Are We Resecting Too Much Colon in Perforated Diverticulitis?

Initially, the Hartmann's procedure was done to reduce mortality in surgery cases of malignant rectal lesions, and not benign disease. However, the procedure was popularized in the management of perforated diverticular disease (PDD) in the 1970s. Herein, we present a case of a patient who had laparotomy and colostomy for PDD.

The Original Rutherford Morison Incision: A Case Report.

In recent years, the Rutherford Morison incision has become synonymous with renal transplant surgery. However, this incision was originally intended for access to the sigmoid colon and pelvis, particularly in the case of a midline previously scarred from operation. We present a case of a middle-aged female with a caecal tumour, requiring resection.

Isolated Perforation of Multiple Jejunal Diverticulae: A Very Rare Cause of Acute Abdomen.

Isolated jejunal diverticular (JD) perforation is extremely rare; it usually presents as a diagnostic dilemma and is often discovered incidentally on laparotomy. Most of these perforations are single. Literature has revealed only one case of multiple small bowel diverticular perforations.

Colorectal resections for malignancy: A pilot study comparing conventional freehand robot-assisted laparoscopic colectomy.

Background: Laparoscopic colectomy is widely accepted as a safe operation for colorectal cancer, but we have experienced resistance to the introduction of the FreeHand robotic camera holder to augment laparoscopic colorectal surgery.

Aim: To compare the initial results between conventional and FreeHand robot-assisted laparoscopic colectomy in Trinidad and Tobago.

Methods: This was a prospective study of outcomes from all laparoscopic colectomies performed for colorectal carcinoma from November 29, 2021 to May 30, 2022.

Primary Retroperitoneal Serous Cyst Adenoma: A Case Report and Literature Review.

Primary retroperitoneal serous cyst adenomas (PRSCs) are extremely rare thin-walled cystic lesions whose pathogenesis is not well understood. Clinical presentation varies depending on the lesion's size and location, i.e.

Necrotizing Soft Tissue Infections of the Breast: A Potentially Lethal Surgical Emergency.

Necrotizing soft tissue infection (NSTI) of the breast is an extremely rare event in surgical practice. It is considered the most aggressive form of soft tissue infection and a true surgical emergency. It is also associated with a high risk of mortality if not diagnosed promptly.

Endovascular Revascularization and Outcomes of Critical Limb-Threatening Ischemia in Trinidad and Tobago: The EVENT Pilot Study-Challenges in a Limited-Resource, Caribbean Setting.

Introduction: This retrospective study investigated major adverse limb events (MALE) and mortality outcomes in critical limb-threatening ischemia (CLTI) patients with tissue loss after an endovascular revascularization-first (EVR-1st) strategy.

Methods: MALE and mortality were assessed in 157 consecutive patients with CLTI and tissue loss from June 2019 to June 2022 at the Eric Williams Medical Sciences Complex, Trinidad and Tobago.

Results: 157 patients underwent the EVR-1st strategy, of whom 20 were pivoted to immediate surgical revascularization (SR).

Gender Influence on Abdominal Aortic Aneurysm Surgery in a Caribbean Population.

Female patients with abdominal aortic aneurysms (AAAs) are usually less common and older than their male counterparts. We report on AAA disease in a Caribbean nation with respect to gender and review their outcomes relative to the male population. Data were collected prospectively and analyzed retrospectively for patients with AAAs who underwent surgery from 2001 to 2018.

Small Bowel Obstruction Caused by an Aggressive Weight Loss Diet in a Patient With No Predisposing Factors.

Phytobezoars are a well-documented cause of small bowel obstruction. Previous reports include patients who have predisposing factors such as gastric surgery, diabetes mellitus, or poor dentition. Consequences of extreme dieting have also been reported, but a resultant phytobezoar and life-threatening bowel obstruction are rare.

Robot-Assisted Common Bile Duct Exploration in Trinidad & Tobago.

Although laparoscopic common bile duct exploration is a feasible and safe option for the operative management of choledocholithiasis, there has been a general reluctance to perform this procedure in Caribbean practice. This is largely because duct exploration is perceived to be difficult with laparoscopic instruments, and endoscopic retrograde cholangiopancreatography (ERCP) has become increasingly available. We report a case in which stones were extracted laparoscopically from the common bile duct, aided by the FreeHand® (Freehand 2010 Ltd.

A Comparison of the Celiacomesenteric Trunk in the Caribbean with Global Prevalence Calculated by a Systematic Review.

Background: Typically, the celiac trunk and superior mesenteric artery branch off separately from the anterior aspect of the abdominal aorta. The celiacomesenteric trunk (CMT) is a rare variant in which those arteries share a common origin. We sought to compare the prevalence of CMT in the Caribbean with the global prevalence as calculated by a systematic review.

Whipple's pancreaticoduodenectomy at a resource-poor, low-volume center in Trinidad and Tobago.

Background: Many authorities advocate for Whipple's procedures to be performed in high-volume centers, but many patients in poor developing nations cannot access these centers. We sought to determine whether clinical outcomes were acceptable when Whipple's procedures were performed in a low-volume, resource-poor setting in the West Indies.

Aim: To study outcomes of Whipple's procedures in a pancreatic unit in the West Indies over an eight-year period from June 1, 2013 to June 30, 2021.

Whipple's operation with a modified centralization concept: A model in low-volume Caribbean centers.

Conventional data suggest that complex operations, such as a pancreaticoduodenectomy (PD), should be limited to high volume centers. However, this is not practical in small, resource-poor countries in the Caribbean. In these settings, patients have no option but to have their PDs performed locally at low volumes, occasionally by general surgeons.

Massive Rectal Hemorrhage From a Stercoral Ulcer.

Massive lower gastrointestinal (GI) bleeding from stercoral ulcers is exceedingly rare. We report a case of a middle-aged man who presented with progressively deteriorating neurologic function with constipation and subsequent massive GI bleeding per rectum. While an uncommon cause of GI bleeding, such patients require rapid resuscitation and timely diagnosis of these ulcers since the usual management of such cases will be futile and harmful due to potentially inappropriate surgical bowel resection.

Minimally Invasive Parathyroidectomy in a Child With Acute Pancreatitis.

Acute pancreatitis (AP) is rarely seen in the paediatric population and is typically not associated with those aetiologies seen in adult pancreatitis. This case describes a 12-year-old female who presented with acute abdominal pain and constipation, with biochemical evidence of elevated serum amylase, calcium (Ca) and parathyroid hormone (PTH) levels. A diagnosis of AP was made, which was settled with conservative management.

Abrikossoff Tumor Clinically Mimicking Carcinoma in Accessory Axillary Breast Tissue.

Abrikossoff tumors are rare benign soft-tissue lesions also known as granular cell tumors (GCT). The histogenesis of these tumors was initially considered to be myogenic but recent studies have revealed a neuroectodermal origin. GCTs of the breast may mimic breast carcinoma based on the triad of radiological, clinical, and pathological features.

Comment on 'Achenbach syndrome in an older man'.

We comment on a previous letter regarding Achenbach syndrome, and suggest that punch biopsy should be performed in all clinically suspected cases to obtain histological confirmation of the disease.

The Pushing Sign for Early Skin Tethering in Breast Cancer.

Skin tethering (ST) is regarded as a classical clinical feature of breast cancer. In many cases, ST is not evident on inspection, with the arm raised and skin pinching over the lump. We have observed that pushing the lump in one or another direction may elicit skin dimpling that was not otherwise evident.

Necrotizing Fasciitis of the Breast Requiring a Life-Saving Mastectomy: A Case Report and Literature Review.

Necrotizing soft tissue infection of the breast is an extremely rare event in routine surgical practice. It is the most aggressive form of soft tissue infection and a real surgical emergency. It is associated with a high risk of mortality if not diagnosed promptly.

Successful Hand Replantation Augmented by Delayed Pedicled Fascio-Cutaneous Groin Flap in an Adult Laborer: A Case Report and Literature Review.

BACKGROUND Upper limb replantation has become an almost routine procedure, with digital and hand reattachments being the most commonly performed. These remain challenging procedures to reconstructive surgeons, especially when there is trauma to the detached limb. Injury to the overlying skin and soft tissue can lead to tissue necrosis, sepsis, and loss of the replanted limb.

Achenbach's Syndrome Revisited: The Paroxysmal Finger Hematoma May Have a Genetic Link.

Achenbach's syndrome describes the sudden occurrence of bruising, pain and swelling of one or more digits of the hand involving the volar aspect of the proximal and middle phalanges. Also known as the paroxysmal finger hematoma, it presents in dramatic fashion, sometimes with a prodrome of tingling, itching or numbness but despite its dramatic presentation, all investigations are normal. Routine blood investigations, as well as coagulation and thrombophilia screens are all negative as are vascular imaging and echocardiography.

Robot-Assisted Minimally Invasive Surgery: First Report from the Caribbean.

Although advanced minimally invasive surgery and robotic surgery were well accepted in developed countries by the turn of the 21st century, they did not enjoy the same popularity in the Anglophone Caribbean. Advanced minimally invasive surgery only became available in select Caribbean countries from the year 2010. And up to the year 2021, robotic surgery was completely non-existent in the Anglophone Caribbean.