A 73-year-old man underwent bilateral spinal decompression of L4/5 for severe spinal canal stenosis, requiring minimal analgesia and providing immediate relief. Two days post-operatively, he presented with new onset bilateral leg pain and difficulty mobilising. MRI demonstrated spinal epidural lipomatosis (SEL), which was not present pre-operatively, at L5/S1. Further surgery was performed with decompression of L5/S1 through removal of epidural fat. At both 3 weeks and 5 months follow-up clinics, the patient was asymptomatic. To our knowledge, this is the first case of acute spinal epidural lipomatosis directly following spinal surgery. It is important to recognise SEL as a complication following spinal surgical intervention, due to the potential development of significant neurological consequences.

A 71-year-old woman was admitted with acute swelling of the right knee, pain on the lateral aspect and restricted movement. There was no instability or locking. She had no history of trauma and was generally in good health. Plain radiographs demonstrated a calcific opacity adjacent to the lateral femoral condyle. This was shown to be within the lateral collateral ligament (LCL) at ultrasound and MRI. A diagnosis of acute calcific periarthritis (ACP) was made. The patient's symptoms resolved within a few weeks with simple analgaesia. ACP presenting with calcification within the LCL is rare. It is important to recognise the clinical and imaging findings of this condition as it may mimic other more serious pathologies such as infection and gout. This may result in unnecessary investigations, misdiagnoses and incorrect treatments.

A 36-year-old male was critically unwell with acute central abdominal pain and distension. CT demonstrated severe pneumoperitoneum leading to compression and total occlusion of the inferior vena cava and occlusion of the aorta. At laparotomy a perforated posterior gastric ulcer was found with four quadrant contamination. A damage control procedure was performed and a re-look laparotomy was carried out two days later where bowel ischaemia was found. Despite being supported on the intensive care unit, unfortunately the patient died. Tension pneumoperitoneum leading to occlusion of the aorta is very rare and the severity of this condition should be recognised; it has never been survived in the reported literature. Rapid assessment and investigation is essential to ensure the timely treatment of this disease.

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