SUMMARYAn otherwise healthy 45-year-old man presented to our emergency department holding his left arm in abduction and external rotation. He reported pain in his left shoulder and chest for the preceding 10 days that had become much worse over the last 48 h and was eased only by holding his arm in this position. The CT of the chest revealed soft tissue swelling around the left sternoclavicular joint consistent with sternoclavicular joint septic arthritis with significant inflammatory involvement of the medial component of the left pectoralis major muscle. The patient was taken to theatre for washout of the left sternoclavicular joint and is currently recovering well at home on intravenous antibiotics.
BACKGROUND
Background: Horse and cattle-related trauma is a common presentation to regional hospitals in Australia. We review local incidence and patterns of injuries relating to horse and cattle trauma over a three-year period at the Toowoomba Base Hospital within the Darling Downs region in Queensland, an area rich in cattle farming and equestrian recreation.
Methods: We conducted a single-centre retrospective cohort study. The inclusion criteria were all patients presenting with injuries following cattle or horse-related incidents between January 2018 and April 2021. Primary outcomes were the mechanism of trauma, confirmed injuries, and the need for admission, operative intervention, or inter-hospital transfer.
Results: A total of 1002 individuals (55% female; mean age 34 years; median Injury Severity Score (ISS) 2) were identified during the study period. Presentations relating to horses (81%) were more frequent than cattle (19%). The most common mechanism of injury was "falling" for horse incidents (68%) and "trampling" for cattle incidents (40%). Horse incidents often resulted in soft tissue injury (55%), upper limb fracture (19%), or lower limb fracture (9%). Cattle incidents often resulted in soft tissue injury (57%), upper limb fracture (15%), and rib fracture (15%). Overall, 14% required admission, 13% required operative intervention, and 1% required inter-hospital transfer.
Conclusions: This local series demonstrates a high volume of cattle and horse-related trauma in our region. Whilst most patients are managed locally without operative intervention, the high frequency of injuries observed necessitates further development of preventative measures and safety advocacy.
Colorectal malignancies are a common general surgical presentation. However, synchronous colorectal cancers are less frequent and typically account for only 3.5% of all colorectal cancers. Of these 3.5% of synchronous colorectal cancers, only approximately 4% are incidental appendiceal malignancies. An 80-year-old gentleman presented with abdominal pain and distension to the emergency department. On examination, the patient had a peritonitic abdomen and a CT scan revealed a large bowel obstruction secondary to sigmoid and rectal neoplasms, concerning for a closed loop obstruction. He underwent an emergency laparotomy and Hartman's Procedure. Intraoperatively the tip of the appendix appeared dilated and was removed. Histology revealed T3N0M0 synchronous sigmoid and rectal cancers, as well as a low-grade appendiceal mucinous tumour. Whilst synchronous colorectal malignancies are a relatively common presentation they typically present in adjacent segments of bowel. They are less frequently seen in association with incidental appendiceal malignancies and no cases have been published in combination with a closed loop large bowel obstruction. This is the first published case of three synchronous colorectal cancers causing a closed loop large bowel obstruction.
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