A 16-year-old boy attended the Emergency Department with sudden severe right iliac fossa pain and associated vomiting. He denied any urinary symptoms, diarrhoea or testicular pain. On examination, he had a locally tender right iliac fossa with guarding. External genitalia and testicular examination revealed an absent right testicle, the left testicle was not tender. The patient was haemodynamically stable. A clinical diagnosis of acute appendicitis and possible testicular torsion was made and the patient sent for an urgent diagnostic laparoscopy. At laparoscopy, the patient was found to have a torted, non-viable right-sided testicle in the abdominal cavity. On discussion with urology, a decision was made to excise the torted testicle as it was atrophic and had significant malignant potential. The appendix was normal. The patient made an unremarkable recovery and was discharged.

A 50-year-old man was referred to the emergency department by his general practitioner with a tender right-sided irreducible inguinal hernia (previously reducible), right-sided testicular pain and scrotal swelling. Clinical examination revealed a non-reducible, tender right inguinal-scrotal hernia and swollen right scrotum. Blood tests showed raised inflammatory markers. The patient went on to have a CT scan which was reported to show an indirect right inguinal-scrotal hernia possibly containing terminal ileum and small bowel mesentery. The scan also showed increased infiltrate changes within the hernia sac suggesting incarceration with possible early strangulation but no obvious evidence of bowel obstruction. The patient was taken to the operating theatre and found to have a large right inguinal-scrotal hernia containing pus and a perforated necrotic appendix. He went to have an appendicectomy and sutured repair of the hernia. Postoperatively, the patient made a good recovery and was discharged 2 days postsurgery.

Aim: The tongue base is an important anatomical area to biopsy when searching for an unknown head and neck primary malignancy. Additionally biopsies must be taken when a clinically apparent tongue base lesion is present and malignancy is suspected. It can be extremely challenging to obtain a meaningful biopsy result for a variety of reasons. Patients who present with head and neck malignancy often come with an array of medical co-morbidities and therefore subjecting them to the risks of a general anaesthetic may not be appropriate. Materials and methods:We present a novel technique of tongue base biopsy which can be performed under local anaesthetic. Alongside this we present a case in which this technique has been utilized by the senior author.Results: The patient presented above had multiple inadequate conventional tonguebase biopsies. Our novel technique yielded a positive result allowing the patient to continue treatment of his recurrent disease. Conclusion:The trans-lingual biopsy of the tongue base under local anaesthetic is a simple, safe and cost effective way to obtain a tissue diagnosis in tongue base malignancy. We believe it to be reproducible and easy to teach.

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