Conservative management of migrated percutaneous endoscopic colostomy tube.

A 68-year-old male nursing home resident presented following dislodgement of a percutaneous endoscopic colostomy (PEC) tube originally sited to prevent recurrent sigmoid volvulus. Computed tomography demonstrated tube migration into the lumen of the recto-sigmoid junction, where it remained for 12 days before passing spontaneously. During this period, the patient remained asymptomatic; the residual colocutaneous fistula functioned as a decompressive valve. Originally, the patient was due to be discharged with early flexible sigmoidoscopy follow-up. However, complex social issues delayed discharge. During his admission, a second PEC tube was successfully inserted next to the previous colostomy site without complication. This is an unusual case and no similar episodes of asymptomatic PEC migration have been reported. We demonstrate that such cases may be offered an appropriate trial of conservative management. Here, we describe our experience and critically appraise the literature.

Paintball-related traumatic liver injury.

Paintball is a popular recreational sport played at both amateur and professional level. Ocular injuries are well recognised, although there is a growing body of literature documenting superficial vascular as well as deep solid organ injuries. An 18-year-old man presented with signs and symptoms consistent with acute appendicitis. Intraoperatively, a grade III liver injury was identified and packed before a relook at 48 h. No further active bleeding was identified; however, follow-up ultrasound at 3 weeks demonstrated non-resolution of a large subcapsular haematoma. The patient was readmitted for a short period of observation and discharged with repeat ultrasound scheduled for 3 months. This represents the first report of paintball-related blunt traumatic injury to the liver. Solid organ injuries of this nature have only been reported three times previously-all in the urological setting. This case also highlights issues surrounding the use of routine follow-up imaging in blunt liver trauma and provides a concise discussion of the relevant literature.

Synchronous metastatic omental melanoma and colonic adenocarcinoma: a case report.

BACKGROUND: Malignant melanoma is a rare malignancy of the skin with very high mortality rates. Distal metastases are common especially to other areas of the skin, subcutaneous tissues lungs or liver. There are no previously reported cases of skin melanoma metastasizing to the omentum. CASE PRESENTATION: A 62 year-old white British man with a past medical history of a malignant melanoma of the skin underwent a laparotomy for a partially obstructing sigmoid tumour. Intra-operatively, a round, smooth textured black lesion was identified on the anterior surface of the omentum; the nodule was confirmed to be a metastatic malignant melanoma with abundant brown pigment and a focal necrotic area. CONCLUSION: A metastatic malignant melanoma was discovered incidentally on the omentum during a laparotomy for bowel obstruction. The significance of this is unclear but it is possible that the omentum may have played a protective role in limiting its spread systemically.

Technology and medicine: the evolution of virtual reality simulation in laparoscopic training.

BACKGROUND: Virtual reality (VR) simulation for laparoscopic surgical training is now a reality. There is increasing evidence that the use of VR simulation is a powerful adjunct to traditional surgical apprenticeship in the current climate of reduced time spent in training. AIM: This article reviews the early evidence supporting the case for VR simulation training in laparoscopic surgery. METHODS: A standard literature search was conducted using the following phrases--'virtual reality in surgical training', 'surgical training', 'laparoscopic training' and 'simulation in surgical training'. RESULTS AND CONCLUSION: This article outlines the early evidence which supports the use of VR simulation in laparoscopic training and the need for further research into this new training technique.