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Snapshot quiz (August 2021 [2])
A 34-year-old woman presented with a 20 cm intra-abdominal tumour with large draining veins and shunting surrounding the mass, detected by abdominal computed tomography (CT) scan. Six years before she underwent surgery for a pelvic tumour. What is the diagnosis?
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Snapshot quiz (August 2021 [1])
An 8 year old boy presented with colicky abdominal pain and chronic anemia. Faecal occult blood analysis was positive, upper and lower GI endoscopy were unremarkable. 99mTC labeled RBC scan showed an abnormal accumulation of tracer in the distal small bowel on the right side of abdomen. Diagnostic laparoscopy followed by open resection was done. What is the diagnosis?
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Snapshot quiz (July 2021)
What has caused the stricture in the small bowel and what has developed in the lumen of the bowel as a result?
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Snapshot quiz (June 2021 [2])
A 69-year-old male who initially presented with Streptococcus bacteremia was later readmitted with recurrent fevers, chills, and abdominal pain. A contrasted computed tomography (CT) scan of the abdomen and pelvis was obtained. What is the diagnosis and management?
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Snapshot quiz (June 2021 [1])
A 75-year-old man with a history of diverticulosis and open appendicectomy presented with intermittent abdominal pain, nausea and vomiting, constipation, reduced appetite and weight loss of 5 kg during the last month. The patient underwent an exploratory laparotomy (Figures a and b). What is the diagnosis?
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Snapshot quiz (May 2021 [2])
A 35-year-old man presented with a 4-day history of abdominal pain and fever. Abdominal examination showed a distended abdomen with signs of localized peritonitis in the right iliac fossa. Admission blood tests included leucocytosis of 24.5 × 109/l and a C-reactive protein level of 450 mg/l. What is shown on the CT image and accompanying intraoperative photograph?
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Snapshot quiz (May 2021 [1])
An 84-year-old man presented to the acute surgical intake with a rapidly growing painless lesion on the chest wall. He had an implantable pacemaker and defibrillator inserted a year previously. What is the diagnosis and management?
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Snapshot quiz (April 2021 [2])
At emergency laparotomy, a 27-year-old man was found to have a localized perforation of the ascending colon with a surrounding abscess. There were multiple other abnormal areas in the small bowel. What is the diagnosis?
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Snapshot quiz (April 2021 [1])
A 42-year-old woman presented with a 3-month history of dyspepsia, weight loss, and vague upper abdominal pain. On examination a palpable umbilical nodule was found. What is this clinical sign called?
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Snapshot quiz (March 2021 [2])
A 70-year-old man with chronic liver disease was diagnosed with colonic adenocarcinoma. What is shown, and what is the cause of the abnormality seen on the coronal image taken from the staging CT scan and on the intraoperative laparoscopic image?
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Snapshot quiz (March 2021 [1])
A 30-year-old woman presented with a history of abdominal pain for 8 days. The pain was initially in the right lower abdomen, but had become generalized 2 days before admission. On examination, she had generalized peritonitis. She had no co-morbidity and came from a North Indian village. At emergency surgery, there was a giant perforation in the caecum with most of the caecum thickened and gangrenous. What caused this presentation?
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Snapshot quiz (February 2021)
A 31-year-old woman with a long history of bowel symptoms presented with a tender abdominal mass. After CT she underwent an urgent colectomy. What is the likely diagnosis?
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Snapshot quiz (January 2021)
A 45-year-old woman with a history of an old burn injury to the chest and abdominal wall presented with a progressive ulcerated lesion on her right flank. What is the diagnosis?
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Snapshot quiz 20/12
A 65-year-old man with no previous surgical history presented with acute abdominal pain, vomiting, anaemia and a raised C-reactive protein level. CT was done and the patient was taken to the operating theatre. What is the diagnosis?
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Snapshot quiz 20/11
During diagnostic laparoscopy in a 50-year-old patient, the following intra-abdominal structure was found near the internal inguinal ring. What is the diagnosis?
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Snapshot quiz 20/10
An 81-year-old man with Parkinson's disease presented with diffuse abdominal pain and distension. The patient underwent an exploratory laparotomy. What is the diagnosis?
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Snapshot quiz 20/9
A 66-year-old man presented with a 1-week history of abdominal pain. Contrast CT of the abdomen showed small bowel obstruction with a transition point in the mid-abdomen. The cause of the obstruction was unclear from the scan. The patient underwent an emergency exploratory laparotomy. What is the structure causing the small bowel obstruction?
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Snapshot quiz 20/8
A 44-year-old woman presented with large-volume rectal and vaginal bleeding. On local examination, prominent pulsations were felt at the left fornix and rectum. What is the diagnosis?
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Snapshot quiz 20/7
A 70-year-old man presented with right upper quadrant abdominal pain and fever. Levels of serum inflammatory markers and obstructive hepatic enzymes were raised. A colectomy had previously been performed for cancer. The photograph shows the liver at laparotomy. What is the diagnosis and what is the usual clinical presentation?
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Snapshot quiz 20/6
What is the condition in this 68‐year‐old man following a laparoscopic cholecystectomy?
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Snapshot quiz 20/5
A 56-year-old woman presented with a rapidly enlarging fungating right breast mass. What is the diagnosis?
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Snapshot quiz 20/4
An elderly man presented with a rapidly enlarging right iliac fossa mass. CT demonstrated a 20-cm well circumscribed lobulated mass, intimately related to the caecum and terminal ileum. Biopsy was not diagnostic. During surgery it was seen that the mass appeared to arise from the mesentery. What is the likely diagnosis?
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Snapshot quiz 20/3
A 92-year-old woman presented with a non-tender suprapubic mass that was resonant to percussion. She was otherwise asymptomatic and denied any urinary symptoms. What was the cause of the mass?
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Snapshot quiz 20/2
An 82-year-old woman presented with a 9-year history of right upper quadrant abdominal pain. For 9 days before hospital admission she had experienced postprandial vomiting. What is the diagnosis?
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Snapshot quiz 19/15
A 33-year-old woman on the oral contraceptive pill presented with severe abdominal pain. What is the cause of small bowel ischaemia?
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Snapshot quiz 19/14
A 34-year-old woman who was breastfeeding presented with 2 weeks of worsening left breast pain, swelling and erythema. What is the complication to be aware of during and after incision and drainage?
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Snapshot quiz 19/12
This patient had undergone distal pancreatic resection for pancreatic cancer, including resection of the coeliac trunk and portal vein. The portal vein was reconstructed with an artificial prosthesis. What has happened?
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Snapshots in surgery: A cautionary tale
A member of the theatre team had a superficial injury to her leg from the spike of a circular stapler (CDH series, Ethicon Endosurgery, Cincinnati, Ohio, USA) that has protruded through a sharps bin (a). Here, the surgeon did not retract the spike before disposal in an overfilled bin. All team members must take care when disposing of circular staplers, beginning with the surgeon retracting the spike immediately after checking the tissue ‘doughnuts’ (b).
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Snapshot quiz 19/11
What is the diagnosis in this endoscopic image, and how should it be managed? The bleeding was caused by tissue friability.
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