ABSTRACT
New anticoagulants such as Rivaroxaban have become a popular choice for patients needing anticoagulation for atrial fibrillation or venous thromboembolism, chiefly because anticoagulation is maintained without the need for monitoring. This can be problematic in cases of trauma, and in this article, we discuss the management and outcome of managing an elderly patient with a shattered spleen while on Rivaroxaban.
ABSTRACT
Rectal bleeding following any form of rectal surgery is a well recognised complication 1, 2, 3 & 4. However retro-rectal bleeding and tracking which then presents as rectal bleeding has not been reported in the literature. We describe a novel way of dealing with this technically difficult post-operative complication.We present two cases of significant rectal bleeding (one following STARR procedure and other after Delormes procedure). Both patients had to be taken back to theatre due to continuing, significant bleeding. Examination under anaesthesia on both occasions revealed a posterior boggy swelling, with an opening which admitted a finger. In both cases clots were evacuated and a corrugated drain was inserted in to the retro rectal space.The authors believe that following any form of rectal surgery, retro-rectal bleeding with tracking can present as rectal bleeding. Treatment in the form of EUA and insertion of corrugated helped to resolve the problem.We present both cases and literature review of the complications of stapled haemorrhoidopexy.
ABSTRACT
We report a case of paediatric Boerhaave's syndrome in 15-year-old girl associated with massive dilatation of the stomach into the pelvis and transient hepatitis of uncertain aetiology. This cluster of clinical finding has not previously been reported. The young girl initially presented with abdominal pain, vomiting and lower urinary tract symptoms. She was initially treated for urinary tract infection after urine dipstick showed leucocytes and nitrates. Later she was found to have the spectrum of findings as described. Patient was treated by restricting to strict no oral intake and gastric decompression. Enteral nutrition maintained via a feeding jejunostomy.Boerhaave's syndrome frequently presents in the context of other emetogenic illnesses which may mimic its features as a result the diagnosis can be difficult. A high index of clinical suspicion is therefore required. We review the literature of paediatric Boerhaave's syndrome to aid the clinician with this diagnostic conundrum.
ABSTRACT
A 52-year-old, Caucasian, British man suffered significant injury following simple fall. A man with no significant past medical history, presented to the accident and emergency with right side chest pain and shortness of breath. He reported a simple fall, two days before admission. Chest radiograph showed simple bilateral pneumothorax and pneumomediastinum. Subsequent computerised tomography confirmed the thoracic injury and identified complex pathophysiology as described. This case shows the extent of injury a person can sustain from a simple fall and the high index of suspicion required to discover the full extent of a patient's injuries. We review the literature to find other forms of presentation.
ABSTRACT
A 40-year-old woman presented with a 2 year history of intermittent left upper quadrant pain. The clinical examination and blood tests were normal, but the pain persisted. An ultrasound scan of the abdomen revealed a hypoechoic mass in the spleen which was further investigated by computed tomography and magnetic resonance imaging (MRI). The differential diagnosis included solitary lymphoma, splenic haematoma, sarcoma, solitary metastasis or partially thrombosed splenic artery aneurysm. The patient underwent elective splenectomy and histology showed the appearance of a rare tumour. We present MRI images of this very rare splenic tumour.
ABSTRACT
CONTEXT: Pancreatic body carcinoma has a poor prognosis with advanced disease at presentation. Recent experience at multidisciplinary team (MDT) meetings suggests increasing prevalence. OBJECTIVE: Our aim was to determine if introduction of MDT meetings has affected the natural history of this disease. DESIGN: Retrospective diagnostic and survival data were collected from 1995 to 2006 at two large teaching hospitals, and divided into pre- and post 2003 groups (based on MDT introduction). PARTICIPANTS: Thirty-one patients with pancreatic body carcinoma (median age at diagnosis 72 years; range 43-87 years). RESULTS: Commonest symptoms at presentation were abdominal pain and weight loss. Eight patients (25.8%) were diagnosed pre MDT (median age 71.5 years, range: 60-87 years) and 23 patients (74.2%) were diagnosed post MDT (median age 67 years, range: 43-85 years; P=0.299 vs. pre MDT). There was a significantly (P=0.024) greater prevalence of more advanced tumours post MDT (stage IV: 15/23, 65.2%) than pre MDT (stage IV: 2/8, 25.0%). Neither tumour markers nor liver biochemistry differentiated tumour stage. Best supportive care was offered to 16 patients (51.6%) while 12 patients (38.7%) were suitable for chemotherapy: 2 out of 8 pre MDT (25.0%) and 10 out of 23 (43.5%) post MDT (P=0.433). For stage III tumours, post MDT patients tended to be younger (median 59 years vs. 74.5 years, P=0.042). Survival was not significantly increased after MDT introduction but chemotherapy offered significant survival benefit on multivariate analysis (P=0.042; hazard ratio: 0.39, 95% CI: 0.16-0.97). CONCLUSION: The trend is towards increased prevalence of pancreatic body cancer and more advanced disease at presentation. Chemotherapy was associated with a survival benefit, although the introduction of the MDT has not significantly altered disease management.
