Open cholecystectomy: Exposure and confidence of surgical trainees and new fellows.

Background: The laparoscopic approach to cholecystectomy has overtaken open procedures in terms of frequency, despite open procedures playing an important role in certain clinical situations. This study explored exposure and confidence of Australasian surgical trainees and new fellows in performing an open versus laparoscopic cholecystectomy.

Materials And Methods: An online survey was disseminated via the Royal Australasian College of Surgeons to senior general surgery trainees (years 3-5 of surgical training) and new fellows (fellowship within the previous 5 years).

Inflammatory fibroid polyp presenting as intussusception.

The majority of adult intussusceptions have a well-defined pathological abnormality as the lead point. We present the case of a 41-year-old female who presented to the Emergency Department on four different occasions with intermittent epigastric pain, associated with vomiting. On the fourth occasion, she was found to have a bowel obstruction caused by an ileocolic intussusception, diagnosed on CT.

Accessory spleen in pancreatic tail.

Intrapancreatic accessory spleens are common asymptomatic masses that generally cause no problems. Usually, they are incidentally found on imaging as a pancreatic mass and they pose a diagnostic and management dilemma due to equivocal imaging findings. Evolving imaging modalities and increasing use of endoscopic ultrasound with fine needle aspirate may result in the avoidance of unnecessary operations and surveillance.

Large Intra-abdominal desmoid tumour: complete resection with preservation of function.

Desmoid tumours are benign monoclonal myofibroblastic neoplasms arising from musculoaponeurotic stromal tissue. They infiltrate local tissue but have no known metastatic potential. The management of desmoid tumours is complicated by their unpredictable nature and rarity, which makes study into their behaviour, and therefore treatment, a challenge.

Spontaneous resolution of a gallstone ileus.

Gallstone ileus is an uncommon complication of cholelithiasis, usually associated with an internal biliary fistula. Management of gallstone ileus is surgical with enterolithotomy the procedure of choice, followed by fistula closure either as a one or two stage procedure. In this case a 66 year old female presented with colicky abdominal pain, computed tomography (CT) clearly showing a gallstone ileus and cholecystoduodenal fistula.

A novel method for managing enterocutaneous fistulae in the open abdomen using a pedicle flap.

A significant proportion of patients with severe intra-abdominal sepsis are managed by leaving the peritoneal cavity open in an attempt to control the infective process, regardless of aetiology. However, a considerable number of these patients develop enterocutaneous fistulae, which compound the clinical situation and delay closure of the peritoneal cavity. We propose a new method of dealing with such fistulae, by simply fashioning a direct pedicle flap to patch the fistulous opening.

Massive inguinoscrotal bladder hernia.

Inguinoscrotal bladder hernias are rare, occurring in 1-4% of all inguinal hernias. Massive inguinoscrotal bladder hernias, where >50% of the bladder is found in the hernia sac are extremely rare. Patients can suffer significant morbidity from such a hernia.

Incarcerated adult femoral hernia containing a fallopian tube.

Femoral hernias are not common in the adult population however they are often associated with higher rates of incarceration compared to other hernia subtypes. Subsequently they have an increased need for emergency surgical intervention. It has been well documented in the literature that femoral hernia sacs can contain an array of anatomical structures and rarely this includes fallopian tube.

Stercoral perforation of the rectum.

Stercoral perforation of the rectum is an uncommon complication of chronic constipation and is therefore often not considered as a differential in patients presenting to primary health-care facilities. Unfortunately, until awareness of this rare but potentially life-threatening disorder is raised patients will continue to be misdiagnosed and potentially suffer from poorer outcomes. We review the literature and discuss a case of rectal perforation and its management.

Primary rectal melanoma.

Primary rectal melanoma is rare and only represents up to 4% of anorectal malignancies. The prognosis of such a diagnosis is significantly different to a metastatic melanoma deposit in the anorectal area and therefore differentiation between the two is of the utmost importance with regards to initial treatment and long-term management. Various immunohistochemical markers have been shown to be associated with primary melanoma and strongly aid in diagnosis.