Endoscopic Evaluation of Biliary Strictures: Current and Emerging Techniques.

The diagnosis of biliary strictures in clinical practice can be challenging. Discriminating between benign and malignant biliary strictures is important to prevent the morbidity and mortality associated with incorrect diagnoses. Missing a malignant biliary stricture may delay surgery, resulting in poor prognostic outcomes. Conversely, it has been demonstrated that approximately 20% of patients who undergo surgery for suspected biliary malignancies have a benign etiology on histopathology. Traditional tissue sampling using endoscopic retrograde cholangiography does not always produce a definitive diagnosis, with a considerable proportion of cases remaining as indeterminate biliary strictures. Recent advances in endoscopic techniques have the potential to improve the diagnostic and prognostic accuracy of biliary strictures.

The missing spleen - A diagnosis of medical identity fraud in surgery: Case report.

INTRODUCTION AND IMPORTANCE: Medical identity fraud is a growing concern in surgery and can adversely affect patient care. Fraudulent medical information can result in misdiagnoses or inadequate preoperative workup of surgical patients. CASE PRESENTATION: A 63-year-old female presented to hospital with a fishbone-related oesophageal perforation. Unbeknownst to the surgical team, the patient was committing medical identity fraud and impersonating another 57-year-old female. She underwent a gastroscopy with removal of the fishbone while her true identity remained concealed. A progress CT scan performed three days post-gastroscopy revealed an absent spleen, which was present on ultrasound as recent as three weeks prior to her admission. The patient was confronted about this discrepancy and confessed to committing medical identity fraud. CLINICAL DISCUSSION: Detection of medical identity fraud remains a challenging problem in healthcare systems worldwide. Various methods have been proposed to improve detection of medical identity fraud but there has been limited studies on their effectiveness in hospital settings. Given the serious health repercussions that can arise from medical identity fraud, it is imperative that better detection methods become available in the future. CONCLUSION: Medical identity fraud is a complex problem that requires better detection methods to prevent patient harm. Surgeons should be aware of the adverse health consequences that can arise from medical identity fraud.

An Unusual Case of Stercoral Perforation in a Patient with 86 cm of Small Bowel.

A 77-year-old male who previously had extensive enterectomy due to ischaemic gut with loss of all but 86 cm of jejunum in addition to a right hemicolectomy presented to the emergency department (ED) with abdominal pain and constipation of 12-day duration. Abdominal imaging with X-ray and CT revealed pneumoperitoneum in addition to a grossly redundant and faecally loaded colon. At laparotomy, rectal perforation was found. In view of the patient's advanced age, comorbidities, and the absence of intraperitoneal faecal contamination, manual disimpaction followed by wedge resection and primary closure of the perforation was done. On postop day 11, a perforation in the sigmoid colon with free subdiaphragmatic gas was picked up on CT after a work up for abdominal tenderness. In the absence of peritonism and other signs of deterioration, conservative management was chosen with subsequent uneventful recovery for the patient.