Almost one-third of the colorectal cancers in this series occurred in the seventh decade and were located distal to the splenic flexure.

The Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology developed this evidence-based practice guideline for management of chronic constipation. A modified Delphi process was used to develop this consensus containing 29 statements, which were generated by electronic voting iteration as well as face to face meeting and review of the supporting literature primarily from India. These statements include 9 on epidemiology, clinical presentation, and diagnostic criteria; 8 on pathophysiology; and the remaining 12 on investigations and treatment. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The members of the consensus team believe that this would be useful for teaching, clinical practice, and research on chronic constipation in India and in other countries with similar spectrum of the disorders.

The Indian Neurogastroenterology and Motility Association (INMA), earlier named the Indian Motility and Functional Diseases Association developed this evidence-based practice guidelines for the management of irritable bowel syndrome (IBS). A modified Delphi process was used to develop this consensus containing 28 statements, which were concerning diagnostic criteria, epidemiology, etiopathogenesis and comorbidities, investigations, lifestyle modifications and treatments. Owing to the Coronavirus disease-19 (COVID-19) pandemic, lockdowns and mobility restrictions, web-based meetings and electronic voting were the major tools used to develop this consensus. A statement was regarded as accepted when the sum of “completely accepted” and “accepted with minor reservation” voted responses were 80% or higher. Finally, the consensus was achieved on all 28 statements. The consensus team members are of the view that this work may find use in teaching, patient care, and research on IBS in India and other nations.

Gastrointestinal: Abdominal wall metastasis after percutaneous endoscopic gastrostomyA 53-year-old woman was referred for evaluation with recurrent carcinoma of the right piriform fossa. She had been previously treated by radiotherapy. Radical surgery was undertaken that included a total laryngopharyngectomy with reconstruction of the pharynx using a flap from the antero-lateral aspect of the left thigh. During the operation, percutaneous endoscopic gastrostomy was performed for post-operative feeding. The resected specimen revealed squamous cell carcinoma of moderate differentiation with infiltration of the tumor into the thyroid gland and into the esophageal wall. All surgical margins were free of tumor. After 5 months, she was noted to have a friable and bleeding mass at the gastrostomy site. The mass had raised margins and was approximately 5 cm in diameter (Fig. 1). Biopsies revealed squamous cell carcinoma of moderate differentiation (Fig. 2). Biopsies of a recurrent neck swelling also showed squamous cell carcinoma. She declined further therapy and is currently being treated symptomatically.Carcinomas of the head and neck are common neoplasms in many countries. Typical sites for metastases include lung, liver and bone. Surgical treatment for these neoplasms often involves prolonged avoidance of oral food and fluids and, because of this, feeding through a gastrostomy tube is widely used during the post-operative period. A metastasis in the abdominal wall at the site of the gastrostomy tube was first reported by Drs Preyer and Thul in 1989. Since that time, an additional 50 cases have been reported with an estimated frequency ranging from 0.5% to 1%. Clinically, metastases may present as non-healing peristomal ulceration, recurrent stomal bleeding, an exophytic peristomal mass or a deep abdominal wall mass. While direct spread of the neoplasm during the endoscopic procedure appears to be the most likely cause for abdominal wall metastases, other hypotheses have been suggested including hematogenous and lymphatic spread to the abdominal wall. The development of a gastrostomy metastasis with carcinoma of the head and neck is a poor prognostic feature. Such patients have a mean survival of 7 months and 1 year survival of <5%.

A 63-year-old male was admitted with complaints of upper gastrointestinal symptoms with fatigue and myalgia. Investigations revealed severe hyponatremia with elevated creatine phosphokinase levels. Following further workup, it was diagnosed as a case of hyponatremia induced rhabdomyolysis. Because of prompt correction of hyponatremia, his renal function was preserved and myoglobinuria induced renal failure was avoided. The importance of early recognition of this potentially dangerous condition is emphasized.