A high index of suspicion based on clinical presentation is essential to diagnose M. fortuitum as a cause of soft tissue infection. Treatment involves aggressive surgical debridement and administration of combination antibiotics based on sensitivity, which should be continued for a period that will ensure complete healing and prevent recurrence.

Choledochal cyst should be considered in all patients below 40 years of age presenting with biliary colic, pancreatitis or recurrent cholangitis with associated dilatation of bile duct. Complete excision of the cyst with restoration of biliary-enteric communication by hepaticojejunostomy form the basis of ideal treatment.

Local application of formalin is a simple, safe, inexpensive and fairly effective outpatient treatment modality for chronic radiation proctitis.

No abstract

Biliary papillomatosis is a rare condition usually detected on imaging or postoperative histopathology. It may be asymptomatic or present with features of cholangitis. We report the management of a patient presenting with haemobilia.We report a rare case of benign biliary papillomatosis (BP) in a choledochal cyst. Papillomatosis arising from the intrahepatic portion of a choledochal cyst presenting with haemobilia has not been reported before. Case historyA 57-year-old woman presented initially with periumbilical pain that had lasted for a week. She also complained of tiredness but did not have loss of weight or appetite. Imaging in another hospital had revealed common bile duct thickening with intrahepatic biliary radicle dilatation and biliary sludge. She was suspected of having cholangiocarcinoma and underwent endoscopic retrograde cholangiopancreaticography (ERCP) with stent placement.General and systemic examination and blood tests were non-contributory. Magnetic resonance cholangiopancreaticography with computed tomography of the abdomen (MRCT) showed dilatation of the common bile duct and left hepatic duct (LHD). There were multiple hyperdense lesions in the LHD suggestive of intrahepatic stones (Figs 1 and 2).The patient was offered cholecystectomy, cholangioscopy, extraction of the hepatolithiasis and hepaticojejunostomy. She came back for the operation four months later. She was pale with a history of two episodes of melaena. Her haemoglobin was 5.7g% and her blood picture was consistent with iron deficiency anaemia. The coagulation profile was normal. Oesophagogastroduodenoscopy, colonoscopy and review of MRCT of the abdomen did not reveal the source of bleeding. She was diagnosed with obscure gastrointestinal bleeding and on-table enteroscopy was added to the plan of operation.