Bilateral spontaneous rupture of the muscular branch of the superficial femoral artery with pseudoaneurysm formation.

Superficial femoral artery muscular branch avulsion may occasionally be associated with blunt trauma in the absence of fractures or even minor injuries. Spontaneous rupture of the superficial femoral artery or its muscular branches is extremely rare, with only five previously reported cases. We report the first case of bilateral spontaneous rupture of the muscular branch of the superficial femoral artery with pseudoaneurysm formation in a young, healthy patient. The patient denied any history of trauma to both his lower limbs. On both occasions, the patient had early surgical intervention with open evacuation of the hematoma and ligation of the avulsed artery. The patient recovered completely without any postoperative complications.

Traumatic epidural emphysema.

STUDY DESIGN: This is a case report. OBJECTIVE: A rare case of epidural emphysema secondary to traumatic pneumomediastinum in the absence of pneumothorax is reported. SUMMARY OF BACKGROUND DATA: Epidural air secondary to traumatic pneumomediastinum in the absence of pneumothorax has only been reported previously by Willing. Other causes of traumatic epidural emphysema include pneumothorax, pelvic fracture, dural enteric fistula, and herniation of a spinal disc. METHODS: A young man who sustained blunt cervical and chest trauma after a basketball game accident was found to have pneumomediastinum and surgical emphysema on a chest radiograph and underwent computed tomography (CT). RESULTS: The CT scan demonstrated surgical emphysema, pneumomediastinum, and epidural emphysema with no pneumothorax. The patient was managed conservatively, and the epidural emphysema and pneumomediastinum resolved spontaneously. CONCLUSION: Epidural emphysema secondary to traumatic pneumomediastinum is benign and self-limiting. However, the life-threatening causes should be considered and ruled out.

Delayed presentation of a patient with a ruptured diaphragm complicated by gastric incarceration and perforation after apparently minor blunt trauma.

Rupture of the diaphragm is almost always due to major trauma and is most commonly associated with road-traffic accidents. We report a case of delayed presentation of a 35-year-old woman with a ruptured diaphragm, 11 days following apparent minor blunt trauma. This case illustrates how the diagnosis of ruptured diaphragm can be missed and demonstrates the importance of considering this diagnosis in all cases of blunt trauma to the trunk. It also demonstrates the potential pitfall of misinterpreting the chest radiograph, and the value of repeat imaging after insertion of a nasogastric tube.

Adult intussusception: experience in Singapore.

INTRODUCTION: Gastrointestinal intussusception is an uncommon clinical entity in adults and is interestingly distinct from its paediatric form. In adults an identifiable lead lesion is found in the majority of cases, of which a significant percentage are malignant. Its treatment is thus different from that of paediatric intussusception. The present study reviews our experience of treating adult intussusception. METHODS: A retrospective review of patients with a postoperative diagnosis of gastrointestinal intussusception between January 1997 and December 2002 was conducted. All patients under the age of 18 and cases of rectal prolapse were excluded. RESULTS: During the 5-year period, there were nine cases of intussusception. There were four male and five female patients, with a mean age of 63.8 years (range 37-85 years). Less than half of the patients (44.4%) presented with acute symptoms. The most common symptoms were abdominal pain and distension. The symptoms were intermittent in 77.8% (7 of 9) of patients. Only two patients had a palpable abdominal mass, while another had signs of acute intestinal obstruction. Computed tomography was the most useful imaging modality, identifying intussusception in six out of six patients. Eight patients had lead lesions occurring at the ileocaecal junction resulting in ileo-colonic intussusception. Of these eight, four were malignant (two adenocarcinomas and two lymphomas). There was one sigmoid-rectal intussusception secondary to adenocarcinoma. All patients were treated operatively. Seven patients were treated with en bloc resection. CONCLUSION: Although uncommon, surgeons need to be aware of the epidemiology and treatment options for adult intussusception. The symptoms and signs are often non-specific and the surgeon might be faced with the diagnosis only at laparotomy. Computed tomography is the most useful imaging modality. An identifiable organic lesion is present in most cases, of which more than 50% are malignant (especially in the large bowel). Operative treatment is thus prudent. En bloc resection is recommended for ileo-colonic and colo-colonic intussusception. There is, however, a role of initial reduction in selected patients with ileo-ileal intussusception.