Diverticular Colovesical Fistula


Very good demonstration of colovesical fistula. This almost certainly represents a ruptured diverticulum forming abscess that then extended into the urinary bladder. Although typically the communications are assessed either via cystogram, enema or both, this may not require further evaluation given the CT findings, depending on the comfort of the surgeon.


Unsuccessful Reduction :-(

This is a really bad fracture dislocation of the ankle and hindfoot extending to the midfoot.  Good appropriate use of imaging to find out why the ankle wouldn’t reduce.  What makes it remarkable is the sheer number of dislocated joints.


Reappearing Gallbladder


Unfortunately, this is an all too common complication of cholecystectomy. This case is unusually unfortunate because the abscess tracks all the way through the porta hepatis and appears to tunnel through the wall of the adjacent 2nd part of the duodenum. Not wanting to feel left out, the laparoscopic port sites in the anterior abdominal wall also developed abscesses (right upper quadrant and periumbilical). Incidental calcified aneurysm of one of the small mesenteric vessels can be seen anterior to the aorta.

This just goes to prove that a minor procedure is when it happens to someone else.

Digital kit cat clock update: OLED



I really love the Nokia 5100 display but wanted to try different varieties.  This is an SSD1306 0.96″ OLED display.  Resolution is 128 x 64 so significantly larger than the pixel size of the Nokia.


The contrast on the OLED is striking, so much so that it is difficult to photograph.  There will probably be more changes to the formatting and layout but the underlying code is the same as previous iterations of the clock with OTA updates, NTP sync, and WiFi Manager.

Taco Friday! Taco Mesh


There is a really good chance that your mesh hernia repair will fail if the mesh is folded up like a taco rather than attached to the abdominal wall. As the image scrolls towards the bottom, the higher density Chevron shaped object contacting the anterior abdominal wall (and I use all of those terms loosely, pun intended) is the mesh.

Note the small bowel obstruction which is unrelated to the recurrent hernia and probably adhesive. Interestingly, the hernia does contain a loop of sigmoid colon which appears nonplussed by the adjacent wad of mesh.

On the upside…no abscess!

Peroneus Quartus

This is one of my favorite accessory muscles.  I have no idea why.  Perhaps it’s because it rarely if ever causes trouble and you have to know what you’re looking at to actually find one.

In my experience, there is a spectrum of appearances, ranging from a distinct separate muscle to one like this one that blends with the adjacent PL.