Kevin Bain

A previously undescribed hernia containing an acutely inflamed appendix—case report and review of management on hernias containing the vermiform appendix

Hernias involving the appendix are unusual and are often found during surgical exploration. The rarity of these hernias makes it difficult to discuss standard of treatment. When an acutely inflamed appendix is encountered within a hernia, appendectomy should be performed with primary repair of the hernia. This case documents the unique finding of an appendix herniating through a previously undescribed region in the abdominal wall found in a patient presenting with acute appendicitis.

Unique presentation of a ruptured Meckel’s diverticulum after blunt trauma

A 25-year-old man with no significant medical or surgical history presented with a complaint of thick, dark drainage from a periumbilical wound for 1 month (figure 1). He reported first noticing the drainage several days after bumping into the corner of a machine at work. He was seen by his primary care physician and prescribed oral antibiotics for persistent drainage and erythema; however, his symptoms failed to improve. Figure 1 Chronic umbilical wound sustained after blunt abdominal trauma, with drainage of a thick, dark fluid for 1 month. On presentation to the emergency department, the patient was afebrile and haemodynamically stable. Lab work was within normal limits. An abdominal CT scan demonstrated a loculated periumbilical fluid collection, with extension intraperitoneally into a portion of thickened small bowel with suspicion of an enterocutaneous fistula (figure 2). Figure 2 Loculated periumbilical fluid collection approximately 3.8×2.2×3.4 cm. An intraperitoneal portion …

Squamous cell carcinoma of cervix origin with rare metastasis to the colon

We discuss the rare case of a 47-year-old female with a history of squamous cell carcinoma (SCC) in situ of the cervix, who presents with a bowel obstruction secondary to a sigmoid colon mass confirmed to be SCC of cervical origin. SCC is one of the rare malignancies of the gastrointestinal tract, and may occur as either a primary or secondary lesion. Metastasis from the cervix to the gastrointestinal tract is a rare occurrence, and has only been described in a handful of case reports. The treatment for colonic metastatic tumor arising from cervical SCC remains controversial. Surgery and debulking are the primary treatment modalities, while the role for radiotherapy and chemotherapy remain ambiguous. Further study is required to compare the efficacy of different treatment regimens.

Splenic abscess following laparoscopic cholecystectomy: a case report of a rare disease and a review of its management

Splenic abscess is a rare disease that has several predisposing factors. Case reports have documented post-surgical development of splenic abscesses, most commonly after laparoscopic sleeve gastrectomy. We present the case of a 69-year-old female with gallstone pancreatitis who underwent an uncomplicated laparoscopic cholecystectomy. The hospital course was complicated by persistent postoperative leukocytosis with a CT scan demonstrating a moderate sized splenic abscess. Interventional radiology was consulted for percutaneous drainage, and the patient was subsequently discharged home in stable condition. Splenic abscess is an important entity to remember as it is associated with significant mortality. Prompt treatment is vital for improving patient survival. Image guided percutaneous interventions have been increasing used and carry numerous benefits compared to surgical approaches. However, there is a paucity of data comparing the efficacy of percutaneous and surgical therapies. Percutaneous interventions can be successfully performed when the abscess is unilocular/bilocular, has a discrete wall, has no internal septations, or has thin liquid content. Further investigation through multicenter, prospective, randomized clinical trials are needed to analyze treatment options.

A unique surgical emergency: ileosigmoid knotting

Ileosigmoid knot (ISK) is a rare cause of bowel obstruction that leads to gangrenous bowel necrosis. In this condition, the ileum and sigmoid colon wrap around each other, causing a knot and strangulation of both structures. ISK is extremely rare in North America; most cases are reported in Asia and Africa. Furthermore, ISK typically presents in adults in their fourth decade or older. Here we present the rare case of an ISK in a 14-year-old male.

Mangled extremity: to salvage or not to salvage?

A man aged 34 years post jump from the platform onto an incoming train presented as a level I trauma notification with bilateral mangled lower extremities and tourniquets in place (figure 1). Our patient was evaluated in a multidisciplinary fashion, making sure to follow proper ATLS guidelines. On presentation, he was hypotensive, but responded to crystalloid and blood products. Secondary survey revealed pulseless, paralysed extremities that lacked sensation and were grossly contaminated. The Mangled Extremity Severity Score (MESS) calculated as 9.1 With …