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Listen to experts in the field discuss the contents of BJS articles in the podcasts, view technical videos of methods described in articles and browse the extensive range of images in the archive of Snapshots in Surgery. Please click on the image for more information.
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Click here to watch a discussion of the BJS Special Issue on surgery in the elderly. Three scenarios on vascular interventions in the elderly are discussed and are included in a Leading Article on the subject entitled "Vascular interventions in the elderly" by J.J. Earnshaw and R.J. Hinchliffe.
Three authors included in the special issue on surgery in the elderly (due out mid-January 2016), discuss the issues surrounding treatment and care of the older patient. Click here to listen.
State-of-the-art lecture on transanal total mesorectal excision by R. Hompes detailing the evolution of the access approach as well as evidence, technique and next steps required. Click here to watch the video (Supporting Information) and read the article.
The forceps is not holding anything. Rather, the appendix is being tented up by magnetic attraction between intraluminal magnets and the instrument’s handle. A teenager underwent minilaparotomy to remove swallowed magnets, which were arrested in the right lower quadrant on serial radiographs. To minimize procedural morbidity, the magnetic attraction between the intraluminal foreign bodies and an extraluminal metal instrument was exploited. Thus, the magnets were dragged from the right colon back into the appendix. From this point, simple appendicectomy allowed easy and clean removal of the magnets. The patient was discharged the following day.
In the October 2015 issue of BJS, two randomized clinical trials, a systematic review and a review on the subject of bleeding in surgery are published. Click on the podcast logo to the right.
The picture shows an interstitial hernia, causing small bowel obstruction. A 76-year-old woman with a history of previous total abdominal hysterectomy was admitted with symptoms and signs of small bowel obstruction. An emergency laparotomy was carried out and a large left-sided interstitial hernia containing distal jejunum was found. The small bowel was bruised but viable with an obvious transition point. A primary suture repair of the interstitial hernia was performed with complete obliteration of the interstitial space.
An interstitial hernia is a rare type of hernia that passes between the layers of the abdominal wall. Classically, as shown here, an interstitial hernia passes through a defect in the transversus abdominus and internal oblique muscles, but not through the intact aponeurosis of the external oblique. These hernias may not present with an obvious lump and may go unrecognized. There should be a high index of suspicion in a patient with previous abdominal surgery presenting with symptoms and signs of small bowel obstruction. Meticulous closure of the abdominal wall at the time ofinitial surgery remains the best way of avoiding interstitial hernia formation.
This woman presented with a 1-month history of abdominal swelling and discomfort. She was otherwise healthy with regular menstruation. CT revealed a large (32 × 24 × 13 cm) unilocular cystic intra-abdominal mass. Differentials included either a mesenteric, ovarian or peritoneal inclusion cyst. At laparoscopy, the cyst was arising from the right ovary. The cyst was decompressed laparoscopically and resected along with the right ovary. The specimen was retrieved via a Pfannenstiel incision.
This 50-year-old woman presented wtih a flare-up of her ulcerative colitis and a painful pretibial skin lesion. Pyoderma gangrenosum (PG) was diagnosed. PG is an uncommon inflammatory and ulcerative skin condition that typically affects young and middle-aged adults, with a female preponderance. It presents with an inflammatory pustule which rapidly progresses to a painful skin ulcer that has a characteristic violacious border. More than half of patients who develop PG have associated systemic disease, notably inflammatory bowel disease. However, unlike erythema nodosum, which is more commonly seen in inflammatory bowel disease than PG, ulcer severity is less likely to be linked directly to disease activity.
Diagnosis is based on history and clinical examination. Biopsy typically shows dermal neutrophilia, accompanied by a mixed inflammatory cell infiltrate with or without lymphocytic vasculitis. Treatment is of the underlying systemic disease. PG lesions usually regress rapidly following treatment with systemic corticosteroids.
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