Objective: Endoscopic upper urinary tract instrumentation is a common urological procedure; often associated with prior ureteric stenting and postoperative urosepsis. This study aimed to explore the clinical utility of preoperative urine and intraoperative urine and ureteric stent cultures in the management of urosepsis post upper urinary tract instrumentation. Methods: Prospective study involving pre-stented patients whose upper urinary tract was instrumented at a single centre between 2017 and 2018. Five cultures were collected per patient. Patients were tracked for development of postoperative urosepsis. Results: The study included 227 patients, with a 5.7% postoperative urosepsis rate. Risk of urosepsis was significantly associated with female gender, steroid use and having a colonized preoperative urine culture, intraoperative bladder urine or stent-end culture, or kidney urine culture. Patients with a colonized intraoperative bladder urine were 11 times more likely to develop urosepsis and were colonized with the same organism isolated from urosepsis cultures for 50% of cases. Conclusions: To our knowledge this is the largest cohort study which analyses five different urinary tract cultures and the relationship with postoperative urosepsis. A positive intraoperative bladder urine culture is an independent predictor of postoperative urosepsis development and causative organism, which could guide antibiotic management for these patients. Level of Evidence 3-b

Acalculous cholecystitis caused by gallbladder torsion is a rare condition. Only 500 cases have been reported since the first diagnosed case in 1898. We present the case of a 89-year-old woman with sudden onset of severe epigastric pain, radiating across her right costal margin, associated with nausea. Her abdomen was soft, mildly distended, Murphy’s negative but with epigastric tenderness and palpable mass. Computed tomography and ultrasound demonstrated significant acute cholecystitis, with the common bile duct measuring 7 mm. Due to the patients’ comorbidities, conservative treatment was initiated, until she was becoming increasing worse, so a laparoscopic cholecystectomy was performed. The operation revealed gallbladder torsion causing complete gallbladder necrosis and perforation with intraperitoneal biliary spillage. Gallbladder torsion should be a high differential if an elderly female patient presenting with sudden onset of abdominal pain, tender epigastric/right upper quadrant mass and a distended gallbladder on imaging. A laparoscopic cholecystectomy must be performed promptly to reduce the likelihood of gallbladder rupture and reduce the mortality and morbidity associated with this condition.

Background: Symptomatic para-oesophageal hiatus (PEH) hernias are treated by surgical intervention, and are associated with older age (>50 years) and higher body mass index (>25 kg/m 2 ). Both risk factors are increasing within the Australian population. Given these trends, this study aimed to determine if the rate of PEH repair is increasing within Australia.

Introduction:Carcinosarcoma of the gallbladder (CSGB) is a rare clinical condition. To date, only 107 cases of CSGB have been reported worldwide. We present our experience of a late presentation of disseminated CSGB. To this we add a discussion of prognostic factors and treatment options for this rare gallbladder malignancy drawn from CSGB cases reported in the literature. Case report: A 73-year-old female presented to our facility with a poorly differentiated CSGB with widespread liver and peritoneal metastases. Fifteen days from the time of hospital admission, the patient suffered an acute episode of massive haematemesis with clinical signs of perforated viscous. Her cause of death was thought to be a tumour-related duodenal erosion. Discussion: Given the poor prognosis of CSGB, particularly when diagnosed at locally advanced or disseminated stages, we suggest a greater role for laparoscopic tissue diagnosis before considering radical surgical intervention.