Acute appendicitis and retroperitoneal abscess: rare complications of sigmoid diverticulitis

Diverticulitis is a common cause of an acute surgical abdomen and computed tomography has become an essential part of work up particularly to identify complications that commonly include intraperitoneal perforation, abscess and fistula formation. We report the case of an 81-year-old male who presented to the emergency department with acute lower abdominal pain and was found to have sigmoid diverticulitis with the rare complications of a diverticular abscess that had formed a sinus tract and perforated into the retroperitoneum and secondary acute appendicitis. Initial management was with intravenous antibiotics, a Hartmann's procedure and appendicectomy. Subsequently the retroperitoneal collection was drained percutaneously. The case was further complicated by the patient's multiple co-morbidities and unfortunately the patient died 6 weeks after admission from sepsis. This case highlights the role of computed tomography in the pre- and post-operative period to identify complications which are often clinically occult and require early surgical and interventional radiology management to optimize outcomes

Constitutional Conflict in Hong Kong Under Chinese Sovereignty

© 2016, T.M.C. Asser Press.The protracted constitutional conflicts between the Chinese state and Hong Kong society over the pace and form of democratization have become a source of political instability. This article sheds new light on these dynamics by analyzing the two sides as locked in a coordination dilemma: both have important common interests to coordinate with each other, but both rank in divergent ways their preferences for and against introducing competitive electoral arrangements into Hong Kong. It is shown how the unwillingness of either side to compromise has caused the gradual breakdown of coordination as focal points like the Basic Law have eroded, culminating in the Umbrella Revolution of 2014, the largest and longest-lasting popular movement in Hong Kong history. The bloodless ending of the Movement is chronicled, along with the persistence of political stalemate in this highly anomalous polity, known throughout the world for its combination of genuine civil liberties with authoritarian rule.Link_to_subscribed_fulltex