Gastrointestinal tract (GIT) foreign bodies represent a significant clinical problem in the Emergency Department, causing a high degree of financial burden, morbidity and mortality. A large variety of foreign bodies are accidentally ingested or inserted into the GIT in different age groups. This a retrospective review of 38 patients who presented to the Emergency Department with GIT foreign bodies between January 2001 and December 2004. Computer database and case note search of patients' personal data, nature of the foreign objects and mode of entry to the GIT were recorded. There were 30 males and eight females (M : F ratio of 3.75:1) with an age range of 10 months to 87 years (median age 25.5 years). Foreign body ingestion/insertion was accidental in 14 patients, deliberate in 11, for anal erotism in 11 and as a result of assault in two cases. The median time before presentation was 12 h, and the mean length of hospital stay was 1.7 days. Treatment was conservative in 15 patients; five patients had gastroscopic retrieval; 15 patients underwent examination under anaesthetic, retrieval and proctosigmoidoscopy and three patients underwent laparotomy for impacted foreign bodies. GIT foreign body ingestion or insertion is common; however, majority of cases can be successfully managed conservatively.

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Ann R Coll Surg Engl 2009; 91: 340-343 340Go-karting is a very popular recreational activity in the UK with easy access to race tracks throughout the country. However, due to the relatively high speeds and lack of seat belt restraint requirements, there are numerous injuries and a significant number of deaths world-wide each year.1 Small bowel injury as a result of any blunt abdominal trauma is rare (3.6%).2 Cases of isolated small bowel injury after blunt trauma are even less common (1%) with the majority (58-70%) associated with multiple injuries.2,3 Isolated duodenal injuries are extremely uncommon.We present three cases of isolated duodenal ruptures, of the D3/D4 segment, due to go-karting accidents occurring over a period of 5 months. Difficulties in clinical diagnosis of duodenal injury and the likelihood of significant complications 2,3 justifies maintaining a high index of suspicion with early investigation for patients attending with similar presentations. Case reports Case 1A healthy 29-year-old woman was brought to the accident and emergency department complaining of epigastric and right upper quadrant pain after crashing a go-kart into the side barriers of the track. Blunt abdominal trauma was sustained as the steering wheel impacted on her epigastrium during the crash. She was normotensive and had a pulse rate of 92 beats/min. There was tenderness in the right upper quadrant; however, the abdomen was soft and there was no guarding. Her white cell count (WCC) was raised at 26 × 10 9 cells/l and the haemoglobin (Hb) was normal at 12.1 g/dl. The amylase level was normal at 51 U/l. Chest and plain abdominal radiographs were unremarkable with no free air demonstrated.She was admitted and had an ultrasound scan of the abdomen the next day which demonstrated minimal perihepatic fluid (Fig. 1A) and normal solid organs. Blood investigations showed improvement and the WCC reduced to 12.1 × 10 9 cells/l. The patient remained stable with no worsening of her signs or symptoms. It was, therefore, decided to treat her conservatively and a computed tomography (CT) scan was performed to exclude any serious injury. This demonstrated a rupture in the wall of the early third part of duodenum, air pockets and a fluid collection in the retroperitoneal spaces (Fig. 1B), particularly in the retropancreatic and right anterior pararenal spaces. Some Imaging, Queen Elizabeth Hospital NHS Trust, London, UK ABSTRACT INTRODUCTION Isolated duodenal injury due to blunt abdominal trauma is extremely rare. We present a series of three such injuries due to go-karting accidents, which presented to our hospital over 5 months. CASE REPORTS Between October 2007 and February 2008, three cases of D3/D4 duodenal rupture presented to our hospital after go-karting accidents. Trauma occurred as a result of the steering wheel impacting on the abdomen. All patients presented similarly with symptoms of epigastric and right upper quadrant pain. In all cases, computed tomography scanning was highly suggestive of duodenal injury and, in particular, ...

Purpose – The high crimes of bribery and money laundering resonate vividly with the public, especially where politically exposed persons (PEPs) are involved. Conventional wisdom thus far, dictates the adoption of even stiffer criminal sanctions for perpetrators of such crimes to solidify deterrence. This paper contends that while this approach may be a viable option in respect of PEPs in Western jurisdictions, it is less so with PEPs in Africa, where their peculiar socio-legal antecedents have rendered the venomous arrow of criminal sanction a largely anodyne prickle. The paper further contends that only a paradigm shift away from criminal to tougher civil remedy options can effectively address the endemic incidents of a growing number of PEPs actively engaged in financial crime aimed at asset stripping the state for personal gain in Africa. Design/methodology/approach – The paper juxtaposes empirical evidence from historical records with comparative regional and international approaches to establish some creative new thinking on the subject matter. Findings – The paper makes an important, significant and persuasive argument for a kind of paradigm shift in the approach to fighting corruption by PEPs in Africa specifically …. It is quite creative in deciphering a major root cause of the ineffectiveness in most of Africa of criminal sanction as an anti-corruption weapon, and in pressing trust law and the principles of fiduciary obligation into the service of thinking through the reinvigoration of the legal battle against corruption in Africa. Originality/value – The paper makes a significant original contribution to the legal and policy literature. The author also displays an impressively sound technical command of the relevant and rather pivotal trust law principles and case law.