Purpose: Phytobezoar is the most common type of bezoar, which can occasionally present as an intestinal obstruction. In this study, the surgical experience and outcome in the management of intestinal obstruction caused by bezoars are described. Methods: A retrospective analysis of all operative cases of bezoars (n = 36) at Khoo Tech Puat hospital between 2011-2017 was performed. Patient demographics, imaging and operative findings, characteristics of bezoars and related morbidities were analyzed. The study population was subdivided into 2 groups based on operative intervention (fragmentation and milking of bezoars, versus enterotomy and/or bowel resection). Results: There were 36 cases of bezoars in 35 patients that were included in this study. Computed tomography scans were diagnostic of bezoars in 27 cases (75%). There were 20 cases (55.6%) that underwent fragmentation and milking of bezoars. The remaining 16 cases (44.4%) required an enterotomy or bowel resection. Bezoars that required enterotomy / bowel resection were more likely to be distally located in the ileum (75% vs 40%, p = 0.01), larger in volume (86.5 mL vs 63 mL, p = 0.04), with significant increase in morbidity rates (43.8% vs 5%, p < 0.01) compared with all other cases of bezoars. Conclusion: Risk factors for enterotomy / bowel resection in bezoar bowel obstruction include, nondiagnostic computed tomography scans, distally located, and larger volumes of bezoars. Fragmentation and milking should be attempted first as it has lower morbidity rates than enterotomy / bowel resection surgery.

Introduction: Small gallbladder polyps (GBP) are usually asymptomatic and benign and are monitored with regular ultrasonography (US) surveillance. Although most centers repeat imaging within a year, there remains no consensus regarding appropriate scan intervals.Aims: To investigate the size stability of GBP and to review the need for close surveillance.Methods: All abdominal ultrasound scans performed in our hospital over 3-month period were reviewed. Patients with sonographic evidence of GBP and with subsequent surveillance were included. The demographics of patients, characteristics of polyps, and subsequent scans over the following five years were reviewed. Histological reports were obtained for patients who underwent cholecystectomy.Results: 96 patients were included in the study. Median age was 51 (range, 24-89) years with a male predominance (67.7%). Main indications for US were hepatitis follow-up (41.7%) and abdominal pain (20.8%). Most patients had multiple polyps (62.5%) and the median diameter of the largest polyp was 4 (range, 3-10) mm. An average of 4.5 scans were performed over five years following detection and most polyps remained stable in size, rarely growing beyond 10mm -only two patients had polyps beyond 10mm. No gallbladder carcinoma was detected during the follow-up period. Conclusion:GBP usually remain stable in size, seldom grow beyond 10mm, and are rarely malignant. Surveillance scans for polyps smaller than 10mm should not be performed at intervals less than a year.

Background/Aims: Sigmoidoscopy is performed in most medical centers to evaluate the distal colons of young adults presenting with hematochezia who are at risk of developing proximal lesions. Colonoscopies offer more complete evaluations but are associated with a higher incidence of complications and possible low yield. Methods: An analysis was conducted on colonoscopies performed in our center on patients 40 years of age or younger. The study population was subdivided into 2 age groups for analysis: <30 years of age and 30-39 years of age. Results: We recruited 453 patients for the study. Patients were 115 and 338 individuals that were <30 and 30-39 years of age, respectively. Hemorrhoids was identified as the cause of bleeding in the majority of cases. The overall incidence of polyps was 6.5%; this was significantly higher in the 30-39 age group (7.4% vs. 1.7%, p=0.026). There were two cases of advanced/malignant polyps. While the majority of the polyps were in the distal colon, 28% of the polyps in the older age group were found in the proximal colon. There was one case of colonic perforation. Conclusions: Colonic polyps are more prevalent in patients aged 30-39. Colonoscopies should be considered for patients over the age of 30 with rectal bleeding.

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INTRODUCTION Self-expanding metal stents (SEMS) can be used as a bridge to surgery (BTS) or for palliation in the treatment of malignant large bowel obstruction. This case series evaluates the short-term outcomes of SEMS and success rates over time. METHODS A total of 75 consecutive patients who underwent colonic stenting for malignant colonic obstruction over a period of six years were included. This time period was subdivided into two equal parts for analysis. The procedure was carried out by a single surgeon from a tertiary institution in Singapore. RESULTS Technical success was reported in 93.3% of cases and clinical success in 81.3% of cases, with better success rates in the second half of the study (89.2% vs. 73.7%; p < 0.05). There were seven cases of inadequate decompression and two cases of colonic perforation. The median duration from stent insertion to surgery was ten days, and the median postoperative length of stay was six days. CONCLUSION SEMS are a safe and effective way of relieving malignant large bowel obstruction, including those that are proximal. The improvement in success over time reflects the importance of having an experienced endoscopist carry out the procedure to ensure optimum success rates.