Patients with chronic stomal inflammation, bleeding or persistent induration and/or mass formation should be followed up closely and investigated for recurrence or development of a new malignancy. There should be a low threshold to obtain an early definitive tissue diagnosis by taking biopsies to prevent local or systemic invasion.

The UK bowel cancer awareness campaigns appear to have improved public awareness of CRC and encouraged symptomatic individuals to seek urgent medical attention. The increase in 2WW referrals has not translated into better survival for symptomatic patients, partly due to the proportion presenting with advanced disease.

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77 patients (56%) were readmitted to hospital, 66 (86%) for clearly alcohol-related reasons. 13 more patients re-attended the AandE Department without readmission. 100 day readmission rate was 50%. 19 patients were readmitted twice and 23 patients >3 times. Readmission was independently associated with unemployment (p = 0.043), self-discharge after index admission (p = 0.011), relapse into drinking (p = 0.028), and (surprisingly) with having received a brief intervention regarding alcohol consumption during the index admission from a dedicated alcohol worker (n = 61, p = 0.009). Seven more patients had died by 21/05/13, 5 from liver disease. Conclusion Patients admitted to hospital with AUDs tend to be socially deprived, frequent hospital attenders with major physical and mental co-morbidity. They have high subsequent alcohol relapse and hospital readmission rates. Reduction of these is not achieved by interventions during the index admission and will require more pro-active measures post-discharge. Introduction National guidelines for the management of upper gastrointestinal (GI) bleeding exist and are based on conclusive evidence for effective clinical practice [1]. A mortality rate in acute admissions of 7% was reported in a national audit of upper GI bleeding [2]. This is an area of high volume, high risk and high cost where improvements can be made. Methods Three prospective audits of all acute admissions with upper GI bleed were undertaken for 4 week periods in 2009 (Audit 1), 2011 (Audit 2) and 2013 (Audit 3). After Audit 1, a new GI bleed proforma was introduced,a rolling,targeted educational programme for Accident and Emergency (AandE) and Medical Admissions Unit (AMAU) trainees was started,mandatory fields for risk scoring were included in the electronic requests and additional evening inpatient endoscopy lists were started. After Audit 2, Saturday and Sunday inpatient endoscopy lists were introduced and a dedicated endoscopy co-ordinator supervised triaging of patients to appropriate lists. Results A total of 115 patients were included in the three audits. 88% were admitted through AandE. There were no deaths and no patients underwent surgery in each of the three audit periods. 13% of all patients had lesions at endoscopy requiring therapy (6% band ligation for variceal bleeding, 7% endotherapy for peptic ulcer bleeding). The proportion of patients in whom a risk score was calculated in the 2009, 2011 and 2013 audits improved with each audit period with completion rates of 0%. 39% and 94%, respectively. (P < 0.001 for comparison of 2009 to 2011, and 2011 to 2013). However, the risk scores were inaccurately calculated by the admitting doctors in 46% and 33% of cases in Audit 1 and Audit 2. The improvement in accuracy between the audit periods was not statistically significant (p = 0.64). There was a statistically significant improvement in the time from admission to endoscopy between the audit periods 2009 and 2013 (median 33.5 h (range 15 to 214 h) versus 23.25 h (range 1.5 to 92 h) (p = 0.0017). The ...

Background Appendicitis is a commonly occurring condition worldwide. The gold standard treatment is appendicectomy. Although training models are commercially available for this procedure, they are often associated with high cost. Here we present a cost-effective model. Aim To establish construct validity of a cost-effective laparoscopic appendicectomy simulation model. Methods Three groups of surgeons were recruited; novices ( n = 31), of intermediate expertise ( n = 13) and experts ( n = 5) and asked to perform a simulated laparoscopic appendicectomy using the new model. Their performance was assessed by a faculty member and compared between the three groups using a validated scoring system (Global Operative Assessment of Laparoscopic Skills [GOALS] score). Results One-way ANOVA test showed a significant difference in task performance between groups ( p < 0.0001). Post-hoc comparisons after the application of Bonferroni correction (statistically significant p value <0.017) demonstrate a significant difference in performance between all groups for all GOALS categories as well as the total score. Effect size calculations showed that experience level had moderate (Eta-squared >0.5 and <0.8) and significant (>0.8) impact on the performance of the simulated procedure. Conclusion The model described in this study is cost-effective, valid and can adequately simulate appendicectomy. The authors recommend inclusion of this model to postgraduate surgical training.

Solitary caecal diverticulitis is a rare and often misdiagnosed cause of abdominal pain. A 63-year-old Caucasian woman was admitted with a 3-day history of left upper quadrant pain and constipation. Preoperative imaging identified a possible transverse colonic tumour. At laparotomy a long, mobile ascending colon resulted in the caecal pole lying in the left upper quadrant and an inflamed gangrenous solitary caecal diverticulum was found. A right hemicolectomy was performed and the patient recovered promptly.

Background Extra Levator Abminoperineal Excision (ELAPE) is widely performed surgery for low rectal cancers. A large defect in the perineum adds significant post-operative morbidity. There is no clear unanimity about the closure of the defect. The aim of the study is to evaluate our experience and outcome of the perineal wound management after ELAPE with partial myocutaneous gluteal (PMG) flap reconstruction in a large series of 81 patients at a single centre in the United Kingdom (UK). Method Retrospective review of all patients undergoing ELAPE and primary PMG flap reconstruction between January 2012 and December 2021 in a large district general hospital. Patient demographics, 30 days morbidity and mortality were studied. Results Total 81 patients (male 52, female 29) had ELAPE (laparoscopic 65, open 11, converted to open 5) and PMG flap closure for low rectal cancer. Mean age of patients was 67.2 years (SD+- 10.7). Length of stay was average 19 days (range: 6 to 168 days). Half of the total patients had neoadjuvant chemoradiation. 18.5% patients developed minor perineal wound complications, whereas only 2.5% patients needed to return to theatre for major wound complications. None of patients had perineal hernia or mortality in 30 days. All flaps were viable during the follow-up. Conclusion PMG flap provides safe and reliable method for perineal closure after ELAPE perineal defect without any additional morbidity compared to conventional closure offering overall good patient outcome and experience.