There is significant prevalence of Low Anterior Resection Syndrome following oncological rectal resection. A low anastomotic height or history of radiotherapy are major risk factors.
The rate of major LARS at this regional centre is 37.5%. Larger prospective multicentre studies are required to determine impact of variables such as type of neoadjuvant therapy, anastomotic techniques and progression of LARS over time.
BackgroundMagnetic resonance enterography (MRE) is the mainstay imaging modality in the evaluation of small bowel Crohn's disease (CD) activity and its associated complications. Few studies have assessed the indications for ordering it and its association with management changes. The objective was to identify the current clinical utilization of MRE and associated management changes in patients with established small bowel CD.MethodsA retrospective audit was conducted on all patients with established CD who underwent MRE at a tertiary centre from November 2014 to December 2017. Clinical indications, radiological findings and management changes were obtained from patient records.ResultsA total of 220 patients underwent a total of 287 MRE examinations. The most common indications for ordering MREs were based on patient symptoms (n = 204, 71.1%) and routine disease surveillance (n = 57, 19.9%). The most common radiological findings were inflammation (n = 156, 54.4%) and strictures (n = 98, 34.1%). Management changes post MRE occurred in 152 of 287 (53%) cases. Of the 152 patients, 87 (57.2%) had changes in medical management, 40 (26.3%) had surgical or endoscopic intervention and 25 (16.4%) had both medical and surgical management changes. Management changes following MRE in patients with new or concerning symptoms were significantly higher than in surveillance patients (OR 4.1, P = 0.000003).ConclusionThis study provides a foundation for understanding the current utilization of MRE in small bowel CD at a tertiary centre. However, its role in altering management particularly within surveillance patients is yet to be defined. Future prospective trials are required to better delineate its role and develop an algorithm for small bowel CD management.
A 40-year-old man presented to our emergency department with a 2-month history of progressively worsening right-sided abdominal pain. The pain increases in severity in the 7 days preceding his presentation. It was constant in nature and not associated with any other gastrointestinal or systemic symptoms. He had no other medical co-morbidities and blood tests performed on presentation were unremarkable (white cell count 6.0 × 109/L and C-reactive protein 1.4 mg/L). On examination, he had a soft abdomen with an isolated focal point of tenderness in his right abdomen. There was no evidence of skin changes, puncture marks or overlying erythema at the tender area.A plain abdominal X-ray (AXR) was arranged by the emergency physicians and revealed an unexpected radio-opaque foreign body
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