The implementation of a SAPU has benefited the management of patients with acute surgical conditions. Ultimately, patient care is enhanced, with patients being reviewed, admitted, and treated earlier.

Aim To review the use of Rouviere's sulcus as an anatomical guard during laparoscopic cholecystectomy. Patients and Methods Anatomical review, not directly involving patients. A review of major anatomical texts, surgical texts and the pubmed database was conducted for all texts or articles pertaining to Rouviere's sulcus. Results The use of Rouviere's sulcus during laparoscopic cholecystectomy results in an additional anatomic guard against biliary tract injury, however proper anatomical exposure is required to maximize the utility of this landmark. Conclusion When combined with other anatomical guards, Rouviere's sulcus is a useful adjunct in the prevention of biliary tract injury.

A 72-year-old Caucasian man was transferred from Trangie Hospital with 7 h history of generalized abdominal pain. It was associated with hypotension. There was no history of fever, vomiting, change in bowel habit or weight loss. He has history of type 2 diabetes mellitus, hypertension, atrial fibrillation (AF), obstructive sleep apnoea and ischaemic heart disease. He is on warfarin for AF. He lives with his wife in Trangie independently. He is an occasional drinker and ex-smoker.On examination, he was afebrile, blood pressure was 70 mmHg systolic and heart rate was 100/min. Abdomen was soft and palpable mass in right lower quadrant was identified. He was taken straight to computed tomography (CT) after resuscitation. CT abdomen and pelvis showed a large (>20 cm) haematoma in the right of the abdomen, with active bleeding in the region of the gastroduodenal artery (GDA). An aneurysm is seen in the superior margin of the collection (Fig. 1).His blood tests showed haemoglobin was 81, white cell count was 13.5 and international normalized ratio was 4.5. He was found to have metabolic acidosis with pH of 7.18 and lactate of 6.5. He was given 2 units each of packed red blood cells and fresh frozen plasma, Fig. 3. Cross-sectional CT showing pancreatic pseudocyst.

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