Abstract:
Background: Emergency surgical admissions most frequently involve common acute abdominal conditions such as appendicitis, bowel obstruction, and cholecystitis. However, rare or unexpected pathologies may occasionally present during on-call duties, posing significant diagnostic and management challenges. These conditions often mimic common surgical presentations and may delay definitive diagnosis and treatment.
Aim: To review a series of rare and unexpected surgical conditions encountered during emergency on-call duties and highlight diagnostic challenges and clinical lessons for the acute care surgeon.
Methods: A retrospective review was conducted of 19 unusual surgical cases encountered during emergency on-call duties at a single institution between January 2025 and September 2025, under the care of one consultant surgeon. Cases were identified from emergency admission records and operative logs. The series included rare malignancies, atypical causes of intestinal obstruction, vascular abnormalities, and unexpected intraoperative findings identified during emergency imaging or surgery.
Results: Patients ranged in age from 19 to 93 years and presented with a diverse spectrum of rare surgical pathologies. Diagnoses included appendiceal neuroendocrine tumour, omental carcinoma, linitis plastica, gallstone ileus, Bouveret syndrome, adult intussusception, intestinal malrotation at the duodenojejunal junction, renal artery aneurysm, gallbladder carcinoma, cholangiocarcinoma, metastatic neuroendocrine tumour of the distal ileum, hepatocellular carcinoma, and intraductal papillary mucinous neoplasm. Several diagnoses were incidental findings during emergency imaging or operative exploration. In one critically ill patient with sepsis of unknown origin, prolonged inotropic support resulted in severe ischemia affecting all four limbs, ultimately requiring limb amputation.
Conclusion: Rare surgical pathologies may present during routine emergency admissions and frequently mimic common acute abdominal conditions. Maintaining a broad differential diagnosis, utilizing early cross-sectional imaging, and applying timely surgical judgment are essential to optimize patient outcomes. Sharing such experiences improves awareness and preparedness among surgeons managing emergency surgical presentations.
Biography:
Ashfaq Chandio is a surgeon specialising in General and Colorectal Surgery with extensive clinical and academic experience within the United Kingdom and Ireland. He is currently associated with Manchester University NHS Foundation Trust, one of the largest teaching hospital organisations in the United Kingdom.
He graduated in medicine from Chandka Medical College Larkana, Pakistan, and subsequently pursued postgraduate surgical training across Ireland and the United Kingdom. During this period he gained broad multidisciplinary surgical experience including colorectal surgery, general surgery, urology, vascular surgery, emergency surgery, and breast and endocrine surgery. He holds the Fellowship of the Royal College of Surgeons in Ireland (FRCSI) and dual European Board of Surgery (FEBS) certifications in General Surgery and Coloproctology. He has also completed a Diploma in Laparoscopic Surgery in France, reflecting his interest in minimally invasive surgical techniques.
He has worked across multiple NHS organisations including Hywel Dda University Health Board, London North West University Healthcare NHS Trust (Northwick Park Hospital), and NHS Grampian. While working in Scotland, he also served as Honorary Senior Lecturer at the University of Aberdeen, contributing to undergraduate medical education and clinical training.
His clinical interests include colorectal disease, laparoscopic and minimally invasive surgery, multidisciplinary colorectal care, and surgical service development. He has also contributed to service innovation, including work related to Colon Capsule Endoscopy at Dr Gray’s Hospital.
He maintains a strong commitment to surgical education and professional training. He has taught and supervised medical students, International Medical Graduates, foundation doctors, surgical trainees, and advanced nurse practitioners. He has served as faculty for surgical training programmes delivered through the Royal College of Surgeons of England, including Basic Surgical Skills (BSS), START Surgery, and CCrISP – Care of the Critically Ill Surgical Patient. He has also contributed to MRCS examination preparation programmes, including teaching in anatomy and peri-operative care.
He has participated in peer-reviewed publications, national and international scientific presentations, and academic collaboration, and has mentored participants in international gastroenterology and surgical conferences.
His professional work reflects a continuing commitment to clinical excellence, surgical education, multidisciplinary collaboration, and mentorship of future healthcare professionals.
