Enterolith ileus as a complication of small bowel diverticulosis.

We report a case of small bowel obstruction which was found to be due to an enterolith obstructing the distal ileum in the manner of "gallstone ileus." The enterolith had formed in an acquired jejunal diverticulum. We review the accepted mechanism of formation of these "stones" and propose a protocol for treatment of this rare complication.

Colonic trauma: modern civilian management and military surgical doctrine.

Colonic trauma, traditionally the domain of the military surgeon, has become commonplace in many parts of the world, where civilian surgeons have developed considerable experience with this complex type of injury. The author highlights the differences between military and civilian management concluding with an overview of current military research into battlefield colonic trauma. This paper reviews military surgical doctrine and summarizes the evolution in civilian surgical practice since the Second World War. South African management is discussed with reference to the author's travelling fellowship visit in 1993. Colonic trauma has been the subject of a military surgical research project, since 1992, with preliminary studies establishing an anastomotic technique suitable for use in the field. This work is summarized with an outline of the research programme.

Aggressive management of intra-arterial Temazepam injection.

Intravenous injection of the oral formulation of Temazepam is a common form of drug abuse. At the request of the Home Office, manufacturers have developed solid dose forms to replace the liquid filled capsules, but a number of cases of accidental intra-arterial injection of the new formulation have been reported, with varying management strategies advocated. A case is presented where prompt aggressive management using surgical and pharmacological measures resulted in complete limb salvage. Previous reported cases and management options are discussed.

An inexpensive method of quality assessment in anastomosis workshops.

A method of comparing the quality of intestinal anastomoses performed in craft workshops is described. The equipment is readily available in any hospital, inexpensive and requires no technical construction. The apparatus accurately measures the intraluminal pressure at the first sign of anastomotic leak and a method of deriving the wall tension is explained. Calculation of wall tension at the point of failure allows comparison of anastomoses of different size. An instructor can therefore monitor the improvement of an individual trainee or rank a class according to the quality of their anastomoses.

Occlusion of a traumatic false aneurysm of the vertebral artery.

A case of false aneurysm of the second part of the vertebral artery due to stabbing with a pair of scissors is described. Successful occlusion of the aneurysm with preservation of vertebral blood flow was achieved by the percutaneous insertion of a silicone-filled detachable balloon.