General Surgery

It is uncommon in clinical practice to discover cancer as either a metastasis within soft tissue or containing heterotopic bone formation. These rarities are documented primarily through case reports in the literature. This report describes a patient with colon cancer whose painful wrist lesion was proven to exhibit both of these unusual features. It is important to...
(Vol 14 p 16-20, General Surgery; Orthopaedics; Pathology; Radiology: 3 September 2014)
A 38-year-old woman was diagnosed as having hyperparathyroidism. Surgery to remove 3.5 parathyroid glands was scheduled along with intraoperative neuromonitoring of the recurrent laryngeal/superior laryngeal nerves. Even though the neuromonitoring during the surgery indicated intact recurrent laryngeal nerves, on removal of the endotracheal tube, the anesthesiologist...
(Vol 14 p 21-23, ENT; Head and Neck Surgery; General Surgery: 23 July 2014)
Necrotizing fasciitis of the abdominal wall is associated with high morbidity and mortality. Early recognition and aggressive debridement of necrotic tissue are essential to achieve good outcomes. We describe an unusual presentation of a woman who was diagnosed with infected wound on the abdomen and was initially treated with traditional therapies.
(Vol 13 p 69-73, General Surgery: 17 December 2013)
We present a case of primary recurrent hydatid cyst of the tibialis posterior in a 55-year-old woman with complaints of leg pain. Hydatid cyst was diagnosed by ultrasonography and serological tests. The patient underwent surgical excision of the lesion with perioperative prophylaxis with albendazole.
(Vol 13 p 23-26, General surgery: 18 June 2013)
We present the case of a 32-year-old woman who presented at 37 weeks’ gestation with foetal bradycardia. At caesarean delivery, an intra-abdominal haemorrhage was noted before the uterine incision was made. A subsequent exploratory laparotomy revealed the source of the bleeding to be an extensive ruptured haematoma involving both lobes of the liver. Radiologic...
(Vol 13 p 42-46, General Surgery; Obstetrics: 18 June 2013)
With the advent of modern techniques including the widespread use of gastric endoscopy, benign gastric lesions are diagnosed more frequently and can be characterized by means of biopsy. Of all gastric tumours, less than 5% are benign and 90% of these are polyps. The treatment options for benign gastric tumours vary from mucosal resection to limited gastric...
(Vol 13 p 17-22, Emergency medicine and surgery; Gastroenterology; General surgery: 26 April 2013)
Ectopic pancreatic tissue is most often an incidental finding of imaging, surgery, or autopsy. Image-guided diagnosis is difficult, and definitive diagnosis usually relies on histological analysis. A case of ectopic pancreatic tissue located near the lesser curvature of the stomach is presented followed by a brief discussion of the clinical management of heterotopic...
(Vol 13 p 30-35, Endocrinology; Gastroenterology; General surgery: 2 April 2013)
A patient was admitted and diagnosed as acute pancreatitis of obscure aetiology. Laboratory investigations and radiological studies failed to reveal the underlying cause. A worm was pulled out of the nasogastric tube by the patient. In a modern society and in developed hospital settings, is it possible that we are missing, or underdiagnosing what we once regarded as...
(Vol 12 p 49-55, Emergency Medicine and Surgery; Gastroenterology; General Surgery: 23 October 2012)
A case of a 27 year-old patient who presented after medical management of a missed miscarriage with an acute abdomen is described. She was found to have a haemorrhagic angiomyolipoma, which was successfully treated radiologically. This case highlights the need to consider this differential in the presentation of acute abdomen in the context of a recent or concurrent...
(Vol 12 p 44-48, General Surgery; Gynaecology; Radiology; Urology: 23 October 2012)
We present a case of a 58-year-old woman with a posterior neck mass who underwent fine-needle aspiration of the lesion, with initial cytopathologic evaluation being consistent with metastatic squamous cell carcinoma. However, following excisional biopsy of the tumor, histopathologic evaluation revealed a pilomatricoma. Appreciation of the difficulty in cytologic...
(Vol 12 p 17-22, Head and neck surgery; General surgery; Paediatric surgery; Pathology: 27 April 2012)
This case report describes a young man in his early 20s who was found to have synchronous adenocarcinoma of the colon and abdominal tuberculosis. This is a rare finding and it is discussed whether a dampened immune response by the cancer allowed a latent tuberculosis infection to become active or vice versa.
(Vol 11 p 103-106, Colorectal surgery; General surgery; Infection and Immunity; Thoracic medicine: 9 December 2011)
Primary mesenteric liposarcoma is a rare malignant tumour of mesenchymal origin. Under the MeSH classification, mesenteric liposarcoma appears to be classified with retroperitoneal neoplasms. Two synchronous mesenteric liposarcomas must be very unusual. We report a rare case of double mesenteric liposarcoma in a 66-year-old female patient. She was treated with wide...
(Vol 11 p 98-102, General Surgery: 9 December 2011)
Solitary fibrous tumour is a rare spindle cell neoplasm of uncertain histogenesis and unpredictable biological behaviour, which was first described in the pleura and subsequently in many extrapleural locations. The clinical, radiologic and histologic features of a case of pelvic extraperitoneal solitary fibrous tumour in a young male are presented.
(Vol 11 p 92-97, General surgery; Oncology: 6 December 2011)
Liposarcoma is a mesenchymal neoplasm of uncertain pathogenesis. It is the second most common soft tissue sarcoma, found uncommonly in the breast, and constitutes less than 1% of all malignant breast tumors. We report a case of a 50-year-old woman with a pleomorphic type liposarcoma of the breast.
(Vol 11 p 87-91, Breast surgery; General surgery; Oncology; Pathology; Radiology: 17 October 2011)
There are numerous reports of inadvertent injury to patients as a result of diathermy. This potential risk also applies to the surgical team. We report a case of a full thickness diathermy burn to the surgeon, occurring due to faulty diathermy forceps. Such incidents should be reported to minimize risk of injury.
(Vol 11 p 74-76, General Surgery: 16 September 2011)
An 80-year-old lady with abdominal pain had a perforated terminal ileum at laparotomy 2 weeks after treatment for Campylobacter jejuni infective colitis. Histology of the excised bowel revealed transmucosal inflammation but no dysplasia or malignancy. Cases of bowel perforation secondary to Campylobacter are more common in children and HIV-positive individuals.
(Vol 11 p 17-19, General Surgery; Infection and Immunity: 26 March 2011)
Cases of cystic hygroma are rare and this report highlights the need for further research into treatment options. A 24-year-old Lithuanian woman was referred for further investigation of a painless but restricting right-sided neck swelling. This case report discusses the differential diagnosis and up-to-date management of cystic hygroma in the adult.
(Vol 10 p 5-11, General Surgery: 26 March 2011)
Spontaneous renal haemorrhage secondary to renal angiomyolipoma, or Wunderlich syndrome, is rare. Renal angiomyolipomata are composed of abnormal vasculature, smooth muscle and adipose tissue. They are more likely to be symptomatic if they are larger than 4 cm, presenting with a history of flank pain, a palpable mass and rarely gross haematuria. Our case illustrates a...
(Vol 10 p 117-119, General Surgery; Histopathology; Urology: 20 December 2010)
Refeeding syndrome is a serious complication of enteral or parenteral feeding of malnourished patients. The learning point from this case report is to raise awareness that total parenteral nutrition is not a simple undertaking. Diagnosing refeeding syndrome requires a high index of suspicion and close collaboration with hospital pharmacists and nutritionists.
(Vol 10 p 63-66, General Surgery: 22 July 2010)
Spontaneous liver haemorrhage due to thrombolysis is an extremely rare and life-threatening condition. This is the only report of spontaneous liver haemorrhage following thrombolysis in the literature that has been managed non-operatively, and proves such an approach is possible. The clinical findings and management of this case are discussed in relation to the relevant...
(Vol 10 p 38-41, Cardiology; General Surgery; Hepatology: 22 July 2010)
Strangulation, secondary to reduced blood flow, is a well-known complication of herniae. Signs of bowel activity do not rule out the possibility of vascular compromise. Raised inflammatory markers and a positive computed tomography scan can lead to a preoperative diagnosis, but the mortality rate remains high.
(Vol 9 p 20-23, General Surgery: 13 July 2009)
Although splenomegaly is found in approximately two thirds of patients with infectious mononucleosis (IM), splenic rupture is uncommon. However, it constitutes the single largest cause of mortality in this group. True atraumatic splenic rupture is very rare and is seen in only 0.5% of all cases of IM. We present a case of a 22-year-old man with atraumatic...
(Vol 9 p 6-8, Critical care, General surgery: 16 March 2009)
‘Plug and patch’ hernia repair techniques have been developed to minimise tissue dissection and suturing, minimise post-operative pain, to return the patient to ‘normal’ levels of activity promptly, as well as to help decrease recurrence rates. As an extension to this concept of repair, a new collagen-based bioabsorbable plug has been developed in an attempt to eliminate...
(Vol 9 p 1-5, General surgery: 16 March 2009)
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.
(Vol 8 p 35-37, General Surgery; Colorectal Surgery: 1 October 2008)
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...
(Vol 8 p 14-18, General Surgery: 8 June 2008)
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.
(Vol 8 p 10-13, Breast Surgery, gastroenterology; General Surgery: 28 February 2008)
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...
(Vol 8 p 6-9, General surgery; Paediatric surgery: 28 February 2008)
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...
(Vol 7 p 67-69, General surgery; Laparoscopic surgery: 16 November 2007)
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.
(Vol 7 p 64-66, General surgery: 25 July 2007)
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.
(Vol 7 p 58-60, Ophthalmology, General practice, Surgery: 13 June 2007)
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...
(Vol 7 p 51-53, General Surgery: 13 June 2007)
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.
(Vol 7 p 48-50, General Surgery: 17 May 2007)
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.
(Vol 7 p 42-44, General Surgery: 14 May 2007)
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.
(Vol 7 p 45-47, ENT/Head Neck Surgery, General Surgery, Endocrinology: 14 May 2007)
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...
(Vol 7 p 36-38, General Surgery: 19 April 2007)
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...
(Vol 7 p 5-8, General surgery: 20 February 2007)
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...
(Vol 6 p 18-21, General Surgery, Gynaecology: 20 July 2006)
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.
(Vol 6 p 11-14, General surgery: 25 May 2006)
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...
(Vol 5 p 46-48, General surgery: 4 November 2005)
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.
(Vol 5 p 26-27, Endocrinology, General surgery: April 2005)
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...
(Vol 4 p L15-L17, Landmark Case Report; General Surgery; Vascular Disease: October 2004)
We report a case of sigmoid perforation caused by Meckel’s diverticulitis. The ætiology, clinical findings and guidelines for therapy are described. Complications of Meckel’s diverticulum should be considered in the differential diagnosis of young patients with recurrent non-specific abdominal pain. If in doubt, operative exploration should be performed.
(Vol 4 p 16-18, Gastroenterology; General Surgery: October 2004)
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.
(Vol 4 p 13-15, General Surgery; Hepatology; Gastroenterology: August 2004)
Testicular tumours occur more frequently in an undescended testis than in a normally 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...
(Vol 4 p 1-3, General surgery: March 2004)
A young woman presented with severe acute abdominal pain, superimposed on a past history of similar attacks. Ultrasonography revealed a small bowel intussusception. This was confirmed on laparotomy, and the lead lesion, an ileal polyp, was excised. Histology showed this to be a Peutz-Jeghers hamartoma. The possibility of intussusception should be kept in mind in adults...
(Vol 3 p 6-7, General surgery: June 2003)
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 the awareness of this potential complication. We present one such case, which required admission.
(Vol 3 p 1-2, General surgery and anaesthesia: January 2003)
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. This has not been described previously.
(Vol 2 p 32-34, General surgery: May 2002)
A 20 year old Turkish man presented with a one year history of weight loss and epigastric pain. Pancreatitis was confirmed with hyperamylasaemia. CT scanning of the pancreas revealed a complex pseudo-cyst and ERCP demonstrated a pancreatic duct stricture. Hydatid disease was suggested on Ultrasound scan but serological tests were negative. After ERCP the patient...
(Vol 1 p 7-10, General Surgery: April 2001)

Editor-in-Chief

Frank Cross
Consultant Vascular and General Surgeon
The London Clinic, UK

Editors

Neil Barnes
Consultant Physician
Barts Health NHS Trust, London, UK
Ali Jawad
Professor of Rheumatology
Barts Health NHS Trust, London, UK

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