A case report of a female neonate referred with antenatally diagnosed cystic lesions within the right hemithorax and under the left hemidiaphragm is presented to highlight the ease with which these lesions can be resected in an asymptomatic post-natal infant with minimally invasive surgery. The diagnostic and cosmetic benefits of minimally invasive surgery are also demonstrated. While excising the documented thoracic cyst, another small cyst was identified adherent to the right main bronchus. An elective laparoscopic excision of the abdominal cyst was also successful. A brief review of the complications and treatment of foregut duplication cysts is detailed.

Torted appendices are a rare occurrence but should be considered when encountering a haemorrhagic congested appendix on laparoscopy. As adhesions are rarely present, laparoscopic excision is usually a feasible option.

Prostate carcinoma presenting initially as supraclavicular lymphadenopathy has been increasingly reported as an uncommon presentation of the disease. The diagnosis is often made on lymph node biopsy as these patients rarely undergo digital rectal examination or serum prostate-specific antigen level measurement as part of their initial investigations. A 74-year-old man presented with supraclavicular lymphadenopathy and subsequently deteriorated with severe shortness of breath associated with venous congestion of the head and neck. The diagnosis of metastatic prostate adenocarcinoma was made only after cervical lymph node biopsy. Following the diagnosis, he was confirmed as having an abnormal prostate on digital rectal examination and a raised serum prostate-specific antigen level. The authors propose that a digital rectal examination and a serum prostate specific antigen level be included in the initial investigation process of male patients with persistent supraclavicular lymphadenopathy. This would prevent delay in diagnosis, allow early intervention and decrease patient morbidity.

We present a report on two monozygotic female twins who underwent a left-sided intercostal thoracotomy in the second month of life for pulmonary artery sling correction. Twenty-four years later, in adulthood, the identical twins had both developed right-sided thoracic scoliosis. No previous accounts of scoliosis development after intercostal thoracotomy for pulmonary artery sling correction have been reported.

Bleeding from the edge of an ileostomy site is a common problem. In those who have undergone a proctocolectomy with ileostomy formation in conjunction with a risk of chronic liver disease (even with normal liver function tests), this may be due to peristomal varices. If this is the case, significant, difficult-to-control and potentially life-threatening bleeding is likely in the future and may require transfusion. Improvements in radiological imaging techniques can give quick, sensitive and specific information to diagnose and guide management in this group. In those patients with major bleeding episodes, an initial conservative management policy should be adopted with the knowledge that, if bleeding persists, propanolol therapy, portosystemic shunt insertion or even liver transplantation may be indicated.

Intracystic papillary breast carcinoma is a rare form of non-invasive carcinoma with an excellent prognosis. It accounts for less than 0.5% of breast cancers. We report the case of a 75-year-old man presenting with a painless cystic lump in the right breast. Ultrasonography showed a cystic lesion and aspiration revealed blood-stained fluid with suspicion of malignancy. Excisional biopsy was necessary to confirm the diagnosis and also indicated that local treatment was adequate.

An 83-year-old man presented with a large intracavitatory metastatic malignant melanoma, infiltrating the anterior leaflet of the tricuspid valve. The tumour was excised completely along with the anterior leaflet of the tricuspid valve which was replaced. The patient was well 2 months after surgery.

A 22-year-old male was admitted to casualty with a penetrating injury to his left ventricle following a stabbing to his chest. Penetrating injuries to major organs that originate or pass through the relatively narrow mediastinal corridor may have catastrophic consequences with little in the way of external signs to indicate the severity of the injury. Clinically, patients with penetrating cardiac injuries may present with cardiac shock due to either volume loss or pericardial tamponade. However, expeditious recognition, resuscitation and surgical treatment of these injuries are imperative if one wishes to reduce their inherently high mortality. Simple methods in trauma resuscitation, often being carried out in less than optimum conditions, are vital in order to save an injured patient's life. Decompression of the pericardial sac by intubation is described as a new and relatively simple method in the initial resuscitation of a patient with sharp cardiac injury, prior to definitive surgery.

An 83-year-old lady presented with oedema of the right breast with no focal masses and was found to have a tumour of thymic origin in the anterior mediastinum. We describe this interesting case along with a review of the causes of unilateral breast oedema.

A 46-year-old man was admitted for surgery on a ruptured mycotic abdominal aortic aneurysm. Emergency repair was performed, during which certain anomalies were noted. First, the bifurcation of the aorta was posterior to the left common iliac vein. Second there were no internal iliac arteries. Also, there were prominent lumbar arteries compensating for the absent internal iliac arteries bilaterally. This, we consider, is the first reported case of congenitally absent bilateral internal iliac arteries.

This is the case of a 40-year-old man with a gluteal abscess as the first presentation of diverticular disease. As well as the unusual site, imaging revealed the lack of a connective tract between the abscess and the abdominal cavity or retroperitoneum. In addition, a lack of gastrointestinal symptoms made this case very unusual. Hence, this highlights the need for a high index of clinical suspicion when the usual clinical pointers that guide to the diagnosis of diverticulitis are absent.

Strangulation of digits, the ‘toe-tourniquet’ syndrome needs prompt intervention as failure to recognise the condition can lead to ischaemia and loss of the appendage. It is a common condition though relatively under reported.1 Those who deal with children more frequently are aware of the condition but this is not the case for all medical practitioners and hence the diagnostic dilemma for accidental injury or child abuse arises.

We report this case to increase physician awareness of the syndrome, to highlight the importance of early release of the tourniquet and to avoid misinterpretation of the condition as child abuse.

Covering large defects in the axillary fossa can be challenging because of its complex shape. A variety of local skin, fasciocutaneous and musculocutaneous flaps have been described, with a number of inherent advantages and disadvantages. The use of the pectoralis minor muscle as a pedicled transposition flap has been described for immediate reconstruction of the breast,1 anterior shoulder reconstruction2 and the treatment of bronchopleural fistula.3,4 We now describe the use of a pedicled pectoralis minor muscle flap for soft tissue coverage of the axillary contents after wide excision of the axilla. This has not been previously described.

This case report is interesting in radiologically showing migration of stones from the gallbladder via the biliary tree and into the gastrointestinal tract.