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Ann R Coll Surg Engl 2020 May 22:1-2. Epub 2020 May 22.

Mahatma Gandhi Institute of Medical Sciences, Sevagram, India.

Ann R Coll Surg Engl 2020 May 21:1-4. Epub 2020 May 21.

University Hospital Southampton NHS Foundation Trust, UK.

Introduction: Consultants and trainees require exposure to complex cases for maintaining and gaining operative experience. Oesophageal atresia (OA) repair is a neonatal surgical procedure with indicative numbers for completion of training. A conflict of interest may exist between adequate training, maintaining consultant experience and achieving good outcomes. Read More

Ann R Coll Surg Engl 2020 May 21:e1-e2. Epub 2020 May 21.

Department of Urology, Great Western Hospital, Swindon, UK.

Bladder cancer is a rare disease in childhood; however, it is one of great clinical significance. Investigation and management follow a tailored approach, which is largely driven by clinical practice patterns in adult patients with the disease. We present the case of bladder cancer in a boy who presented to the primary care practitioner with visible haematuria. Read More

Ann R Coll Surg Engl 2020 May 21:1-5. Epub 2020 May 21.

Jaslok Hospital and Research Centre, Mumbai, India.

Introduction: Major glossectomy is the treatment of choice in locally advanced tongue cancer. It remains the only option in the presence of recurrent or residual disease. The long-term outcomes for patients undergoing major glossectomy have traditionally been poor, with significant morbidity and poor oncological outcomes. Read More

Ann R Coll Surg Engl 2020 May 21:1-4. Epub 2020 May 21.

Leeds Teaching Hospital NHS Trust, UK.

Introduction: In June 2013, the National Institute for Health and Care Excellence (NICE) published guidance on the management of women with a family history (FH) of breast cancer (BC) and a personal diagnosis of BC. When diagnosed with BC, pressure of timely treatment takes priority and there is potential for a significant FH to be overlooked. This can affect treatment options and follow-up imaging (FUI) surveillance. Read More

Ann R Coll Surg Engl 2020 May 21:e1-e3. Epub 2020 May 21.

West London Vascular and Interventional Centre, Northwick Park Hospital, Harrow, Middlesex, UK.

Endovascular aneurysm repair is an established treatment for ruptured abdominal aortic aneurysm. Primary aortocaval fistula is an exceedingly rare finding in ruptured abdominal aortic aneurysm, with a reported incidence of less than 1%. The presence of an aortocaval fistula used to be an unexpected finding in open surgical repair which often resulted in massive haemorrhage and caval injury. Read More

Ann R Coll Surg Engl 2020 May 21:e1-e4. Epub 2020 May 21.

National University Hospital, Singapore.

We describe the case of an 89-year old Caucasian woman admitted with confusion and severe clinical manifestations of acute hypercalcaemia. There was no history suggestive of any malignancy and initial management included correction of the hypercalcaemia with intravenous fluid therapy. Sestamibi parathyroid scintigraphy and neck ultrasonography demonstrated a 4cm left-sided thyroid lesion and a nearly 2cm right-sided thyroid lesion. Read More

Ann R Coll Surg Engl 2020 May 11:e1-e2. Epub 2020 May 11.

Department of General Surgery, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, South Wales, UK.

Spigelian hernias are generally considered to occur through solitary defects in the fascial layers of the anterior abdominal wall in the 'Spigelian hernia belt' but can be found anywhere along the line of the linea semilunaris. They are uncommon in children and in adults thought to be acquired and associated with obesity. We describe an unusual case of Spigelian herniation previously unreported and possibly previously unrecognised. Read More

Ann R Coll Surg Engl 2020 May 6:e1-e3. Epub 2020 May 6.

St Michael's Hospital, Dun Laoghaire, Dublin, Ireland.

We present a rare case of primary colorectal linitis plastica presenting as an acute admission to hospital with a wide range of systemic symptoms, sudden rapid deterioration and subsequent mortality. A postmortem examination revealed a primary linitis plastica of the colon and rectum with diffuse metastatic disease. To our knowledge, this is the first report of primary colorectal linitis plastica presenting as an acute deterioration as a result of extensive metastatic disease. Read More

Ann R Coll Surg Engl 2020 May 6:1-5. Epub 2020 May 6.

General Surgery Department, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Bordesley Green East, Birmingham, UK.

Introduction: In the UK, general surgeons must demonstrate competency in emergency general surgery before obtaining a certificate of completion of training. Subsequently, many consultants develop focused elective specialist interests which may not mirror the breadth of procedures encountered during emergency practice. Recent National Emergency Laparotomy Audit analysis found that declared surgeon special interest impacted emergency laparotomy outcomes, which has implications for emergency general surgery service configuration. Read More

Ann R Coll Surg Engl 2020 May 6:e1-e4. Epub 2020 May 6.

Ear, Nose and Throat Department, Royal Surrey County Hospital, Guildford, Surrey, UK.

Tumour-to-tumour metastasis is a rare phenomenon. It occurs when a primary tumour is a recipient of a separate tumour within the same individual. We present a case of a 66-year-old woman with known breast cancer who presented with one-sided nasal symptoms. Read More

Ann R Coll Surg Engl 2020 May 6:e1-e3. Epub 2020 May 6.

Department of General Surgery, University Hospital Monklands, Airdrie, UK.

A 62-year old man who presented unwell with no specific symptoms or signs was found to have portal venous circulation gas complicating a small diverticular abscess. He was successfully managed with a course of antibiotics and had full resolution of symptoms, therefore avoiding the need for surgical intervention. While most commonly associated with bowel ischaemia and therefore often warranting emergency laparotomy, portal venous gas within the context of other underlying pathology often presents opportunities for delayed surgery or more conservative management options. Read More

Ann R Coll Surg Engl 2020 May 6:e1-e2. Epub 2020 May 6.

University Hospitals Bristol NHS Foundation Trust, UK.

Autoimmune disorders and their manifestations can be very problematic to diagnose and manage. The symptoms can be ambiguous and debilitating. Early intervention is necessary to counter the unforgiving consequences of delayed intervention, such as loss of sight or hearing and destruction of affected tissues. Read More

Ann R Coll Surg Engl 2020 May;102(5):334

Ege University, Faculty of Medicine, Izmir, Turkey.

Ann R Coll Surg Engl 2020 May 30;102(5):394-396. Epub 2020 Apr 30.

Stoke Mandeville Hospital, Aylesbury, UK.

Ann R Coll Surg Engl 2020 May 30;102(5):333. Epub 2020 Apr 30.

Royal Gwent Hospital, Newport, UK.

Ann R Coll Surg Engl 2020 May 30;102(5):323-332. Epub 2020 Apr 30.

University Hospital of Parma, Italy.

Introduction: Several articles have been published about the reorganisation of surgical activity during the COVID-19 pandemic but few, if any, have focused on the impact that this has had on emergency and trauma surgery. Our aim was to review the most current data on COVID-19 to provide essential suggestions on how to manage the acute abdomen during the pandemic.

Methods: A systematic review was conducted of the most relevant English language articles on COVID-19 and surgery published between 15 December 2019 and 30 March 2020. Read More

Ann R Coll Surg Engl 2020 Apr 29:1-9. Epub 2020 Apr 29.

St George's University Hospitals NHS Foundation Trust, Tooting, London, UK.

Introduction: Head and neck carcinoma of unknown primary represents 1-5% of all head and neck cancers and presents a diagnostic and therapeutic dilemma. In approximately 40% of cases, a primary tumour location remains unknown despite investigation. With advancements in our understanding of the role of high-risk human papilloma virus in head and neck cancer, transoral robotic surgery presents an option for diagnosis and therapy. Read More

Ann R Coll Surg Engl 2020 Apr 29:e1-e6. Epub 2020 Apr 29.

Department of Otolaryngology - Head and Neck Surgery, Northwick Park Hospital, Harrow, UK.

Head and neck tumour thrombus is a rare pathology and at present there are no reported cases of tumour thrombus secondary to acinic cell carcinoma of the parotid gland. We report a case of an 81-year-old man with an acinic cell carcinoma of the left parotid and an intravenous tumour thrombus extending from the retromandibular vein into the internal jugular vein. This case also highlights the importance of radiological imaging in the management of tumour thrombus. Read More

Ann R Coll Surg Engl 2020 Apr 29:e1-e3. Epub 2020 Apr 29.

Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK.

Lymphadenopathy is a common presentation in surgical assessment units and has numerous differential diagnoses. In one-stop breast clinics, its discovery often raises concerns of malignancy. This case report focuses on the case of a 33-year-old pregnant woman presenting to the breast clinic with a right axillary lump, which was found to be the result of toxoplasmosis. Read More

Ann R Coll Surg Engl 2020 Apr 29:1-6. Epub 2020 Apr 29.

Kettering General Hospital NHS Foundation Trust, UK.

Introduction: UK and European guidelines recommend consideration of a self-expandable metallic stent (SEMS) as an alternative to emergency surgery in left-sided colonic obstruction. However, there is no clear consensus on stenting owing to concern for complications and long-term outcomes. Our study is the first to explore SEMS provision across England. Read More

Ann R Coll Surg Engl 2020 Apr 29:e1-e2. Epub 2020 Apr 29.

Imperial College Healthcare NHS Trust, London, UK.

Following open reduction and internal fixation for a proximal humerus fracture a 71-year-old man re-presented with wound changes consistent with infection and elevated inflammatory markers. No significant improvement was seen with concomitant intravenous antibiotics and multiple debridement procedures. This case was further complicated by soft tissue breakdown at the site of a left thigh haematoma also requiring debridement. Read More

Ann R Coll Surg Engl 2020 Apr 24:1-4. Epub 2020 Apr 24.

Pennine Acute Hospitals NHS Trust, Manchester, UK.

Introduction: Guidelines for nasal injury state that assessment should be at 7-10 days post-injury and manipulation within 14 days. We performed a plan, do, study, act improvement cycle to assess whether a dedicated nasal fracture service led to better outcomes.

Materials And Methods: A retrospective study was carried out of all patients undergoing manipulation under anaesthesia for nasal trauma between February 2013 and December 2016 in a district general hospital. Read More

Ann R Coll Surg Engl 2020 Apr 24:e1-e3. Epub 2020 Apr 24.

Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK.

A 42-year-old woman was referred for consideration of left-sided mastectomy and immediate reconstruction. She previously had a bilateral breast augmentation using silicone implants. She desired to maintain her breast size and natural appearance. Read More

Ann R Coll Surg Engl 2020 Apr 24:e1-e3. Epub 2020 Apr 24.

Parma University Hospital, Parma, Italy.

Minimally invasive oesophagectomy has become popular, but studies showed a higher rate of postoperative hiatus hernia compared with open oesophagectomy. Our video presents the laparoscopic biosynthetic mesh repair of a symptomatic giant hiatus hernia in a 71-year-old man who had undergone minimally invasive oesophagectomy one year earlier for distal adenocarcinoma of the oesophagus. The operative time was 120 minutes. Read More

Ann R Coll Surg Engl 2020 Apr 24:1-5. Epub 2020 Apr 24.

Royal Manchester Children's Hospital, Manchester, UK.

Introduction: Management of blunt splenic injury has changed drastically with non-operative management increasingly used in paediatric and adult patients. Studies from America and Australia demonstrate disparities in care of patients treated at paediatric and adult centres. This study assessed management of splenic injuries in UK adolescents. Read More

Ann R Coll Surg Engl 2020 May 24;102(5):355-362. Epub 2020 Apr 24.

First Affiliated Hospital of Harbin Medical University, Harbin, PR China.

Introduction: Gastric cancer is the fourth most common cancer in the world. By the time the patients are diagnosed with stage IV gastric cancer, many patients already have distant metastases. There is no unified systemic treatment plan in existence. Read More

Ann R Coll Surg Engl 2020 Apr 24:1-8. Epub 2020 Apr 24.

School of Medicine, Anglia Ruskin University, Chelmsford.

Introduction: To date, studies have shown a high prevalence of burnout in surgeons. Various factors have been found to be associated with burnout, and it has significant consequences personally and systemically. Junior doctors are increasingly placing their own health and wellbeing as the most important factor in their decisions about training. Read More

Ann R Coll Surg Engl 2020 Apr 24:e1-e5. Epub 2020 Apr 24.

Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

Acromioclavicular joint injuries are common and account for up to 12% of all shoulder girdle injuries and have been reported as being as high as 50% in sports-related shoulder injuries. While the majority of acromioclavicular joint dislocations can be treated non-operatively, there are certain injury configurations, which can include high-grade dislocations in overhead athletes, where surgery may be indicated. The surgical management of acromioclavicular joint instability has moved towards recreating the action of the coracoclavicular ligaments by resuspending the clavicle on to the coracoid. Read More

Ann R Coll Surg Engl 2020 Apr 24:e1-e4. Epub 2020 Apr 24.

Department of Radiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Deep vein thrombosis is a common clinical condition, with well-known risk factors. An unusual case of venous leiomyoma manifesting as a deep vein thrombosis in the left femoral vein of a 55-year-old man was managed successfully at our institution with anticoagulation, en-bloc excision and reconstruction of the femoral vein with spiral vein graft. Read More

Ann R Coll Surg Engl 2020 Apr 24:1-2. Epub 2020 Apr 24.

Singapore General Hospital, Singapore.

Ann R Coll Surg Engl 2020 Apr 24:1-8. Epub 2020 Apr 24.

Royal Devon and Exeter Hospital, Exeter, UK.

Introduction: In breast cancer, early identification of distant metastasis changes management. Current guidelines recommend radiological staging in patients with a preoperative positive axilla; no guidelines address a preoperative negative axilla with subsequent positive sentinel lymph node biopsy. This study investigates whether current guidelines adequately identify distant metastasis in a positive sentinel lymph node biopsy population that had radiological staging. Read More

Ann R Coll Surg Engl 2020 May 24;102(5):321-322. Epub 2020 Apr 24.

Ann R Coll Surg Engl 2020 Apr 24:e1-e3. Epub 2020 Apr 24.

Rio Hortega University Hospital, Valladolid, Spain.

Small bowel obstruction from internal hernias is a familiar pathology for the surgeon, with an incidence of 0.5-5.8%. Read More

Ann R Coll Surg Engl 2020 Apr 24:1-7. Epub 2020 Apr 24.

Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.

Introduction: Endoscopic vein harvest is the technique of choice in North America, where it constitutes 80% of conduit harvest for coronary artery bypass grafting. The UK has much lower rates, despite demonstrable perioperative benefits. Concerns about patency and long-term survival are often cited as reasons for poor uptake and evidence in the literature thus far has only addressed mid-term outcomes. Read More

Ann R Coll Surg Engl 2020 Apr 24. Epub 2020 Apr 24.

Nuffield Orthopaedic Centre, Oxford, UK.

Ann R Coll Surg Engl 2020 Apr 24:1-6. Epub 2020 Apr 24.

Whittington Health NHS Trust, UK.

Necrotising enterocolitis (NEC) is a rare cause of the acute abdomen in adults and carries one of the highest mortality rates in gastroenterology. However, its rarity confines research to small case reports. Both its pathogenesis and aetiology remain enigmatic in adult patients, proving timely diagnosis and management a challenge. Read More

Ann R Coll Surg Engl 2020 Apr 23:e1-e3. Epub 2020 Apr 23.

Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.

Complete surgical resection of a giant solitary fibrous tumour of the pleura can be challenging. We describe our technique for dealing with one such tumour. A clamshell incision proved inadequate for visualising the extent of the tumour. Read More

Ann R Coll Surg Engl 2020 May 23;102(5):392-393. Epub 2020 Apr 23.

Sherwood Forest Hospitals NHS Foundation Trust, Sutton-In-Ashfield, UK.

Ann R Coll Surg Engl 2020 May 23;102(5):393-394. Epub 2020 Apr 23.

Torbay Hospital, Torquay, UK.

Ann R Coll Surg Engl 2020 Apr 23:1-2. Epub 2020 Apr 23.

Port-of-Spain General Hospital, Trinidad, West Indies.

Ann R Coll Surg Engl 2020 Apr 22:e1-e3. Epub 2020 Apr 22.

St Mary's Hospital, London, UK.

Paediatric stridor can indicate serious pathology and requires prompt evaluation and management. Causes range from laryngomalacia to aerodigestive tract foreign bodies. We report on a chronic presentation of paediatric stridor, discuss the workup, management and lessons learned. Read More

Ann R Coll Surg Engl 2020 Apr 20:1-6. Epub 2020 Apr 20.

Lancashire Teaching Hospitals NHS Foundation Trust, UK.

Introduction: The national reconfiguration of vascular surgery means that arterial centres serve larger populations with increased demand on resources. Emergency general surgery ambulatory clinics facilitate timely review and intervention, avoiding admission; a critical limb ischaemia (CLI) 'hot clinic' (HC) was implemented to achieve similar for vascular patients. The aim of the study was to determine HC efficacy. Read More

Ann R Coll Surg Engl 2020 Apr 20:e1-e3. Epub 2020 Apr 20.

Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK.

Laryngeal haemangiomas can commonly be seen in children, and first-line treatment is usually propranolol. However, in adults, cavernous haemangioma of the vocal cord(s) is an extremely rare condition - with this being the only published adult case presenting with acute respiratory distress - the mainstay of treatment is surgical excision under microlaryngoscopy. Presentation in adults can be unpredictable, but primarily consists of hoarseness which can be associated with, dyspnoea, dysphagia, and haemoptysis - and in one documented case stenosis of the aero-digestive tract led to death. Read More

Ann R Coll Surg Engl 2020 Apr 17:1-6. Epub 2020 Apr 17.

Southmead Hospital, Westbury on Trym, Bristol, UK.

Introduction: Shoulder arthroplasty rates are increasing in the UK. No data have been published from a UK centre on predictors of length of inpatient stay following shoulder arthroplasty. This study analyses the length of inpatient stay following shoulder arthroplasty in a high-volume UK centre and identifies predictors of prolonged inpatient stay. Read More

Ann R Coll Surg Engl 2020 Apr 17. Epub 2020 Apr 17.

North Manchester General Hospital, Manchester, UK.

Ann R Coll Surg Engl 2020 Apr 17. Epub 2020 Apr 17.

North Manchester General Hospital, Manchester, UK.

Ann R Coll Surg Engl 2020 Apr 17:1-4. Epub 2020 Apr 17.

Whiston Hospital, St Helens and Knowsley NHS Trust, Rainhill, Prescot, UK.

Introduction: Pilonidal disease is a chronic condition involving the sacrococcygeal area. It can have a significant impact on quality of life, social activities and occupation. Surgery is the mainstay of treatment. Read More

Ann R Coll Surg Engl 2020 Apr 1:e1-e4. Epub 2020 Apr 1.

The Queen Elizabeth Hospital, King's Lynn, UK.

Femur component fracture is very rare with Oxford unicompartmental knee replacement. We report a case from the UK with displacement and rotation of the broken femoral component posterior to the peg. Potential predisposing factors include polywear with metal on metal articulation. Read More

Ann R Coll Surg Engl 2020 Apr 1:e1. Epub 2020 Apr 1.

Royal Blackburn Hospital, East Lancashire Hospitals Trust, Blackburn, UK.

A postoperative radiograph demonstrated a folded radio-opaque structure in the nasopharynx, resembling a retained throat pack, despite her not having any respiratory symptoms. Retention of a throat pack is a never event. Read More