This 72 year old lady presented with a three month history of colicky lower abdominal pain and rectal bleeding. Rectal and sigmoidoscopic examination were unremarkable. A barium enema was requested. This image is from
a barium enema series showing a typical 'apple core' stricture. The appearances are typical of a colonic carcinoma. Benign strictures have smooth and tapering edges. The patient proceeded to an uncomplicated sigmoid colectomy. It was a Duke's C
tumour and she had adjuvant chemotherapy.
This elderly patient fell at home. She was assessed in A & E and allowed home. She represented several days later with increasing confusion and a left-sided weakness. This film is from a head CT showing a
cresentric shaped haematoma extending over most of the right side of the brain. There is effacement of the lateral ventricles and shift of the midline structures. The appearances are typical appearance of a subdural haematoma.
This 20 year rugby player sustained a head injury with transient loss of consciousness. He made a rapid recovery but was admitted for observation. Twelve hours after injury his Glasgow Coma Scale started to fall. He
developed a dilated pupil on the side of his injury. An urgent CT scan was arranged. This showed the typical lentiform appearance of an acute extradural haematoma. He was transferred to the local neurosurgical centre where he underwent burr
hole evacuation of the clot. He made an uncomplicated recovery from his surgery.
This 85 year old man presented with a sudden onset of severe epigastric and shoulder tip pain. Examination showed him to be dehydrated, toxic with generalised peritonism. An erect chest X-ray showing free gas under
the diaphragm suggestive of a visceral perforation. At surgery he was shown to have a perforated pre-pyloric ulcer that was oversewn. Free gas under the diaphragm is seen in approximately 60% of patients with a perforated peptic ulcer - Absence
of free gas does not exclude a diagnosis of visceral perforation. Free gas will also be seen on films taken after abdominal surgery but it should have dispersed by 7 to 10 days.