Melanoma - goes where it wants and does what it pleases. A case report of primary gastric melanoma.

Melanoma is a common global cancer, however, extracutaneous forms are most often from metastasis. Primary extracutaneous forms are rare, with primary gastric melanoma exceedingly so, with approximately only 50 cases reported worldwide in the literature. The mainstay of management is surgical resection with minimal data on adjuvant therapy. Its prognosis remains poor due to its aggressive behaviour and late presentation. Our case demonstrates a primary gastric melanoma presenting with gastric perforation requiring emergency operative management.

Surgical drainage of spontaneous sublingual haematoma.

This is a case presentation of a man in his late 80s who presented to emergency department with a sublingual haematoma secondary to warfarin usage for atrial fibrillation. His international normalised ratio was rapidly reversed, and he was taken to theatre for successful surgical drainage of the haematoma. He was kept intubated and ventilated for 48 hours postoperatively to allow swelling to settle then extubated and rehabilitated prior to discharge home.

Euthanasia and surgeons: an overview of the Victorian Voluntary Assisted Dying Act 2017 and its relevance to surgical practice in Australia.

Surgeons play a significant role in the treatment of patients with many types of cancer, including the management of advanced and recurrent disease after long periods of apparent remission. The recently introduced Victorian Voluntary Assisted Dying (VAD) Act represents a shift in paradigm in Australian medical practice. To be eligible for VAD, the new legislation requires patient assessment by a physician with at least 5 years post-fellowship experience and relevant expertise in the patient's condition. Given many specialist surgeons' experience in managing advanced and often incurable malignancy, it is likely that many will receive referrals for assessment for VAD. It is foreseeable that other states and territories in Australia will follow suit with similar legislation. It is imperative that surgeons receiving referrals to assess patients seeking access to VAD are familiar with the legislation and assessment process. This article summarizes the current regulation of VAD in Australia, including the patient application and assessment process, briefly reviews world-wide assisted dying practices and discusses the relevance to surgeons practicing in Australia.

Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored.

BACKGROUND: A laparotomy is still considered mandatory for patients without previous abdominal surgery presenting with a small bowel obstruction (SBO) because of a perceived high incidence of underlying lesions. However, there is no evidence in literature to support this assumption. We analyzed the etiology of SBO in this subgroup of patients to establish the need for a mandatory laparotomy. METHODS: A retrospective analysis was conducted over a 5-year period. Basic demographics, radiology results, operative findings, and outpatient investigations were analyzed. RESULTS: Of 689 patients presenting with an SBO, a total of 62 patients, 9.0%, had a virgin abdomen. A known underlying disease (inflammatory bowel disease, malignancy) was the cause in 13 patients. The remaining 49 patients had adhesions in 75.5% and a newly diagnosed malignancy in 10.2% as a cause. CONCLUSIONS: Adhesions are by far the most likely cause of SBO in patients without previous abdominal surgery followed by a small number of newly diagnosed malignancies. Both prevalences are in equal proportion to patients with previous abdominal surgery. A trial of nonoperative management may therefore be justified.

Nonabsorbable suture material in the biliary tract.

Nonabsorbable sutures may act as a nidus for stone formation within the biliary tree. A case of a large stone formed as a consequence of a Prolene suture within the biliary tract is presented.