An 86-year-old woman presented three years after laparoscopic cholecystectomy with right upper quadrant pain and raised inflammatory markers. Liver function tests were normal; however, a previous ultrasound scan suggested a common bile duct stone so she was treated for cholangitis secondary to choledocholithiasis. Repeat ultrasound scan again showed a common bile duct (CBD) stone and also a subdiaphragmatic abscess. CT scan confirmed the abscess, associated with a surgical clip from her previous surgery. There was no evidence of a persistent CBD stone on the CT scan. She was treated conservatively with intravenous antibiotics and her symptoms improved. Follow-up MRI did not show any choledocholithiasis. Surgical clips causing delayed abscess formation are very unusual. We discuss the presentation, investigations and treatment of this interesting case. Existing relevant literature is reviewed, and management strategies to treat such rare complications are suggested.
We present the case of an unusual complication of insertion of a naso-jejunal feeding tube (NJT) using a guidewire, where the guidewire formed an alpha-loop in the naso-pharynx, becoming entrapped after cutting into the soft palate. This required ENT input and a general anaesthetic to rectify the situation.
SUMMARYAxillary artery aneurysms are extremely rare. We report a case of an axillary artery aneurysm in a keen rugby player who had previous internal fixation of the shoulder for recurrent dislocation.
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