Fever of unknown origin: a rare retroperitoneal cause.

The authors present a patient with fever of unknown origin and vague loin pain. Baseline investigations revealed elevated inflammatory markers and imaging eventually identified a renal mass. Radical nephrectomy was performed at a collaborative surgical list involving both the urology and vascular surgical teams. Histological examination confirmed a retroperitoneal paraganglioma and the patient made a rapid recovery and remains well at follow-up. This case draws attention to the rare diagnosis of retroperitoneal paraganglioma and the potential for diagnostic delay. Furthermore, the vital multi-disciplinary approach to the optimum management of patients with such tumours is highlighted.

The thrombosed brachial-cephalic fistula used for renal dialysis--a cautionary note.

Arteriovenous fistulae (AVF) are commonly required for dialysis prior to renal transplantation, and are subsequently left insitu, even if thrombosed. The authors present one of two patients in whom progressive digital ischaemia occurred, and was initially overlooked, many years following formation of an AVF. The patient was surgically explored and clot protruding from the thrombosed vein into the brachial artery was noted. The arterial defect was closed with a vein patch and histological examination of the fistula confirmed clot. The patient recovered satisfactorily and remained well 6 months postoperatively. The authors would suggest that embolisation from a thrombosed AVF does occur, has a significant morbidity and can lead to digital loss. Furthermore, transplant patients are usually long suffering and will often put up with what they describe as 'aches and pains' as part of their illness. The authors suggest those patients suffering with evidence of ischaemia warrant excision of the fistula.

Gallstone pancreatitis after laparoscopic cholecystectomy.

This case report describes the rare presentation of an unknown dumbbell shaped (or hourglass with diaphragmatic membrane) gallbladder presenting as gallstone pancreatitis 5 months after laparoscopic cholecystectomy for cholelithiasis and our management strategy. This case highlights the importance of ensuring adequate exposure at the time of operation to prevent such presentations.

An extreme presentation of pancreatic pseudocyst.

Pancreatitis is a serious and common presentation to general surgery departments. There are many complications associated with pancreatitis and we present an undescribed presentation of a pancreatic pseudocyst and include its management strategy.