A field guide,
quietly documented.

Surgical removal of a limb or part of a limb — most often the toes, foot or lower leg — when tissue is irretrievably damaged by peripheral vascular disease, uncontrolled diabetes, severe trauma or aggressive infection.

Acute inflammation of the vermiform appendix — the classical surgical emergency. Delay risks perforation, peritonitis and a far more difficult recovery.

Weight-loss surgery for patients with morbid obesity (BMI ≥ 35 with comorbidity, or ≥ 40 without). It is not cosmetic surgery — it is a metabolic operation that reliably reverses type-2 diabetes, hypertension and sleep apnoea.

A localised collection of pus within the breast — most often in lactating mothers (puerperal abscess) but also seen in smokers and in the sub-areolar region of non-lactating women.

Any breast lump deserves a triple assessment — clinical examination, imaging (mammography or ultrasound) and needle biopsy. The overwhelming majority are benign fibroadenomas or cysts; the minority that are malignant are highly treatable when caught early.

Injury to the skin and deeper tissues from heat, chemicals, electricity or radiation. Severity is graded by depth (first-, second-, third-degree) and by percentage of body-surface area involved.

Surgical removal of the foreskin, indicated for phimosis, recurrent balanoposthitis, paraphimosis or on religious/cultural grounds. Performed at any age from infancy to adulthood.

A spectrum of foot problems in diabetic patients — from callus and ulcer to deep infection, osteomyelitis and gangrene — driven by neuropathy, poor blood supply and immune compromise.

A small tear in the lining of the anal canal, almost always caused by the passage of a hard stool. Once it becomes chronic, spasm of the internal sphincter perpetuates the pain and prevents healing.

An abnormal tunnel connecting the anal canal to the skin around the anus, almost always the sequel to a perianal abscess. It will not close on its own.

Hardened deposits — cholesterol, pigment or mixed — that form within the gallbladder. Many remain silent for years; those that migrate, obstruct or inflame become symptomatic and require surgery.

A defect in the abdominal wall through which tissue — usually fat or bowel — protrudes. Inguinal, umbilical, incisional and hiatus hernias each have their own natural history. None resolve on their own.

Surgical removal of the uterus, indicated for fibroids, uncontrolled menorrhagia, endometriosis, prolapse or gynaecological cancer. Approaches — abdominal, vaginal or laparoscopic — are chosen case by case.

Blockage of the small or large bowel — mechanical (adhesions, hernias, tumours) or functional (paralytic ileus). A surgical emergency that requires prompt diagnosis and, often, prompt operation.

A localised collection of pus within the liver — amoebic (common in India) or pyogenic (bacterial). Untreated it can rupture into the chest or abdomen with catastrophic consequences.

Swollen, engorged veins in the lower rectum and anal canal. Internal piles (Grades I–IV) bleed and prolapse; external piles form thrombosed lumps at the anal margin. Common, benign, and highly treatable.

A chronic sinus in the natal cleft — the crease at the top of the buttocks — caused by hair burrowing into the skin. It affects young, hirsute men and recurs stubbornly if not managed correctly.

Benign enlargement of the prostate — the walnut-sized gland at the neck of the bladder — is nearly universal after the age of 60. It compresses the urethra and progressively obstructs urinary flow.

Crystalline deposits — calcium oxalate, uric acid, struvite or cystine — that form in the kidney or ureter. Small stones may pass on their own; larger ones obstruct, infect and damage renal function.

The thyroid gland at the front of the neck can enlarge diffusely (goitre), form a single or multiple nodules, over- or under-secrete hormone, or — uncommonly — develop cancer. Each requires a distinct workup.

Tortuous, dilated superficial veins of the legs — usually the long saphenous and its tributaries — caused by incompetent valves. If left untreated they progress to skin discolouration, eczema and venous ulceration.

Skin and mucosal growths caused by the human papillomavirus (HPV). They may be common (hands), plantar (soles), filiform (face) or anogenital (condylomata) — each with its own treatment nuance.