HighlightsPrimary necrotising fasciitis of the breast is an extremely rare entity.We present the youngest patient described in the literature.Prompt resuscitation and surgical intervention are critical to successful management.

A 79-year-old woman presented with postprandial epigastric pain. She had normal vital signs, inflammatory markers and liver function tests. Ultrasound and CT of the abdomen demonstrated features consistent with acute cholecystitis. Her medical comorbidities and extensive abdominal surgical history prompted the decision to treat non-operatively. Despite optimal medical management, worsening abdominal pain and uptrending inflammatory markers developed. She underwent an emergency laparoscopy which revealed a necrotic gallbladder secondary to an anticlockwise complete gallbladder torsion; a rare condition associated with significant morbidity and mortality if managed non-operatively. Laparoscopic cholecystectomy was achieved without complication and the patient had an uneventful recovery. Preoperative diagnosis of torsion of the gallbladder is difficult. However, there are certain patient demographics and imaging characteristics that can help surgeons differentiate it from acute cholecystitis; a condition which can be safely managed non-operatively in selected patients. The differentiating features are elaborated on in this case report.

We present two rare cases of small bowel obstruction (SBO) secondary to Meckel’s diverticulum (MD) where the mechanism of obstruction was not readily apparent. Both were cases of virgin abdomen with pre-operative CT scans demonstrating SBO without a clear underlying cause or mass. Diagnostic laparoscopy was performed, which established the underlying cause to be MD, and laparoscopic-assisted resection was undertaken to resect small bowel and perform a side-to-side stapled anastomosis. We subsequently describe the different mechanisms by which MD can cause obstruction as described in the literature.

No abstract

No abstract