WEST AFRICAN SURGICAL TRAINING · CASE CASCADES
Case Cascades
One patient. One Friday night. Fifteen decisions. Each cascade walks you through a real emergency from triage to discharge — with every choice you make revealed and referenced. Ghana-anchored, Bailey & Love-grounded, examinable in Membership Surgery, WACS Part 2, and MRCS Part B.
GI Emergencies 5 cases
GI EMERGENCIES · MEMBERSHIP SURGERY
Typhoid perforation — Korle Bu, Friday night
Master B, a 22-year-old university student, was carried in by his roommate at 20:30. He has had eight days of high unremitting fever, headache, and profound anorexia. He was self-medicating with paracetamol and 'Malex' (…
Bailey & Love 28e Ch 68 · Sabiston 21e Ch 46 · Hunter's Tropical Medicine 10e · WHO Typhoid Position Paper 2018 · Chatterjee World J Surg 2019
Start cascade →
GI EMERGENCIES · MEMBERSHIP SURGERY
Massive haematemesis — 65M, Korle Bu 02:00
Mr K, a 65-year-old carpenter, is brought in having vomited large volumes of fresh red blood twice and passed black tarry stool three times over the last four hours. He is on daily aspirin and ibuprofen for back pain. He…
Bailey & Love 28e Ch 65 · Sabiston 21e Ch 47 · SIGN 105 · NICE CG141 · Baveno VII (variceal 2022) · Forrest 1974 · Glasgow-Blatchford 2000
Start cascade →
GI EMERGENCIES · MEMBERSHIP SURGERY
Appendicitis at 22 weeks — 28F, Korle Bu antenatal
Mrs A, a 28-year-old teacher at 22 weeks in her second pregnancy, presents with 18 hours of central abdominal pain migrating to the right flank, anorexia, nausea and one episode of vomiting. Vitals BP 118/72, HR 104, tem…
Bailey & Love 28e Ch 71 · Sabiston 21e Ch 51 · SAGES 2017 pregnancy guidelines · WSES 2020 acute appendicitis
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GI EMERGENCIES · MEMBERSHIP SURGERY
Sigmoid volvulus — 72M, distended abdomen
Mr N, a 72-year-old retired teacher from Aburi, is referred with 3 days of progressive abdominal distension, colicky abdominal pain, absolute constipation and one episode of vomiting today. History of chronic constipatio…
Bailey & Love 28e Ch 68 · Sabiston 21e Ch 51 · WSES 2018 colonic volvulus · ASCRS practice parameters 2016
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GI EMERGENCIES · MEMBERSHIP SURGERY
Perforated peptic ulcer — 48M NSAID user, sudden pain
Mr M, a 48-year-old accountant, presents 6 hours after sudden onset of severe epigastric pain that then became generalised. He has been taking daily ibuprofen for back pain and drinks socially. He is toxic-appearing: BP …
Bailey & Love 28e Ch 65 · Sabiston 21e Ch 46 · WSES 2020 perforated peptic ulcer · Boey 1982 · Graham 1937
Start cascade →
Hepatobiliary 2 cases
HEPATOBILIARY · MEMBERSHIP SURGERY
Obstructive jaundice — rural Volta, 55F
Mrs A, a 55-year-old subsistence farmer from a village outside Ho in the Volta Region, presents with three weeks of progressive yellowing of the eyes, dark urine, pale stools, and generalised itching. She has lost 6 kg o…
Bailey & Love 28e Ch 68, 76 · Sabiston 21e Ch 55 · Blumgart 6e · van der Gaag NEJM 2010 (DROP-IN) · ESPEN 2021 · ISGPS 2016 POPF
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HEPATOBILIARY · MEMBERSHIP SURGERY
Pancreatic pseudocyst — 6 weeks after severe AP
Mr D, a 46-year-old lorry driver, was admitted six weeks ago with alcohol-induced severe acute pancreatitis. He was discharged after 12 days. He returns with a two-week history of dull epigastric pain, early satiety, 4 k…
Bailey & Love 28e Ch 68 · Sabiston 21e Ch 55 · Blumgart 6e Ch 55 · Revised Atlanta Classification 2012 · ESGE 2020 pancreatic collections
Start cascade →
Vascular Emergencies 3 cases
VASCULAR EMERGENCIES · MEMBERSHIP SURGERY
Acute limb ischaemia — 68M smoker, cold pulseless leg
Mr O, a 68-year-old retired policeman and 40-pack-year smoker, presents 4 hours after sudden onset of a cold painful right leg while watching football. He is known hypertensive on amlodipine, in atrial fibrillation for 5…
Bailey & Love 28e Ch 57 · Sabiston 21e Ch 63 · Rutherford 1997 classification · ESVS 2020 acute limb ischaemia · TASC II 2007 · STILE 1994 · TOPAS 1998
Start cascade →
VASCULAR EMERGENCIES · MEMBERSHIP SURGERY
Ruptured AAA — 72M, collapsed in ED
Mr T, a 72-year-old retired driver, collapsed at home two hours ago with sudden severe back and abdominal pain. He was brought in by ambulance. He is a lifelong smoker with known hypertension and an AAA screening result …
Bailey & Love 28e Ch 57 · Sabiston 21e Ch 63 · ESVS 2019 AAA guidelines · IMPROVE trial 2014 · Hardman index
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VASCULAR EMERGENCIES · MEMBERSHIP SURGERY
Acute mesenteric ischaemia — 78F AF, pain out of proportion
Mrs A, a 78-year-old retired seamstress, presents with 6 hours of central abdominal pain that came on suddenly at supper. She has permanent atrial fibrillation, warfarin was stopped 8 days ago for a dental extraction and…
Bailey & Love 28e Ch 65 · Sabiston 21e Ch 47 · WSES 2017 acute mesenteric ischaemia · ESVS 2020 mesenteric
Start cascade →
Endocrine Emergencies 2 cases
ENDOCRINE EMERGENCIES · MEMBERSHIP SURGERY
Thyroid storm — 32F, 3 weeks post-partum
Mrs P, a 32-year-old market trader three weeks post-partum (uncomplicated vaginal delivery), presents agitated, confused, tremulous and febrile. Family report a 3-month history before pregnancy of weight loss and palpita…
Bailey & Love 28e Ch 46 · Sabiston 21e Ch 37 · ATA 2016 Hyperthyroidism guidelines · Burch & Wartofsky 1993
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ENDOCRINE EMERGENCIES · MEMBERSHIP SURGERY
Post-thyroidectomy neck haematoma — stridor at 6h
Mrs L, a 48-year-old woman, had a total thyroidectomy this morning for a multinodular goitre. Six hours later she has stridor, an obviously swollen anterior neck, tense collar dressing, a suction drain that is 'gone dry'…
Bailey & Love 28e Ch 46 · Sabiston 21e Ch 37 · BAETS 2021 · ATA 2020 thyroid surgery guideline
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Neurosurgical Emergencies 1 case
Surgical Sepsis 1 case
Breast 1 case
Colorectal 1 case
Trauma 2 cases
TRAUMA · MEMBERSHIP SURGERY
Compartment syndrome — 27M, closed tibial fracture
Mr F, a 27-year-old motorcyclist, was brought in 4 hours ago after a low-speed collision with a taxi. He has a closed mid-shaft tibial fracture that has been reduced and back-slabbed. He now complains of severe calf pain…
Bailey & Love 28e Ch 34 · Sabiston 21e Ch 22 · Mubarak & Hargens 1978 · AAST fasciotomy consensus
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TRAUMA · MEMBERSHIP SURGERY
Blunt splenic trauma — 34M RTA, FAST-positive transient responder
Mr M, a 34-year-old driver, arrives 45 minutes after a high-speed RTA. He was restrained. ATLS primary survey: airway patent, breathing symmetrical, circulation — BP 92/58 (after 1 L crystalloid en-route it was 118/72), …
Bailey & Love 28e Ch 35 · Sabiston 21e Ch 22 · WSES 2017 splenic trauma · AAST OIS · EAST 2012 splenic trauma
Start cascade →
Urology 1 case
West African Emergency Surgery 1 case
Why case cascades?
Multiple-choice banks test recall. Cascades test judgement — the decision-making thread that connects triage to theatre to post-op. In the exam you'll be asked "what next?" over and over. This is how you rehearse for that.
Every step is grounded in Bailey & Love 28th edition, Sabiston 21st, WSES / ERAS / NELA guidelines, and Cochrane-level evidence where it exists. Where West African practice diverges from Western textbooks (biological mesh availability, transfer distances, unit capacity), the cascade calls it out.