The prognosis of patients with CM from CRC is dismal. Surgery may increase survival, but the additional benefit of perioperative radiotherapy cannot be ascertained due to paucity of data. Further studies are required to identify the role of the different oncological and surgical therapies and identify those patients likely to benefit most. Identification of patients who are at higher risk of developing brain metastases may be another important area for future research.

A 69-year-old man presented to the emergency department with sudden onset abdominal pain. He was hypotensive and tachycardic with a peritonitic abdomen. On admission, the patient had been taking clopidogrel, a known cause of spontaneous retroperitoneal haematoma. An initial computed tomography of the abdomen showed a mass in the pelvis, which was thought to most likely be a gastrointestinal stromal tumour arising from the sigmoid colon. Explorative surgery identified a retroperitoneal haematoma of the rectosigmoid region. There was no evidence of bowel perforation. Hence a washout and closure was performed. Five days following an initial improvement, the patient developed symptoms of peritonitis. A second operation revealed that the rectum had become necrotic and perforated with free faeces. The ischaemia was caused by the retroperitoneal haematoma restricting the blood supply to this part of the upper rectum.

We discuss the case of an independent 80-year-old Caucasian woman, being treated with new oral anticoagulants for a previous deep vein thrombosis, who had fallen on her right shoulder. She made a delayed presentation to the emergency department with a wrist drop in her right dominant hand. She had right arm bruising with good distal pulses but had a global neurological deficit in the hand. Plain radiographs of the shoulder, humerus, elbow, forearm and wrist demonstrated no fractures. MRI showed a significant right axillary lesion distorting the surrounding soft tissues, including the brachial plexus, and CT with contrast confirmed this to be a large axillary pseudoaneurysm. This was treated with an endovascular stent resulting in slightly improved motor function, but the significant residual deficit required subsequent rehabilitation to improve right upper limb function.