The Surgical Reg

Necrotising fasciitis! Two words that instantly twist the guts of any surgeon with an icy squeeze.  It’s bad enough when the back of your mind whisperingly flirts with the possibility of this dreaded diagnosis whilst reviewing a patient with a perfectly innocent, garden-variety cellulitis in the light of day. It’s a little more troubling when, later that night at 3am, you suddenly sit bolt upright clutching at the damp bedsheets, utterly convinced that somehow you missed the first subtle signs. It is of course worse by far to peek under the bedsheets and instantly just know. For a disease that is supposedly vanishingly rare according to the textbooks, I feel that in my short career I have already encountered more than my fair share. Four cases of barbaric, destructive, ruthless dissection are seared into my memory. The overpowering smell. The sensation of human flesh liquified to a grey soup. The putrefaction of normal anatomy to the point where a deluge of stinking liquid leaks out of

Squeezing impatiently through the waddling crowd of the unhealthy and the overweight in a hospital's corridors and stairways (and the world in general), it is astounding to remember that that the lifetime prevalence of gallstone disease is actually only about 10% to 20%. It's even more difficult to keep this at the forefront of your mind in a General Surgery outpatient clinic or On-Call, when there is barely a patient who doesn't have abdominal pain that they attribute to their inevitable gallstones! Nonetheless, I assumed that the decision making was a foregone conclusion in these patients who present with typical biliary colic and have proven stones or sludge - of course we should just whip their gallbladder out! Whilst this bit is easy, the practical business of listing a patient for cholecystectomy is a little harder - particularly with the decimation wrought by the COVID-19 pandemic on waiting list times. Patients with uncomplicated biliary colic are extraordinarily fo

This may come as a surprise to those who bemoan the stress, unpredictability and long hours, but it was refreshingly great to be on-call last week! Predictably there were frustrations, as I found myself frequently lost in this new hospital, constantly ignorant of how the system works and rather peeved at being left high and dry by a rota gap for the on-call SHO on two days. But in general it was good to be back on the horse, attempting to sift through and make sense of huge numbers of patients with belly pain, vomiting and bleeding that were coming at me from all directions, and trying to determine who needed an operation and in what order. One of the highlights, having just unscrubbed after finishing a particularly horrendous appendix, was a call from obstetric theatres, asking to attend for a woman having a c-section. Scrubbing in, the Consultant Obstetrician had already got into the peritoneal cavity, and was concerned about a small bowel injury. The patient had had previous c-secti