NCT00530933 (http://www.clinicaltrials.gov).

Sacral nerve stimulation can maintain a persistent clinical benefit in the long term for the majority of patients. Some patients will experience deterioration in their symptoms over time, for reasons yet unknown.

Reports of magnet ingestion are increasing rapidly globally. However, multiple magnet ingestion, the subsequent potential complications and the importance of the early identification and proper management remain both under-recognized and underestimated. Published literature on such cases could possibly represent only the tip of an iceberg with press reports, web blogs and government documents highlighting further occurrence of many more such incidents. The increasing number of complications worldwide being reported secondary to magnet ingestion point not only to an acute lack of awareness about this condition among the medical profession but also among parents and carers who will be in most cases the first to pick up on magnet ingestion. There still seems to be no consensus on the management of magnet ingestion with several algorithms being proposed for management. Prevention of this condition remains a much better option than cure. Proper education and improved awareness among parents and carers and frontline medical staff is key in addressing this rapidly emerging problem. The goal of managing such cases of suspected magnet ingestion should be aimed at reducing delays between ingestion time, diagnosis time and intervention time.

No abstract

This study would suggest that SNS is not an effective treatment for chronic anal pain in the majority of patients. PNE is not an effective means of identifying which of these patients are likely to respond to permanent SNS.

Conjoint twins have always been a surgical challenge. The authors report an unusual finding in a surviving epigastric heteropagus twin. A 17 year old boy who underwent laparotomy for acute intestinal obstruction revealed a blind ending but complete duplication of the large bowel and an accessory liver in the falciform ligament, along with a separate gall bladder but with fused bile ducts.The findings suggest that the duplicated bowel loop and the accessory liver were remnants of the incomplete parasite twin, assimilated into the body of the autosite, which remained asymptomatic for 17 years. This case is being reported because of the uniqueness of the finding.A 17 year old boy was referred in January 2002 with features of acute intestinal obstruction. He gave a history of surgery in childhood, details of which were not available at that time. Examination showed a grossly distended abdomen with a 15 6 10 cm scar over the upper abdomen. Hernial sites and external genitalia were normal. Auscultation showed absent bowel sounds.Biochemical and haematological parameters were normal. Abdominal radiography showed multiple air-fluid levels suggestive of intestinal obstruction. Ultrasound of the abdomen showed a dilated bowel loop and a suspected duplication of the liver and gall bladder.Exploratory laparotomy showed the abdomen to be filled with a distended large bowel loop that was densely adherent to the parietus. Further exploration revealed the abdomen to be in two compartments and separated by a layer of thick membrane.The anterior compartment contained an enormously dilated and distended loop of large intestine measuring about 150 cm in length and 5-15 cm wide and ending blindly at both ends. It had a glistening surface with areas of haemorrhage and multiple congested blood vessels (fig 1). The lumen was filled with yellowish non-feculent fluid. The mucosa appeared flattened with multiple ulcers and whitish specks. Attached fatty tissue showed multiple lymph nodes and one of them appeared yellowish white with a cord-like structure. No mesentery or any definite vascular pedicle was seen. There was no evidence of any connection to the underlying normal bowel. The posterior compartment contained the normal stomach, small gut, and large bowel with normal peristaltic activity.Further exploration revealed an accessory lobe of liver within the falciform ligament, separate from the normal liver (fig 2).There was a large vascular pedicle, which when traced, was seen to arise from the right hepatic artery of the normal liver. Two distinct gall bladders were also observed. However, there was fusion of the bile ducts at the common bile duct level. The rest of the viscera were normal. The duplicated large bowel was excised in toto.Histopathological and microscopic examination of the resected specimen showed a dilated segment of large intestine with ulceration and inflammation of the wall. Lymph nodes in the fatty tissue showed reactive changes. The yellowish white cord-like structure showed attached testicular tissue with predo...

No abstract

PNS is an effective treatment in the short term for bowel dysfunction in some patients with complete CES.