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Highlights • Midgut malrotation in adulthood is rare, with reported incidence 0.1–0.5%. • Acute appendicitis with undiagnosed midgut malrotation has been sparsely described. • Presenting symptoms are often atypical which delay diagnosis. • Early recognition with appropriate imaging is key to diagnosis and appropriate management., Introduction Acute appendicitis in the setting of midgut malrotation is uncommon. Midgut malrotation commonly presents within the first month of life. A minority remain asymptomatic and may present with concomitant abdominal pathology making diagnosis difficult. Presentation of case This paper reports a rare case of a 73-year-old male diagnosed with acute appendicitis and asymptomatic MM .The patient underwent a laparoscopic appendectomy, but had an unplanned return to theatre for washout of post-operative intra-abdominal haematoma. Discussion Midgut malrotation is commonly described by the stringer classification and type 1a is the most common in adults. There have only been a handful of documented cases of acute appendicitis with midgut malrotation occurring in the adult population. Previous delay in diagnosis has led to a delay in definitive management. Both laparoscopic and open surgery has been used in the past. Conclusion Acute appendicitis with malrotation should be considered in elderly patients presenting with atypical signs and symptoms. Imaging offers significant advantage for timely and definitive management.

Arterial occlusion following blunt trauma is an uncommon occurrence. We report an unusual case of delayed external iliac artery occlusion in a young male following blunt abdominal injury. He was successfully treated with thromboendarterectomy and saphenous vein patch repair. There have only been a handful of documented cases occurring in the paediatric population. All patients presenting with groin injury from this mechanism should be carefully investigated and monitored for risk of vascular injury.

Targeted α-therapy is an experimental approach to the management of cancer. Short range α-particle radiation from a radioisotope attached to a targeting monoclonal antibody kills targeted cancer cells. Survival results are analyzed from a previously reported Phase I study of systemic targeted α-therapy for patients with stage IV metastatic melanoma or in-transit metastases. Following intravenous administration of 46–925 MBq of the α-immunoconjugate, 213Bi-cDTPA-9.2.27, 38 patients were followed to observe response and toxicity. Responses were measured by physical examination, computed tomography at 8 weeks and blood sampling. Toxicity was monitored by blood pathology, urine analysis, glomerular filtration rate and human antimouse antibody response. The maximum tolerance dose was not achieved as there were no adverse events of any type or level. However, an objective partial response rate of 10% was observed, with 40% stable disease at 8 weeks and a median survival of 8.9 months. These results were unexpected because of the short half-life of the 213Bi and short range of the α-radiation. Survival analysis demonstrated melanoma-inhibitory activity, disease stage, lactate dehydrogenase and treatment effects to be significant prognostic indicators for survival.