Annals of the Royal College of Surgeons of England
-
Ann R Coll Surg Engl · Jul 2010
Case ReportsLook what's eroding through the chest wall? Salmonella osteomyelitis of the ribs in an immunocompetent adult not associated with sickle cell disease.
We describe a case of Salmonella typhimurium osteomyelitis in an immunocompetent adult male patient without sickle cell disease. We are not aware of a previous report of this combination.
-
Ann R Coll Surg Engl · Jul 2010
Peripheral neuromodulation via posterior tibial nerve stimulation - a potential treatment for faecal incontinence?
Faecal incontinence is a prevalent and important condition, with a range of treatment options. Neuromodulation via sacral nerve stimulators is efficacious, but expensive and associated with complications due to device implantation. Peripheral neuromodulation via posterior tibial nerve stimulation (PTNS) has been assessed in urinary incontinence, but there is minimal evidence for its use in faecal incontinence and no literature from the UK. This retrospective review aimed to assess the efficacy of PTNS in faecal incontinence. ⋯ PTNS is a potentially efficacious, technically simple and minimally invasive alternative treatment modality for faecal incontinence. These early results are encouraging, but we await medium- and long-term follow-up, and a larger randomised trial comparing PTNS with alternative treatments and placebo.
-
Ann R Coll Surg Engl · Jul 2010
Case ReportsUpper limb deep vein thrombosis: a potentially fatal complication of a clavicle fracture.
We present a case a 48-year-old man who was diagnosed with an upper limb deep vein thrombosis post clavicle fracture. He was successfully investigated with a computed tomography (CT) venogram, thrombophilia was excluded, and he was subsequently treated with a 3-month course of anticoagulation. We illustrate this case with photographs and a three-dimensional colour reconstruction of a CT venogram to raise awareness of the condition. A suitable level of clinical suspicion should be maintained by the orthopaedic surgeon; delayed arm swelling with venous congestion following a clavicle fracture should be investigated with CT venography and thrombophilia should be excluded.
-
Torsion of the spleen is a rare cause of abdominal pain. Predisposition occurs following abnormal development of splenic suspensory ligaments. We report a case of splenic torsion in a spleen sited in a normal anatomical position and discuss the latest treatment options. To the best of our knowledge, this has not been reported in the literature to date. ⋯ Splenic torsion in a wandering spleen has been described with an incidence of < 0.2%. Symptoms vary from asymptomatic to an acute surgical abdomen. Diagnosis is commonly made using colour Doppler sonography or enhanced computed tomography. Surgery is guided by clinical setting, with preservation of the spleen as the goal.
-
Ann R Coll Surg Engl · Jul 2010
Training in laparoscopic colorectal surgery - experience of training in a specialist unit.
Laparoscopic colorectal surgery, although technically demanding, is an increasingly desirable skill for coloproctologists. We believe that trainees with adequate supervision from an experienced trainer may perform these procedures safely with good outcome. ⋯ Adequately trained and supervised trainees may perform major colorectal resections without compromising outcome.