Our study has demonstrated a high incidence of intestinal leakage following VAC therapy. The reasons for this are multifactorial. We would recommend caution in using it on patients with bowel anastomoses or enterotomy repairs.

In certain patients with rectal cancer, CRM positivity may be predicted from pre-operative MRI pelvic measurements. This may influence the choice of adjuvant therapy.

QoL provides a better survival estimate than measurement of tumor size and could be used as a surrogate end point for survival in treatment trials.

Loop ileostomy closure is associated with morbidity and mortality. Anaemia and hypo-albuminaemia may be associated with poor outcome.

No abstract

We have demonstrated that a quarter of patients develop complications after loop ileostomy closure. The majority of these are minor. Methods to reduce the number of complications, such as optimum time for closure and distal limb irrigation techniques, need to be studied.

Background: The use of a loop ileostomy is an effective method in protecting pelvic anastomoses. Its use has increased recently, although there is some debate as to the routine use of a stoma. Reversal of the ileostomy is associated with a significant morbidity, which may be related to impaired function of the bypassed distal limb of the ileum. Aim: To investigate the changes that might occur in the distal limb after an interval of faecal diversion. Methods: Full-thickness intestinal circular muscle (CM) strips were prepared from excised loop ileostomies taken at the time of closure. The study sample was from the distal limb and the control from the proximal limb. Contractile activity was measured using an organ bath set up to record isometric contraction after stimulation by acetylcholine (ACh). Histological sections were assessed for an index of villous atrophy, smooth muscle area, and nerve and vessel density. Analysis was with the Wilcoxon signed ranks test for paired data and the Mann-Whitney U test for unpaired data. Results: Samples were acquired prospectively from 35 consecutive patients. The median time between formation and closure of ileostomy was 34 weeks. Significant reduction was observed in the strength of CM contraction, smooth muscle area and median villous index of the distal limb compared with the proximal limb. Conclusion: Impaired intestinal function has been proposed as a contributory factor in the morbidity that may follow closure of loop ileostomy. Significant loss of contractility and smooth muscle strength and villous atrophy occur in the distal ileal limb after faecal diversion. Methods of preventing these changes should be considered.

INTRODUCTION Small bowel obstruction (SBO) in pregnancy is rare and is most commonly caused by adhesions from previous abdominal surgery. Previous literature reviews have emphasised the need for prompt laparotomy in all cases of SBO because of the significant risks of fetal loss and maternal mortality. We undertook a review of the contemporary literature to determine the optimum management strategy for SBO in pregnancy. METHODS The MEDLINE ® and PubMed databases were searched for cases of SBO in pregnancy between 1992 and 2014. Two cases from our own institution were also reviewed. RESULTS Forty-six cases of SBO in pregnancy were identified, with adhesions being the most common aetiology (50%). The overall risk of fetal loss was 17% and the maternal mortality rate was 2%. In cases of adhesional SBO, 91% of cases were managed surgically, with 14% fetal loss. Two cases (9%) were managed conservatively with no complications. Magnetic resonance imaging (MRI) was used to diagnose SBO in 11% of cases. CONCLUSIONS Based on our experience and the contemporary literature, we recommend that urgent MRI of the abdomen should be undertaken to diagnose the aetiology of SBO in pregnancy. In cases of adhesional SBO, conservative treatment may be safely commenced, with a low threshold for laparotomy. In other causes, such as volvulus or internal hernia, laparotomy remains the treatment of choice.