SummaryBackground:Splenic rupture is a potentially life-threatening condition, often associated with chest or abdominal trauma. Spontaneous rupture is very rare and is usually reported as being secondary to underlying pathological conditions.Case Report:We discuss the case of a 56 year old man who presented with sudden onset left-sided abdominal pain, with no history of trauma.Conclusions:A computed tomography (CT) of the abdomen revealed a ruptured spleen with free fluid in the abdomen. Conservative management was ineffective and the patient underwent laparotomy and splenectomy, followed by routine post-splenectomy management. He was discharged home and remains well.
Gastrointestinal stromal tumours (GISTs) are rare. GISTs comprise 0.2% of gastrointestinal tumours and only 0.04% of small intestinal tumours. Jejunal GISTs are the rarest subtype. Only 10–30% progress to malignancy [Choi (Response evaluation of gastrointestinal stromal tumors. Oncologist 2008;13:4–7)]. We present a 70-year-old male, with multiple co-morbidities, who had extensive investigations over 5 years for vague abdominal pain. All investigations were normal. He presented with symptoms and signs of small bowel obstruction (SBO), confirmed on a computed tomography scan and demonstrated to be secondary to lesion-induced intussusception. The patient had emergency small bowel resection, was discharged after 4 days and remains well. This case report highlights the rarity of jejunal GISTs and, as extensive initial investigation yielded all false-negative results, indicates the difficulty in diagnosing jejunal GISTs. Adhesions are the commonest cause of SBO in patients with previous abdominal surgery, followed by newly diagnosed malignancies [Beardsley et al. (Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored. Am J Surg 2014;208:243–8)]. Consequently, in patients with a virgin abdomen, underlying tumours should be considered.
Mesenteric cysts are rare, benign gastrointestinal cystic lesions, which are often non-troublesome and present as an incidental radiological finding. However, surgery is often performed in the acute setting to remove lesions that are symptomatic. This report highlights the case of a large, symptomatic mesenteric cyst managed successfully with initial conservative measures followed by planned elective surgery. A 44-year-old female presented with a four-day history of generalised abdominal pain associated with distension, fever, diarrhoea and vomiting. Computer tomography revealed a large (21.7 cm × 11.8 cm × 14 cm) mesenteric cyst within the left abdomen cavity. She was admitted and treated conservatively with intravenous fluids and antibiotics for four days, which lead to complete symptom resolution. Follow-up at intervals of one and three months revealed no return of symptoms. An elective laparotomy and excision of the mesenteric cyst was then scheduled and performed safely at nine months after the initial presentation. Compared to acute surgery, acute conservative management followed by planned elective resection of a symptomatic mesenteric cyst may prove safer. The withholding of an immediate operation may potentially avoid unnecessary operative risk and should be considered in patients without obstructive and peritonitic symptoms. Our case demonstrated the safe use of initial conservative management followed by planned elective surgery of a mesenteric cyst found in the acute setting, which was symptomatic but was not obstructive or causing peritonitic symptoms.
Background Given the risk of surgical site infection (SSI), the use of mesh in contaminated ventral hernia repair (VHR) is not standardized and still a clinical dilemma. This meta-analysis aimed to assess whether mesh use increased the risk of SSI in patients following VHR in contaminated field. Methods We performed a systematic review of published literature. Studies comparing the mesh repair and anatomic repair, the use of mesh in different Center for Disease Control and Prevention (CDC) wound classes and mesh repair with synthetic mesh or other type of meshes to treat complicated and contaminated VHR were considered for analysis. The main outcome was SSI incidence. Results Six studies compared mesh and suture repairs. No significant difference in SSI incidence was observed between patients with complicated VHR in the mesh and suture repair groups. Five studies analyzed mesh repair in patients by field contamination level. There was no significant difference between the use of mesh in clean-contaminated, contaminated and dirty field versus clean wound class. Moreover, there was no significant difference between the use of mesh in clean-contaminated and contaminated cases. Four studies compared mesh repair technique with synthetic mesh or other type of meshes were included. The incidence of SSI was significantly lower in the synthetic mesh group. Conclusions The use of mesh repair in the management of complicated VHR compared to suture repair is not associated with an increased incidence of SSI even in potentially contaminated fields.
A 37-year-old incarcerated man presented to the accident and emergency department following the deliberate ingestion of eight cylindrical batteries. He also admitted to inserting a razor blade wrapped in cling-film into his rectum; in addition, he sustained a self-inflicted laceration to his left antecubital fossa, using the metal casing from a battery. His medical history included a borderline and emotionally unstable personality disorder. He had ingested several batteries 12 months previously and required an emergency laparotomy to retrieve them. On the present admission, as there was no clinical evidence of small bowel obstruction, he was treated conservatively with serial radiographs. Following conservative management, the batteries failed to progress through the gastrointestinal tract, hence a laparotomy was performed and all the batteries were extricated. This paper discusses the management and associated sequelae of patients presenting following the intentional ingestion of a battery.
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