A Tale of Two Meckel's: small bowel obstruction secondary to Meckel's Diverticulum.

We present two rare cases of small bowel obstruction (SBO) secondary to Meckel's diverticulum (MD) where the mechanism of obstruction was not readily apparent. Both were cases of virgin abdomen with pre-operative CT scans demonstrating SBO without a clear underlying cause or mass. Diagnostic laparoscopy was performed, which established the underlying cause to be MD, and laparoscopic-assisted resection was undertaken to resect small bowel and perform a side-to-side stapled anastomosis. We subsequently describe the different mechanisms by which MD can cause obstruction as described in the literature.

Traumatic Abdominal Wall Hernias Following High-Velocity Trauma in Children.

Traumatic abdominal wall hernias following blunt high-velocity trauma are uncommon in children and can result in concurrent abdominal visceral injuries. We present one such case of a 9 year-old boy requiring a trauma laparotomy to repair visceral injuries following a motor vehicle accident.

Morbidity and mortality with atrial fibrillation following colorectal surgery.

Post-operative atrial fibrillation (POAF) is a common, self-limiting complication following non-cardiac surgery. It is associated with other complications such as pneumonia and sepsis, increased hospital stay and in-hospital mortality. The aim of the study is to identify risk factors, morbidity and mortality associated with POAF. METHODS: Retrospective cohort study of 571 consecutive patients who presented for colorectal surgery at The Canberra Hospital. Seventy-four patients were excluded due to history of atrial fibrillation and a further 124 patients were lost to follow-up at 1 year. Patient characteristics, intraoperative factors and post-operative outcomes were retrospectively collected. One-year mortality data were collected for 373 patients in the cohort. RESULTS: A total of 497 patients were included, 33 (6.6%) developed POAF within 30 days of surgery. POAF is associated with ischaemic heart disease (24.2 versus 11.6%, P = 0.035), emergency (66.7 versus 34.1%, P = 0.0001) and open procedures (87.9 versus 70.9%, P = 0.036). There is a higher incidence of post-operative complications including pneumonia (24.2 versus 9.1%, P = 0.006), abdominal collection (21.2 versus 9.7%, P = 0.049) and sepsis (21.2 versus 7.5%, P < 0.0001). POAF had a higher in-hospital mortality (9.1 versus 2.6%, P = 0.035) and 1-year mortality (33.3 versus 8.8%, P < 0.0001). CONCLUSION: POAF is a common presentation following colorectal surgery and is associated with infective complications, reflecting an inflammatory process. Risk factors for POAF have been clearly identified in the literature; however, further studies need to be conducted on preventative strategies. There is a significantly higher 1-year mortality rate compared with the controls, the aetiology of which has not yet been widely reviewed.

Predictors of slow colonic transit in children.

PURPOSE: Slow transit constipation (STC) and functional fecal retention (FFR) are two forms of severe intractable constipation in childhood diagnosed by nuclear transit studies (NTS). This retrospective study aims to identify the predicting factors for STC and FFR by looking at the association with neuropsychiatric disorders (NPD), obesity, family history of constipation and atopic disease. PATIENTS AND METHODS: A retrospective chart review was conducted on children with intractable constipation referred for NTS between 1st April 2003 and 1st April 2014. Comparisons were made between STC, FFR and normal transit patients with regards to NPD, obesity (BMI z score >95th percentile), family history of constipation in first and second-degree relatives and atopic disease which included food allergy, asthma and eczema. RESULTS: Between 2003 and 2014, 97 patients were referred for a NTS. Out of 36 patients with NPD, 21 (58.3 %) had STC and 13 (36.1 %) had FFR (p < 0.05). 15.8 % of patients with constipation were obese, compared to 6.4 % in the general Australian paediatric population (p < 0.05). There was no significant association between constipation and atopic disease or family history. CONCLUSION: Neuropsychiatric disorders, in particular autism, are useful predictors of STC and FFR in children. Obesity may be associated with a higher risk of developing chronic constipation.