Femoral hernias account for ~4% of all groin hernias but are much more common in females, especially those over the age of 70. Risk of incarceration is overall low but can include structures such as bowel, omentum, bladder, ovary and very rarely, the appendix. The subset of femoral hernias containing the vermiform appendix is known as de Garengeot hernias. We describe a rare case of an 87-year-old female patient who presented with an incarcerated right femoral hernia confirmed on contrast-enhanced computed tomography scan of the abdomen and pelvis, with subsequent open hernia reduction revealing a perforated necrotic appendix with pus contained in the hernia sac. Histopathology revealed acute appendicitis with increased stromal fibrosis suggestive of a chronic process. Pre-operative diagnosis of de Garengeot hernias remains challenging due to their non-specific presentation and attenuated clinical symptoms, and most diagnoses are made intraoperatively.

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Full Title: Walking the boundaries -using the six-minute walk test for accurate assessment of the level of fitness in breast clinic outpatients.

Popliteal artery aneurysms (PAA) are the commonest arterial aneurysm of the periphery. It is defined as focal dilation more than 50% of the normal vessel diameter, which usually varies between 7 and 11 mm. The most common presentation for PAA is claudication due to luminal stenosis caused by mural thrombus or acute limb ischaemia due to thromboembolism. It is much less common for patients to present with mass effect symptoms due to compression of adjacent structures, and of these, common peroneal nerve compression is particularly uncommon. We present a rare case of a 92-year-old female presenting with 4-month history of left foot drop with radiological evidence of common peroneal nerve compression secondary to PAA measuring 22 × 21 mm in size. To the best of our knowledge, this is the smallest reported popliteal aneurysm presenting with foot drop. We also present the endovascular treatment option used.

An 83-year-old lady with no previous history of gallstones, presented with a sudden-onset severe epigastric pain radiating through to the back associated with nausea and vomiting. On examination, the patient’s vital signs were normal. There was severe epigastric tenderness on palpation, as well as moderate right upper quadrant tenderness. Serological investigations showed raised inflammatory markers and serum lipase of 13 000, confirming the diagnosis of acute pancreatitis. Liver function tests were mildly deranged with a normal bilirubin of 12 μmol/L. An abdominal ultrasound demonstrated a distended gallbladder with multiple subcentimeter gallstones and diffuse wall thickening up to 7 mm, consistent with cholecystitis. A follow-up CT abdomen demonstrated evidence of pancreatitis with moderate peripancreatic fat stranding. The diagnosis of concomitant acute cholecystitis and gallstone pancreatitis was made based on the radiological and biochemical findings. The patient underwent an uncomplicated laparoscopic cholecystectomy. The histopathology confirmed cholelithiasis with acute on chronic cholecystitis.