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In the December 2016 issue of BJS, three papers are published on the national registries of oesophagogastric cancer in three countries: the Netherlands, Japan and Sweden. Professor J. V. Reynolds, National Lead in Ireland for Oesophageal and Gastric Cancer, discusses the papers and their findings. Click here to listen to the podcast. Click on the podcast logo for citation details of the papers.
This stricture of the terminal ileum is caused by Crohn's disease (A). The typical features illustrated here are: creeping fat (B), thickened mesentery (C), thickened fibrotic intestinal wall (D) and dilated small bowel proximal to the stricture (E). The other abnormality that is not a feature of Crohn's disease is a small Meckel's diverticulum (F).
A 55-year-old woman presented with a 1-day history of generalized abdominal pain, distension and vomiting.The X-ray showed a classical coffee bean sign, representative of acute large bowel obstruction secondary to sigmoidvolvulus (a). Flexible sigmoidoscopy revealed a large area of necrotic mucosa and a patch of viable mucosa (b). Followingdecompression and derotation, the patient was managed conservatively and recovered fully.
Totally laparoscopic management of gallstone ileus
Laparoscopic Management of Gall Bladder Fistulae
Laparoscopic colorectal surgeon and the sacro-colpo-pexy mesh
This patient previously underwent coronary artery bypass grafting using the right gastroepiploic artery. During laparoscopic cholecystectomy for gallstone removal, it was confirmed that an artery was running adjacent to the left side of the falciform ligament from the pylorus to the mediastinum through a hole in the left diaphragm. The most important point in this case is that the surgeons were aware of the existence of this graft before surgery, allowing easy and safe completion of standard laparoscopic cholecystectomy while protecting the graft.
The cause of this black spleen is Rituximab treatment before ABO-incompatible solid organ transplantation. The recipients undergo antibody titre reduction by means of rituximab treatment and one or more episodes of plasmapheresis. Previously, splenectomy was done to reduce the B cell load; rituximab therapy means that surgical splenectomy can be avoided. This 50-year-old woman underwent successful ABO-incompatible liver transplantation after preoperative antibody titre reduction by rituximab therapy and plasmapheresis. The spleen was black and atrophied secondary to rituximab therapy.
The cause of this lady’s spontaneous neck haematoma, illustrated in the right image, is parathyroid adenoma. This 74-year-old woman presented with a large bruise over her neck. Blood tests revealed hypercalcaemia (12·0 mg/dl; range 8·4–10·2 mg/dl) and a high parathyroid hormone level (661 pg/ml; range 11–67 pg/ml). Functional imaging showed likely hyperfunction of the left superior parathyroid gland. A left hemithyroidectomy was done with left superior parathyroidectomy. Histopathology was consistent with parathyroid adenoma, with focal haemorrhagic infarction.
This lesion on the stomach, seen at laparoscopy, is a thermal injury to the stomach. Bleeding occurred during endoscopic mucosectomy, which was controlled with intense cauterization. After the procedure, the patient had abdominal pain and pneumoperitoneum on X-ray. Laparoscopy showed a thermal injury with a small perforation in the major curve of the stomach.
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