SWORD

A case of advance CA rectum complicated with colocutaneus fistula.
- defination of high output fistula
- management:
fluid loss replace with hartmans, Hartmans is not use for fluid maintainance because of its HCO3 content. Prolong use of Hartmans pt will become metabolic alkalosis.
local control - stoma bag around fistula, to avoid skin excoriation

A case POD 12 for lap cholecystectomy, discharge post op day 1 - op uneventful until 5 days ago pt developed epigastric pain which radiate to back.
Q: what could be the diagnosis or worries?
A: bile leak, maybe due to dislodge clips

Pt amylase was 651, with LFT showed hepatocellular injuries i.e. raised in ALT, AST
A diagnosis of acute pancreatitis was made

2nd case was a referral from orthopaedic wanting as to do scope to look for primary. She presented with right shoulder pain and swelling x 6/12 and now paraplegic x 1/12. Noted a scapulla mass. HPE preliminary came back as metastasis tumour. Thoracolumbar ? mets to T12. CA 125 raised 241. No GI symptoms. No obstructive sx. No neck or breast mass.
Prof Ismail bought up the issue was for advance cases like this is scope indicated or just academic. If a tumour was to be found in GI, prognosis is poor. The best management for her is to palliate the pain with radiotherapy and palliative chemo.

* to do a mammogram one need to be standing so paraplegic pt is out of the question

TQ