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Pathological examination of this right-sided mass revealed a solid and cystic mass, weighing 765.0 g and measuring 13.8×11.0×9.0 cm. The cystic areas contained gelatinous mucus (red arrow) and sebaceous material with hair (yellow arrows), measuring 3.0×2.5 cm in aggregate. The final pathological diagnosis was consistent with a teratoma. Although no further treatment was indicated, the patient remains under surveillance owing to the mucinous nature of the lesion.
A leading article by psychosurgeon, Uttam Shiralkar on psychological insight for surgeons, and an article by Anna Pinto, Colin Bicknell and colleagues on surgical complications and their implications for surgeons' well-being, are discussed in this podcast. What happens when things go wrong in the operating theatre? How do surgeons cope and how are they supported?
This 58-year-old woman had abdominopelvic computed tomography and vaginal ultrasound investigations suspicious of a right ovarian tumour. Her CA 125 level was normal. At laparotomy there was an extraluminal tumour of the mid-jejunum that was resected with end-to-end anastomosis. Possible diagnoses included malignant transformation in a Meckel’s diverticulum or secondary tumour of the small bowel. Histology with immunohistochemistry revealed a high-grade gastrointestinal tumour. The patient received adjuvant imatinib therapy.
Advances to the Care of Surgical Patients through Contributions of the Journal of the American College of Surgeons and the BJS - Centennial Report
An 85-year-old man presented to clinic with a 6-week history of a painless, swollen right leg. He had a pulsatile right thigh. The computed tomography angiogram shows a large right popliteal aneurysm. The options for management are: radiological stenting using a covered stent; and a bypass procedure to exclude the aneurysm. The patient was managed with a bypass procedure from the superficial femoral artery to the below-knee popliteal artery using reversed saphenous vein. The aneurysm was ligated proximally and distally. This aneurysm was deemed unsuitable for radiological stenting owing to the tortuosity of the vessel. The right leg was swollen due to thrombosis of the popliteal vein caused by the pressure effect from the popliteal aneurysm. As this was at least 6 weeks old, the patient did not receive warfarin therapy.
A 71-year-old man presented with sudden-onset lower abdominal pain. On examination he was found to have generalized peritonitis and computed tomography demonstrated intra-abdominal free fluid, but no free gas. The abdominal viscera had a normal appearance and the appendix was not seen. A spontaneous perforation in the dome of the urinary bladder was found at laparotomy. Spontaneous bladder perforation is very uncommon but should be considered in the differential diagnosis in a patient with peritonitis. Aetiological factors cited in the literature include chronic inflammation, bladder outflow obstruction and postradiotherapy. In this patient a circumferential cuff of bladder was excised and the perforation repaired. Histology revealed no evidence of active inflammation or neoplasia.
This 10×15-cm ‘tumour’ was excised from the small bowel mesentery 4 years after nephrectomy. It was an encapsulated haematoma as result of the previous surgery.
A 68-year-old man presented with a short history of intermittent claudication affecting the right leg. The CT angiogram demonstrates a right-sided persistent sciatic artery (upper arrowheads), which takes origin from the internal iliac, passes posteriorly out of the pelvis and descends to supply the popliteal artery (lower arrowheads). Arrows depict the diminshing external iliac artery leading to a rudimentary right superficial femoral artery. Arterial anatomy is normal on the left side. Patients with a persistent sciatic artery usually present with a pulasatile gluteal mass and increased pain when sitting, or following arterial rupture. During early embryonic development, the sciatic artery is the primitive lower limb vessel which normally regresses. In rare cases it persists as a continuation of a hypertrophied internal iliac artery.
NaCl control sinusoidal perfusion failure
This 52-year-old woman presented with symptoms of rectal bleeding and constipation. The initial diagnosis was submucosal tumour, presumed colonic lipoma, after colonoscopy (a) and computed tomography (b); arrow shows tumour. She underwent laparoscopic left hemicolectomy with removal of the tumour (c); histology showed a schwannoma. Preoperative colonoscopy with biopsy is often non-diagnostic for submucosal tumours. Schwannoma is a rare possibility when a submucosal tumour is encountered.
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