Management of epistaxis: a guide for junior doctors.

Epistaxis is commonly seen as an acute presentation to the emergency department. The level of severity can range from a minor ooze to a life-threatening bleed. The initial management is often the responsibility of junior doctors working in otolaryngology or the emergency department, so they must be familiar with the initial steps in treating this often distressing condition. The COVID-19 pandemic has complicated matters further as much of the management takes place in the upper airway. This article outlines the key considerations in the management of epistaxis, especially during the COVID-19 pandemic.

Spontaneous gastric perforation in an 11-year-old boy with anorexia nervosa: rare presentation with right iliac fossa pain.

Spontaneous gastric perforation is rare in children. It is usually associated with prematurity, foreign bodies and trauma. Anorexia nervosa (AN) can be an underlying condition although no cases are reported in the literature. We are reporting a rare case of 1-year-old boy with AN who presented with right iliac fossa (RIF) pain mimicking acute appendicitis. Intraoperative findings proved a gastric perforation. Pathophysiology of this condition in AN is poorly understood. Gastric smooth muscle atrophy and ischaemia can be the possible underlying mechanisms. The case discussed here highlights the fact that any abdominal pain in patients with underlying eating disorders (EDs) should raise suspicion of perforation as diagnosis can be far more complicated.