Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Sep 2011
Case ReportsDefunctioning loop ileostomy: not always a safe option.
A 74-year-old woman underwent a low anterior resection and defunctioning loop ileostomy for a T1 N1 M0 rectal adenocarcinoma. Three months following surgery she attended complaining of pain inferior to the loop ileostomy. ⋯ The clinical diagnosis of necrotising fasciitis was confirmed radiologically on emergency computed tomography. The patient underwent an emergency debridement of the anterior abdominal wall.
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Ann R Coll Surg Engl · Sep 2011
Case ReportsGiant sigmoid diverticulitis mimicking acute appendicitis.
Giant colonic diverticula are a rare manifestation of diverticular disease and there are fewer than 150 cases described in the literature. They may have an acute or chronic presentation or may remain asymptomatic and be found incidentally. ⋯ We describe the acute presentation of an inflamed giant sigmoid diverticulum with right iliac fossa pain. We discuss both the treatment options for this interesting condition and also the important role of computed tomography in the diagnosis and management of abdominal pain in elderly patients.
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Ann R Coll Surg Engl · Sep 2011
Cardiopulmonary exercise testing provides a predictive tool for early and late outcomes in abdominal aortic aneurysm patients.
The aim of this study was to determine if cardiopulmonary exercise testing (CPET) predicts 30-day and mid-term outcomes when assessing suitability for abdominal aortic aneurysm (AAA) repair. ⋯ CPET provided the only means in this study of predicting both 30-day outcome and 30-month mortality. CPET could therefore become an increasingly important tool in determining the optimum management for AAA patients.
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Ann R Coll Surg Engl · Sep 2011
Case ReportsDysphagia and airway compromise as a result of retropharyngeal haematoma following undiagnosed odontoid peg fracture: a case report.
Airway compromise following a cervical spine injury is an unusual cause of respiratory distress. We describe a patient who developed a retropharyngeal haematoma that caused dysphagia, dysarthria and acute airway compromise seven days following a fall, with no other signs of cervical spine injury. The patient was found to have a type 2 fracture through the junction of the odontoid peg and body of C2 with an associated prevertebral haematoma and soft tissue oedema. ⋯ In elderly patients with a minor history of falls one should always think of possible fractures and appropriate investigations should be carried out. Retropharyngeal haematomas secondary to cervical spine fractures require a prompt multidisciplinary approach and appropriate management of both the airway and cervical spine. Joint care from the orthopaedic, anaesthetic, and ear, nose and throat teams is necessary.