This study investigates the appropriateness and diagnostic yield of colonoscopy referrals in an African setting using the American Society of Gastrointestinal Endoscopy guidelines: a prospective, descriptive, cross-sectional hospital-based study. A total of 311 patients were included in the study; 228 referrals (73.3%) were considered appropriate and clinically significant pathology was found in 157 patients, giving an overall diagnostic yield of 50.5%. Diagnostic yield in those with appropriate referrals was 58.8% and 27.7% (P = 0.004) in those with inappropriate referrals. In our setting these guidelines are useful in improving diagnostic yield and reducing the rate of inappropriate referrals for colonoscopy. However, patients above the age of 50 presenting with lower gastrointestinal symptoms should undergo a colonoscopy even if the indication was inappropriate, especially in countries which are not implementing colorectal cancer screening programmes for average risk patients.
We present a case of a fifty-year-old male with acute thrombosis of the celiac trunk secondary to advanced pancreatic cancer. He was admitted to the emergency department with a 4-day history of upper abdominal pain and coffee ground vomitus. Abdominal examination showed signs of generalized peritonitis. CT abdomen was done without contrast because of impaired renal function.The findings consisted of a large pancreatic neck and body mass, fat stranding, free fluid and distended bowel loops. Emergency laparotomy revealed a voluminous pancreatic mass arising from the neck and body of the pancreas, with the coeliac trunk being completely infiltrated by the tumour. A gangrenous stomach and lower oesophagus with big gastric perforation were also noted. The patient also had extensive splenic infarction, however the liver was normal. He became unstable during surgery and nothing could be done. He did not recover from anaesthesia and died in the ICU after 24 hours.
We present a case of a fifty-year-old male with acute thrombosis of the celiac trunk secondary advanced pancreatic cancer. He was admitted to the emergency department with four days history of upper abdominal pain and coffee grown vomitus. Abdominal examination showed signs of generalised peritonitis. CT abdomen was done without contrast because of impaired renal function, the findings were big pancreatic neck and body mass, fat stranding, free fluid and distended bowel loops. Emergency laparotomy revealed big pancreatic mass arising from the neck and body of the pancreas, coeliac trunk completely infiltrated by the tumour, gangrenous stomach and lower oesophagus with big gastric perforation. He also had extensive splenic infarction and liver was normal. He was unstable during surgery and nothing could be done. He did not recover from anaesthesia and died in the ICU after 24 hours.
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