Robin Brown

Acute right iliac fossa pain: not always appendicitis or a caecal tumour: two case reports

BackgroundA solitary diverticulum of the caecum is a rare benign condition which was first described by Potier in 1912 [1]. Clinical symptoms are usually a manifestation of complications arising from inflammation, perforation or haemorrhage. Despite radiological imaging, a pre-operative diagnosis is infrequent.Case presentationWe report two cases of right iliac fossa pain associated with a solitary caecal diverticulum. We discuss the clinical presentation, investigative modalities, and current therapeutic guidelines associated with this rare condition and highlight the difference from the more common conditions of appendicitis in the young and caecal neoplasms in the older patient.ConclusionComplications of a solitary caecal diverticulum should be considered in the differential diagnosis of acute right lower quadrant pain. Mild caecal diverticulitis verified pre-operatively by radiological imaging or laparoscopically can be ameliorated by antibiotics alone. However, severe inflammation, perforation, haemorrhage or torsion necessitates a localised or radical resection. The presence of multiple diverticula, caecal phlegmon, or the inability to rule out an underlying caecal neoplasm warrants a right hemicolectomy.

Testicular infarction secondary to protein S deficiency: a case report.

BackgroundProtein S deficiency is an inherited cause of thrombophilia. We present the second reported case in the literature of a man developing testicular infarction secondary to protein S deficiency.Case presentationA 63 year old man presented with sudden onset of pain in his left hemi-scrotum. Despite oral warfarin therapy the plasma INR was only 1.4 at presentation. Doppler ultrasound scan of the scrotum confirmed absent blood flow to the left testis with increased echogenicity. Orchidectomy was performed to remove the necrotic testis. Post-operatively the patient did well and was referred to the Regional Haemophilia and Thrombosis Centre for further management.ConclusionThe case highlights a rare but potential complication of protein S deficiency and demonstrates the importance of adequate anticoagulation in these patients.

The effect of sporting events on emergency department attendance rates in a district general hospital in Northern Ireland

Background:  Previous studies have reported a conflicting relationship between the effect of live and televised sporting events on attendance rates to emergency departments (ED). The objectives of this study were to investigate the relationship of major sporting events on emergency department attendance rates and to determine the potential effects of such events on service provision.

Penile Ulceration Secondary to Nicorandil Use

Nicorandil is a medication used for treatment and prevention of angina pectoris. Its mode of action involves both arterial and venous vasodilation. Although there are numerous known side effects, one of the more unusual, adverse reactions is ulceration of the external genitalia. This case reports the finding of penile preputial ulceration secondary to the use of Nicorandil. The authors make some recommendations for management.

Early and delayed presentation of traumatic small bowel injury

Traumatic small bowel injury (TSBI) is rare and presents in only 1% of patients following blunt trauma. Delay in diagnosis can result in significant morbidity so a high index of suspicion is required in patients with abdominal injuries and a significant mechanism of injury. We discuss three cases of TSBI with varying presentations, and discuss their investigation and treatment.

Familial urothelial cell carcinoma of the bladder with autosomal dominant inheritance and late onset phenotype

ObjectiveFamilial Urothelial cell bladder cancer is rare. We report two families with urothelial cell carcinoma (UCC) of bladder with family history in other relatives, displaying probable autosomal dominant inheritance and a late onset pure UCC phenotype, and document the phenotype in each family.MethodsDescriptive familial study on two pedigrees over three generations.ResultsTwo families with UCC bladder were identified, and the phenotype documented, each family having three cases of late onset UCC.ConclusionSome cases of UCC are hereditary and may display autosomal dominant inheritance with late onset of the cancer. Clinicians should be aware of the existence of a familial late onset UCC phenotype when managing cases of UCC.