Complete Spontaneous Regression of Colorectal Cancer: A Report of Two Cases.

Spontaneous regression of cancer is rare, and rarer still in colorectal cancer. We present a report of two cases of spontaneous regression of histologically proven proximal colonic cancers described in detail, alongside endoscopic, histological, and radiological images. We discussed the potential mechanisms by reviewing previous literature.

Hernioscopy: A Description of an Adjunct Technique in Emergency Femoral Hernia Surgery.

Femoral hernias commonly present as an emergency with a large proportion strangulated or with contents that are threatened. Many surgical options are available including minimally invasive surgery and multiple open approaches. A low approach allows a relatively simple repair of the hernia and has a long-established history of safety with reproducible outcomes and low recurrence rates. It is technically less challenging than a high approach but does not allow easy assessment or management of hernia sac contents. We highlight and describe a technique that can be used when the hernia reduces spontaneously at induction, or when the surgeon cannot be confident that the contents are viable. Hernioscopy is the technique of utilizing a laparoscope inserted via the hernia sac to either examine the abdominal contents or facilitate the safe creation of pneumoperitoneum and further insertion of ports transabdominally when the patient has pelvic adhesions. We describe the operative steps taken to make this a feasible approach and reduce the need for unnecessary laparotomies and the associated morbidity.

The Utility of Minimally Invasive Surgery in the Emergency Management of Femoral Hernias: A Systematic Review.

Background: Femoral hernias are a relatively rare type of hernia but have a high complication rate, with a high proportion either presenting as an emergency or requiring emergency management. Minimal access surgery has been shown to be safe, with good results, in an elective setting, but there is little published evidence of its utility in an emergency. Methods: A systematic review was conducted searching PubMed, OVID, Embase, and Cochrane reviews for ((Femoral hernia) AND (laparoscop* OR minimal access OR robotic)) AND (strangulat* OR obstruct* OR incarcerat*). Results: 286 manuscripts were identified of which 33 were relevant. 24 were individual case reports, 3 case series, 4 cohort studies or case control series, and 2 high level reviews of National registers. Conclusion: Minimal access surgery can avoid an unnecessary laparotomy for the assessment of hernial contents, especially via a TAPP approach. Minimal access repair of femoral hernias as an emergency is feasible and can be done safely with results similar to open surgery but good quality evidence is lacking.

Falciform ligament torsion as a rare aetiology of the acute abdomen.

The falciform ligament is a remnant of the embryonic ventral mesentery containing the obliterated umbilical vein and round ligament. It extends from the umbilicus to the superior aspect of the diaphragm. We report about a 53-year-old fit and well patient who presented with acute upper abdominal pain with tenderness to palpation. Ultrasound scan was unremarkable, but blood tests revealed raised inflammatory markers. Thus, computed tomography was performed. This demonstrated acute torsion and fat necrosis of the falciform ligament, which was the aetiology of the upper abdominal pain. Such pathology is rare with 23 previously reported cases. Conservative management is usually proposed, but on occasion, surgical intervention may be warranted in cases that do not respond to initial supportive measures. We describe this case to demonstrate a rare cause of a common presentation to the surgical service.

Loin Pain Hematuria Syndrome-a case report.

Loin pain hematuria syndrome (LPHS) is a rare idiopathic condition. LPHS can present with both unilateral and bilateral loin pain, microscopic or macroscopic hematuria. It is a diagnosis of exclusion. The management options for this condition include pain management with narcotics or opioids, renal denervation, kidney autotransplantation and neurectomy or nephrectomy. However, these treatment modalities are the last resort.

Acute appendicitis located within Amyand's hernia-a complex case with concurrent acute cholecystitis.

Amyand's hernia is the presence of the vermiform appendix within an inguinal hernia sac. It is rare, and even rarer is the presence of acute appendicitis within the sac. It presents in a variety of different ways and often is only diagnosed intra-operatively. We present the case of a 90 year old male with extensive co-morbidities presenting with right upper quadrant pain, who on computed tomography scan of the abdomen, had acute cholecystitis alongside acute appendicitis within Amyand's hernia. Ultimately given his co-morbidities, a conservative approach with prolonged antibiotic therapy was adopted, with a successful outcome. This case highlights that although classifications for treatment of Amyand's hernia exist, careful clinical assessment is warranted in each case to ensure optimal outcome based upon individual circumstances.

Enterobius Vermicularis: A Parasitic Cause of Appendicular Colic.

Enterobius vermicularis is the most commonly identified parasite incidentally found within the appendix of a clinically diagnosed appendicitis. This parasitic cause of appendicular colic, primarily affecting children, is an important cause of negative appendicectomy. We report an unusual and interesting case of a young female who presented with clinical features of acute appendicitis. Laparoscopic appendicectomy revealed the presence of an Enterobius vermicularis infestation originating from the lumen of her vermiform appendix. Our case report is supplemented with a review of the literature, an overview of the parasitology, and discussion of pertinent symptomatology and peri-operative management strategies.

Torsion of undescended abdominal testicle in a 16-year-old and its management.

A 16-year-old boy attended the Emergency Department with sudden severe right iliac fossa pain and associated vomiting. He denied any urinary symptoms, diarrhoea or testicular pain. On examination, he had a locally tender right iliac fossa with guarding. External genitalia and testicular examination revealed an absent right testicle, the left testicle was not tender. The patient was haemodynamically stable. A clinical diagnosis of acute appendicitis and possible testicular torsion was made and the patient sent for an urgent diagnostic laparoscopy. At laparoscopy, the patient was found to have a torted, non-viable right-sided testicle in the abdominal cavity. On discussion with urology, a decision was made to excise the torted testicle as it was atrophic and had significant malignant potential. The appendix was normal. The patient made an unremarkable recovery and was discharged.

Historical aspects of eosinophilic esophagitis: from case reports to clinical trials.

Eosinophilic esophagitis (EoE) is a clinicopathological condition characterized clinically by symptoms of esophageal dysfunction in the absence of acid reflux, with typical endoscopic findings and eosinophilia on biopsy. This article looks into the historical clinical recognition and description of EoE, in particular clinical manifestations, natural history, and epidemiology. Additionally, the evolution of endoscopic recognition and development of clinical trials are described: EoE is an isolated disease of the esophagus, although it is associated with other antigen-driven diseases such as asthma, rhinitis, and atopic dermatitis. After initial case reports which were mostly not typical of the disease state now described, the first case series were described in 1993 and 1994 in adults, and 1995 in children. Although rarely seen before 2000, the disease is now commonly recognized. Randomized clinical trials have now been performed on topical steroids, and on biological agents targeted against IL-5, IL-13, and other mediators. Therapy with dilatation may be best guided by measures of compliance and distensibility. Work is needed on biomarkers of the disease's severity and progression, and predictive indexes of complications. EoE is a relatively new disease of increasing importance. It represents an important diagnosis in patients with upper gastrointestinal symptoms and must be considered in all patients with dysphagia where the diagnosis is not certain and in all patients who have an assumed diagnosis of reflux but are not responding to standard reflux therapy.