Medway Maritime Hospital is a general hospital in Gillingham, England within the NHS South East Coast. It is run by Medway NHS Foundation Trust. It is Kent's largest and busiest hospital, dealing with around 400,000 patients annually. It was founded as the Royal Naval Hospital in 1902 for the Naval personnel at the Chatham Dockyard. The hospital was where the Piano Man was taken after being found wandering in a soaking wet suit and tie.
Anastomotic leak (AL) is a feared complication of colorectal surgery, associated with high morbidity, mortality and adverse oncologic outcomes. Despite advances in perioperative care, its incidence remains significant, and prevention is a central challenge in modern colorectal practice. This review summarizes the current evidence on AL with a focus on risk factors, diagnostic considerations and preventive strategies. Patient-related risks include malnutrition, comorbidities, lifestyle factors and, more recently, alterations in the gut microbiota. Intraoperative contributors involve technical aspects of anastomosis construction, adequacy of vascular perfusion and procedure complexity, while postoperative risks relate primarily to delayed recognition and insufficient recovery pathways. Preventive measures span the entire perioperative continuum. Nutritional optimization, risk stratification and modulation of the microbiota represent key preoperative interventions. Intraoperatively, strategies emphasize meticulous technique, assessment of perfusion with emerging technologies and selective use of protective measures such as diverting stomas or transanal tubes. Postoperatively, standardized surveillance and adherence to enhanced recovery protocols are critical for early detection and mitigation of complications. Taken together, the evidence underscores that AL is a multifactorial complication requiring a multimodal prevention strategy. This review provides a structured overview of established knowledge and highlights evolving concepts, with the goal of informing both clinical decision-making and future research.
Uterine artery embolisation (UAE) is a recognised minimally invasive treatment for symptomatic uterine fibroids, with a generally favourable safety profile. Although post-embolisation complications are well documented, vulvar necrosis is exceptionally rare. We report the case of a 50-year-old woman of Black African heritage who developed severe vulvar symptoms eight days after UAE was undertaken for symptomatic multiple fibroids. She presented with intense vulvar pain, swelling, erythema, ulceration, and right-sided gluteal skin changes, alongside numbness in the lateral right leg. Examination revealed ulceration and sloughing of the right vulva, with progression to gluteal necrosis over seven days. CT and MRI imaging demonstrated inflammatory changes and infarction of the subcutaneous fat in the right buttock, consistent with non-target embolisation. Multidisciplinary assessment concluded that the findings were due to extravasation of embolic material into the gluteal region. The patient received broad-spectrum intravenous antibiotics, neuropathic pain management, and multidisciplinary care involving gynaecology, surgery, interventional radiology, pain management, neurology, and tissue viability teams. She underwent surgical debridement of the necrotic vulvar tissue, achieving full healing. The gluteal necrosis was managed conservatively with spontaneous resolution. At three-month follow-up, she was asymptomatic from a gynaecological perspective; at two years, she was diagnosed with right leg pain syndrome, possibly piriformis-related. Vulvar necrosis following UAE is an exceptionally rare but clinically significant complication. This case highlights the need for early recognition of post-procedural vulvar or gluteal changes and rapid multidisciplinary intervention to optimise outcomes. Increased reporting of such cases may help clarify risk factors, refine preventive strategies, and guide management.
