Annals of the Royal College of Surgeons of England
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Although the acute thrombosis and strangulation of haemorrhoids is a common condition, there is no consensus as to its most effective treatment. ⋯ Ambiguities exist in the terminology used to describe the two separate pathologies that make up the acute complications of haemorrhoids. These complications have traditionally been treated conservatively. There is evidence that early operative intervention for strangulated internal haemorrhoids is safe and effective. A suggested algorithm for treatment is given, based on the published literature.
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Ann R Coll Surg Engl · Oct 2014
Case ReportsDelayed diaphragmatic rupture presenting with acute gastric volvulus.
Gastric volvulus is a rare complication of diaphragmatic rupture. We report the case of an 82-year-old man who presented following an out-of-hospital cardiac arrest. ⋯ Insertion of a nasogastric tube was unsuccessful (completing Borchardt's diagnostic triad) and his condition prevented both operative and endoscopic reduction of his volvulus. He died soon afterwards.
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Ann R Coll Surg Engl · Oct 2014
Comparative StudyA retrospective case note review of laparoscopic versus open reversal of Hartmann's procedure.
First described in 1921, Hartmann's procedure is the gold standard treatment for complicated sigmoid diverticular disease. It is also used commonly for other causes of perforation of the large bowel. However, the reversal rate in the UK is much lower than in comparable countries, at only 18-22%. Furthermore, laparoscopic reversal (LRH) is used far less frequently than open reversal (ORH) despite evidence that a laparoscopic technique reduces patient morbidity and decreases patient recovery time. ⋯ The overall reversal rate for Hartmann's procedure remains low. Shorter hospital stays, lower 6-month reoperation rates and reduced 30-day complication rates are associated with LRH when compared with ORH.
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Ann R Coll Surg Engl · Oct 2014
Case ReportsUsing a TightRope® to treat a complex fracture of the trapezium.
We present the case of a 23-year-old man with a combined scaphoid fracture and comminuted trapezium fracture, treated surgically with percutaneous fixation of the scaphoid fracture and concomitant Arthrex Mini TightRope(®) stabilisation of base of thumb metacarpal to base of index finger metacarpal. The patient made a good functional recovery, returning to usual activities within six weeks. We suggest that this technique could be used to treat complex trapezium fractures that cannot be reconstructed with surgery.