Background Vasculitis and phlebitis with vascular occlusion within appendix specimen is rare. Several authors have reported COVID-19 related veno-occlusive disease in hepatic pathology, but lymphoid aggregation with phlebitis is unusual in appendix specimen. We present a case with medium size venule phlebitis in an appendix of a patient recovered from COVID-19 infection. Case presentation A 27-year-old who recently recovered from COVID-19 infection 12 weeks prior, presented with acute appendicitis, confirmed on computed tomography and operative findings. He underwent an uneventful laparoscopic appendicectomy. Histopathology showed veno-occlusive vasculitis within the appendix specimen. Conclusions Veno-occlusive disease within the appendix is uncommon. Emerging data suggest COVID-19 infection can cause systemic vascular complications. We herein report a case of healthy patient with no past medical history with an unusual findings of medium vessels phlebitis within the appendix post COVID-19 infection.

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Background: Emergency presentations of hernias can pose significant morbidity. In addition, providing optimal surgical intervention can be challenging due to patient and disease factors with multiple treatment modalities available. Recently there have been several guidelines written to help standardize practices in hernia management. The aim of our study was to review emergency hernia operations at our tertiary level teaching hospital, the method of repair and how this matched to international guidelines. Methods: We performed a retrospective chart review of all the patients who underwent emergency hernia surgery for strangulated/incarcerated hernias in our department over a 3-year period. Adherence to guidelines was assessed looking at appropriateness of mesh utilization, as well as the appropriateness of antibiotic usage. Results: A total of 184 cases from April 1st 2018 to March 31st 2021 were included. Of these hernias 12% contained necrotic or perforated bowel, 42% contained viable incarcerated bowel, and 45% contained just incarcerated fat. The compliance to the appropriate use of mesh overall was 85%, with a variation by hernia type. The global compliance to appropriate antibiotic therapy was high, at 89.7%. With antibiotic use compliance being very high in clean wounds (95.6%), and dirty wounds (100%). But lower in clean/contaminated or contaminated wounds (36.8%). Conclusion: Compliance at our hospital was globally good. Areas of decreased compliance seem to be mostly regarding mesh use and antibiotic use in potentially contaminated fields and the concept of risk of bacterial translocation versus actual contamination, as well as in mesh use in smaller umbilical hernias. MethodsWe performed a retrospective chart review of all the patients who underwent emergency hernia surgery for strangulated/incarcerated hernias in our department over a 3-year period. All paediatric patients (age under 18) were excluded.

Rationale: Gastrointestinal stromal tumour (GIST) is the most common mesenchymal tumour of the gastrointestinal tract with 10% to 30% being malignant. Resection of GIST lesions require wide local excision to achieve negative margins. Patient concerns: A 68-year-old woman presented with acute on chronic dyspeptic symptoms, including abdominal pain, postprandial nausea, bloating, and early satiety. She did not have any history of previous malignancy or gastro-intestinal haemorrhage. The patient had no other significant past medical history. Diagnoses: Endoscopy revealed a 2 cm nodular lesion in the gastric antrum which was confirmed to be GIST on endoscopic ultrasound and computed tomography. Intervention: The 2 cm GIST was successfully resected (RO) endoscopically. Outcomes: The patient was discharged from the hospital the next day, and follow-up suggested no disease recurrence. Lessons: To the best of our knowledge, this is the first reported case of endoscopic submucosal dissection for a 2 cm GIST. The current gold standard for the majority of GISTs is laparoscopic resection, with open resection sometimes needed for larger malignant tumours with multi-visceral involvement. Endoscopic or combined endoscopic/laparoscopic techniques are evolving and may become the preferred choice for smaller lesions and for lesions in areas that are more difficult to approach surgically, such as around the esophagogastric junction and the pre-pyloric antrum.

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