IndicationsSpontaneous rupture of the bladder is a rare occurrence and therefore unlikely to be diagnosed pre-operatively. The majority of ruptures are due to blunt trauma or iatrogenic causes [ 1,2]. Pre-operative diagnosis can be made in such cases and suitable patients selected for laparoscopic repair, bringing the advantages of minimal access surgery to these patients.We report two cases of intraperitoneal rupture of the bladder, one spontaneous and the other of traumatic,' non-iatrogenic cause; both were repaired laparoscopically. The first patient was a 22-year-old lady who was admitted in August 1992, with a 1 week history of painful micturition culminating in severe abdominal pain. She had generalized peritonitis and catheterization revealed blood-stained urine. Emergency diagnostic laparoscopy performed after resuscitation revealed 1.5 L of bloody ascitic fluid and a 2 cm rupture at the dome of the bladder. Biopsy revealed acute innammation with perforation.The second patient was a 54-year-old man who presented with abdominal pain and an inability to pass urine following a car accident. There was no evidence of pelvic fracture or any other intra-abdominal injury. An urgent cystogram revealed an intra-peritoneal bladder rupture. Emergency diagnostic laparoscopy revealed a 3 cm rupture at the dome of the bladder with bloodstained urine in the peritoneal cavity. MethodUnder general anaesthesia, three working ports were placed a 5 mm port was sited above the suprapubic area and two other ports of 5 mm and 10 mm, at the same level as the sub-umbilical port on either side along the mid-clavicular line. The rupture was repaired laparoscopically with two layers of absorbable suture. The bladder was distended with 300 mL of saline to test for leaks. The peritoneal cavity was then lavaged thoroughly with saline before withdrawal of the ports and closure of the incisional wounds. 50Catheter drainage was continued for 1 week after the operation to allow adequate healing. No complications were encountered and there was little need for postoperative pain relief. Both patients recovered quickly with the second one returning to work after 2 weeks. The first patient had total bladder failure and was taught intermittent self-catheterization. Comparison with other methodsIn accodance with our practice, we performed a diagnostic laparoscopy to confirm the diagnosis and exclude other pathology or injury. Using established laparoscopic suturing techniques, we repaired the rupture as for open methods. Similar laparoscopic repairs have been reported for iatrogenic perforation of the bladder [2] and perforated peptic ulcers [3]. If laparoscopic surgery is not available, the only other surgical option would be conventional laparotomy followed by open repair of the bladder perforation. Advantages and disadvantagesWe feel that intraperitoneal rupture of the bladder from any cause can be safely repaired laparoscopically avoiding the problems associated with a large abdominal incision. The benefits of minimal access surgery to the pa...

Background: Obtaining pus swabs from perianal abscesses after incision and drainage for subsequent microbiological analysis is traditionally performed by general surgeons. Our aim is to assess the current practice in our institution, emphasizing on whether pus swabs were sent or not, as well as to identify any associations between the revealed microbiology and the occurrence of immediate post-operative complications and re-admission rates with fistula-in-ano up to 12 months post the emergency drainage. Finally, we aimed to identify if the any members of the surgical team reviewed at any stage post-operatively the results of the microbiological examination of the obtained pus swabs and if that resulted in changes of the patient management. Methods:We reviewed the operative findings and perioperative antimicrobial management of all patients within our institution that required surgical treatment of perianal abscesses over a 6-week period and re-assessed them after 12 months from the performed drainage, with respect to re-admission and identification of occurred fistula-in-ano.Results: A total of 24 patients met our inclusion criteria. Pus swabs were sent in 66.7% of cases and only a third of the requested microbiology reports were reviewed by a part of the surgical team. All patients were discharged prior to the release of the microbiology results with no subsequent change in the management plan. We did not find any consistent association between the microbiology results and re-admission with perianal abscess, with or without fistula-inano. Conclusions:We do not recommend routine use of pus swabs when draining perianal abscesses unless clinical concerns arise, including recurrent perianal sepsis, immuno-compromised status or extensive soft tissue necrosis, especially when these features are associated with systemic sepsis.

The surgical management of complicated appendicitis, especially when clinical diagnosis has been delayed substantially, can be challenging for the emergency general surgery team. The treatment plan needs to be tailored on an individual basis, with careful evaluation of the preoperative imaging studies, patients' prior intra-abdominal surgery and assessment for potential role of combining laparoscopic techniques with percutaneous interventions and/or open surgery. Herein, we present a clinical case with extensive extraperitoneal collections secondary to misdiagnosed appendicitis, which was treated using a single-stage laparoscopic transabdominal pre-peritoneal (TAPP) approach, bypassing the need for additional interventional radiology procedures or open surgeries, which are the most commonly used approaches in similar cases.

Primary peritoneal tumors are rarely encountered and their management is usually challenging for the clinicians. Especially when the patients with advanced peritoneal malignancy present as surgical emergencies, usually with symptoms of obstruction, perforation or gross space-occupying lesions, the on-call surgical team has to weigh the pros and cons of urgent versus delayed treatment and plans a safe and simultaneously oncologically beneficial therapeutic approach. Herein, we present a case of a Caucasian man who was referred as suspected complicated appendicitis by his primary care physician, with the final diagnosis being benign multicystic mesothelioma. We describe the challenges of the clinical decision making for the emergency general surgeon and relevant diagnostic and therapeutic pitfalls, which can be potentially minimized by early liaison with tertiary units specializing in the treatment of disseminated peritoneal malignancy.