We describe a simple system for marking up a patient for a Limberg flap for pilonidal disease treatment. The technique involves only the use of a ruler and produces a consistent marking for the flap. In our hands it has been used in over 120 cases with no failures of rotation or flap necrosis.
The majority of patients with small bowel diverticula are asymptomatic, however, associated complications include inflammation, intestinal obstruction, perforation and gastrointestinal haemorrhage. Bladder divertulae are uncommon and can herniate into the femoral or inguinal canal as well as the scrotum. We report the case of an elderly lady who underwent laparotomy for an incarcerated femoral hernia and was found to have the catheter balloon stuck into a bladder diverticulum in the femoral canal and coexisting small bowel diverticular perforation.
Peptic ulcers in the second part of the duodenum are a rare occurrence and present challenging management. Conventional surgical operations are associated with life threatening complications. We describe a case of a perforated duodenal ulcer in a medically unstable patient who was deemed unfit for lengthy definitive surgery. An emergency laparotomy and 'triple-ostomy' was performed. We recommend this procedure as an alternative for the emergency repair of D2 ulcers, especially in patients with multiple co-morbidities.
case HistoryA 57-year-old man was admitted with right sided chest pain and increasing shortness of breath. He was commenced on treatment for right middle lobe pneumonia. Twenty-four hours into admission he deteriorated and suffered increasing abdominal pain and so a surgical opinion was sought.The patient had been discharged three weeks prior to this admission following a stroke. During that previous admission he had developed pneumonia and was therefore discharged on antibiotics. Past medical history included bronchiectasis and osteoarthritis, for which he was taking diclofenac. On examination, the patient looked cachetic and unwell and had cool clammy peripheries. His pulse was 90 beats/min and regular, his blood pressure 90/50mmHg, respiratory rate 25 breaths/min, oxygen saturation 93% on 35% O 2 and he had a temperature of 37.5 o C. There was generalised abdominal tenderness with guarding and rebound. A digital rectal examination was normal.A full blood count showed a white cell count of 26.7 x 10 9
Hemorrhage from stoma due to ectopic varices is a rare condition, which can be seen in patients due to portal hypertension of any cause. Resnick et al. were the first to describe in the year 1968. Unfortunately, there has been no randomized controlled trials to formally assess the best management approach for such a condition, and conservative methods are temporary as they re-bleed within 1 year time. Definitive treatment requires a multidisciplinary team approach as they have a high mortality and morbidity rate. The treatment is aimed at reducing the portal-hypertension, which can be achieved with porto-systemic shunts.
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