Laparoscopic resection of a gastrointestinal stromal tumour in a Meckel's diverticulum.

A Meckel's diverticulum (MD) is a congenital abnormality of the gastrointestinal tract which is estimated to be present in 2% of the population. Gastrointestinal stromal tumours (GISTs) are rare, soft-tissue tumours which represent 0.1%-3% of all gastrointestinal tumours. The association of an MD and a GIST is extremely unusual since fewer than 3% of MD harbour primary neoplasms and most of these neoplasms are carcinoid tumours. While MDs may remain asymptomatic throughout life, a small proportion may be complicated by occult gastrointestinal bleeding, inflammation, perforation and small bowel obstruction. A tumour in an MD may be asymptomatic or can cause vague abdominal pain and small bowel obstruction if it is larger in dimension. The authors present a rare case of a 5.5 cm GIST in an MD that was completely resected through a laparoscopic approach.

Can the General Surgeon Use Quilting Sutures to Prevent Seromas Following Abdominal Wall Surgery?

A common post-operative complication of many operations is seroma formation, which, while generally considered to be relatively minor, can be problematic for patients and a drain on healthcare resources due to the need for frequent outpatient reviews and repeated aspirations. Several mechanisms have been implicated in the development of seromas, and drains have traditionally been used as a preventative strategy. However, drains are falling out of favour, not least because the evidence to support their use is limited and conflicting. In recent years, the use of quilting sutures, also known as progressive tension sutures, is starting to emerge as a favourable alternative for preventing post-operative seroma formation. Several studies and trials support their use in abdominal wall operations such as abdominoplasties and at abdominal wall donor sites in reconstructive breast operations. General surgeons perform many operations on the abdominal wall, such as ventral hernia repair, that predispose the patient to seroma formation. Can quilting sutures be used in operations on the abdominal wall to prevent seroma formation? This aim of this review was to evaluate the use of quilting sutures as described in several studies to reduce the incidence of post-operative seroma.

The Many Guises of Endometriosis: Giant Abdominal Wall Endometriosis Masquerading as An Incisional Hernia.

Endometriosis is defined by the presence of ectopic endometrial tissue outside the uterine cavity. Although it is a leading cause of chronic pelvic pain and infertility, its clinical presentation can vary, resulting in diagnostic and therapeutic challenges. Extrapelvic endometriosis is particularly difficult to diagnose owing to its ability to mimic other conditions. Endometrial tissue in a surgical scar is uncommon and often misdiagnosed as a granuloma, abscess, or malignancy. Cyclical hemorrhagic ascites due to peritoneal endometriosis is exceptionally rare. We report the case of a pre-menopausal, nulliparous 44-year-old woman who presented with ascites and a large abdominal mass that arose from the site of a lower midline laparotomy scar. Five years previously, she had undergone open myomectomy for uterine fibroids. Soon after her initial operation she developed abdominal ascites, which necessitated percutaneous drainage on multiple occasions. We performed a laparotomy with excision of the abdominal wall mass through an inverted T incision. The extra-abdominal mass consisted of mixed cystic and solid components, and weighed 1.52 kg. It communicated with the abdominopelvic cavity through a 2 cm defect in the linea alba. The abdomen contained a large amount of odourless, brown fluid which drained into the mass. There was a large capsule that covered the small and large bowel, liver, gallbladder, and stomach. Final histology reported a 28×19×5 cm mass of endometrial tissue with no evidence of malignant transformation. The patient recovered well post-operatively and has remained asymptomatic. Our case illustrates that, despite being a common disease, endometriosis can masquerade as several other conditions and be missed or diagnosed late. Delay in diagnosis will not only prolong symptoms but can also compromise reproductive lifespan. It is therefore paramount that endometriosis is to be considered early in the management of premenopausal women who present with an irregular pelvic mass or hemorrhagic ascites.

Application of the Prevena™ Incision Management System Following Complex Ventral Hernia Repairs with Abdominal Wall Reconstruction.

Surgical site infections (SSIs) are a drain on the healthcare economy. A recent development for the primary prevention of wound infections is the use of negative pressure wound therapy (NPWT) on closed wounds. The Prevena™ Incision Management System (KCI USA, Inc., San Antonio, TX) is a new NPWT designed for application on closed surgical incisions in order to prevent potential wound-related complications. We evaluated the use of this new technology on large abdominal incisions following complex ventral hernia repairs with abdominal wall reconstruction in patients with risk factors for developing wound complications and conducted a review of the current literature pertaining to the use of NPWT on closed incisions.

Paraganglioma mimicking adrenal incidentaloma.

Paragangliomas can be confused with adrenal incidentalomas because of their proximity to the adrenal glands. A 71-year-old man presented with left-sided abdominal pain. A computed tomography scan showed a large cystic mass with a solid component arising from the left adrenal gland (Figure 1).

Ileo-ileal intussusception from Crohn's ileitis.

Crohn's disease can cause abdominal pain and diarrhoea. A 33-year-old man presented with a 3-month history of recurrent abdominal pain and occasional diarrhoea.

Management of a giant inguinoscrotal hernia with an ulcerated base in a patient with cardiac disease.

Giant inguinal herniae pose a surgical challenge, though not uncommon in the developing world they are a rare presentation in the UK. We present a patient with cardiac disease who presented with a giant inguino-scrotal hernia complicated by a bleeding scrotal ulcer. We describe his medical management and the surgical repair of the hernia and refashioning of his scrotum.

Isolated duodenal rupture due to go-karting accidents--braking news.

INTRODUCTION: Isolated duodenal injury due to blunt abdominal trauma is extremely rare. We present a series of three such injuries due to go-karting accidents, which presented to our hospital over 5 months. CASE REPORTS: Between October 2007 and February 2008, three cases of D3/D4 duodenal rupture presented to our hospital after go-karting accidents. Trauma occurred as a result of the steering wheel impacting on the abdomen. All patients presented similarly with symptoms of epigastric and right upper quadrant pain. In all cases, computed tomography scanning was highly suggestive of duodenal injury and, in particular, demonstrated presence of retroperitoneal air centred around the duodenum. Treatment required laparotomy and operative repair in all cases. CONCLUSIONS: Duodenal injury presents insidiously due to its retroperitoneal position. A low threshold for investigating patients presenting with epigastric and right upper quadrant pain should be adopted along with active clinical vigilance to exclude serious and life-threatening trauma after go-karting accidents.