Recurrent hydatid disease, a case report and literature review

Hydatid disease (HD) remains endemic in Australia, with estimated incidence highest in rural and indigenous populations. Its recurrence is defined by new active cysts arising after appropriate therapy, and affects anywhere between 2-25% of total cases. Available treatment options include surgical resection, percutaneous drainage, and chemotherapy. Interestingly, their individual contributions to long-term minimisation of recurrence are scarcely described in the literature. We present a unique case of a 27-year-old female with recurrent hepatic HD requiring repeat operations and long-term chemotherapy. Prevention and treatment of recurrent HD requires careful evaluation of a multitude of factors, including disease characteristics, patient attributes, physician expertise and availability of resources. Consistent long-term follow up is required to better ascertain the long-term efficacy of reported treatment modalities for preventing recurrence. Despite a growing body of research looking at treatment of HD, there remains a considerable amount of controversy regarding most effective approach for minimising and preventing its recurrence

Pancreatectomy for metastatic real cell carcinoma : twenty years of experience at a tertiary centre

Renal Cell Carcinoma (RCC) accounts for approximately 90% of primary renal malignancies, of which the clear cell subtype is most common. While metastatic disease is common at the time of diagnosis and generally confers a poor prognosis, metastatic RCC may demonstrate relatively indolent behaviour and present many years after resection of the primary tumour, including to the pancreas. The available literature suggested that surgical resection was appropriate for select patients, including those with a solitary pancreatic metastasis, minimal comorbidities and uncomplicated progress from initial treatment of their primary renal malignancy. A retrospective case series of patients presenting with RCC metastases to the pancreas, managed via surgical resection at a tertiary teaching hospital was reviewed. Analysis of patient demographics, investigations, management and outcomes were performed, with a focus on post-operative morbidity and overall survival. Between 2000 and 2020, 7 patients underwent pancreatic resection of RCC metastases at our tertiary teaching hospital with curative intent. Median age at time of resection was 66 years. No post-operative mortality or major morbidity was experienced by the 7 patients, although 4 patients developed some degree of pancreatic insufficiency. Four patients experienced recurrent metastatic RCC, with median time to recurrence of 3.5 years. This was the largest local study to describe an Australian experience of the surgical management of RCC pancreatic metastases. These patients are frequently afforded prolonged survival following pancreatic resection, but often develop other distant sites of disease and second renal tumours

First reported case series of Candida krusei peritonitis secondary to a perforated viscus

Candida peritonitis is associated with high mortality and multiple organ failure. With an evolving epidemiology of candidaemia indicating an increasing prevalence of rare Candida species worldwide, consideration of multidrug-resistant fungal pathogens as a cause of abdominal sepsis is paramount. We report three cases of Candida krusei as a cause of secondary and tertiary peritonitis. These cases highlight that the early use of an echinocandin class antifungal in patients not responding to standard regimens warrants consideration

Port-site metastasis of pancreatic adenocarcinoma following 'successful' completion of neoadjuvant chemoradiation using FOLFIRINOX

Diagnostic laparoscopy is a well-established investigation as part of the initial staging for malignancy of the pancreatic head and tail. To date, there have only been a handful of cases of port-site metastasis due to pancreatic cancer, and none of those were following diagnostic laparoscopy and/or neoadjuvant treatment

Recurrent hydatid disease : a case report and literature review

Hydatid disease (HD) remains endemic in Australia, with estimated incidence highest in rural and indigenous populations. Its recurrence is defined by new active cysts arising after appropriate therapy, and affects anywhere between 2-25% of total cases. Available treatment options include surgical resection, percutaneous drainage, and chemotherapy. Interestingly, their individual contributions to long-term minimisation of recurrence are scarcely described in the literature. We present a unique case of a 27-year-old female with recurrent hepatic HD requiring repeat operations and long-term chemotherapy. Prevention and treatment of recurrent HD requires careful evaluation of a multitude of factors, including disease characteristics, patient attributes, physician expertise and availability of resources. Consistent long-term follow up is required to better ascertain the long-term efficacy of reported treatment modalities for preventing recurrence. Despite a growing body of research looking at treatment of HD, there remains a considerable amount of controversy regarding most effective approach for minimising and preventing its recurrence

[In Press] More than just a tickle in the throat, a giant oesophageal lipoma

A 55-year-old male, with no significant past medical history, presented with progressive dysphagia, dysphonia, and 9-kg-weight loss. His physical examination was unremarkable. He underwent Endoscopy and Endoscopic Ultrasound (EUS), both identifying a submucosal lesion extending 15 to 31 cm from the incisors and was covered with normal overlying mucosa (Fig. 1). The EUS report described the lesion as hyperechoic with well-defined borders, favouring a lipoma of the oesophagus. Although, both endoscopies identified the proximal origin of the lesion, the exact size of the base could not be determined

Laparoscopic fundoplication performed in community hospital settings : a protocol for systematic review

Background: Laparoscopic fundoplication (LF) is well-established as the surgical intervention of choice for management of refactory gastro-esophageal reflux disease. Much of its success lies in the reported benefits in symptom control outlined by the postoperative patient. It is unclear whether patient-reported outcomes differ according to the institution type providing care. This review aimed to address this knowledge gap by reviewing the available evidence examining patient-reported outcomes of LF in non-metropolitan centers. Objectives: To investigate patient-reported outcomes of LF performed in regional or community-based hospitals. Data sources: Four electronic databases, and citations of relevant articles. Study eligibility criteria: Only studies that separately reported patient-reported outcomes of LF performed in regional or community hospitals were included; papers deemed to be unclear about the type of facility in which LF surgeries were performed, or in which data from LF surgeries performed in regional/community hospitals was combined with data from major metropolitan hospitals, were excluded. Study appraisal: Only studies that were graded as fair or good using Quality Assessment Tool for Observational Cohort and Cross-sectional studies were eligible for inclusion in this review. Seven studies were then eligible for inclusion, all of which were observational cohort studies with 6 of the studies reporting on a single intervention arm. Results: Seven observational cohort studies were included in the review, with a combined total of 1071 patients who underwent LF at non-metropolitan centers. Of these, data was collected for 742 patients, yielding an overall response rate of 69.3%. All 7 studies assessed patients' post-operative outcomes through questionnaires that were based on a modified Likert scale or a similar tool. Overall patient satisfaction was high (86%) and a significant majority of patients stated they would recommend the procedure to others (93.3%). Post-operative prevalence of reflux and dysphagia compared favorably to rates generally reported in the literature (11.9% and 17.6% respectively). Further research is required to ascertain the safety of performing these procedures in non-metropolitan hospitals. Conclusion: Current evidence suggests that patient-reported outcomes are favorable for patients undergoing LF in community settings, and are broadly comparable to those undergoing LF in tertiary-level centers

Haemosuccus pancreaticus caused by calcified stone eroding into the splenic vein

Haemosuccus pancreaticus is defined by a bleed from the papilla of Vater via the pancreatic duct. It is a rare cause of upper gastrointestinal bleeding, usually associated with chronic pancreatitis leading to the formation of pseudoaneurysms of the hepatic, gastroduodenal or pancreaticoduodenal arteries. Less commonly reported are cases of pancreaticolithiasis, pancreatic tumours, trauma, infections or pancreatic divisum. Patients typically present with intermittent and repetitive epigastric pain and upper gastrointestinal bleeding, which is often not severe enough to cause haemodynamic instability despite its usual arterial origin. In our case, however, this appears to be of a venous origin

Laparoscopic diagnosis and management of peritonitis chronica fibrosa incapsulata

Sclerosing encapsulating peritonitis (SEP) is a total or partial fibrocollagenous membrane encapsulating the small intestine which can result in an acute or subacute small bowel obstruction. Overall, SEP is an incompletely understood peritoneal adhesional phenomena that has been described by other names including peritonitis chronica fibrosa incapsulata and ‘abdominal cocoon’. 1 We report the first Australian case managed with a completely laparoscopic surgical approach

Fast-track ambulatory abscess pathway : an Australian streamlined emergency surgery pathway

Background: Superficial skin abscesses account for a significant burden of emergency surgical admissions. The aim of this study was to evaluate the effectiveness of an ambulatory care pathway for emergently treating abscesses of the body requiring operative drainage. Method: A retrospective study of a prospective patient database was performed, using randomized patient selection. Patient demographics, length and cost of stay were compared between patients undergoing operative management for skin abscess before and after the implementation of the fast-track ambulatory abscess pathway (FAAP). Results: In total, 100 patients were analysed with 50 in the pre-ambulatory care pathway group and 50 in the FAAP group. The pre-ambulatory care pathway group had a mean age of 37.7 ± 15.8 years versus FAAP group of 35.3 ± 14.5 years. Total length of stay for the group was 85 versus 17 days with a mean comparison of 1.7 days versus 0.34 days (P < 0.001). This translated into a total cost saving of $74 100 in the FAAP group, with a mean comparison cost between the groups of$2884 versus $1402 (P < 0.001). Both reductions in length of stay and cost of stay were statistically significant after implementation of the pathway. Conclusion: This is the first Australian study to report the findings from an ambulatory care pathway for an emergency surgical intervention. We have shown that skin abscesses presenting through emergency can be managed as a day-case procedure, thereby decreasing these patients' overall length and cost of stay