Acute or chronic blood loss from pseudoaneurysms of the splanchnic artery in chronic pancreatitis poses diagnostic and management challenges. Arteriographic examination offers both diagnostic and therapeutic options, with success rates of 76%-100% for both modalities. In cases of failure of embolization, repeat embolization is also an option. Surgical intervention is advocated for rebleeding and failure of embolization. Evidence-based guidelines regarding the optimal treatment modality for this condition are lacking. There has been a reported case of dislodgement of coil into the stomach through a gastropseudocystic fistula. We report the case of a migrating steel-wire coil through the gastrointestinal tract and splenic artery pseudoaneurysm. We highlight the potential complications of pseudoaneurysm and other available therapeutic management options.

The management of patients with an open abdomen is challenging. Control of intra-abdominal fluid secretion, facilitation of abdominal exploration and preservation of fascia for abdominal wall closure can test even the most experienced surgeon. Over the years various techniques have been tried to minimise complications and expedite closure with VAC® therapy (KCI Medical, Witney, Oxford UK) being the newest. This article provides an overview of the techniques available for the management of the open abdomen from towel clips to VAC®.

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A 20-year-old woman was referred to the early pregnancy assessment unit (EPAU) by her GP, with 3 months amenorrhoea and spotting per vaginam. She had a complete miscarriage in 2004 and normal vaginal delivery in January 2006. She had continued to have irregular vaginal bleeding since her last childbirth. She was not using any contraception and her pregnancy test was negative 2 months before presenting to her GP. Trans-abdominal ultrasound scan revealed a slightly bulky uterus with no gestational sac and several irregular cystic areas suggestive of hydatidiform mole. Serum b-hCG revealed titres of 410,000 IU/l and was sent to regional trophoblastic centre for further quantification. She did not have any headache, focal neurological or respiratory symptoms. Haematological, renal, liver and thyroid function tests were within normal limits. The regional trophoblastic centre at Sheffield was contacted regarding advice to proceed with suction evacuation of uterus. However, in view of persistent symptoms following her childbirth a plan was made for further assessment and referral to the regional centre, to rule out persistent gestational trophoblastic neoplasia (GTN)/postpartum choriocarcinoma.Subsequent investigations revealed a b-hCG level of 63,929 IU/l; and on ultrasound, a mass measuring 2.2 6 1.8 6 3.3 cm was noted in the uterine cavity. There was no evidence of metastasis on imaging studies. The WHO score for persistent GTN was 4 (low risk) and she received 7 cycles of single agent chemotherapy with intramuscular Methotrexate and Folinic acid. Her follow-up plan included weekly serum samples for 6 weeks; followed by monthly serum and urine samples for 6 months and then 13-weekly urine samples reducing to twice yearly urine samples for life. She was advised against pregnancy for at least 6 months from the end of chemotherapy.

Testicular germ cell tumours are the most common malignancies in men aged 15-40 years.1 There has been an increased incidence over the past few decades in the UK, 2,3 US 4 and other Caucasian populations. 5 Although the aetiology is unknown, developmental urogenital abnormalities, 6 undescended testes and inguinal hernias have all been associated with higher rates, 7 with sedentary lifestyle, early puberty and genetics also implicated as risk factors. 8-10The British Testicular Tumour Panel and Registry classifies malignant testicular germ cell tumours into two main histological groups: seminomas and teratomas. 11Para-aortic lymph nodes are the most common sites of metastatic disease.Along with the tumour pathology and clinical stage, preoperative staging investigations inform the choice of further treatment, which may be surveillance, chemotherapy or radiotherapy.12 Chemotherapy is usually recommended for those with evidence of metastatic disease while surgical resection is considered for patients with significant residual masses, particularly in the para-aortic region.Surgery is most likely to play a role in improving the outcome of treatment by resecting residual masses in intermediate and poor prognosis patients who are in remission following chemotherapy.Retroperitoneal lymph node dissection (RPLND) is the most common form of surgery required 13 and national guidance recommends that the treatment of patients with advanced disease or recurrence should be carried out in specialised centres.14 In the North Trent Cancer Network (NTCN), vascular surgeons have been members of the germ cell multidisciplinary team and patients requiring RPLND for metastatic testicular cancer have been treated by the vascular service since 1990. This paper reviews our experience and considers the case for involvement of vascular surgeons in the management of these tumours. MethodsAll patients diagnosed with testicular germ cell tumour in the NTCN between 1990 and 2009 were entered into a germ cell database. Patients referred to the vascular service for RPLND were identified through this database. The main indications for surgical referral were a residual para-aortic mass of >1-2cm after chemotherapy or as part of the treat- ABSTRACT inTRodUCTion in the north Trent Cancer network (nTCn) patients requiring retroperitoneal lymphadenectomy for metastatic testicular cancer have been treated by vascular service since 1990. This paper reviews our experience and considers the case for involvement of vascular surgeons in the management of these tumours. PaTiEnTS and mEThodS Patients referred by the nTCn to the vascular service for retroperitoneal lymphadenectomy between 1990 and 2009 were identified through a germ cell database. data were supplemented by a review of case notes to record histology, intraoperative and postoperative details. RESULTS a total of 64 patients were referred to the vascular service for retroperitoneal lymph node dissection, with a median age of 29 years (16-63 years) and a median follow-up of 4.9 years. Ten patients ...