The management of injury to the distal tibiofibular syndesmosis remains controversial in the treatment of ankle fractures. Operative fixation usually involves the insertion of a metallic diastasis screw. There are a variety of options for the position and characterisation of the screw, the type of cortical fixation, and whether the screw should be removed prior to weight-bearing. This paper reviews the relevant anatomy, the clinical and radiological diagnosis and the mechanism of trauma and alternative methods of treatment for injuries to the syndesmosis.

Even though surgery for diastasis is controversial, we advocate repair for cosmesis and restoring function of the recti muscles. Our 'Venetian blinds' technique provides a solid repair and reduces the risk of seroma. The use of a prosthesis for the repair is mandatory to prevent recurrence. The adequacy of repair was assessed by measuring the IRD preoperatively and postoperatively with computed tomography (CT) scan. Laparoscopy provides all of the benefits of minimal access surgery.

It is well known that bronchogenic carcinoma frequently metastasises to the bony skeleton, but it is most unusual for it to present in the form of a musculoskeletal abscess. Presented here is the case report of a patient with what appeared initially to be a right sided gluteal abscess and which turned out to be the metastasis from a bronchogenic carcinoma. The Magnetic Resonance Image (MRI) scan carried out proved to be very helpful in arriving at a probable clinical diagnosis; however, it was histopathological studies of the abscess wall itself that ultimately gave the definitive diagnosis. We believe that this may represent one of the first documented cases in which on MRI scan has been used to confirm the presence of a gluteal abscess.

Laparoscopic cholecystectomy is the gold standard for managing cholecystolithiasis, despite being associated with a higher incidence of gallbladder perforations (10 % -40 %) [1] and spillage of gallstones (6 % -30 %) than is the open procedure. Although rare (0.08 % -0.3 %) [2], gallstone spillage could potentially lead to serious morbidity such as gallstone abscesses, which can present from as early as 1 month to as late as 20 years after the procedure, almost anywhere in the abdominal cavity [3]. A female patient underwent an apparently uneventful laparoscopic cholecystectomy 3 years back. She was referred to us with clinical and radiological signs suggestive of "residual" cholecystitis. Her magnetic resonance cholangiography showed an apparently anatomically intact gallbladder containing multiple stones and a low-inserting cystic duct with features suggestive of calculous cholecystitis (l " Fig. 1 and Fig. 2). The coronal section (l " Fig. 3) confirmed these findings. However, to our surprise, diagnostic laparoscopy revealed a walled-off abscess cavity at the gallbladder fossa containing 30 -40 ml frank pus with multiple gallstones giving a deceptively identical appearance to a "nonextracted" gallbladder. There was no trace of residual actual gallbladder or cystic duct. The patient recovered well after laparoscopic drainage of the abscess with removal of stones. This unique postcholecystectomy appearance of MR images could have confused the second surgeon while putting the previous surgeon at a risk of serious litigation. It could well be called a "pseudo" cholelithiasis. Such a deceptive appearance has not been reported before. In today's era of laparoscopic cholecystectomy, if this possibility were to be considered, it would reduce the number of false-positive diagnoses of "residual" cholelithiasis wherein a diagnostic laparoscopy and drainage (as in this case) could significantly reduce the access trauma. However, gallbladder perforation should be avoided as far as possible. If it occurs, all spilled stones should be retrieved and the patient informed. Moreover, routine use of endobags for specimen retrieval is strongly recommended in all laparoscopic cholecystectomies to avoid such potentially morbid sequelae.

No abstract