Invasive Plant Species Establishment and Range Dynamics in Sri Lanka under Climate Change.

Plant invasion has been widely recognized as an agent of global change that has the potential to have severe impacts under climate change. The challenges posed by invasive alien plant species (IAPS) on biodiversity and ecosystem stability is growing and not adequately studied, especially in developing countries. Defining climate suitability for multiple invasive plants establishment is important for early and strategic interventions to control and manage plant invasions. We modeled priority IAPS in Sri Lanka to identify the areas of greatest climatic suitability for their establishment and observed how these areas could be altered under projected climate change. We used Maximum Entropy method to model 14 nationally significant IAPS under representative concentration pathways 4.5 and 8.5 for 2050 and 2070. The combined climate suitability map produced by summing up climatic suitability of 14 IAPS was further classified into five classes in ArcMap as very high, high, moderate, low, and very low. South and west parts of Sri Lanka are projected to have potentially higher climatic suitability for a larger number of IAPS. We observed suitable area changes (gains and losses) in all five classes of which two were significant enough to make an overall negative impact i.e., (i) contraction of the very low class and (ii) expansion of the moderate class. Both these changes trigger the potential risk from IAPS in Sri Lanka in the future.

Unexpected finding of arc of Buhler with celiac artery stenosis during workup for a suspected pancreatic lesion.

Knowledge about normal and pathological anatomical variants is a key point for all surgeons to perform safe procedures and manage unexpected findings. One example of this is vascular anomalies involving the celiac and superior mesenteric arteries (CA and SMA) and their anastomoses. During a routine workup of a suspected calcified pancreatic lesion, an asymptomatic arc of Buhler was found, connecting the CA and SMA, with 90% stenosis of the celiac trunk. This embryological variant, despite being a rare occurrence, has significance in various surgical procedures, including pancreatoduodenectomy, liver transplantation and interventional radiological procedures, such as gastroduodenal artery ligation and embolisation.

A rare case of emphysematous pancreatitis: managing a killer without the knife.

Emphysematous pancreatitis (EP) is a rare and severe complication of acute pancreatitis carrying a high mortality with only a handful of case reports and small studies reporting these cases and their management. The presence of emphysematous pancreatitis is often indicative of infected pancreatic necrosis with the mainstay of treatment being pancreatic necrosectomy; however there are cases where it may be appropriate to have a trial of conservative management, and there is a small body of evidence to support this. This paper describes a case of an 87-year-old male with acute emphysematous pancreatitis successfully managed with conservative cares.

A rare case report of ascending colon perforation secondary to acute pancreatitis.

INTRODUCTION: Severe acute pancreatitis is associated with high morbidity and mortality. This is a result of the development of pancreatic and extra-pancreatic necrosis with subsequent infection which can lead to multiorgan failure. Complications include localized ileus, abscess formation, mechanical obstruction, rupture and perforation into the gastrointestinal tract and fistula formation (Aldridge et al., 1989; Bassi et al., 2001 [1,2]). CASE PRESENTATION: A 72 year old man attended the emergency department with acute epigastric pain. Biochemistry results were reviewed with a lipase of 1680 U/L (ref range <60 U/L). He was treated conservatively. He had a labile course throughout his admission and on day 7 he had significant deterioration. Abdominal CT scan demonstrated marked mechanical large bowel obstruction at the level of the sigmoid colon, caecum dilated with features suggestive of ischaemia in the caecal wall and backflow dilatation of the small bowel loops. The patient was transferred to a tertiary centre for subsequent laparotomy and bowel resection. DISCUSSION: Colonic complications of acute pancreatitis are uncommon. An analysis of pooled data reports the incidence of colonic complications from acute pancreatitis to be 3.3% and those from severe acute pancreatitis 15% (Bassi et al., 2001 [2]). Knowledge about colonic perforation from acute pancreatitis has been limited to few case reports, thus diagnostic and management dilemmas continue to persist. CONCLUSIONS: We report a rare case of ascending colon perforation in severe acute pancreatitis. This is particularly unusual given the anatomical propensity for splenic flexure involvement or transverse colon involvement being noted in literature. This highlights the high index of suspicion required for colonic complications given the varied, non-specific and often delayed presentation of complications.

Colorectal cancer in young patients: a retrospective cohort study in a single institution.

BACKGROUND: Young onset colorectal cancer is on the rise, with a disproportionate increase in incidence among young people, both in Australia and internationally. Current national guidelines for bowel cancer screening in average risk individuals include only patients greater than 50 years of age. It is well recognized that colorectal cancer is a highly treatable malignancy when detected at an early stage, and timely diagnosis yields a greater than 90% chance of cure and survival. The aims of this study were to define the clinical presentations leading to colonoscopy in young patients and assess the incidence of malignancy in this group. METHODS: This is a retrospective cohort study including all patients ≤35 years of age without any baseline indication for early bowel cancer surveillance that underwent colonoscopy at Caboolture Hospital from January 2017 to April 2018. RESULTS: A total of 224 patients underwent colonoscopy in the study period. A total of 210 (93.8%) had symptoms including rectal bleeding (51.7%), altered bowel habit (25.9%), abdominal pain (10.3%) and symptomatic anaemia (6.7%) prior to colonoscopy. Two cases of invasive adenocarcinoma were identified (0.89%, P < 0.01), both of which were symptomatic and were defined as stage IIIB disease on histopathology. CONCLUSION: In a theoretically low-risk population, the incidence of malignancy was nearly 1%. More advanced disease at diagnosis may be due to a delay in investigating these patients due to an overall low suspicion of cancer in young individuals. As such, investigation should be offered early to young patients presenting with any warning symptoms.

The dilemma of stump appendicitis - A case report and literature review.

INTRODUCTION: Stump appendicitis is one of the rare delayed complications post appendectomy with a reported incidence of 1 in 50,000 cases. Stump appendicitis can present as a diagnostic dilemma if the treating clinician is unfamiliar with this rare clinical entity. A PubMed search was conducted to identify cases of stump appendicitis following appendectomy. Sixty one cases of SA that were reported in English medical literature were analyzed. PRESENTATION OF CASE: We report a case of stump appendicitis (SA) with a systematic review and challenges encountered during the management. DISCUSSION: The interval from original appendectomy to stump appendicitis ranged from 4 days to 50 years. SA followed appendectomy in 58% of open and 31.6% of laparoscopic procedures. SA was frequently misdiagnosed as constipation, gastroenteritis or right sided diverticulitis, therefore leading to a significant delay to surgery. Computerized Tomography diagnosed SA in 56.3% of cases. Perforation with gangrene of the stump occurred in 60%. CONCLUSION: Stump appendicitis can represent a diagnostic dilemma if the treating physician is unfamiliar with this uncommon clinical entity. Radiological imaging is required to aid diagnosis and a completion appendectomy is the modality of treatment.

Small bowel obstruction secondary to bilateral obturator hernia: a rare occurrence.

Obturator hernia (OH) is a rare type of pelvic hernia. It can cause significant morbidity and mortality, especially in the elderly age group. Delayed treatment is associated with high rates of strangulation (25-100%). We present an 88-year-old woman who presented with symptoms of bowel obstruction and right hip pain. Computed tomography (CT) abdomen revealed bilateral OHs and bowel obstruction secondary to the right OH. She was managed conservatively due to her age and co-morbidities and her bowel obstruction subsequently resolved. She was discharged, only to re-present 1 month later with similar complaints. A repeat CT scan revealed bilateral OHs and bowel obstruction due to the left OH. She underwent midline laparatomy and both OHs were reduced. The right OH was fixed with polypropylene mesh plug and the left OH was fixed with primary closure. The patient recovered and no recurrence was noted during follow-up.