Traumatic transection of the pancreatic duct

A young man presented after a mountain biking accident having received a sharp blow from his handlebars to just below his right costal margin. Although initially he was clinically well and his primary investigations were normal, he was admitted for observation. After becoming peritonitic, his amylase increased to 502 U/ml, and an axial CT scan showed transection of the pancreas. An endoscopic retrograde cholangio-pancreatography (ERCP) was arranged in the operating department, confirming ductal damage. A stent was placed to bridge the pancreatic duct preoperatively, and a laparotomy lavage was carried out and an external drain placed. The patient recovered well and 12 weeks later, after the stent was removed, there was no evidence of pancreatic stricture. Pancreatic injuries must be suspected in blunt abdominal trauma, and preoperative endoscopic stenting may provide the definitive procedure for ductal injuries

Maimonides: an early but accurate view on the treatment of haemorrhoids

Moses Maimonides was not only one of the most influential religious figures of the middle ages, but also a pioneer in a wide variety of medical practices. A brief history of his life, and what is known about his medical education, is given here. His paper on haemorrhoids is summarised, as well as a review of the current understanding of the pathogenesis, prevention and treatment of this common condition. The comparison of Maimonides' writings to modern understanding of not only the prevention and treatment of haemorrhoids, but also his approach to the patient as a whole in terms of pre‐ and postoperative care, demonstrate how ahead of his time this great philosopher was