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Jejunal gastrointestinal stromal tumour revealed by massive haematemesis (April 2023 [2])
A 56-year-old male experienced massive haematemesis for 2 days. Neither oesophagogastroduodenal endoscopy nor colonoscopy demonstrated a cause. An urgent abdominal computed tomography scan showed active jejunal bleeding. At explorative laparotomy, a large jejunal GIST was found.
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Peri-anal monkeypox (April 2023 [1])
A 44-year-old male, who has sex with men, presented with proctalgia and peri-anal lesions. In addition, he had inguinal lymphadenopathy and ulcerated papules on his extremities, trunk, and face. On polymerase chain reaction testing, a diagnosis of monkeypox was made. Given the current prevalence, monkeypox should be considered in patients with new peri-anal lesions.
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Curious cause of small bowel obstruction (March 2023 [2])
A 60-year-old woman presented with abdominal pain, distension, and constipation. A computed tomography scan showed small bowel obstruction. At laparotomy, the small bowel was found to be obstructed by a fallopian tube. The fallopian tube band was released and right-sided salpingectomy performed.
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Unusual cause of caecal ischaemia (March 2023 [1])
A 69-year-old man presented with right lower quadrant abdominal pain and fever. His medical history was notable for erectile dysfunction treated with an inflatable penile prosthesis. A computed tomography scan showed caecal ischaemia. Diagnostic laparoscopy (Video File) found the caecum had lodged in the empty reservoir of the penile prosthesis, causing ischaemia.
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Disseminated peritoneal leiomyomatosis (February 2023 [2])
A 55-year-old woman with a prior history of laparoscopic uterine myomectomy presented with an incisional hernia. Preoperative computed tomography reported calcified lymph nodes in the mesentery. At laparotomy, multiple tumours of up to 8 cm were found. An ileocaecal resection and omentectomy were performed. Following histopathological assessment, a diagnosis of Peritoneal Leiomyomatosis was made.
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Miliary peritoneal tuberculosis causing abdominal pain and ascites (February 2023 [1])
A 73-year-old male presented with abdominal pain and progressive ascites. Cytological assessment of the ascites found no abnormality. An exploratory laparoscopy was performed, which was converted when miliary seeding was identified. Histopathological examination demonstrated peritoneal tuberculosis.
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Parathyroid cyst: enigma (December 2022 [1])
A 25-year-old gentleman, with chronic calcific pancreatitis and bilateral medullary nephrocalcinosis caused by hypercalcaemia, was found to have a 3.2×3.6 cm right inferior parathyroid adenoma. Contrast-enhanced computed tomography of the neck showed an enlarged well-defined cystic right inferior parathyroid gland located posterior to the right lobe of the thyroid with retrosternal extension. He underwent focused parathyroidectomy under the cervical block with the removal of a brown coloured cyst.
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Glucagonoma syndrome (November 2022 [1])
A 37-year-old female patient was referred with a widespread itchy rash, weight loss, and new-onset diabetes mellitus. Blood glucagon hormone measurement was >500 pg/ml. Laparoscopic distal pancreatectomy and splenectomy was performed. Her complaints disappeared afterwards. Surgery is the mainstay of treatment for glucagonoma disease and associated symptoms.
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Amyand’s hernia (August 2022 [2])
During a laparoscopic right inguinal hernia repair, the patient’s appendix was found in an indirect hernia sac. This finding is called an Amyand’s hernia.
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Presence of testicle in indirect hernia sac during laparoscopic inguinoscrotal hernia repair (June 2022 [1])
During laparoscopic surgery for a right inguinoscrotal hernia in an adult male patient, the patient’s testicle was seen in the hernia sac (Fig. 1). The presence of a testicle in an indirect hernia sac is not uncommon, especially in congenital hernias. Surgeons should be aware of this condition to avoid injury during repair.
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Snapshot quiz (February 2022)
A 25-year-old man, treated one year previously for a signet ring mid-rectal adenocarcinoma, presented with facial swelling and multiple nodular swellings on the neck and back. What is the diagnosis?
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Snapshot quiz (January 2022 [1])
A 14-year-old female patient presented with progressive abdominal distension and constipation. An MRI scan was performed and the patient was taken to the operating theatre. What is the diagnosis from these intraoperative images?
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Snapshot quiz (December 2021 [2])
A 32-year-old woman presented with pain and numbness in the right leg. Radiological imaging and subsequent core biopsy diagnosed a large sciatic notch dumbbell-shaped lipoma measuring 17 cm. What is the surgeon doing and why?
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Snapshot quiz (October 2021 [2])
A 45-year-old woman presented with decreased mouth opening, foul smell from the oral cavity and a chain of nodular swellings over chin, neck and chest region for 3 months. These had increased in size and number over the past month. Dimpling over her left cheek and scar marks over her neck and chin region were also noted. What is the diagnosis?
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Snapshot quiz (September 2021 [2])
A 55-year-old man presented with a 6-month history of multiple swellings on the right buttock and sacral region with a yellowish discharge. The patient frequently walked barefoot, but denied any history of trauma. Fine-needle aspiration cytology showed acute dense inflammation, nuclear debris, and numerous filamentous bacilli, which on staining revealed Gram-positive bacilli. 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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The Association of Surgeons in Training was originally established in 1976 and is the second largest surgical specialty association in the UK with over 2,700 members, from all ten surgical specialties.

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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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