No abstract

In addition to removing residual disease after primary chemotherapy, surgery has a wider role in the management of metastatic teratoma. Carefully timed interventional surgery for disease not responding to chemotherapy can be lifesaving. Surgery for early relapse should be preceded by chemotherapy but surgery alone is appropriate where relapse occurs several years after primary treatment, although raised levels of tumour markers or extensive recurrence might be an indication for preliminary chemotherapy.

An 81 year old man who had a reducible right inguinal hernia for 40 years presented with a 4 day history of irreducibility and a 2 day history of tenderness in his hernial sac. At operation a gangrenous appendix was found in the inguinal canal lateral to and outside the sac of an indirect hernia. This condition has not previously been described.