21st century twist on Cullen's sign: new generation anticoagulants and splenic traum.

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.

Acute rectal ischaemia following emergency abdominal aortic aneurysm surgery.

We present a case of isolated rectal ischaemia, a rare complication after emergency surgery for a ruptured abdominal aneurysm. We discuss the possible aetiology of this condition and how this rare condition may be missed unless care is taken at the time of reoperation.

Elective surgical removal of migrated intrauterine contraceptive devices from within the peritoneal cavity: a comparison between open and laparoscopic removal.

BACKGROUND: Intrauterine contraceptive devices (IUCDs) comprise the most popular form of reversible contraception. Uterine perforation is a rare but potentially serious complication associated with their use. We examined all reported cases of elective surgical removal of peritoneally migrated IUCDs, to compare laparoscopic and open approaches, and to identify beneficial surgical techniques. DATABASE: MEDLINE and Embase were searched using the following medical subject heading terms: (IUCD or IUD or IUS or intrauterine device or intrauterine devices, copper or intrauterine devices, medicated) AND (migrated or displaced or foreign-body migration or intrauterine device migration) AND (peritoneal or peritoneal cavity). The Cochrane Library was searched using the terms IUCD, IUD, IUS, and intrauterine device. Additional studies were identified by manually searching the reference lists of the studies found through database search. Studies were included irrespective of language or publication type. DISCUSSION: We identified 129 cases, reported in 30 studies. In the majority of cases (93.0% [120/129]), surgery was attempted laparoscopically; however 22.5% (27/120) of surgeries were converted to open operations, giving an overall rate of open surgery of 27.9% (36/129). This systematic review supports the use of laparoscopic surgery for elective removal of migrated IUCDs from the peritoneal cavity. With complications rarely reported, it is also likely the procedure could be undertaken in an outpatient setting. The use of intraoperative adjuncts (ie, cystoscopy) and the rate of conversion to open surgery are influenced by the site of the IUCD. Therefore, accurate preoperative localization of the device is advised.