Mixed infection of Actinomyces israelii and Fusobacterium nucleatum presenting as a neck mass.

This report presents the case of a mixed infection of Actinomyces israelii and Fusobacterium nucleatum, presenting as an extensive neck mass progressing through tissue planes and causing bony destruction. Despite multiple abscess aspirates, imaging and serological investigations, the causative organisms proved elusive over the course of the patient's long admission, only to be identified postdischarge. The patient was successfully initiated on a prolonged course of intravenous antibiotics and did not suffer from any complications. This report aims to raise awareness of the presentation, pathogenicity and treatment of Actinomyces and Fusobacteria infections, given a notable difficulty in diagnosis.

Loss of domain leading to intra-operative cardiorespiratory arrest during open repair of a giant inguinoscrotal hernia and hydrocele.

We present the case of a 73-year-old man with a longstanding, giant inguinoscrotal hernia and hydrocele treated by an open approach, complicated intra-operatively by loss of domain leading to cardiorespiratory arrest. Surgery involved a midline approach by the general surgeons. Protruding viscera were mobilised, freed from adhesions, and returned to the abdominal cavity with closure of the internal ring, followed by reconstruction of the penis and scrotum by the plastic surgery and urology teams. Following abdominal closure, the patient developed severe cardiorespiratory instability attributed to large fluid shifts and increased intra-abdominal pressure due to loss of domain. The abdomen was therefore left open, and an ABThera negative pressure therapy system was employed. Two days later the abdomen was closed without tension. The remainder of the patient's post-operative recovery was unremarkable.