• Brask Iversen posted an update 6 months, 1 week ago

    An 84-year-old man presented to a rural hospital in Australia with haemodynamic instability and abdominal pain. Investigation revealed haemorrhage from a lesion in his liver-an incidental finding of a hepatocellular carcinoma. Initial resuscitation and damage control surgery was performed at the peripheral hospital prior to transfer to a tertiary centre 386 km away for the second stage of management. The second stage of management included interventional radiological embolization of the bleeding liver vessel and subsequent resection of the liver tumour. This was all undertaken with new policies in place to limit the spread of infection at the peak of the COVID-19 epidemic.Retrocaval ureter or circumcaval ureter is considered a rare congenital anomaly. We reported a case of 48-year-old woman who presented with right flank pain. In investigations, we found a retreocaval ureter that was treated surgically. In conclusion, retrocaval ureter is rare cause of flank pain and one of the challenging cases for urologists that needs careful investigations.Mesenteric injuries and traumatic intussusception are rare surgical presentations following blunt trauma, with potentially life-threatening complications. Diagnosis relies on high clinical suspicion and judicious use of imaging in trauma. Literature suggests that these presentations should always be managed operatively for diagnostic clarity, manual reduction of intussusception and, if indicated, resection of involvement segment. However, in the setting of a stable patient with a reassuring examination, this may not be necessary. This case presents the successful expectant management of a traumatic mesenteric haematoma acting as a pathologic lead point for small bowel intussusception.Jejunal diverticulosis is a rare phenomenon often identified either incidentally on imaging or intra-operatively. Complications of jejunal diverticulosis are associated with high rates of mortality. For this reason, it remains important that this pathology is considered amongst differentials for an acute abdomen. A 78-year old gentleman presented with a short history of generalized lower abdominal pain. Computer tomography scan revealed a large inflammatory abscess relating to a perforated jejunal diverticulum. The patient was taken to theatre where he underwent small bowel resection with primary anastomosis. Early cross sectional imaging is vital to allow early diagnosis and prompt management of this pathology. Small bowel resection with primary anastomosis was associated with an excellent clinical outcome.Large posterior circulation intracranial aneurysms have a high risk of significant morbidity or mortality if left unmanaged. Endovascular techniques are well established as primary treatment for such aneurysms. This includes placement of endovascular flow diversion stents that result in progressive thrombosis and resolution of aneurysms. Successful stent placement is reliant on suitable cervical vascular access. We report a case of a 60-year-old male without direct vertebral artery access to a fusiform basilar artery aneurysm. Fasiglifam Successful endovascular treatment required a novel hybrid technique utilizing a right common carotid to V3 segment vertebral arterial bypass to gain endovascular access to the aneurysm.Ischaemic stroke is a rare manifestation of hypercoagulability induced by underlying malignancy. It is proposed that paraneoplastic non-bacterial thrombotic endocarditis (NBTE) is the most common cause, predisposing to the formation of friable valvular lesions composed of platelets and fibrin that embolize commonly. Pancreas, gallbladder, stomach, colon and gynaecological malignancies have all been associated with NBTE. We describe a female patient who presented to our facility with syncope and limb weakness. Magnetic resonance imaging of the brain revealed ischaemic strokes in both the anterior and posterior circulation. Further investigation revealed a pelvic mass that was biopsy proven to be ovarian malignancy. Prognosis is heavily reliant on disease stage, thus diagnostic clues suggesting the possibility of underlying malignancy in the presentation of stroke should prompt a thorough investigation to exclude malignancy.Gastric rupture due to blunt trauma is rare, occurring in only 0.07-1.2% of all abdominal blunt traumas. We reported a case with a 10-cm-long hole and review 25 cases in Japan. A 22-year-old man was involved in a traffic accident, 2 h after eating a lot of food. He had suffered muscular defense in the abdomen. An abdominal computed tomography (CT) scan revealed free air, disruption of the gastric wall and a lot of food residue. The laparotomy showed a burst of 10 cm that ran parallel to the long axis from the cardia to the body. A simple closure was primarily performed and drains were placed in the abdominal cavity. The patient was discharged on the 32nd day. Most cases of gastric rupture are diagnosed intraoperatively, but careful evaluation of CT scans and patient interviews are needed to make an accurate preoperative diagnosis.Management of periacetabular lesions involves complex clinical decision making. The modified Harrington procedure with total hip arthroplasty can recreate pelvic stability with a cement rebar construct as well as a functional hip. This study analyzes the modified Harrington procedure to assess construct longevity and patient outcomes. We queried a prospectively maintained database to identify all patients at a large academic medical center from 2017 to 2019 with periacetabular metastatic disease treated with a modified Harrington. Medical records were reviewed and complications, patient outcomes, Musculoskeletal Society Tumor (MSTS) scores, and implant survival were recorded. A total of nine patients were treated with the modified Harrington between 2017 and 2019. At maximum follow- up there were zero revisions or longterm complications. The mean preoperative MSTS score was 2.2 (range, 0-18), compared to the mean postoperative MSTS score of 17.7 (range, 9-25) recorded at a mean 4 (range, 1-30) months following surgery (p less then 0.001). The modified Harrington technique total hip technique for reconstruction in periacetabular metastatic bone disease is a safe procedure with effective symptom relief, improvement in function, and excellent implant survivorship.

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