Internal Iliac Artery Patency as a Predictor of Above-Knee Amputation Stump Healing.

BACKGROUND: The primary aim of this study was to assess the role of internal iliac patency in predicting outcomes of above-knee amputation (AKA) stump healing. The secondary objectives were to assess the accuracy of Wound, Ischemia, and Foot Infection (WIfI) classification system in predicting AKA stump healing and its association with delayed mortality. METHODS: This is a retrospective study performed in a vascular surgery unit in a tertiary hospital on patients who underwent AKAs over 1 year, from July 2021 until June 2022. Patient demographic data, WIfI scoring, outcome of AKAs, and patency of profunda femoris and internal iliac artery (IIA) were collected. To minimize confounding, a single vascular surgeon performed all computed tomography imaging reviews and arterial measurements. Approval for this study was obtained from the National Research Registry, NMRR ID-23-01865-KQ4 (investigator initiated research). RESULTS: Ninety patients underwent AKA over 1 year, from July 2021 until June 2022. Occluded IIA in the presence of patent profunda femoris did not affect the wound healing of the AKA stump. There was significant association between WIfI scoring and mortality. Patients with a WIfI scoring of 3 to 4 were observed to have a higher mortality rate compared with patients with normal healing: 47 (72.0%) vs. 4 (80.0%); P = 0.021. CONCLUSIONS: In this study, the IIA patency shows no statistically significant effect on AKA stump healing; however, the small number of patients is a drawback of the study. This study also demonstrates that the WIfI score can be a prognostic factor for mortality in patients undergoing AKA.

Single-stage inferior vena caval intravenous leiomyomatosis excision.

Intravascular tumour extension can occur in many different types of cancer. Those with the highest tendency include renal cell carcinoma, adrenal cortical carcinoma and hepatocellular carcinoma. Inferior vena cava (IVC) tumour thrombus in gynaecological malignancy is rarely reported. We present a report on a female patient with extensive IVC tumour thrombus (intravenous leiomyomatosis) with concurrent intrauterine leiomyomatosis. She underwent a single-stage procedure, involving laparotomy and a sternotomy to remove her pelvic tumour, as well as the intracaval and intracardiac thrombus. The clinical presentation and management of this rare tumour will be detailed in this case report.

Case Report: Rectal Perforation Secondary to a Toothbrush in an Elderly Man.

Rectal foreign bodies often constitute an arduous diagnosis and perplexing management. A 72-year-old gentleman who is mentally sound was brought to the emergency department for severe epigastric pain of a 1-week duration. On examination, he was pyrexial and in sepsis. The abdomen was guarded. A digital rectal examination was normal. Erect chest radiography revealed air under the diaphragm and abdominal radiography showed neither dilated bowel nor foreign body. A diagnostic laparoscopy was performed which revealed a yellow hard rod-shaped foreign body at the pelvis. Upon conversion to midline laparotomy, the foreign body was found to be a toothbrush with intraperitoneal rectal perforation of 1 cm in length. The brush was removed and the perforation was repaired primarily. A diverting transverse loop colostomy was created. Rectal foreign bodies may cause life-threatening rectal injuries including lacerations, bleeding, perforation, and obstruction. It is deemed crucial that any patient with rectal foreign body demands an orderly approach with the intention of diagnosis, management, and post-extraction evaluation.

Role of imaging in managing lateral trocar site incisional hernia after abdominoperineal resection.

Trocar site incisional hernia (TSIH) is an unpleasant complication of laparoscopic surgery. A 70-year-old male with low rectal carcinoma underwent a laparoscopic abdominoperineal resection after completion of neoadjuvant radiotherapy. The postoperative recovery was smooth; however, he developed abdominal distension and pain over the previous drain site after removal on day 3. In view of diagnostic ambiguity, an imaging tool was requested as an adjunct to further management. Computed tomography of the abdomen showed small bowel obstruction secondary to herniated ileal loops passing through the right iliac fossa anterior abdominal wall defect at the previous drainage site. An exploration was made and the rectus defect was closed using a non-absorbable suture.

Ankle pseudoaneurysm: distal posterior tibial artery pseudoaneurysm in a child following blunt trauma.

Pseudoaneurysm of the ankle involving the posterior tibial artery is a rare presentation with only four paediatric cases previously reported in English literature. We report a new case following blunt trauma with the clinical presentation and management strategy. A 6-year-old boy presented with a pulsatile swelling at the medial aspect of ankle following a history of blunt trauma 3 weeks ago. Imaging confirmed pseudoaneurysm involving the distal posterior tibial artery. Excision of the pseudoaneurysm was performed without any complication.

Rare Intracardiac Tumor: Primary Cardiac Lymphoma Presenting as Atypical Angina.

Primary lymphomas of the heart are extremely rare, accounting for 2% of all primary cardiac tumors. Due to the rare presentation, there is no proper consensus available on treatment strategy. Preoperative confirmation of the pathology is fundamental in guiding an early treatment plan, which allows for improved prognosis. Unfortunately, in most cases, primary cardiac lymphoma is only identified on postoperative histopathological analyses, which affect the treatment plan and outcome. Here, we report a unique case of primary cardiac lymphoma presented with dyspnea and reduced effort tolerance. Young age, rapid onset of symptom, and absence of cardiac risk factors prompted us towards further imaging and emergency resection. The patient received a course of postoperative chemotherapy and was disease-free on six months of follow-up.