Partially avulsed anus in blunt traumatic perineal laceration: Case report.

Blunt civilian perineal laceration with anorectal avulsion is rare and usually associated with severe pelvic trauma. The principles of management of these injuries consist of repair of the laceration (primarily or secondary), diversion of fecal stream, and presacral drainage of the wound. Unnecessary diversion of fecal stream may add complications and increases patient's morbidity. We report a case of severe blunt traumatic perineal laceration associated with partially avulsed anus which was managed without colostomy. The wound healed completely with preserved anal sphincter function. To our knowledge, no similar cases of anal avulsion were treated without diversion of the fecal stream in the English literature.

Gallstone Dislodgement in the Airway during ERCP: A Case Report and Review of the Literature.

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic procedure with many studied complications. We are presenting a rare complication of ERCP in choledocholithiasis: gallstone dislodging into the airway upon retrieval. The patient is a 37-year-old female admitted with obstructive jaundice. She was evaluated, and her management plan included a referral for an ERCP to extract the impacted common bile duct stones. Upon retrieval of the gallstone, it fell out the basket and lodged into the airway which was confirmed on bronchoscopy and successfully retrieved. This report describes successful management of a rare but potentially dangerous complication of ERCP to remove impacted CBD stones. The possible complications of delayed removal or inability to remove gallstones from the airway have yet to be studied and reported but are likely to include recurrent chest infections, bronchiectasis, and empyema of the lung.

The evolution of surgical training in the UK.

Surgical training in the UK has undergone major reforms over the last few decades. The focus has shifted from time based training to competency based training programs. This paper discusses the transformation of assessment in surgical training in the UK from the apprenticeship model to a more objective workplace-based assessment model. The paper describes the different milestones during this transformation process and discusses the assessment of surgical and nonsurgical skills in a measurable way; moreover, it highlights the strengths and weaknesses of different assessment tools.

Antibiotics versus appendectomy in the management of acute appendicitis: a review of the current evidence.

BACKGROUND: Acute appendicitis remains the most common cause of the acute abdomen in young adults, and the mainstay of treatment in most centres is an appendectomy. However, treatment for other intra-abdominal inflammatory processes, such as diverticulitis, consists initially of conservative management with antibiotics. The aim of this study was to determine the role of antibiotics in the management of acute appendicitis and to assess if appendectomy remains the gold standard of care. METHODS: A literature search using MEDLINE and the Cochrane Library identified studies published between 1999 and 2009, and we reviewed all relevant articles. The articles were critiqued using the Public Health Resource Unit (2006) appraisal tools. RESULTS: Our search yielded 41 papers, and we identified a total of 13 papers within the criteria specified. All of these papers, while posing pertinent questions and demonstrating the role of antibiotics as a bridge to surgery, failed to adequately justify their findings that antibiotics could be used as a definitive treatment of acute appendicitis. CONCLUSION: Appendectomy remains the gold standard of treatment for acute appendicitis based on the current evidence.

Urachal fistula presenting as umbilical sepsis: a rare case in an adult male.

BACKGROUND: Urachal anomalies are rare normally presenting during childhood. They are difficult to diagnose and surgical treatment is always needed to prevent recurrence. CASE REPORT: A 28 year old male presented with a red tender umbilical swelling that was confused with an umbilical hernia. The correct diagnosis of a urachal fistula was reached after performing a CT scan. The patient was initially treated with oral antibiotics and complete surgical excision of the fistulous tract was carried out at a later stage after controlling the infection. CONCLUSIONS: Staged resection is the treatment of choice in urachal anomalies associated with sepsis. Surgical excision of the urachal remnant is necessary to prevent recurrence.