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INTRODUCTION: Surgery for perforated small bowel malignancy is associated with dismal morbidity and mortality rates. The aim of the paper was to highlight our institution's surgical experience in the management of patients with malignant small bowel perforation. METHODS: A retrospective review of all patients who underwent operative intervention for malignant small bowel perforation from 2004 to 2007 was performed. The diagnosis was confirmed upon histological evaluation. RESULTS: Emergency surgery was performed in seven patients with perforated small bowel malignancy during the study period. All were above 55 years old, with the majority (6/7) having an ASA score of 3 and above. Pneumoperitoneum on chest radiograph was seen in only one patient while computed tomographic scans demonstrating the pathology were performed in the rest. All patients underwent exploratory laparotomy with resection of the diseased segments within 24 h of admission. Jejunum and the ileum were the sites of perforation in six and one patients, respectively. Three patients had synchronous small bowel tumours. Two patients had stoma created due to extensive peritoneal soilage and haemodynamic instability. Lymphoma was the aetiology in four patients. The other pathologies included leiomyosarcoma (n = 1) and metastatic lung tumours (n = 2). The 30-day peri-operative mortality rate was 42.9% (n = 3). One was discharged to a hospice while another two received chemotherapy upon discharge. These three patients passed away within a year from the surgery. The last patient defaulted follow up. CONCLUSION: In our small series, patients who were admitted for perforated small bowel malignancy have a high peri-operative mortality rates. For those who survived the initially operation, the long term outlook is still dismal. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Osteochondroma is the most common bone tumour and is usually found around the knee. Typical presentations range form painless masses around the joint to mechanical irritation caused by direct pressure over surrounding muscles. Snapping of the knee caused by an osteochondroma however has not been described in literature. Method: An active 19-year-old gentleman presented with snapping of the left medial hamstring tendon for over 5 years, but with recent increase in frequencies of attack. The patient was initially diagnosed to have a sporting injury. Radiological investigation showed an opaque lesion on the medial border of the proximal tibia, which was suggestive of an osteophyte. Results: The lump was surgically excised and the patient made good recovery with resolution of symptoms. Histological results revealed the lesion to be that of an osteochondroma. Conclusion: Although rare, osteochondroma should be considered as a differential when approaching a case of snapping knee pain. [Copyright &y& Elsevier]