Tapia's syndrome in a patient with COVID-19.

A 42-year-old man developed bilateral Tapia's syndrome (recurrent laryngeal and hypoglossal nerves paralysis) following prolonged ventilation for COVID-19 pneumonia. Examination showed global tongue atrophy and bilateral asymmetric vocal cord palsy. He improved rapidly without specific treatment, suggesting that neuropraxia was the likely mechanism of injury. Tapia's syndrome has been reported disproportionately more often in association with COVID-19, possibly from injury to hypoglossal and vagal nerves during ventilation in the prone position.

Not everything in the gallbladder is gallstones: an unusual case of biliary ascariasis.

A 25-year-old female presented with a sore throat, fever and epigastric pain after coming from India. She had an obstructive pattern of liver function tests and an ultrasound scan abdomen showed features suggestive of acute cholecystitis and pancreatitis, with no obvious gallstones. She made no improvement with intravenous antibiotics. Subsequently, a contrast CT demonstrated a curvilinear structure within a thickened gallbladder and common bile duct. After input from multiple specialities, she had a MR cholangiopancreatography (MRCP) which further confirmed the curvilinear filling defect impacted in the gallbladder neck and proximal common bile duct. Biliary ascariasis with mild pancreatitis was diagnosed and was successfully treated with mebendazole. At one-month outpatient follow-up, her liver function tests and ultrasound scan had returned to normal. This case report discusses the radiological findings seen with biliary ascariasis using a range of imaging modalities. It also highlights the importance of the multidisciplinary team in managing a patient who presents a diagnostic challenge, in order to achieve the best patient outcome.

Nasogastric tube knotting: a rare and potentially overlooked complication among healthcare professionals.

Nasogastric tube placement is a common procedure performed in surgical and medical specialities. The occurrence of knot formation is perhaps one of the least well-recognised complications associated with its usage. We present a case of nasogastric tube knotting to remind colleagues of this rare but important complication. A 75-year-old woman with adhesional bowel obstruction was admitted under the general surgery team. A wide bore nasogastric tube was inserted for drainage and decompression. Although placement of the tube was deemed to be successful, there was no drainage of gastric content evident. On removal of the 'non-functioning' tube a simple knot was seen at its proximal end. A further nasogastric tube was placed and the patient's symptoms resolved with conservative management. Nasogastric tube knotting is a rare and often overlooked complication with the potential to cause significant trauma on tube removal if unrecognised.

Small bowel hamartoma: a huge diverticulum of small bowel.

A-20-year old male, with no significant medical history, presented with clinical features mimicking a perforated acute appendicitis. Because of features of peritonitis, a laparotomy was performed which showed a segment of small bowel with multiple large diverticula and mesenteric cysts. A segmental small bowel resection was performed. The patient made an uneventful recovery from surgery. Histology revealed features of a small bowel hamartoma.