bluuebunny/crossref_metadata_2025_split huggingface dataset:
230 A Rare Case of Catamenial Pneumothorax (CP) in a Middle-Aged Patient with Liver Herniation
Authors: Bushra R 
Published: November 2022

Abstract
Catamenial pneumothorax (CP) is the recurrent accumulation of air in the pleural cavity in reproductive-age women without concomitant respiratory disease.
We report a forty-year-old lady with no past medical history first presented to her local hospital with haemoptysis, severe chest pain, recurrent spontaneous pneumothorax, and dyspnoea, coinciding with menstruation. In addition to a right-sided pneumothorax, in this admission, the chest radiograph showed a right-sided nodule overlying the right hemithorax, and CT showed multiple right-sided ‘pleural’ nodules on the diaphragmatic side.
She underwent a single-port VATS procedure which revealed herniation of the liver through a centrally located diaphragmatic defect, together with the adhesion of the superior lobe to the parietal pleura. The diaphragm was repaired using multiple stitches, followed by buttressing and plication to cover further and reinforce the fixed portion, and a pleurectomy was undertaken to prevent recurrent pneumothorax.
The aetiology of CP remains obscure. However, physiologic hypotheses, the migration theory, the metastatic or lymphovascular microembolisation theory, and the transgenital-transdiaphragmatic passage of air theory are mentioned in other literature. Radiological investigations such as CXR and CT scans showed pneumothorax or pleural nodule evidence, and Investigative inspection of the pleural diaphragmatic surface at thoracoscopy often reveals defects (termed fenestrations) as well as small endometrial deposits. These deposits have also been seen on the visceral pleural surface among women undergoing routine surgical treatment for recurrent pneumothorax.
The most effective treatment strategy is early surgical repair and resection of the diaphragm and the affected lung with pleurodesis and hormonal therapy to achieve amenorrhoea.
231 Tillaux Fracture in a 40-Year-Old Man: A Rare Case Report
Authors: Kwan TY , Khalik M 
Published: November 2022

Abstract
Tillaux fracture is an intra-articular Salter-Harris III fracture affecting the anterolateral aspect of the distal tibia. It is commonly seen in children and adolescents but rare for adults. As Tillaux fracture can be unstable, misdiagnosis may result in delayed surgical treatment and development of complications such as post-traumatic arthritis and persistent syndesmotic instability.
A case of adult Tillaux fracture is reported, involving a 40-year-old gentleman who sustained a low energy injury. He presented to local hospital after being assaulted by a stranger. He tripped over a low fence and sprained his left ankle in external rotation. On examination, he was not able to weight bear. There were swelling and focal tenderness at the triangular concavity of distal fibula. Ankle X-Ray was reported as normal. It required CT scan for diagnosis after reviewed by orthopaedics team at fracture clinic. The patient was subsequently treated with lag screw fixation and recovered after 6 weeks post-operatively.
This case highlights the importance of a systematic method to interpret ankle X-Ray. It is essential to observe the tibio-fibular overlap and any change in the outline of bony cortex of the fibular notch. CT scan has a high sensitivity in delineating fracture pattern hence it should be performed when there is difficulty to confirm the diagnosis solely based on X-Ray.
In conclusion, Tillaux fracture should be suspected when patients present with external rotation injury. There should be low threshold to perform CT scan when there is any uncertainty with the ankle X-Ray interpretation.
296 Knowing When to Put the Knife Down - a Case Report on Osteoradionecrosis of the Chest Wall
Authors: Randall C , Sankar T 
Published: November 2022

Abstract
Radiation therapy is a common treatment for carcinoma of the breast. It has shown to reduce the incidence of local reoccurrence and improve life expectancy, but it is not without complications. Osteoradionecrosis (ORN) of the chest wall is a recognised but rare complication, which can lead to full thickness necrosis, localised infection, and pathological rib fractures.
This case report discusses a 78-year-old female with a history of adjuvant radiotherapy for a left breast malignancy, who developed three distinct wounds on her left anterior chest wall. Over five years, these wounds ulcerated and formed sinus tracks exposing the rib cage. The patient also developed various local infections requiring antibiotics.
Management options were explored, ranging from conservative dressings, anti-inflammatories and steroids to medical options traditionally used to treat ORN of the mandible, such as the combination of Pentoxifylline and vitamin E, and Hyperbaric Oxygen Therapy (HBO2). However, the most beneficial definitive treatment proposed was surgical intervention using either a latissimus dorsi or an upper limb fillet flap. Despite this, the patient's social, cosmetic, and surgical concerns focussed the current management towards the conservative highlighting the importance of “putting down the knife” and the role of monitoring the disease with biannual clinic follow ups. While surgery is likely a necessity in the future, this case study highlights the importance of considering medical input and keeping the patient's interests at the forefront of surgical practice.
333 A Rare Case of Skeletal Muscle Metastasis of Colorectal Cancer
Authors: Bodapati S , Kulkarni N 
Published: November 2022

Abstract

Introduction
Colorectal carcinoma is one of the most commonly diagnosed cancers. Metastasis is seen in the liver, lung, peritonium and bone. Though skeletal muscles make up a majority of our body mass, they are an extremely rare site for metastasis
A 74 y/male known to have total ulcerative colitis was put on the 2WW due to change in bowel habits, weight loss and anemia. Investigations revealed a large cavitating lesion in the right colon with no evidence of metastasis. He underwent an open total pan procto-colectomy, small bowel resection and end ileostomy
Histopathology showed the tumour was a completely excised adenocarcinoma
During surveillance it was noted his CEA levels were high, for which he had a host of investigations including a CT scan and a PET scan, all of which had no interval changes.
He mentioned that he noticed a lump in his left thigh. Orthopedicians advised an MRI scan which showed a tissue lump covering the front of the thigh, within the vastus medialis.
A biopsy revealed metastatic adenocarcinoma.
He also had left wrist pain. A thorough examination revealed a hard mass within the swelling. Ultrasound confirmed a solid well circumscribed mass with vascularity.
Given the above information the patient felt he would be like to complete the remaining of his life with dignity and comfort at home and was fast-track discharged.

Discussion
Skeletal muscle metastasis of colorectal cancers is always associated with a prognosis that is somber and terminal. A high degree of suspicion is needed for diagnosis.
344 A Rare Case of Meckel's Diverticulitis With a 3 Cm Enterolith
Authors: Abunaser M , Sabri S , O'connor A , Arora P , Andrews C 
Published: November 2022

Abstract
Meckel's diverticulum (MD) is a rare condition that affects only 2% of general population. Only 4 to 6% of those Meckel's diverticulea are symptomatic. Furthermore, having a MD containing enterolith is extremely rare, and herein we present a case of 55-year-old lady with Meckle's diverticulitis containing a 3 cm enterolith. The patient presented with symptoms mimic appendicitis; however, upon further evaluation with an enhanced abdomino-pelvic CT an MD containing enterolith was confirmed. An interval laparoscopically assisted diverticulectomy was performed and the patient recovery was un-eventful.
362 The Scarlet Pimpernel: A Case of Polyarteritis Nodosa Presenting as a Left Hepatic Artery Aneurysm
Authors: Kuganesan T , Sayers A , Brown S , Hutton L 
Published: November 2022

Abstract
A 54-year-old female presented to a secondary care hospital with right upper quadrant pain, headache, and persistent dysuria after empirical antibiotic treatment for a urinary tract infection (UTI). Her brother had died under the age of 50 from aneurysmal disease associated with Polyarteritis nodosa (PAN). Urinalysis demonstrated erythrocytes, leucocytes, and nitrites. Her CRP was 428mg/L and ESR 102 mm/hr. CT of the abdomen and pelvis showed reduced attenuation within both kidneys, and she was treated as acute bilateral pyelonephritis with IV antibiotics. Her abdominal pain changed, she described a “pop” in her right hypochondrium, and she developed a new visual disturbance, despite normalisation of her inflammatory markers. This warranted a repeat CT scan which showed an occlusion of the left hepatic artery with surrounding inflammation and an 8mm aneurysm proximally. MRI and CT venogram of the head was unremarkable. PAN was diagnosed on remote consultation with a tertiary care hospital. It is a necrosing vasculitis affecting small to medium sized arteries with aneurysmal dilatation. There is no genetic cause known, though familial cases have been described. The patient was started on treatment dose Dalteparin and transferred to a tertiary hospital. Selective embolisation of the hepatic artery aneurysm was not undertaken, but she was treated with glucocorticoids and cyclophosphamide. This case highlights a rare condition presenting similarly to a treatment refractory UTI requiring multidisciplinary patient care and the need for repeat imaging following clinical deterioration/change.
440 Gallbladder Volvulus: A Rare Cause of Acute Abdominal Pain in Paediatrics
Authors: Jaly Y , Clarke M , Driver C 
Published: November 2022

Abstract
Gallbladder volvulus or torsion is an extremely rare but recognised entity, which can cause acute abdominal pain. We describe an unusual case of a previously well 8-year-old male who presented with a short history of right-sided abdominal pain and vomiting and was found to have a gallbladder volvulus at laparoscopy. The patient was admitted with a history of sudden onset, severe, right-sided abdominal pain associated with non-bilious vomiting. On examination, he had localised right-sided abdominal tenderness. Laboratory investigations showed mildly raised inflammatory markers. The working diagnosis was acute appendicitis, and he was taken to theatre for a diagnostic laparoscopy. At laparoscopy, a necrotic, torted gallbladder was identified with its long axis horizontal. The gallbladder was de-torted and a laparoscopic cholecystectomy was performed. The postoperative course was uncomplicated, and the patient was discharged home on the third postoperative day. Gallbladder volvulus is an unusual diagnosis in children and is characteristically described in elderly women. The presentation can mimic that of acute appendicitis or cholecystitis. The diagnosis is challenging and is usually made incidentally, either radiologically or at the time of surgery.
476 Case Report: A Fishy Case of Flexor Tendon Injury
Authors: Mactier M , Davies K , Gilmour A 
Published: November 2022

Abstract

Introduction
We describe the first documented case of a flexor pollicis longus (FPL) tendon injury occurring secondary to a fish bite.

Case Report
A 52-year-old right hand dominant male was referred with inability to flex his right thumb following a pike bite whilst fishing in a nearby Loch. Clinical examination revealed superficial abrasions to his right thumb with two deeper puncture wounds over the volar pulp. He had no active flexion of the interphalangeal joint. Radiographs showed no fracture/foreign body. Given deep animal bite, intravenous antibiotics and operative exploration were indicated. Intraoperative findings revealed 100% division of the FPL tendon (zone II); this was repaired using a modified Strickland method. The patient completed 48 hours intravenous antibiotics and was discharged with physiotherapy-led follow up.

Discussion
Animal bites are a common presentation to the Emergency Department however non-domesticated animals account for &lt;5% cases. We are not familiar with managing marine animal bites and the literature is lacking. Only 2 cases of sting-ray injuries have been described, both of which were associated with delayed presentation and poor functional outcome. Aquatic injuries also contain unique bacterial flora including Vibrio, Aeromonas and Pseudomonas which merits consideration.

Conclusion
This case highlights the importance of managing innocuous wounds with caution in case of underlying structural damage. Unusual animal bites should be closely monitored with low index for surgical exploration to avoid delayed complications. Discussion with microbiology specialists should also be considered.
509 Splenosis, an Important Differential for Peritoneal Metastases
Authors: Tanwar A , Gurung C , Pangeni A , Shrestha A , Basnyat P 
Published: November 2022

Abstract
Splenosis is defined as the auto-transplantation of splenic tissues in other sites of the body. It is a rare benign condition and can be an incidental finding. However, early diagnosis is essential as the differential diagnosis of splenosis includes peritoneal metastases.
Early identification relies on recognising relevant past medical history including splenic injury and or splenectomy. Splenosis can be confirmed through the usage of a technetium-99m colloid scan. By using nuclear medicine scans, repeated invasive investigations such as biopsy and diagnostic laparoscopies can be avoided.
We present here a case of a 51-year-old woman who was extensively investigated by the gynaecology department and general surgery department, even undergoing a diagnostic laparoscopy following repeated presentations to primary and secondary care with chronic abdominal and pelvic pain. She had a splenectomy 28 years earlier for traumatic splenic injury. CT scan of abdomen and pelvis showed features suspicious of multiple peritoneal metastases and hence she was urgently referred to a colorectal cancer multidisciplinary meeting. A subsequent technetium-99m colloid scan confirmed multiple splenic nodules in the peritoneal cavity. The patient was reassured and discharged.
In conclusion, in a patient with a known history of splenic trauma, splenosis is an important differential diagnosis. A careful past medical history and appropriate investigations will avoid unnecessary referral and invasive investigations.
536 Conservative Management of the Colonic Gallstone
Authors: Hurst K , Peiris B , Booth M 
Published: November 2022

Abstract
A 74-year-old woman presents with a 7-day history of increasing lower abdominal pains and reduced bowel movements; resulting in absolute constipation.Twenty-four hours prior to admission she also had symptoms of nauseous and significant abdominal distention. Her past medical history included; diverticulitis, type 2 diabetes, hypercholesterolemia, an ultrasound scan in 2005 confirming gallstones, but no previous abdominal surgery.She was initially treated for bowel obstruction and a CT arranged. CT showed a 4.5 cm gallstone in mid-sigmoid colon and a cholecystocolonic fistula. She was booked for colonoscopy±laparotomy, but on the morning of her planned procedure she repeatedly opened her bowels. Subsequent colonoscopy was negative and repeat CT confirmed the stone was no longer within the gastrointestinal tract.
Several case reports have clearly documented the presence of a cholocystocholic fistula leading to sigmorectal bowel obstruction from gallstones. These reports, however, have all implied that management should primarily be with a laparotomy. Although colonoscopy has also been trialled, few cases appear to have been successful and conversion to laparotomy has been high. This case report highlights a role for conservative management in colonic gallstones, avoiding the morbidity and mortality associated with laparotomy +/- bowel resection.
539 A Case at Crossroads—Urological Presentation, Cardiac Complication and Haematological Diagnosis: Should Imaging Be Pursued Prior to Orchidectomy at All Costs?
Authors: Yasen Z , Kazzazi F , Ioannides K , Velmurugan S , Zegocki K , Li C 
Published: November 2022

Abstract
This case report explores the interesting case of a 71-year-old gentleman who presented with a testicular lump following trauma. Ultrasound imaging of the testicle demonstrated malignancy and subsequently orchidectomy was listed. Due to a scheduling difficulty, this was prioritized ahead of his whole-body computed tomography scan. Intraoperatively, he developed electrocardiogram changes suggestive of a non-ST elevated myocardial infarction. Post-operative imaging demonstrated a diffuse large B-cell lymphoma encroaching the heart and greater vessels. This case report highlights the importance of preoperative imaging, even where it may prove challenging. We assess the adequacy of current guidelines within the UK on imaging for new testicular malignancies.
542 Laparoscopic Division of a Congenital Splenogonadal Portosystemic Shunt: A Case Report
Authors: Charuvila S , Lloyd A , Bhardwaj N , Lloyd D 
Published: November 2022

Abstract
We describe a rare congenital portosystemic shunt. A 37-year-old woman was found to have a previously unreported congenital shunt following investigations into secondary causes of hypertension. The abnormal venous shunt connected the splenic vein to the left ovarian vein. The patient underwent a laparoscopic procedure to successfully divide the shunt. She made a full recovery without complications. To our knowledge, this is the first presentation of a congenital portosystemic shunt involving the splenic and ovarian veins to be reported. This case demonstrates that such a shunt can be amenable for laparoscopic management. The case report shows preoperative scans and intraoperative images.
551 Bilateral Carpal Tunnel Syndrome Following AstraZeneca (AZD1222) COVID-19 Vaccination: A Case Report
Authors: Tullie S , Michell A , Reid A 
Published: November 2022

Abstract
Covid-19 infections correlate with peripheral neuropathy. Correlations extend to vaccination, with reports of polyradiculoneuropathy. We report a case of a 59-year-old right-hand dominant female presenting with bilateral carpal tunnel syndrome (CTS) nineteen days after AZD1222.
BSSH diploma-qualified hand surgeon assessment identified increasing median nerve (MN) paraesthesia and upper limb pain. Symptoms occurred post-AZD1222 second dose administered 12-weeks after the first. Past medical history was unremarkable, and she had not contracted Covid-19. Examination found severe CTS-signs: thenar weakness, positive provocative tests (Phalen's and Tinel's) and 8mm MN static 2-point discrimination. Electrophysiology confirmed very severe wrist bilateral median neuropathies, with no evidence of widespread peripheral neuropathy. Left carpal tunnel decompression found a swollen MN bulging through the transverse carpal ligament. The patient reported symptom improvement 2 weeks post-operatively.
This was reported using MHRA “yellow card” protocols as symptoms occurred within the period of neuropathic side effects. Proposed neuropathy mechanisms in Covid-19 include vasa nervorum microangiopathy. Post-vaccine effects could be connected to such changes in microcirculation implicated in CTS. Vaccines containing SARS-CoV-2 antigens enhance autoimmunity and may cause antibody-mediated effects on the synovial sheath, worsening symptoms in pre-existing CTS. Though we do not claim causality, emerging post-vaccination effects may include exacerbation. It is not uncommon for clinicians to diagnose CTS in patients with symptoms overlooked until an inciting event. With Covid-19 ‘boosters' the long-term strategy, vaccinations may increase neuropathy contribution. Increasing caseloads may present future challenges to hand surgeons managing CTS. Recording correlations may provide a basis for investigating CTS pathophysiology post AZD1222.
602 Using Plastic Surgery Techniques in Abdominal Wall Surgery
Authors: Lee-A-Ping K , Chintapatla S , Chitsabesan P , Lim P , MacLeod T 
Published: November 2022

Abstract
Complex Abdominal Wall Hernias (CAWH) present a huge challenge to surgeons and patients often requiring Abdominal Wall Reconstruction (AWR). AWR aims to restore abdominal wall anatomy, improve function, and reduce the risk of future herniation. Plastic surgery techniques can be used including primary closure, skin grafts, flaps, tissue expansion and small bite, small stitch technique. Below are two cases where some of these techniques were utilised.

Case 1
LC is a 65 y/o female with CAWH. Her gastric band became infected requiring a laparotomy for perforation of gastroesophageal junction. She subsequently had primary open repair of abdominal hernia using Permacol. It became infected requiring 5 debridements and application of a VAC device. Her hernia was a Ventral Hernia Working Group (VHWG) grade 3 at 10cm×16cm. Her CAWH was repaired using a Rives-Stoppa technique and a Surgimend mesh. The epigastric component of her wound was closed using a superiorly based local rhomboid flap and a Prevena VAC dressing.

Case 2
KH is a 37 y/o female with a para-ileal conduit skin granuloma that was painful and refractory to other treatments such as silver nitrate and steroid topical treatments. She had excision of the area of granulation and her wound was closed using a local advancement flap taking account of previous scars raised and a prevena VAC dressing.

Discussion
CAWH requiring AWR is a complex operation benefiting from plastic surgical specialists. Plastic surgical techniques can help with closure of the abdominal wall and reduce complication rates including wound infections and incisional hernia.
609 Metachronous Osteoid Osteoma of the Mid-Diaphysis of the Fibula and Distal Humerus: A Case Report
Authors: Adlan A , Azzopardi C , Davies AM , Botchu R 
Published: November 2022

Abstract
A 7-year-old boy presented with a 4-week history of pain and swelling of the right leg. He had a history of mucoepidermoid carcinoma of the parotid gland, treated by surgical resection without any complication. There was no other significant past medical history. A radiograph of the right leg showed a lytic lesion of the right diaphysis of the fibula with periosteal reaction. An MRI of the right leg showed osteoid osteoma of the fibula with marked cortical thickening with osseous and soft tissue oedema. The patient subsequently had a Jamshidi biopsy and curettage of the lesion, with the histopathological results of the biopsy showing fragments of a typical osteoid osteoma nidus with irregular calcified bony lamellae. His symptoms had significantly improved after the procedure, and he was ambulating without any discomfort or pain. The patient remained asymptomatic until he returned seven years later with right elbow swelling, pain and reduced range of movement over 2–3 months. A radiograph of the elbow joint had shown a large effusion with a sclerotic lesion on the coronoid fossa of the distal humerus in keeping with an osteoid osteoma. The patient had a confirmational biopsy and subsequently radiofrequency ablation of the lesion with complete resolution of pain. To our knowledge, our case is an atypical presentation of osteoid osteoma in two widely separate bones, between the lower and the upper limb separated by seven years disease-free interval.