Early surgery has been recommended by most authors for fractured penis. Because of gross swelling of the penis, early surgery might have to be performed with an extensive degloving incision of the penis to enable better exposure. We report a case in which the man presented late with deformity and pain. Simple repair at that stage provided a good result in this patient; hence, it might be possible to repair a fractured penis at a later stage without degloving the penis. Additionally, this presentation could probably explain the pathogenesis of the ''rolling sign'' described by us earlier.

Small bowel volvulus is a rare but life-threatening surgical emergency. Owing to its rarity, it is seldom entertained as a differential for small bowel obstruction. The aetiology may be either primary or secondary, with secondary being more common in the Western world. Prompt diagnosis and urgent surgical treatment is required if bowel necrosis is to be prevented, which is associated with increased mortality. We present a case of primary ileal volvulus with a gangrenous segment and a brief overview of the current literature.

Pacing and defibrillation leads may need to be removed for several reasons including infection, interference with others leads, lack of vascular access or redundancy. However, the removal of chronically implanted leads is a major technical challenge because of the extensive adhesions that develop along the course of the leads over time. The techniques to remove chronic leads have been greatly facilitated by the development of an excimer laser sheath. We undertook an analysis of our experience with laser extraction in the first 50 leads attempted. An excimer laser sheath system, developed by the Spectranetics Corporation, was used to extract 50 chronically implanted leads in 34 patients. The mean patient age was 64+/-12 years, all were male and the average duration that the leads had been implanted was 5.0+/-3.9 years. Two-thirds of the leads were pacemaker and one-third were defibrillator leads. There was a 100% clinical success rate and 48 of the 50 leads were completely removed. There were no major complications. There was one minor complication of subclavian vein thrombosis and two haemodynamically non-significant episodes of air embolism. The main limitation observed was failure of the excimer laser sheath to advance in 18% of cases, probably due to the presence of calcified adherences on leads. Two strategies were found useful to deal with this problem: under the clavicle stainless-steel sheaths were used to break up calcified adherences and within the venous system the laser sheath was upsized in order to advance over the calcification on the lead. It was concluded that excimer laser has greatly facilitated the removal of chronically implanted pacemaker and defibrillator leads. There is a high success rate and low complication rate in our experience. The main limitation of laser is the presence of calcified adherences.

The study suggests that if stringent measures are taken to shorten the operating time, LC can be safely and effectively performed in SCD patients with minimal perioperative complications.

Objective: The first world witnessed a laparoscopic revolution in the 1990s. At the start, laparoscopic surgery was heavily criticized and ridiculed. Despite this, the specialty has blossomed where almost any procedure can be done laparoscopically with the now obvious tremendous benefit to the patients. The objective of this paper is to examine where the Caribbean is placed relative to the rest of the world in terms of laparoscopic surgery and to understand why we are here. Design and Methods: The literature written on laparoscopy in the region was reviewed and contributions were taken from key surgeons in three main islands, Trinidad and Tobago, Barbados and Jamaica. Results: Though the first laparoscopic cholecystectomy in the Caribbean, in most islands, took place in the early 1990s like the rest of the world, there was relative dormancy for at least a decade in Trinidad and Tobago and even longer in other islands with regards to implementing advanced procedures or increasing case volumes. Reasons for this included lack of funding, lack of operating time in public facilities, lack of information of the public and the medical fraternity but most importantly lack of trained laparoscopic surgeons. This last factor was proven to be the key one in Trinidad and Tobago in 2003, Jamaica 2005 and Barbados 2011, when the return of trained personel engineered the transition from basic to advanced laparoscopy. Conclusion: Despite the delay of approximately 10 years in Trinidad and Tobago and 15 years in other islands, the return of trained surgeons has seen a rapid increase in case variety and volumes in laparoscopy. The wheels of motion of the laparoscopic revolution in the Caribbean have finally begun. RESUMENObjetivo: El primer mundo fue testigo de una revolución laparoscópica en los años 1990. Al comienzo, la cirugía laparoscópica fue muy criticada y ridiculizada. A pesar de ello, la especialidad ha florecido, siendo el caso que ahora casi cualquier procedimiento puede hacerse laparoscópicamente, con evidentes grandes beneficios para los pacientes. El objetivo de este trabajo es examinar donde se encuentra el Caribe en relación con el resto del mundo en lo que se refiere a la cirugía laparoscópica, y asimismo el por qué nos hallamos en ese lugar. Diseño y Métodos: Se examinó la literatura sobre laparoscopia escrita en la región, y se tomaron contribuciones de cirujanos claves de tres islas principales, a saber, Trinidad y Tobago, Barbados y Jamaica. Resultados: Aunque las primeras colecistectomías laparoscópicas en la mayoría de las islas del Caribe, tuvieron lugar a principio de los años 1990 como en el resto del mundo, hubo un período de relativa inactividad por espacio de casi una década en Trinidad y Tobago, y aun por más largo tiempo en otras islas, en relación con la implementación de procedimientos avanzados o el aumento del volumen de casos. Las razones para esta relativa inactividad incluyeron la falta de fondos, la falta de tiempo de operación de los centros públicos, la falta de información del público y l...

Splenic cysts are relatively uncommon entities in surgical practice and treatment options vary. We present a case of a young adult woman who presented with a left-sided abdominal mass. A large splenic cyst was diagnosed by abdominal ultrasound and computed tomography. Laparoscopic partial excision with marsupialisation was performed with uneventful recovery and minimal blood loss. Histopathology revealed an epidermoid cyst of the spleen. This report describes the case, and includes a short review of the literature. Laparoscopic partial excision with marsupialisation is a safe and appropriate method of treatment for large splenic cysts.

Colonic volvulus usually occurs as a single event that can affect various parts of the colon. The usual sites affected being the sigmoid colon (75%) and the caecum (22%). The phenomenon of multiple sites simultaneously undergoing volvulus is an extremely rare occurrence. Synchronous double colonic volvulus is extremely rare and to the best of our knowledge, this is the 4th reported case of simultaneous sigmoid and caecal volvulus in the English literature. The clinical presentation and the radiological findings are that of large bowel obstruction. Classic radiological findings may not be present or may be overlooked due to its rarity. Treatment of this condition is early surgical intervention to prevent the sequalae of a colonic volvulus and its associated mortality. We report a case of an 80-year-old man with synchronous volvulus of the sigmoid colon and caecum.

Solid pseudopapillary neoplasms of the pancreas are uncommon, accounting for only 1-2% of all pancreatic neoplasms. These tumors are being detected at an increased rate, probably due to the increased awareness and the liberal use of imaging. We report two cases of patients with solid pseudopapillary pancreatic tumors and review the existing literature.