An interesting case of acute, severe postoperative hyponatraemia following carotid endarterectomy.

A 62-year-old man with no major comorbidities became acutely hyponatraemic on the second postoperative day following a routine carotid endarterectomy. He developed a headache, became hypertensive and confused, and then had a seizure and required intubation and admission to the intensive care unit. A CT angiogram of his head and carotid arteries was normal, as was a subsequent MRI head. His serum and urine osmolality were low. He was treated by fluid restriction and his hyponatraemia resolved over 3 days. On discontinuation of sedation the patient woke up appropriately. The cause of his hyponatraemia was initially a mystery but when questioned by the medical team he admitted that he drank about 5 litres of water in the afternoon on the second postoperative day. At this point the diagnosis of dilutional hypervolaemic hyponatraemia secondary to water intoxication could be made.

Delayed radionecrosis of rectum presenting as soft tissue inflammation of thigh--an unusual case.

This is a case report of a 53-yr-old gentleman with soft tissue inflammation of the thigh, secondary to delayed radionecrosis of rectum. He presented with this condition, one-and-half years after he had pre-operative radiotherapy and low anterior resection for Dukes'B adenocarcinoma of rectum. In this report we emphasise the need for the clinician to be alert of this delayed side-effect of pre-operative radiotherapy and also the need for patients receiving high-dose radiotherapy to be warned of this possible complication, although it is rare.