Noncompressible torso hemorrhage (NCTH) involving the thoracic, abdominal, and pelvic regions from both blunt and penetrating trauma is recognized as a major cause of potentially preventable death. These patients have injuries not amenable to standard hemorrhage control techniques (tourniquets, wound packing, manual compression) and are at high risk of exsanguinating before undergoing definitive management in the operating theater or the interventional radiology suite. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive early management strategy that may provide temporary hemorrhage control in hemodynamically unwell patients with torso hemorrhage and bridge to definitive hemostasis.

Background Appendicitis is a leading cause of surgical hospital admission. To date, there have been no published epidemiological studies describing appendicitis in tropical and remote Australia and none specifically documenting appendicitis in Indigenous Australians. This descriptive study used available state data to investigate appendicitis across Far North Queensland (FNQ). Methods Queensland Health hospital admission data for FNQ was analysed to explore appendicitis epidemiology and outcomes in FNQ, 2012–2018. Population data for the same time period provided rates. Results Over the study period, 3458 hospital presentations for appendicitis were available for analysis. Mean incidence was 178 per 100 000/yr. Median age was 27 years with 50.1% female patients. The annual rate of appendicitis was higher in the Indigenous population. Most patients had a laparoscopic procedure with a low rate of conversion to open surgery (2.6%). More than 80% of patients were discharged from hospital in less than 3 days. Intensive care (ICU) admission rate was low overall (1.1%) although higher for Indigenous people (2.4%). Following discharge, the hospital re‐admission rate was 3.8% and all‐cause mortality was 0.03%. Conclusion The incidence of appendicitis in FNQ is higher than that reported in the rest of Australia in both Indigenous and non‐Indigenous populations. Despite logistical challenges of health care, clinical outcomes are in line with best practice across the country. Clinicians in FNQ should maintain a high index of suspicion for diagnosing appendicitis in rural and remote settings.

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Background: Ventral hernias are increasingly managed with minimally invasive laparoscopic surgery. Invasive open surgery is typically used for the repair of large-sized hernias (>10 cm diameter). The two methods are often considered mutually exclusive. We report a hybrid technique for repair of medium to large-sized hernias. Methods: Data was collected prospectively from 44 hernias repaired using the hybrid technique from 2012 to 2020. Operative data was examined and follow-up conducted by both clinical and phone review. As for surgical technique, laparoscopic access was established via a 5 mm optical port and two (or more) 5 mm ports were added under vision. Hernia contents were reduced and extraperitoneal fat excised around the defect. Hernias with diameters ranging from 5 to 10 cm were fixed using the hybrid technique. A small incision was made directly over the hernia and polyester mesh was placed intraabdominally before defect closure with a transfascial suture. Pneumoperitoneum was re-established and mesh fixation achieved using absorbable tacks and/or fixation sutures. Results: Of the 44 ventral hernias repaired with the hybrid technique, 43 were secondary hernias from incisional defects. Average hernia diameter was 6.6 cm. 86% of patients were discharged within the first 48 h. Four patients (9%) had recurrences during the study period. Minor complications occurred in 8 patients (18%): 3 (7%) had post-operative wound infection, 3 patients (7%) developed post-operative seroma. Two patients (5%) had clinically significant wound haematoma. Conclusion: Laparoscopic hybrid ventral hernia repair can be safely performed by a combination of laparoscopic and open techniques, offering an alternative method in the management of medium-sized ventral hernias.

Omphalocaval shunt post traumatic splenectomy in a cirrhotic patientThe authors present a case of omphalocaval shunting for haemorrhage control in a cirrhotic patient following traumatic splenectomy.A 42-year-old patient presented to the emergency department 3 days post blunt trauma to the abdomen. Her past medical history included Child-Pugh C alcoholic liver cirrhosis with coagulopathy, pancytopenia and hepatosplenomegaly, with no varices on most recent endoscopy. On presentation, she was haemodynamically stable, with left upper quadran (LUQ) tenderness and left flank haematoma, haemoglobin of 85 g/L, platelets of 23 × 10 9 , international normalised ratio (INR) of 2.5, total bilirubin of 200 μmol/L and albumin of 24 g/L.