surgeons may encounter endometriosis when extraperitoneal forms of the disease mimic a symptomatic inguinal hernia in premenopausal women. Diagnosis is often difficult, especially in the absence of menstrual symptoms, and is often made during surgical groin exploration. We present a case of extraperitoneal endometrioma simulating a symptomatic inguinal hernia and discuss the pathogenesis and management. (General Surgery, Gynaecology; July 20th 2006) More...
Delayed diagnosis of abdominal pain
by T. E. Rix and P. Sinha
We report the case of a 48-year-old woman with abdominal pain who was misdiagnosed with sigmoid volvulus, causing a delay in the correct diagnosis of caecal volvulus. The reasons for this misdiagnosis are explored, to bring attention to this common and potentially fatal error, and to the features and management of caecal volvulus. (General Surgery; May 25th 2006) More...
A giant inguinoscrotal hernia: a case report and review of the literature
by W. Al Sarakbi, A. Agrawal and N. Taffinder
The authors report a case of giant inguinoscrotal hernia. Problems arise in management for both the patient and the surgeons because of the rarity of reported cases as there is no standard surgical procedure in place for their treatment. A literature review leads to a discussion of the various methods of surgical intervention described to overcome the dilemma of surgical repair. (General Surgery; November 4th 2005) More...
Hypothyroidism presenting as recurrence of previously surgically decompressed carpal tunnel syndrome
by V. Reid, A. S. M. Jawad and J. D. Perry
We report the case history of a 45-year-old woman who presented with symptoms of bilateral carpal tunnel syndrome 8 years after a successful surgical decompression of both tunnels. (Endocrinology, General surgery; April 2005) More...
The epic 1954 operation that led to one of surgery's major
advances: carotid endarterectomy by John E. Connolly
The first report of a successful operation for carotid stenosis in 1954 owes credit to the neurologist Fischer who noted that carotid disease is localized and thus could conceivably be bypassed or locally excised. With this knowledge Professor Pickering of St Mary's Hospital, London, wisely obtained a carotid arteriogram on one of his patients and suggested to Rob and Eastcott that they surgically correct the block. Their famous successful operation in 1954 startled the medical world. However, only after clinical trials conclusively showed the benefit of carotid endarterectomy in preventing stroke, was it widely accepted. Modern advances in the technique of the procedure are listed. (Landmark Case Report; General Surgery; Vascular Disease; October 2004) More...
Perforation of the sigmoid colon as a result of Meckel's diverticulitis in a child ......................... N. Butz, C. J. Krones, G. Bohm, K. Lindemann-Docter, G. Steinau and V. Schumpelicky
Rheinisch-Westfalische Technische Hochschule Aachen, Pauwelsstr.
30, 52074 Aachen, Germany. More...
Spontaneous biliary peritonitis: two unusual cases by MG Berry and James T. Allardice
Two patients with biliary peritonitis without demonstrable perforation are described. Despite
biliary peritonitis almost invariably following biliary tract perforation, none could be identified
with contemporary imaging. This condition is extremely rare, difficult to diagnose pre-operatively
and has high mortality. (August 2004) More...
Laparoscopic management of testicular tumour in undescended intra-abdominal testis with torsion
Testicular tumours occur more frequently in an undescended testis than in anormally developed testis. Moreover, they usually present as a palpable mass but occasionally they can present with pain as a result of torsion. We present the case of a 30-year-old male who was found to have a testicular tumour which had developed in an intra-abdominal testis and presented with pain as the main symptom. Based on clinical and radiological data, orchidectomy was then carried out laparoscopically. (March 2004) More...
Adult intussusception caused by Peutz-Jeghers hamartoma — an unusual presentation
A young woman presented with severe acute abdominal pain, superimposed on a past history of similar attacks. Ultrasonography revealed a small bowel intussusception. (June 2003) More...
Complete femoral nerve block following blind ilioinguinal local anaesthetic blockade for inguinal hernia repair
Inadvertent femoral nerve palsy has been previously described following ilioinguinal nerve block. At a time when increasing numbers of inguinal hernia repairs are being performed as day case procedures, it is important to raise awareness of this potential complication.. (February 2003) More...
Hernia Ovary Inguinale With Ovulating Luteal Cyst: A Case Report
The inguinal hernia sac can occasionally contain unusual intra and extra peritoneal structures. A case of acute presentation of ovulating ovary in indirect inguinal hernia is presented. (May 2002) More...
Hydatid Disease Presenting As Pancreatitis
A 20-year old Turkish man presented with a one year history of weight loss and epigastric pain. Pancreatitis was confirmed with hypermylasaemia. CT scanning of the pancreas revealed a complex pseudo-cyst but serological tests were negative. (April 2001) More...
