What is the precaecocolic fascia?

The precaecocolic fascia, previously known as Jackson's membrane, is a variable vascular peritoneal fold between the ascending colon and the right posterolateral abdominal wall. First described in 1913, it was originally thought to be of developmental or inflammatory origin and associated with abdominal pain. This investigation aimed to review its frequency, form and structure and look for evidence of association with malformation of the bowel, or previous inflammation. 26 dissecting room cadavers were studied to identify the precaecocolic fascia, any malrotation of the colon or signs of previous inflammation: adhesions, surgical scars, or absence of the appendix. Its structure was examined histologically and latex injections were used to trace the arteries. Membranes comparable with previous descriptions of the precaecocolic fascia occurred in 12 of 26 abdomens. They varied in form and size from long and translucent to short, thick, and opaque. In structure, the fascia resembled a fold of peritoneum containing a thickened fibrous lamina. Large thin-walled arteries in the fascia crossed the arteries in the wall of the colon at the point of attachment. No significant association with colonic malrotation or markers of previous inflammation were found. Attention should be paid to the definition of the precaecocolic fascia and "membrane" seems a more appropriate term than "fascia". It is one of a recognized group of peritoneal folds/bands, doubtful in origin but unlikely to be post-inflammatory. It may modify colonic mobility or complicate colonic operations.

Giant right coronary artery aneurysm presenting as an STEMI.

Giant coronary artery aneurysms are an infrequent finding. They are typically discovered incidentally, rarely presenting with any symptoms. We present the case of a 72-year-old gentleman who presented with an ST elevated myocardial infarction. On investigation, the gentleman was found to have a giant right coronary artery aneurysm which was partially filled with a fresh thrombus. The thrombus occluded the RCA, triggering the myocardial infarction which leads to this gentleman's presentation to a tertiary cardiac centre. The gentleman underwent a successful resection of the aneurysm and coronary artery bypass graft over the RCA lesion with a saphenous vein conduit. This gentleman has since been discharged from hospital after an uncomplicated postoperative course.