INTRODUCTION The management of colonic injury following damage control surgery (DCS) remains controversial, particularly regarding whether delayed repair (delayed primary repair or anastomosis) or delayed diversion is the safer approach at the repeat laparotomy. This study evaluates the outcomes of these two strategies in penetrating colon injury patients requiring damage control surgery. METHODS A retrospective review was conducted of patients sustaining penetrating colon injuries admitted to a South African tertiary trauma centre over 12 years (2012-2024) using an electronic trauma registry. Patients who underwent DCS and survived to planned second-look laparotomy were analysed. At relook, definitive management was categorised as either restoration of bowel continuity (primary suture repair or resection with anastomosis) or delayed diversion (end colostomy with or without mucus fistula). Data on demographics, admission physiology and Injury Severity Score were analysed, with leak rate, mortality and gastrointestinal complications as primary outcomes. RESULTS A total of 653 patients sustained penetrating colonic injury and 132 (20%) required DCS. After exclusions, 96 patients were analysed (42 in the delayed repair group and 54 in the delayed diversion group). The delayed repair group had a 24% leak rate. In the delayed diversion group, 9% of patients experienced colon-related complications. Colon-related morbidity associated with delayed repair was significantly higher than with delayed diversion. CONCLUSIONS Restoration of bowel continuity for penetrating colon injuries at repeat laparotomy following DCS is associated with a high rate of anastomotic leak or suture-line failure. Extreme caution is advised when considering delayed repair in this setting.
Background The posterior malleolar fracture (PMF) is now understood through three-dimensional imaging and mechanism-based classification, yet this understanding is not new. We argue that its central mechanism (rotation of an axially loaded talus within the ankle mortise) was inferred by Bonnin three-quarters of a century ago, obscured by an era of radiographic, size-based description, and later confirmed and made visible by computed tomography (CT). This continuity is frequently overlooked in the wider literature. Methods We present a narrative review of the primary historical literature alongside contemporary CT-based and cadaveric studies. Results Bonnin’s cadaveric experiments showed that a rotating, axially loaded talus behaves as a wedge within the mortise, splitting the posterior tibial margin (the injury we now term a rotational pilon fracture) and he held that damage to the plafond, not the size of the fragment, determined the prognosis. Attention later shifted to the proportion of articular surface involved – a quantity poorly measured on radiographs and divorced from mechanism. CT has since reintroduced the mechanism in living patients: the Mason–Molloy classification describes three pathomechanical types that confirm and refine Bonnin’s observations, and management has moved from size thresholds to classification-guided fixation. Conclusions Bonnin and Mason, two Hunterian Professors separated by more than half a century, performed essentially the same investigation with the tools available to them and reached the same conclusion. Recognising that the modern classification visualises a mechanism Bonnin had already inferred (rotation of a loaded talus) restores a continuity the wider literature has largely missed.
Introduction Preauricular sinuses are common congenital anomalies that can lead to recurrent infections. Various surgical techniques, including simple sinusectomy and the more extensive supra-auricular approach, are used to excise these tracts. This study aimed to compare the outcomes of sinusectomy vs supra-auricular excision in a paediatric population. Methods A retrospective cohort study was conducted at a tertiary paediatric referral centre. Cases from the period 2009–2025 were identified and clinical records were reviewed. Data were compiled and analysed between the sinusectomy and supra-auricular approaches. Statistical tests were used to identify significance. Multivariable Firth penalised logistic regression was used to assess recurrence according to surgical approach and operative adjuncts. Results A total of 63 patients (71 ears; mean age 6.9 years) were included: 37 (52.1%) underwent sinusectomy and 34 (47.9%) supra-auricular excision. Postoperative complications occurred in 12 of 37 (32.4%) sinusectomy cases vs 4 of 34 (11.8%) supra-auricular cases (odds ratio [OR] 3.6, p < 0.05). Recurrence occurred in 9 of 37 (24.3%) vs 2 of 34 (5.9%) cases, respectively (OR 5.14, p < 0.05). The supra-auricular approach (adjusted OR 0.14, 95% confidence interval [CI] 0.02–0.68) and cartilage excision (adjusted OR 0.20, 95% CI 0.04–0.82) were independently associated with lower recurrence. Conclusions In this paediatric series, supra-auricular excision was associated with lower recurrence and complication rates than sinusectomy. Analysis suggests that cartilage excision may independently contribute to lower recurrence and this association with surgical approach persists after adjustment for operative adjuncts. We recommend the supra-auricular approach as the preferred technique for recurrent or symptomatic preauricular sinuses in children.
Liver cysts are often detected as an incidental finding and require treatment in symptomatic cases due mainly to their exerted pressure effect. We present a case of a 77-year-old female patient who was diagnosed three years before with a giant hepatic cyst occupying the right hemi-liver and was subsequently referred to our hepatobiliary services following presenting with progressive dyspnoea, exertional fatigue in addition to bilateral lower limb oedema. Computed tomography imaging revealed an increase in cyst size with cardiac and significant inferior vena cava compression in addition to displacement of the right kidney. This case report highlights the importance of continued surveillance versus consideration of prophylactic drainage in carefully selected patients given the risks of future development of life-threatening complications.
INTRODUCTION Giant inguinoscrotal hernias (GIH), defined as hernias extending below the midpoint of the inner thigh, are rare in developed countries. Loss of domain, the risk of abdominal compartment syndrome, and the absence of standardised guidelines make surgical management particularly complex. We present a case of GIH managed with single-stage repair and complex abdominal wall reconstruction, alongside a literature review of surgical strategies. CASE HISTORY A 55-year-old bed-bound man presented with a progressively enlarging left scrotal swelling over 5 years. Computed tomography demonstrated a giant left inguinoscrotal hernia measuring 53cm craniocaudally with 72% loss of domain, containing the majority of the small and large bowel. He underwent elective single-stage repair via midline laparotomy comprising reduction of hernia contents, omentectomy, left orchidectomy, partial scrotal excision, bilateral anterior component separation and abdominal wall reconstruction using Strattice biologic mesh underlay with Prolene mesh onlay reinforcement. The patient recovered without significant complications with no evidence of recurrence at 15 months. FINDINGS A structured literature review identified 15 published cases of GIH repair with abdominal wall reconstruction. Surgical approaches were categorised into four groups: debulking or resection of abdominal contents, techniques to increase abdominal cavity volume, combination strategies and use of adjuncts such as botulinum toxin. CONCLUSIONS There remains no consensus on the optimal surgical management of GIH. This case supports anterior component separation as an effective single-stage strategy for GIH with significant loss of domain. In the absence of a standardised technique, a multidisciplinary approach is essential for optimising outcomes.
