Adult Burkitt's lymphoma presenting as intussusception: first UK case report.

Colonic intussusception is rare in adults and can present with non-specific symptoms that can make diagnosis difficult and delayed. Unlike in children, it is commonly due to a pathological lead point that is often malignant. This case is the first reported case of adult intussusception due to Burkitt's lymphoma in the UK. We describe the case of a 22-year-old woman who presented with 4-week history of intermittent epigastric pain. On the third hospital admission, the diagnosis was made by abdominal computed tomography, which showed the 'target' sign, suggestive of intussusception. A right hemicolectomy was performed and histology later confirmed Burkitt's lymphoma. This case demonstrates the difficulty in diagnosing intussusception in adults, which must be considered in recurrent abdominal pain when more common causes have been ruled out. The rare diagnosis of Burkitt's lymphoma made early diagnosis and treatment important.

A Case of Stercoral Perforation Detected on CT Requiring Proctocolectomy in a Heroin-Dependent Patient.

Stercoral perforation of the colon is rare but carries with it significant morbidity and mortality. Stercoral perforation usually occurs in elderly, immobile patients with chronic constipation. In this manuscript, we report the case of stercoral perforation in a patient due to chronic heroin dependence. We report the case of a 56-year-old male patient with stercoral perforation, diagnosed by computed tomography, secondary to heroin dependence, requiring proctocolectomy and an end ileostomy. There are very few reports in the literature describing cases of stercoral perforation and questions have been asked about the importance of preoperative cross-sectional imaging. In our case, the diagnosis of stercoral perforation was made only on CT. Although this is not the first such case to be reported, it is significant as preoperative CT imaging was influential not only in determining the aetiology of the abdominal distension seen on the plain film, but also in detecting the pneumoperitoneum which was not evident clinically or on plain radiographs.

One year negative appendicectomy rates at a district general hospital: A Retrospective Cohort Study.

INTRODUCTION: There is no defined 'acceptable' Negative Appendicectomy Rate (NAR) in the UK. Despite advances in radiology and predictive scoring systems, appendicitis remains a clinical diagnosis but inevitably some patients will have an entirely normal appendix removed. We sought to define our local practice and results. METHODS: A one year retrospective observational study was performed in our institution on all appendicectomies performed on an emergency basis. Cases were identified with the hospital electronic theatre record system and histopathology reports were retrieved and analysed. RESULTS: 390 patients were identified over a one year period and split into two groups. Group A (n = 128) was defined as those patients who had no evidence of appendiceal pathology or tissue, giving a NAR of 32.8%. Group B (n = 262) comprised patients whose appendices had any histopathological finding other than normal. Our NAR was not found to be significantly different when compared to a recent large published series (p = 0.711). Within six months, Group A had 19 (14.8%) emergency readmissions compared to 25 (9.54%) in Group B. This was not found to be statistically significant on Fisher's exact testing (p = 1.00). DISCUSSION: Our NAR of 32.8% is higher than expected but comparable to those previously published. Although this did not have a significant impact on patient morbidity as shown by our re-admission rates, revision of our current policy to remove the appendix should no other pathology be identifiable may improve outcomes.