Non-sebaceous lymphadenoma of the submandibular gland: diagnostic challenges in the head and neck cancer pathway.

Non-sebaceous lymphadenoma (NSLA) is a rare benign salivary gland tumour with lymphoid and epithelial components and without sebaceous differentiation. The large majority of the reported cases arise within the parotid gland. We present an NSLA arising from the submandibular gland. The tumour presented as a painless longstanding neck lump. Ultrasound, fine needle aspiration, MRI and positron emission tomography found features supportive of squamous cell carcinoma. The patient was treated with surgery for oropharyngeal carcinoma of unknown origin, in accordance with local and national guidelines. The final histological assessment revealed the level Ib neck lesion to be NSLA. Although a rare occurrence, these lesions may pose a diagnostic challenge in the head and neck cancer pathway.

Paediatric duodenal injury complicated by common bile duct rupture due to blunt trauma: a multispecialist approach.

We report a case of late presenting duodenal perforation with common bile duct rupture secondary to blunt handlebar trauma in an 11-year-old boy. The patient presented with upper abdominal wall ecchymosis, pain and vomiting. He was discharged after 24 hours with resolving symptoms. However, the boy presented 2 days later febrile with signs of peritonitis. CT indicated duodenal perforation, which was confirmed during laparotomy where common bile duct rupture was also demonstrated. Primary repair of the duodenum was undertaken. Here, decompression was achieved with a nasogastric tube proximal to the injury and T-tube duodenostomy distally. Common bile duct repair was achieved over a biliary stent. This case represents a rare subset of duodenal injury for which there is a paucity of evidence for optimal surgical management, particularly in the paediatric setting. This operative plan will guide surgeons and junior doctors in managing complicated cases like this in future.