Intraoperative hypercarbia and massive surgical emphysema secondary to transanal endoscopic microsurgery (TEMS).

We describe a case where full-thickness excision of a rectal lesion caused massive surgical emphysema and subsequent hypercarbia with associated difficulties with ventilation. This unique case highlights the risks of respiratory failure with extraperitoneal insufflation as in this case and as more commonly with intraperitoneal insufflation. Transanal endoscopic microsurgery (TEMS) is a technique that is being increasingly used in the management of large and early malignant rectal polyps.

Upper gastrointestinal bleeding due to gastric stromal tumour: a case report.

Introduction: Gastro-intestinal stromal tumours are the most common mesenchymal tumours of the gastro-intestinal tract. This case report highlights the necessity of early surgical intervention in such cases to avoid mortality due to rebleeding and to raise the awareness of rare causes of upper gastrointestinal bleed and their management.

Case Presentation: A 61-year-old male presented to the accident and emergency department with a one-day history of haemetemesis with coffee ground vomiting.

Occult small bowel perforation in a patient with Ehlers Danlos syndrome: a case report and review of the literature.

Patients who present with a co-existing connective tissue disorder add a degree of complexity to operative intervention. We present an unusual case of a 53-year-old Caucasian female patient with Ehlers Danlos syndrome who presented with an occult perforation of the distal ileum. The patient had known small bowel diverticulae yet the perforation occurred within the normal bowel wall.

A review of risk scoring systems utilised in patients undergoing gastrointestinal surgery.

Introduction: Adequate stratification and scoring of risk is essential to optimise clinical practice; the ability to predict operative mortality and morbidity is important. This review aims to outline the essential elements of available risk scoring systems in patients undergoing gastrointestinal surgery and their differences in order to enable effective utilisation.

Methods: The English literature was searched over the last 50 years to provide an overview of systems pertaining to the adult surgical patient.

A primary adenocarcinoma of the transverse colon mimicking Crohn's disease: a case report and literature review.

Diarrhoea and weight loss are presenting features of both Crohn's disease and colorectal cancer; however, the two conditions can usually be distinguished on the basis of characteristic patterns of abnormalities observed at the time of initial blood testing and imaging. In patients with suspected Crohn's disease these are often considered sufficient grounds to commence empirical treatment before the results of histology are available. This case report describes a 45-year-old man whose initial clinical, endoscopic and radiological investigations were strongly suggestive of a diagnosis of Crohn's disease, but who subsequently was found to have an adenocarcinoma of the mid-transverse colon.

A rare case of isolated wound implantation of colorectal adenocarcinoma complicating an incisional hernia: case report and review of the literature.

Background: The reported case illustrates an instance of colonic adenocarcinoma presenting as an isolated tumour 3 1/2 years after open surgery. The presentation was in some respects unique as it was complicated by an incisional hernia and occurred in the anterior abdominal wall. A literature review was performed.