While causality cannot be inferred, interventions aimed at improving muscle oxygen supply, or preventing its deterioration, might reduce the development of adiposity in children with type 1 diabetes.

Combined hepatectomy and lymph node resection for CRLM in the setting of enlarged or suspicious lymphadenopathy is justified as imaging and operative findings are poor guides in determining positive lymph node disease.

Abdominal tuberculosis: an easily forgotten diagnosisa ns_5801 559..560 Abdominal tuberculosis (TB) is an uncommon condition in Australia. Diagnosis can be delayed because of its atypical presentation. We report two patients with atypical abdominal pain who turned out to have abdominal TB presenting to our institution within a month.The first, a 34-year-old Indian male living in Australia for 3 years and no recent travel history, presented to emergency department with a 2-month history of central abdominal pain, which had increased in the last week and localized to the right side. He had previously been fit and well. Clinically he was afebrile and haemodynamically stable with normal blood parameters other than a raised C-reactive protein (CRP) of 44 (normal < 10). He was markedly tender in his right iliac fossa with no other abnormal findings. A computed tomography (CT) scan of his abdomen and pelvis demonstrated a 5 ¥ 5 ¥ 5 cm rim-enhancing collection around the caecal pole communicating with a 10 ¥ 7 ¥ 5 cm pelvic collection (Fig. 1).The provisional diagnosis of an appendiceal abscess was made and laparoscopy was arranged. However, at the time of laparoscopy, the intra-abdominal fluid was found to be a serous exudate, with diffuse multiple peritoneal nodules present in all quadrants of the abdominal wall (Fig. 2). Biopsies were taken with histopathology showing necrotizing granulomatous inflammation consistent with disseminated intra-abdominal TB (Fig. 3). He was subsequently treated with anti-TB treatment.The second patient, a 41-year-old female originally from Indonesia, who has been living in Australia for 8 years with no recent travel history, was admitted to the medical high dependency unit of the hospital with dyspnoea, malaise and diarrhoea. She was being treated empirically for atypical pneumonia, based on CT findings prior to ascitic tap, which was done for diagnostic reasons because of ongoing abdominal symptoms. It showed acid-fast bacilli a week later. During the second week of her admission, she developed acute abdominal pain with peritonism, associated with an increase in Fig. 1. Forty-one-year-old female with abdominal ascites and thickened proximal small bowel on a computed tomography scan of the abdomen and pelvis.Fig. 2. Intra-operative view of the 34-year-old male patient with atypical right iliac fossa pain, showing multiple diffuse peritoneal nodules throughout the abdomen.Fig. 3. Histopathology image of the peritoneal nodule from the 34-yearold male with abdominal pain, showing necrotizing granulomatous inflammation.

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