Bilateral persistent sciatic arteries complicated by unilateral acute lower limb ischaemia.

We present a case of a middle-aged Caucasian woman who developed acuteon top of chronic limb ischaemia secondary to thrombotic occlusion of a persistent sciatic artery (PSA). Timely investigation and treatment were instituted resulting in a favourable outcome. PSA is an uncommon congenital, developmental, arterial anomaly which can cause serious lower limb complications such as acute or critical limb ischaemia and amputation. As this condition is rarely encountered in regular clinical practice, and has a limb-threatening potential, it is important to be aware of its cause, presentation and management. We describe the embryologic aetiology of PSA and discuss different investigation modalities and treatment options.

Submucosal lipoma acting as a leading point for colo-colic intussusception in an adult.

Intussusception in adults is a rare condition, in contrast to paediatric intussusception where the majority of cases are idiopathic, ∼90% of adult cases have identifiable aetiology. The clinical presentation is often non-specific abdominal pain. We report the case of a 49-year-old gentleman who presented to our emergency department with a 10-day history of colicky abdominal pain. Computed tomography imaging revealed a lipomatous mass lesion in the transverse colon leading to intussusception. An extended right hemicolectomy was performed with a good result. Histology confirmed that the leading point of the intussusception was a large submucosal lipoma. Gastrointestinal lipomas are rare and largely asymptomatic. However, they may cause abdominal pain, bleeding per rectum, obstruction or intussusception. Since adult colonic intussusception is frequently associated with malignant organic lesions, the differential diagnosis is important, and timely surgical intervention paramount.

Unusual cause of a painful right testicle in a 16-year-old man: a case report.

INTRODUCTION: Urgent surgical exploration of the scrotum of a child or teenager who presents with a painful and swollen testicle is paramount if testicular torsion is not to be missed. It is extremely rare for a non-scrotal pathology to present with acute scrotal signs. Here we present such a rare case and emphasize the importance of being aware of this potential clinical pitfall. CASE PRESENTATION: A 16-year-old Caucasian man presented as a surgical emergency with a five to six hour history of a painful, red, and swollen right hemiscrotum. He also complained of vague lower abdominal pain, vomiting, and watery diarrhea. He had a temperature of 38.5°C and a tender, red, and swollen right hemiscrotum. The right testicle appeared elevated. He was mildly tender in his central and upper abdomen and less so in the lower abdomen. No convincing localizing abdominal signs were noted. He had an increased white cell count (15 × 109/L) and C-reactive protein (CRP; 300 mg/L). Urgent right hemiscrotal exploration revealed about 5 ml of pus in the tunica vaginalis and a normal testicle. A right iliac fossa incision identified the cause: a perforated retrocecal appendix. Appendectomy was performed, and both the abdomen and scrotum washed copiously with saline before closure. The patient made an uneventful recovery. CONCLUSION: Acute appendicitis presenting with scrotal signs due to a patent processus vaginalis is an extremely rare clinical entity. To date, fewer than five such cases have been reported in the medical literature. It is, therefore, extremely important to be aware of this unusual clinical scenario, as only a high index of suspicion will enable prompt, successful management of both the appendicitis and the scrotal abscess.