Totally laparoscopic resection for diverticular fistulae is safe and feasible. Fistulae should not be considered as a contraindication to laparoscopic resection for an experienced laparoscopic surgeon.

IntroductionCervical spine fractures and dislocations are uncommon injuries that can have serious neurological consequences. These injuries require adequate stabilisation to prevent further spinal cord injury during transfer between hospitals. Evacuation often requires a combination of road ambulance, helicopter and fixed wing aircraft from military hospitals. This paper outlines the neck injuries sustained during Op Telic and discusses the need for Halo vests to be available at Role 3. MethodologyThe MND(SE) Hospital databases were used to identify all casualties admitted with either a "Cervical" or "Neck" injury. The databases covered the period from 24 March 2003 until 15 April 2004. The diagnoses were categorised into minor and serious cervical spine injuries. We defined a serious cervical spine injury as either a fracture or dislocation. We looked at the discharge letters of all casualties evacuated to a Role 4 hospital to confirm whether the casualties had serious cervical spine injuries. ResultsForty seven casualties were admitted and all were British except three, two Iraqi civilians and one US soldier.Thirty three casualties were returned to their unit for duty, or discharged at the airhead on return to the UK. Fourteen casualties required hospital treatment. There were five serious cervical spine injuries over the study period which included one Hangman's fracture of C2, one flexion compression injury of C5, one flexion compression injury of C7,one unifacetal dislocation and one bifacetal dislocation. ConclusionsFive casualties were treated at MND(SE) Hospital for serious injuries to the cervical spine. Two patients were transferred without Halo stabilisation after failing to obtain halos in Iraq. One casualty was kept until a Halo was flown out from the UK.

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The patient very soon rallied after the operation the stump was enveloped in cotton wool, and was kept somewhat raised for about a fortnight. The ligature came away on the sixteenth day: there was no recurrence of bleeding, and the patient progressed favourably afterwards.The reasons that induced me in this instance to tie the common femoral artery, instead of stripping open the stump, and searching for the bleeding vessel, were, the prostrate condition of the patient, the facility of the operation, the small quantity of blood that would be lost during its performance, and the probability that the bleeding came from some large branch of the profunda. During the operation not half an ounce of blood was lost. Had the stump been laid freely open, the severity of the operation, and the large amount of blood that would have escaped from a number of small vessels, and probably from the artery that had given way, might, in the enfeebled state of the patient, have brought on a fatal termination.

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