Simon Rajendran

Rapid resolution of phlegmonous gastritis using antibiotics alone

A 65-year-old woman presented with severe epigastric pain and vomiting. On examination she was pyrexial, tender with guarding in the epigastrium with associated leukocytosis and severely impaired renal function. She was given intravenous fluids and ciprofloxacin. A CT scan showed diffuse generalised thickening of the entire gastric wall (fig 1) with a presumptive diagnosis of gastric …

Intrathoracic fracture-dislocation of the humeral head. Is removal of the humeral head necessary?

We present a case of a 68-year-old female who presented to the emergency department with shortness of breath and right shoulder pain after falling down a flight of stairs. Chest x-ray revealed multiple rib fractures and a large haemothorax on the right side (figure 1A). x-Ray of the humerus showed a complex fracture of the surgical neck of the humerus with …

Little old ladies’ hernia: a clinical diagnostic conundrum

A 56-year-old woman with type 1 diabetes presented with a 2 day history of vomiting and was diagnosed with diabetic ketoacidosis. Following initial improvement on therapy she developed abdominal distension and was referred to the surgical team for further evaluation. Clinical examination revealed obvious small bowel obstruction (fig 1A). Computed tomography (CT) demonstrated a hernia passing through the right obturator foramen (fig 2 …

Enterobius granulomas as a cause of abdominal pain.

An 18-year-old woman presented with lower abdominal pain. Ultrasound (US) showed a dilated appendix. Laparoscopy revealed a mildly inflamed appendix with no other intra-abdominal abnormalities. Laparoscopic appendicectomy was performed. Histology revealed serosal thickening with no transmural inflammation or intraluminal worms. The patient re-presented 9 days later. US showed a peri-caecal collection and antibiotics were started. MRI demonstrated reduction in collection size. In addition, a small tubular structure deep in the pelvis, adjacent to the sigmoid …

The diagnosis and treatment of a symptomatic mesenteric cyst

The diagnosis and treatment of mesenteric cysts is challenging due to rarity, lack of specific symptoms and variability in location and size. This report aims to discuss current diagnostic and treatment strategies. A 35-year-old woman presented with non-specific abdominal pain. CT revealed a 5×5×3 cm septated abdominal cyst (figure 1). Aspiration (figure 1) demonstrated no malignant cells. Return of symptoms confirmed recurrence using MRI 2 months later (figure 2). Laparotomy confirmed 5 cm cyst attached to ileal mesentery (figure 3). Cyst was excised intact (figure 3 …

Intravesical foreign body: clinical features and diagnostic clues

A 32-year-old woman presented with lower abdominal pain. Her history included surgery for spina bifida, intermittent self-catheterisation and intravenous heroin use. Examination was unremarkable. Plain film abdomen revealed three calcified pelvic masses (figure 1). Given her history of heroin use, she was initially suspected of couriering illicit drugs through body packing. On retrospective review of images, masses on the anteroposterior image were not identified on the lateral image (figure 1) raising the suspicion of intravesical origin. On repeat questioning, the patient admitted to …

Laparoscopic resection of a large hepatic cyst compressing the inferior vena cava

A 67-year-old man presented with sudden onset shortness of breath that began while playing golf. Abdominal examination revealed a large mass extending to the umbilicus. CT pulmonary angiography demonstrated a pulmonary embolus and a large hepatic cyst (figure 1). MRI confirmed a 20 cm hepatic cyst in the right lobe compressing the inferior vena cava (IVC; figure 2). A smaller cyst (5 cm) and gallstones were also visualised. Hydatid serology and tumour markers (CA19-9 and α-feto protein) were negative. The patient underwent an uncomplicated …

Endovascular treatment of a symptomatic isolated infrarenal aortic stenosis.

A 72-year-old woman presented with a 10-month history of progressively worsening lower-back pain radiating to both lower limbs. The pain was aggravated by movement severely restricting daily activities. Symptoms were attributed to neurogenic claudication due to spinal stenosis. Pain was managed with analgesia and epidural injections. Worsening symptoms prompted further investigations. Magnetic resonance angiography demonstrated a focal infrarenal aortic stenosis with no evidence of …

Endometriosis: unusual cause of groin swelling

A 36-year-old woman presented with crampy lower abdominal pain and a lump in her left groin. The lump present for 3 years and has slowly increased in size with occasional episodes of tenderness. Her medical history includes hysterectomy for fibroids. Examination revealed a 2×2 cm groin swelling lateral and superior to the pubic tubercle. CT revealed a solid lump …

Double stenting in advanced colorectal cancer

An 86-year-old woman presented with complete large bowel obstruction secondary to tumour ingrowth of a previously placed enteric stent (figure 1). She was deemed not fit for surgical intervention. A second stent (covered ultraflex stent) was inserted through the occluded bare-metal stent using a combination of endoscopy and fluoroscopy (figure 2). Recovery was uneventful and CT 4 months later …