Large bowel obstruction (LBO) after colorectal surgery draws wide differentials. To our knowledge, LBO due to blind colonic limb mucocele of a side-to-end colorectal anastomosis has not yet been described. We report a man in his late 50s presenting with pain, abdominal distension and constipation. He had extensive surgical history; notably, a side-to-end colorectal anastomosis was fashioned following Hartmann-type colostomy reversal. CT and MRI suggested a mucus-filled short blind colonic segment compressing the anastomotic site and causing LBO. Flexible sigmoidoscopy under general anaesthesia showed external rectal compression and lumen narrowing. Transrectal needle aspiration of the blind segment yielded 145 mL of mucoid fluid. The patient’s symptoms improved and he was discharged with outpatient Gastrografin enema and flexible sigmoidoscopy which confirmed successful blind segment emptying. This case highlights that blind colonic loop mucoceles in colorectal anastomosis can rarely cause obstruction, and endoscopic management is feasible when accurate diagnosis is confirmed on imaging.
Introduction: Testicular torsion is a time-sensitive surgical emergency. Assessment of the acute scrotum warrants rapid surgical review and low threshold for surgical intervention.Materials and methods: A retrospective cohort study was undertaken for a three-month period during the first wave of the 2020 COVID-19 pandemic and the corresponding period in 2019. Data were collected for all scrotal explorations undertaken at our non-urological centre during this time.Results: Sixteen scrotal explorations were performed from April to June 2019, one had testicular torsion (6.25%). Forty-one explorations were performed from April to June 2020, nine had testicular torsion (21.95%). The most common diagnosis was epididymitis or epididymo-orchitis in 2019 and 2020 (27% and 37.5%, respectively). Sixty-two percent of patients presented within 12 hours in 2019 compared to only 37% during the first wave of the coronavirus disease 2019 (COVID-19) pandemic.Conclusion: This study found an increase in the number of patients presenting with acute scrotal pain triggering surgical intervention and the number of patients with testicular torsion. This is likely to reflect a decrease in patients able to access primary care assessment but may also be related to COVID-19. There was a marked delay in the presentation which has significant implications for testicular viability.
Background Large bowel obstruction (LBO) after colorectal surgery draws wide differentials. Very few reports of LBO secondary to closed loop mucocele have been published. To our knowledge, LBO due to mucocele of the blind colonic limb of a side-to-end colorectal anastomosis has not been described. Case Details A 57-year-old man presented with pain, gradual abdominal distension and one week history of constipation. He had extensive surgical history – colo-vesical fistula takedown, sigmoid resection and Hartmann type end colostomy followed by reversal, and mesh repair of incisional ventral hernia among others. Notably, a side-to-end configuration was fashioned as a descending colo-rectal anastomosis. CT, followed by MRI scans, of the abdomen and pelvis respectively suggested a mucus-filled short blind colonic bowel segment compressing the anastomotic site as the cause of large bowel obstruction proximal to the site. On flexible sigmoidoscopy under general anaesthesia, external compression of the rectum with narrowing of the lumen was noted. Transrectal needle aspiration of the blind colonic segment yielded 145 mL of mucoid fluid and allowed proximal examination. Anastomotic site was of normal calibre. The patient's symptoms improved and he was discharged with scheduled outpatient follow-up. Gastrografin enema post-discharge demonstrated an end-to-side rectosigmoid anastomosis with local rectal stenosis and showed the blind loop had emptied. Conclusion This case highlights that blind colonic loop mucoceles in colorectal anastomosis can rarely cause obstruction and endoscopic management is feasible when accurate diagnosis is confirmed on imaging.
Introduction Idiopathic omental infarction is a very rare cause of abdominal pain in the pediatric age group. We report a case of suspected acute appendicitis in an 8-year-old child, noted to have omental infarct on diagnostic laparoscopy. Case presentation An 8-year-old male child with no other medical issues presented to the acute surgical take with a 2-day history of right iliac fossa pain. The pain was of sudden onset and there were no other associated urinary or bowel symptoms. On clinical examination, there was right iliac fossa tenderness. There were mildly raised inflammatory markers. An ultrasound scan performed showed a possible blind-ending tubular structure measuring 7mm in the right iliac fossa with a small amount of free fluids. A presumptive diagnosis of acute appendicitis was made and the patient was taken to theatre. Upon diagnostic laparoscopy, we noted blood in the RIF with a normal-looking appendix and area of omental infarction adjacent to the appendix. We proceeded to excise the area of mesenteric infarction using an energy device. The appendix was removed to avoid future diagnostic confusion. Conclusion Idiopathic omental infarction is an extremely rare cause of abdominal pain in children and may mimic acute appendicitis. Ultrasound imaging may be misleading. Laparoscopic exploration allows for accurate diagnosis as well as treatment.
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