Anastomotic leaks following abdominoperineal resection with rectal anastomosis become clinically significant in 2.9%-22% of cases. Local recurrence of cancer and local inflammation are the most common causes of these leaks. Colonic perforation presenting with suppurative involvement of the lower extremities has been previously reported. We describe herein the case of a colorectal anastomotic leak secondary to pathology-proved acute appendicitis presenting with suppurative necessitation causing right hip septic arthritis five years following lower anterior resection (LAR) for stage unspecified colorectal cancer. No similar case has been demonstrated in the surveyed literature.

Objective: Few reports have evaluated postoperative continuous thoracic epidural analgesia on patients who received a lung transplant. This analgesic modality may facilitate extubation, early ambulation, and achieve adequate pain control with minimization of opioid use. An opioid sparing technique could minimize the side effects of opioids such as ileus, constipation, and somnolence.

Methods: A retrospective chart review following local IRB approval was performed. A total of 97 patients’ charts were collected, from April 2015 to March 2017. Forty-eight patients received T6-7 epidural, and forty-nine patients received standard intravenous (IV) analgesia. Outcome measures collected included length of intensive care unit stay, total duration of hospitalization, need for reintubation or noninvasive intermittent positive pressure ventilation (NIPPV), need for IV lidocaine gtt, and total narcotics consumption during hospitalization in milligrams of morphine equivalents (MME).

Results: Both groups were comparable in age, BMI, and race/gender distribution. Additionally, patient pain requirements were comparable between groups. However, a significantly smaller proportion of thoracic epidural patients required NIPPV post-operatively, (20.4%, 53.2%: p =.0015). Further, the number of patients requiring reintubation was almost halved, (12.5%, 21.3%: NS). Patients receiving thoracic epidural also experienced shorter ICU times (p =.0335) and on average, an overall reduced length of stay by six days.

Conclusions: For patients undergoing lung transplant, epidural analgesia is a viable alternative to IV pain control. Further, it significantly reduced respiratory depression and length of stay in the ICU. More refined comparisons can be made by conducting a precise prospective study with a more structured protocol in place.

We describe a case of a 70-year-old female who presented with pain and swelling in her right groin. CT scan of the abdomen and pelvis found Amyand’s hernia with evidence of inflammation of the appendiceal tip consistent with appendicitis. Laparoscopic appendectomy and open hernia repair revealed an incarcerated hernia. Using blunt dissection, the inflamed tip of the appendix was found in the femoral canal. The appendix was removed. The patient had a De Garengeot’s hernia, not the Amyand’s hernia initially suspected. Patient was discharged home the following day.

Objective: Trapeziometacarpal (TM) joint arthritis is a common source of hand pain in patients presenting to the hand surgeon’s clinic. Long-term data on the natural history of symptomatic TM arthritis is lacking.

Methods: We identified 251 patients with symptomatic TM arthritis and performed a retrospective chart review which identified treatment modalities (including surgery) and long term outcomes which were assessed via a telephone survey.

Results: We found that of the 251 patients who presented with symptomatic TM arthritis, the 114 patients who had surgery had less pain and disability in the long term than those patients who were treated conservatively with splinting or injection (average pain score 1.8 vs. 3.8). However, the majority of patients did not ultimately undergo surgery.

Conclusions: Although patients fare better from a pain and function standpoint with surgery, surgery is not inevitable.

Patients with colorectal cancer will develop recurrence of the disease with greater than 90% having it in the first 5 years following surgery. If detected early, may be amenable to potentially curative surgical resection. This provides the rationale for a follow-up strategy in patients with resected colorectal cancer. We report a case of a 68-year-old female who had a loco regional recurrence after 13 years of primary surgery involving the middle part of sacrum, raising the question regarding the long term surveillance.

We describe the phenomenon of the development of lower urinary tract symptoms (storage) following accidents in which there is no direct bladder trauma or pelvic fracture and propose the term “Whiplash bladder”. That bladder symptoms may develop in such circumstances is under appreciated in the urological and medical legal literature.