Objective. To document the histology of Ross River virus (RRV) arthritis and to examine inflamed synovium for viral RNA. Methods. Biopsy tissue from the inflamed knees of 12 patients with RRV infection was studied using conventional and immunostaining techniques. Reverse transcriptase-polymerase chain reaction technology was used to probe for the presence of viral RNA in the synovial biopsy samples and in serum. Results. Hyperplasia of the synovial lining layer, vascular proliferation, and mononuclear cell infiltration were the main histologic changes. RRV RNA was found in knee biopsy tissue that was obtained from 2 patients at 5 weeks after the onset of symptoms. Conclusion. RRV RNA was identified in inflamed synovium more than a month after symptoms began. Inflammation was apparent in the absence of detectable virus in the majority of patients.

Rectal hyposensitivity (RH) is commonly found in patients with intractable constipation, faecal incontinence or both. Anal sensation may also be blunted in these conditions. We aimed to determine whether RH is associated with anal hyposensitivity, which may reflect a combined viscero‐somatic neuropathy. One hundred and fifty‐eight female patients with chronic constipation underwent physiological investigation including rectal sensation to volumetric balloon distension, and distal anal mucosal sensation to electrostimulation. Data were also obtained from 32 healthy female volunteers. Anal mucosal electrosensory thresholds were significantly higher in patients compared with volunteers (median: 2.4 mA, range: 0.4–19.6 vs 1.1 mA, range: 0.1–4.2, respectively), although the patient group was older (P < 0.0001), but there was no difference (P = 0.572) in the incidence of blunted anal sensation between those with normal rectal sensation (n = 113, 20% abnormal) and RH (n = 45, 24% abnormal). Irrespective of rectal sensory function, there was a strong association between symptom duration (P = 0.012) and anal hyposensitivity. One‐fifth of constipated female patients had evidence of diminished anal sensation. However, the presence of RH was not associated with an increased frequency of anal hyposensitivity, thereby suggesting that different aetiopathogenic mechanisms underlie the development of anal and rectal hyosensitivity. Further studies in carefully selected, homogenous patient populations are necessary to elucidate these mechanisms.

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Dear Sir, Laparoscopic ventral mesh rectopexy (LVMR) has been gaining wide acceptance for the treatment of rectal prolapse and rectal intussusception [1,2]. The laparoscopic approach has allowed low postoperative morbidity and shorter hospital stay, including a day procedure [3]. However, the technique brings certain challenges with regard to mesh fixation and closure of the peritoneum to avoid complications from exposure of synthetic mesh to the bowel.We operated on a fit 30-year-old woman by standard LVMR for symptomatic, radiologically proven fullthickness rectal intussusception. The synthetic mesh was anchored to the rectum inferiorly using absorbable sutures and proximally to the sacral promontary using ProTack TM (Covidien, Mansfield, MA, USA). The peritoneum over the mesh was closed with the self-anchoring V-Loc TM wound closure device (Covidien) in a continuous fashion from the inferior limit of the peritoneal incision to the sacral promontary (Fig. 1). On the following day the patient developed severe generalized abdominal pain. An urgent CT scan revealed some dilated small bowel loops. As her pain continued despite analgesia an urgent diagnostic laparoscopy was performed. This revealed small bowel obstruction (Fig. 2) secondary to the small bowel mesentery snagging to the barbed end of the V-Loc suture (Fig. 3). The bowel was healthy and easily released. The end of the V-Loc suture was trimmed and buried by closing peritoneum over it using absorbable sutures. The patient made an uneventful recovery following this procedure.Laparoscopic ventral mesh rectopexy is an effective treatment for rectal prolapse but it involves dissection in a confined space. The V-Loc suture eliminates the need for knots, enabling the surgeon to close incisions faster without compromising strength or knot security. On this occasion the small bowel mesentery became snagged on the protruding barbed end of the suture causing bowel obstruction, a complication that has not been previously reported. We feel it is important to highlight this so that those using this type of barbed suture ensure that the ends are snugly cut and buried. Figure 1 Peritoneal closure over mesh showing the protruding V-Loc suture over the promontory (marked by arrow).Figure 2 Small bowel adherent to the sacral promontory (marked by arrow).Figure 3 Arrow showing the small bowel mesentery attached to the V-Loc suture. Colorectal Disease ª 2013 The Association of Coloproctology of Great Britain and Ireland. 15, 1543-1547 1543 Correspondence