Here, we report a case of malignant psoas syndrome presented to us during the second peak of the COVID-19 pandemic. Our patient had a medical history of hypertension, recently diagnosed with left iliac deep vein thrombosis and previous breast and endometrial cancers. She presented with exquisite pain and a fixed flexion deformity of the left hip. A rim-enhancing lesion was seen within the left psoas muscle and was initially deemed to be a psoas abscess. This failed to respond to medical management and attempts at drainage. Subsequent further imaging revealed the mass was of a malignant nature; histology revealing a probable carcinomatous origin. Following diagnosis, palliative input was obtained and, unfortunately, our patient passed away in a hospice shortly after discharge. We discuss the aetiology, radiological findings and potential treatments of this condition and learning points to prompt clinicians to consider this diagnosis in those with a personal history of cancer.

Introduction Children with acute abdominal pain are frequently seen in paediatric A&E at DGH. Acute appendicitis is the most common surgical cause of acute abdominal pain in children. Diagnosis and management can be a problem in the absence of paediatric surgical unit Methods A retrospective study was conducted at a busy DGH where general surgical department is routinely involved in the management of acute abdominal pain in children. 6 months data was collected from 01/06/21 to 30/11/21. Results 381 patients (5–16 years) attended paediatric emergency with complaint of abdominal pain. 24% referred to surgeons (females 53%, mean age 10.9 years). All Presented with pain in RIF, migratory pain was in 42%. Nausea and vomiting were reported in 38%, loose stools in 10.8% and loss of appetite in 21.7%. Duration of pain vary between 24 hours to 3 weeks. WCC was raised in 32% patients, US was performed in 21.7%, CT scan in 5.4%, MRI 1%, and 1% had both Ultrasound and MRI. 46.7% did not have any radiological investigations. Appendectomy was performed in 21% (19) patients including laparoscopic in two. Duration of stay range from less than 24 hours to 5 days. 46.7% were discharged within 24 hrs of review, 21.7% stayed for one and only 2% stayed for five days. 1 patient was readmitted following a post operative collection that was managed conservatively. 2 referred to tertiary paediatric unit for complicated appendicitis. Conclusion This data proves that paediatric patients with suspected appendicitis can be safely managed in a surgical unit at DGH.

Introduction Ingestion of foreign bodies are not uncommon, however enterohepatic migration of fish bones causing liver abscesses remains a rare phenomenon. Case Report We present the case of a 58-year-old female admitted with 11 days history of fever, rigors, shortness of breath and malaise associated with vomiting and diarrhoea. Her COVID-19 rapid antigen test was negative. She was tender in the left lower quadrant of her abdomen and inflammatory markers were markedly high so initial differential diagnosis included colitis and diverticulitis. Contrast Computed Tomography of the abdomen and pelvis showed an 8.1cm irregular hepatic lesion initially thought to be a multi-loculated abscess, malignancy or complex cyst. She was started on broad-spectrum antibiotics, escalated to Intensive Care Unit (ICU) and discussed at the hepato-biliary multi-disciplinary team (MDT) where magnetic resonance images demonstrated a perforated duodenum from a 2.5cm fish bone penetrating from the duodenal wall into the liver parenchyma causing a necrotic abscess. She underwent percutaneous drainage of the hepatic abscess. Endoscopic retrieval was then attempted; however, the fish bone was not visualised. Definitive management followed with laparoscopic removal of the fish bone and primary duodenal repair. Discussion Identification of the cause of the abscess during MDT discussion enabled prompt source control which was key in managing intra-abdominal sepsis – radiological drainage in the first instance prevented secondary peritonitis from a potentially ruptured abscess and enabled the patient to be de-escalated from ICU. Previous literature suggests endoscopic retrieval however, laparoscopic surgery remains safer for managing complications following removal of sharp foreign bodies.

Introduction The small bowel obstruction in a non-operated abdomen is rare, and the most common causes are hernia and neoplasm. The complete mechanical small bowel obstruction due to an omental band in a patient with no previous abdominal surgery is rare, and less than five cases have been reported in the literature. Case presentation We report a 65 year old male patient presented to the emergency department with complaints of abdominal pain, distension, vomiting and obstipation for four days. On clinical examination, his abdomen was distended, diffusely tender, guarding. The blood investigations showed elevated White blood cells and neutrophils with normal CRP and the Serum lactate. The Abdominal X-ray was suggestive of SBO. The Computed tomography of the abdomen and pelvis showed marked dilatation of the jejunum, the ileum is entirely collapsed, the impression of a double beak sign in the mid-abdomen which would suggest closed-loop obstruction due to a possible internal hernia. We proceeded with emergency diagnostic laparoscopy converted to laparotomy, which showed omental band causing closed-loop proximal small bowel obstruction. The bowel loops appeared congested with the constriction band due to omental band. The omental band was divided, and the obstruction was relieved. Postoperatively patient recovered well and was discharged on day three post-op. Discussion The timely diagnosis and intervention could prevent complications like strangulation, ischemia and gangrene. Though the omental band is rare, it should still be suspected as an aetiology in patients without prior abdominal surgery.