Lactation anaphylaxis (LA) is an extremely rare condition with only five other cases having been previously reported in the literature. Patients will exhibit cutaneous symptoms, respiratory symptoms, gastrointestinal symptoms, and/or cardiovascular symptoms. Post-partum, the drop in hormones is thought to facilitate an exaggerated histamine response. An elevated serum tryptase level performed between 15 minutes to three hours of onset of symptoms will confirm a true anaphylactic reaction. It is important to be aware of this extremely rare medical condition and its management with antihistamines. Better awareness and education of medical staff on this very rare phenomenon can help to better manage these patients.

Suprapubic cartilaginous cyst (SPCC) is a rare condition known to occur in postmenopausal multiparous women. It is due to the degeneration of the pubic symphysis. Due to its slow progression and rarity in occurrence, it is often misdiagnosed. Presentation includes a painless mass in the suprapubic region, urinary retention, recurrent urinary tract infections, dysuria and dyspareunia. Knowledge of this condition is of great importance, as this is a benign condition that is managed conservatively, thereby avoiding unnecessary procedures. Surgical resection has not shown to have any additional benefit. Once suspected, MRI is ideal for diagnosis. This case report discusses a SPCC with punctuate calcifications and a locule of gas within it. This is the first documented case of a SPCC with punctuate calcifications.

Sigmoid colon diverticulosis is commonly seen in both the surgical outpatient and emergency departments. Rarely, these sigmoid diverticulum, which usually range from 2-3mm to 2cm in size, can enlarge to more than 10 times. This is due to a ball-valve type mechanism that traps colonic gas inside the sigmoid diverticulum causing it to gradually enlarge. Patients with a giant sigmoid diverticulum (GSD) must be investigated thoroughly as two per cent of patients will present with a colonic carcinoma either within or distal to the GSD. Clinical symptoms of a GSD can range from chronic abdominal pain, altered bowel habits, abdominal distention, weight loss, bleeding, perforation, fistula formation, or bowel obstruction. CT and plain abdominal x-ray is the investigation of choice for its diagnosis. Barium enema is useful to determine the presence of a carcinoma within the GSD. Sigmoidoscopy is useful to rule out a distal colonic carcinoma. This is the first published case where nocturnal diarrhoea is the primary differentiating symptom in the patient. The treatment of choice for a GSD is complete resection of the diverticulum and/or the adjacent sigmoid colon. This can be performed with a primary anastomosis or a double-stage procedure.

No abstract

Sarcoma of the small bowel is an extremely rare type of small bowel malignancy and represents around 10 per cent of small bowel cancers. Usually asymptomatic, patients can present with chronic abdominal distention with pain and/or weight loss. Most pathologists now refer to small bowel sarcomas (SBS) as gastrointestinal stromal tumours as they are mesenchymal neoplasms believed to be derived from the interstitial cells of Cajal in the gastrointestinal tract. SBS can be highly vascular and commonly ulcerate and/or bleed. They tend to be aggressive and have a poor prognosis. Surgery is the treatment of choice for SBS, with definitive diagnosis usually made postoperatively with the aid of histopathology. We would like to highlight the importance of careful intra-operative examination of an unknown small bowel (SB) mass, which can give the surgeon clues to the type of tumour present. This case report aims to demonstrate this important process: recognising SBS intra-operatively will aid the surgeon with performing the appropriate resection as minute omental metastasis can be present with SBS; in such cases an omentectomy during the laparotomy is recommended. In institutions where available, intra-operative radiotherapy is ideal.