BackgroundFuruncular myiasis is a parasitic infection of a live mammal by fly larvae commonly seen in Africa. However, with an increase in international tourism, there is a significant rise in exotic infection in non-endemic areas which can pose a diagnostic challenge to doctors and potentially lead to delay in treatment. From the current literature, only 12 cases were reported in the UK.Case presentationWe report an unusual case of multiple abscesses in a 32-year-old white British woman presenting to our Emergency department in the UK after returning from a holiday in The Gambia, West Africa. She did not complain of systemic symptoms and was otherwise fit and healthy with no significant past medical history. During examination, two maggots were expressed from the abscesses by applying lateral pressure to each lesion. The larvae were found to be Cordylobia anthropophaga. She was discharged with antibiotics to prevent secondary infection with no further follow-up.ConclusionWith globalization, the need for increasing awareness of tropical diseases has become important to win the battle against future epidemics.

No abstract

Small bowel obstruction is the most common surgical emergency after a patient has had abdominal surgery. However, Boerhaave syndrome secondary to an ileostomy obstruction has not been reported in current literature. We present a rare case of two concurrent surgical emergencies in a patient with Boerhaave syndrome and small bowel obstruction. A 38-year-old woman presented with sudden onset severe central chest pain associated with breathlessness. She had a history of Crohn's disease, which had been treated with pancolectomy and ileostomy. Clinical examination showed an extensive palpable surgical emphysema extending from the neck to the pelvis with a distended abdomen. Computed tomography contrast of the chest and abdomen reported bilateral pneumothoraces, ruptured oesophagus and distended small bowel secondary to obstruction at the ileostomy. She was referred to the nearest cardiothoracic centre for an urgent assessment. Unfortunately she passed away shortly after the scan. Ruptured oesophagus is associated with a high mobidity and mortality if it is not recognised, so early diagnosis and prompt treatment is crucial in reducing the mortality rate. There is a strong association between stoma formation and incidence of small bowel obstruction but no difference between an ileostomy and colostomy. This case helps to illustrate the challenging management of chronic recurring abdominal obstruction and the delicate balance of risk of complication versus benefit of various management being surgical or conservative. All general surgeons should be wary of the potential complication of oesophageal perforation secondary to intestinal obstruction.

No abstract

A previously healthy 18-year-old man presented to the emergency department with retrosternal chest pain, hemoptysis and dyspnea after rugby tackle. He was accidentally head butted on the sternal angle by an opponent running in the opposite direction attempting to tackle him. He immediately developed retrosternal chest pain and had to be carried off the pitch. He complained of shortness of breath with hemoptysis and was urgently transferred to hospital.On arrival, he was alert, oriented and in moderate respiratory distress. Oxygen saturations were 88% on room air with a respiratory rate of 24/min. This improved to 98% on high-flow 15L of oxygen. The trachea was central and chest movements were symmetrical with no flail segment. Air entry was equal bilaterally and percussion was resonant on both sides. There was bruising over the sternal angle with tenderness on palpation. Heart sounds were normal on auscultation and his ECG was normal. He was hemodynamically stable.He was kept on supplementary oxygen, started on intravenous morphine for analgesia, intravenous normal saline and kept fasted. An initial portable chest x-ray was normal as shown in Figure 1. AbstractIntroduction: Rugby is the most popular contact sport in the world outside USA1. Musculoskeletal injuries are the most common type of rugby injury. To our knowledge, a tracheal rugby injury has not previously been reported in the literature. We present the first case of tracheo-bronchial injury (TBI) reported in a rugby player.Case report: An 18-year-old male presented to the emergency department with chest pain, hemoptysis and dyspnea after a rugby injury. CT scan showed a tracheal laceration, confirmed on bronchoscopy. This was successfully repaired surgically. He made an uneventful recovery and was discharged after a 6-week follow-up.Discussion: TBI has not previously been reported in rugby players and is rare in sports. It is associated with significant morbidity and mortality. Early recognition, timely airway establishment and effective management of associated injuries is crucial to reduce mortality and complications.