Endoscopic management of esophageal anastomotic leaks and perforations with the use of esophageal stents is technically feasible. It seems to be safe and effective when performed along with mediastinal or pleural drainage. Esophageal stent can, therefore, be considered as a treatment option in the management of patients who present early after esophageal perforation or anastomotic leak with limited mediastinal or pleural contamination.

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The finding of appendicitis within an inguinal hernia is a recognized phenomenon: Amyand's hernia. The development of necrotising soft tissue infection-necrotising fasciitis-is associated with high morbidity and mortality. We present a case of Amyand's hernia resulting in a severe, life-threatening necrotising soft tissue infection, which is previously unreported in English literature. We outline features relating to the diagnosis of this rare condition, and improve awareness among clinicians of the possibility of appendicitis within a direct inguinal hernia, and highlight the importance of appropriate initial surgical intervention for necrotising soft tissue infection to improve survival for these patients.

We present a case of a middle-aged woman, who presented with abdominal pain less than 24 h following an uneventful colonoscopy for rectal bleeding. Initial diagnosis was thought to be colonic perforation. An urgent CT scan performed owing to dropping haemoglobin and blood pressure revealed a large perisplenic haematoma. An urgent laparotomy was performed in which the patient had a total blood loss of 2500 ml and required splenectomy. The patient recovered well postoperatively.Colonoscopy is a commonly performed procedure in which complications of perforation and bleeding are well recognised. This case represents one of the rare but serious complications that endoscopists and patients should be aware of to aid prevention and early diagnosis.

To investigate anorectal function in solitary rectal ulcer syndrome 22 patients were studied by means of balloon expulsion, intestinal transit time, barium enema and evacuation proctography. Half of the patients tested had difficulty in expelling a water filled balloon. Delay in intestinal transit was noted in only three patients. Barium enema was of little benefit in diagnosing the condition. Evacuation proctography was the investigation of choice in that it showed at least one abnormality of pelvic floor function in all of the patients and can help select patients for surgery.