Overt gastrointestinal bleeding secondary to left inferior phrenic artery pseudoaneurysm postgastric bypass surgery.

Bleeding from a visceral artery pseudoaneurysm (VAPA) is a rare but significant complication of bariatric surgery. Patients may present with gastrointestinal (GI) haemorrhage in the forms of haematemesis, melaena, haematochezia or haemodynamic compromise. Although CT angiogram, endoscopy and laparoscopy form essential parts of diagnostic assessment, small pseudoaneurysms with intermittent bleeding may be overlooked. We report the case of a man in his 40s who presented to the emergency department with massive GI bleeding and subsequent haemodynamic instability, secondary to a pseudoaneurysm from a vascular injury during a recent bariatric procedure. This case highlights the diagnostic challenges of obscure, intermittent bleeding involving the bypassed stomach with unremarkable investigation findings, and aims to raise awareness among clinicians in considering the less common postgastric-bypass complications.

Unique cases of large and small bowel obstruction in intraperitoneal renal transplantations: a case series and review of literature.

Bowel obstruction is a common cause for the acute abdomen with different aetiologies that shapes subsequent management plans. Small bowel obstruction often develop due to intra-abdominal adhesions in patients with prior abdominal surgery and for large bowel obstructions, more commonly due to tumours and lesions. Disruptions to normal intra-abdominal anatomy as seen in pancreatic-kidney transplantation or kidney transplant alone can result in increased risk of bowel obstruction-especially if the donor graft is implanted within the intraperitoneal plane. We present two patients from separate institutions with history of simultaneous pancreas-kidney (SPK) transplantation (Patient 1) and intraperitoneal renal (Patient 2) transplant whom both presented with bowel obstruction requiring surgical intervention. Given the specificity and operative intricacies of our cases, we aim to present our findings and surgical management of these rare presentations in hopes of increasing awareness to this uncommon but significant cause of bowel obstruction in a transplant patient.

Massive mixed epithelial-stromal tumour of seminal vesicle requiring challenging abdominoperineal resection: a case report and review of literature.

Mixed epithelial-stromal tumours (MESTs) are a rare biphasic tumour that frequently arise in women from the renal and urogenital tract. They are also seen in men but are exceptionally uncommon with only few cases reported to originate from the seminal vesicles. Malignant transformation of its epithelial or stromal components is possible; however, by in large, these tumours are benign in nature. We report the case of a 48-year-old man with no remarkable medical or surgical history who presented with a huge expanding pelvic and intra-abdominal mass that required extensive surgical management including a pelvic exenteration. Histopathological analysis concluded the diagnosis of benign MEST originating from the seminal vesicles with no malignant features. No further systemic therapy was recommended for our patient. Given the technical intricacy in the operative resection of this tumour, we aim to present our findings and surgical management of this complex MEST.

How to do it: delayed sphincteroplasty for obstetric anal sphincter injury.

Obstetric anal sphincter injuries are a common cause of faecal incontinence in women. Symptoms can arise immediately after delivery or have an onset many years postpartum. The anterior sphincter defect may be occult and unrecognised at the time of delivery or result from a breakdown of a primary repair. A delayed sphincteroplasty is a management option for those with persistent symptoms after a non-operative approach. Our patient is a 35-year-old female who presented with faecal urgency and incontinence to liquid stool and flatus. She was 8 months post-partum (G4P2) following a singleton vaginal delivery. She suffered a sphincter injury following a precipitous labour, described as a grade 3c perineal tear, which was repaired at the time in the operating theatre. Endoanal ultrasound revealed a persistent 40% defect in the anterior internal and external anal sphincters. Our approach to a delayed sphincteroplasty is described in detail. We employed a method that involved the identification, careful dissection, and separate repair of both anal sphincter muscles.

A Case of Cutaneous Botryomycosis of the Lower Leg in a Young Adult Male.

We present a case of cutaneous botryomycosis of the lower leg in a young adult male. Botryomycosis is a chronic granulomatous response to bacterial infection. As a cutaneous lesion, it can easily be mistaken for a malignant, autoimmune or inflammatory mass. We were able to successfully treat our patient with primary surgical excision, vacuum-assisted closure (V.A.C.™) dressing and subsequent split thickness skin graft (STSG). Use of a V.A.C. dressing with subsequent grafting has not previously been reported in the literature.

Single stage repair of a giant inguinoscrotal hernia by a combined laparotomy and inguinal approach.

Giant inguinoscrotal hernias are an uncommon but challenging surgical entity. We report on how to repair a giant inguinoscrotal hernia using a single-stage approach suitable for emergency surgery. This involves a combined laparotomy and inguinal approach, with posterior component separation and transversus abdominis release.