Aneurysms of the hepatic artery are rare. If untreated, aneurysms of the extra-hepatic portion of the artery frequently rupture and this is nearly always fatal. Although the diagnosis may be made clinically or radiographically some cases of ruptured aneurysm are only discovered post mortem. We describe a case in which an hepatic artery aneurysm complicating pancreatitis was diagnosed by real-time and Doppler ultrasound. A 70-year-old woman presented with acute onset of epigastric pain. Physical examination revealed epigastric tenderness with absent bowel sounds. A serum amylase of 8000 + IU (normal ≤ 300 IU) confirmed a diagnosis of acute pancreatitis and the patient received supportive therapy.

No abstract

Protein-calorie malnutrition or kwashiorkor is extremely rare after gastric bypass surgery. We report a case of a woman referred to a weight management clinic in the United Kingdom who developed bilateral leg oedema 2 years after gastric bypass surgery in Tunisia. Her serum albumin concentration was 24 g/l, and her body mass index was 16.2 kg/m(2). A review of the postoperative report of her bariatric surgery revealed that she had undergone a distal bypass with anastomosis of the intestine at 1 m proximal to the ileocaecal valve. She required gastrostomy feeding for 6 months before undergoing revisional surgery to a proximal Roux-en-Y gastric bypass in order to restore healthy weight. We recommend that if patients are having their bariatric surgery outside of their country of residence, they should always obtain a copy of the operative notes so that these are readily available if complications arise.

No abstract

Percutaneous transluminal angioplasty is a well established technique with wide application, but its place in the overall management of peripheral vascular disease is not well defined. This study compares similar groups of patients with peripheral vascular disease in 1981 and 1984, before and after the introduction of the technique to a district general hospital. More patients are now being investigated and treated and this is almost entirely due to the availability of angioplasty. The rates for surgery have not changed. Percutaneous transluminal angioplasty should therefore be seen as a new and separate form of treatment for peripheral vascular disease, not necessarily influencing or replacing surgery, and requiring its own allocation of resources in accordance with the increase in the level of care afforded by the technique.