Laparoscopic cholecystectomy is associated with spillage of gall stones in 5%–40% of procedures, but complications occur very rarely. There are, however, isolated case reports describing a range of complications occurring both at a distance from and near to the subhepatic area. This review looks into the various modes of presentation, ways to minimise spillage, treating the complications, and the legal implications.

The incidence of metallic rings causing genitalia strangulation has been widely reported. The removal of the constricting rings can be challenging and might need resources not usually available in the hospital. We report one such case where the assistance of a fire crew was required to remove the ring.

We have demonstrated that paediatric PEG procedures and continuing management by a supporting team can be successfully and efficiently provided in the district general hospital. It should be possible for the majority of similar hospitals to provide local access and increase the availability of PEG feeding for children.

A33-year-old woman presented with a painful lump in the right gluteal region, 7 months after normal vaginal delivery of her child. There was no history of altered bowel habits, bleeding per rectum, dyspareunia or difficult labour. On examination she was afebrile. Local examination revealed asymmetry with a tender lump in the right gluteal region and some redness of the overlying skin. Rectal examination revealed a tender right lateral rectal wall. Magnetic resonance imaging (Figure 1) revealed a 12×8×8 cm complex ‘cyst’ in the right ischiorectal fossa displacing the levator ani upward and the rectum medially, with an apparent pseudo capsule. In the T1-weighted sequences, it had higher signal intensity than the bladder. On T2-weighted sequences, the lesion was of very high intensity. Also in the surrounding fat were multiple linear foci of high intensity, representing oedema or increased vascularity. In view of the location, it was suggested that this could be an abscess. Examination under anaesthesia revealed a boggy swelling in the ischiorectal fossa. An incision to drain this abscess revealed no pus, however, a soft fatty lump protruded from the incision. The incision was extended and a soft tissue mass 12 cm in diameter was enucleated. The cavity was packed and skin incision closed after 3 days. Histopathology revealed an angiomyxoid tumour, extending to the resection margins. Subsequently she was sent to a specialist centre. Computed tomography of the chest was normal. After discussion with the patient about the possibility of incontinence and stoma, re-excision was performed. Histology suggested low grade, sarcomatous changes in a pre-existing myofibroblastic lesion, either angiomyxoma or angiomyofibroblastoma. Immunostaining was positive for desmin and weakly positive for actin and calponin. Staining for caldesmin and myogenin were negative. CD34 was present in few scattered spindle cells. No adjuvant therapy was given. She had one admission since then with a wound collection, which was drained.

We report the case of a 72-year-old man who presented with weight loss, anorexia and a change in bowel habit. Computed tomography (CT) of the chest, abdomen and pelvis demonstrated widespread thoracic and abdominal lymphadenopathy and a lesion within the splenic flexure. This was confirmed as an adenocarcinoma after a colonoscopic biopsy. A CT guided biopsy of the abdominal lymph node confirmed the adenocarcinoma. Within three days of admission, the patient developed worsening, progressive cerebellar symptoms that left the patient aphasic and bed bound. CT of the head was reported as normal. Magnetic resonance imaging of the head demonstrated widespread leptomeningeal metastases. We describe a case of isolated leptomeningeal metastasis from a colorectal primary tumour. Leptomeningeal carcinomatosis is rare following any solid organ malignancy. It most commonly occurs following breast cancer, lung cancer and melanomas.1 There is only one other report in the literature of isolated leptomeningeal metastases following colorectal cancer.2 Leptomeningeal metastases classically demonstrate diffuse seeding of neoplastic cells throughout the meninges 3 and can present with a wide range of neurological symptoms. These include visual and hearing disturbances, change in mental state, sensory abnormalities, hemiplegia and isolated cranial nerve abnormalities.3 Our case is the first in the literature that demonstrates isolated cerebellar signs associated with a colorectal primary tumour. case historyA 72-year-old man presented as a surgical emergency. He gave a six-week history of anorexia, a 9kg weight loss and a change in bowel habit. He previously opened his bowels every day but was now passing loose stools twice weekly. He had a past medical history of hypertension. Two weeks prior to his symptoms beginning, he had helped his eldest son move into a new house. On examination, he had a soft, non-tender abdomen with no palpable masses and normal neurological findings. All haematological markers were within normal limits. His alkaline phosphatase was slightly raised but all other biochemistry was normal. Both his chest and abdominal radiographs were normal. He was initially started on intravenous fluids and had an urgent computed tomography (CT) of the chest, abdomen and pelvis.CT demonstrated a thickening at the splenic flexure of the colon and widespread lymphadenopathy throughout the abdomen and thorax consistent with lymphoma (Fig 1). The case was discussed at the colorectal multidisciplinary team meeting and an urgent oesophagogastroduodenoscopy (OGD), colonoscopy and CT guided biopsy were organised. The OGD revealed two benign duodenal ulcers and gastritis. The colonoscopy demonstrated a concentric splenic flexure tumour that was biopsied and showed an adenocarcinoma