Complete abdominal wall disruption with herniation following blunt injury: case report and review of the literature.

Acute traumatic abdominal wall hernia (TAWH) is a rare type of hernia that occurs after a low- or high-velocity impact of the abdominal wall against a blunt object. With few cases reported, a consensus in diagnosis and management has not been established in the literature. A systematic review of the literature for adult cases of traumatic abdominal wall hernia due to blunt abdominal trauma was undertaken. All original articles were reviewed and data were compiled and tabulated qualitatively. Diagnostic imaging modalities and their reported description of the abdominal wall hernia were detailed correlated with the laparotomy findings. We also report a case of TAWH following blunt abdominal trauma, and describe integration of this management into clinical practice. Fifty-five cases of adult TAWH were found in the English literature. Most hernias contained either small bowel (69%) or large bowel (36%), with 16% of TAWH containing both. Concurrent intra-abdominal injuries were seen in 60% of cases, with an almost equal number of associated bowel (44%) and solid organ (35%) injuries. Twenty percent of diagnosis of TAWH was delayed, ranging from 2 days to 9 years. While TAWH is uncommon, a high index of suspicion is required in patients who present with blunt abdominal trauma. A staging system for TAWH can facilitate appropriate management priorities and treatment. CT scanning is crucial in the diagnosis of TAWH, and aids in definitive management of these patients. The literature supports immediate surgical exploration for most TAWH.

Recurrent phyllodes tumor of the breast: defining the role for skin-sparing mastectomy and autologous reconstruction.

Phyllodes tumors (PTs) are uncommon fibroepithelial tumors of the breast, noteworthy for their difficult excisions and high recurrence rates. In the setting of recurrence, there is no consensus in the literature as to the extent of excision or the impact on reconstructive options. Breast-conserving surgery and simple mastectomy have each been described with mixed reports. Despite a shift toward the selective use of skin-sparing mastectomy and nipple-areola complex-sparing mastectomy in breast carcinoma, neither the role for these techniques nor the role for breast reconstruction in recurrent PT has been described. A case report is presented demonstrating the utility of skin-sparing mastectomy and autologous breast reconstruction for locally recurrent PT of the breast, with a literature review of management options in this setting presented. The case presented highlights an appropriate setting for autologous microsurgical reconstruction of the breast in recurrent PT. The literature review highlights a lack of any published management consensus, with only the role for mastectomy suggested for recurrent high-grade or malignant lesions. A potential management algorithm is thus presented. Skin-sparing mastectomy, particularly for intermediate-grade lesions, may allow wider resections while enabling aesthetically pleasing reconstructive options without affecting recurrence rates.

Risk factors for colonic perforation after screening computed tomographic colonography: a multicentre analysis and review of the literature.

BACKGROUND: Computed tomographic (CT) colonography (or 'virtual' colonoscopy) has become an increasingly popular tool for colorectal cancer screening. Colonic perforation, an uncommon complication, is a risk that has not been widely reported. METHODS: A systematic review of the literature was undertaken to identify all reported risk factors for colonic perforation following CT colonography. In addition, a retrospective multicentre study was undertaken, evaluating all CT colonographies in 10 major metropolitan tertiary referral centres. All colonic perforations were assessed for risk factors. RESULTS: A range of 'patient'-related and 'procedure'-related risk factors were identified in the literature. Among 3458 CT colonographies, there were two cases of colonic perforation contributing to an incidence of perforation of 0.06%. There was no statistical correlation between the incidence of perforation and institutional experience (P = 0.66). Risk factors common to both cases and the literature included age, recent colonoscopy and manual colonic insufflation. Diverticular disease and recent colonic biopsy were also notable factors. CONCLUSION: There is a small but real risk of perforation following CT colonography. Patient selection and preventative procedural measures may reduce this risk. The importance of the consent process is emphasized.