No abstract

Duodenal diverticulum perforation is a rare and life-threatening pathology. Perforation secondary to iatrogenic causes is rare, with only 14 cases previously reported. This paper explores a world-first case report on iatrogenic duodenal diverticulum perforation during right laparoscopic nephroureterectomy and a systematic review of all reported cases of duodenal diverticulum perforation in the literature.

A male in his 50s arrived by ambulance at a regional Australian hospital after being pinned by a buffalo against a fence by the chest and abdomen. Primary and secondary surveys identified an open fibula fracture and superficial abrasions. CT trauma series identified retropharyngeal free gas extending to the right carotid sheath. Flexible nasoendoscopy revealed a normal upper airway and no site of perforation. Oesophagoscopy and gastroscopy were completed to evaluate for a site of free gas leakage. A hypopharyngeal tear was identified 15 cm from the incisors at the cricopharyngeal sphincter. A gastrograffin swallow was completed which showed no leak. The decision was made to manage the patient conservatively with intravenous dexamethasone and intravenous ceftriaxone/metronidazole for antibiotic prophylaxis. The patient had his diet gradually upgraded and was discharged home 4 days later with oral amoxicillin and clavulanic acid.

A 50-year-old male presents to the emergency department in rural Australia with a sore throat, globous sensation of his oropharynx and a swollen uvula. Within the previous 12 months, this was his third and most severe presentation of Quincke’s disease. In all instances, it was aggravated by cold weather. His airway was not compromised. He was admitted under the Ears, Nose and Throat (ENT) specialist and managed with 200 mg of intravenous hydrocortisone, followed by regular intravenous dexamethasone as well as paracetamol for analgesia. He improved over 12 h and was discharged with 1 week of steroids. He followed up with the ENT specialist in the community. A cause could not be found. He was subsequently consented and booked for a partial uvulectomy.

Urachal cancer is a rare non-urothelial malignancy that involves the urachus, often occurring at the junction of the urachal ligament and the bladder dome. It accounts for less than 1% of all bladder tumours. Cancer during pregnancy is rare, with the incidence of all cancers in pregnancy estimated to be 25-27 per 100 000 pregnancies. Urachal cancer in pregnancy is an even rarer phenomenon, with only a handful of case reports published to date. After a systematic review, only five cases have been reported in the English literature. We aim to review the cases presented in the literature and to examine the outcomes of the management of urachal cancer in pregnancy to date.