Desmoid tumours exhibit fibroblastic proliferation and arise from fascial or musculoaponeurotic structures. Despite their benign microscopic appearance, and their negligible metastatic potential, the propensity of desmoid tumours for local infiltration is potentially significant in terms of deformity, morbidity and mortality due to pressure effects and obstruction of vital structures and organs. The rarity of desmoid tumours, coupled with the variability in their clinical course, renders these lesions a vexing entity, and makes demonstration of the efficacy of any specific intervention difficult. Failure to recognize the potential for malignant behaviour in this tumour renders desmoids susceptible to inadequate treatment. This distinct pathological entity is reviewed with a specific focus on aetiology and treatment.

In-hospital delay was not an independent predictor of perforation in adults with acute appendicitis although delays may contribute if patients are left to wait unduly. Tachycardia at presentation may be a quantifiable feature of those more likely to have perforation and who should be given higher surgical priority.

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Minor difficulties with continence may occur after low anterior resection. Intraoperative injury to the internal anal sphincter or its nerve supply may contribute to this. To study the effect of low anterior resection on the anal sphincter mechanism, anal manometry was performed on 20 patients before and 10 days after resection. Fifteen patients were studied again 6 months after operation. Resting, maximum squeeze and squeeze increment pressures were recorded. Intraoperative manometry (n = 11) and presacral nerve stimulation (n = 6) were performed to determine whether peroperative injury to the internal anal sphincter had occurred. Resting and maximum squeeze anal canal pressures were reduced by low anterior resection, and did not recover. The squeeze pressure increment did not change. Division of the inferior mesenteric artery, full mobilization of the rectum and mesorectum, and rectal transection did not affect resting anal pressure, which was reduced after EEA anastomosis (mean (s.e.m.) before, 40(5) mmHg; after, 27(4) mmHg; P less than 0.05, n = 5). Presacral nerve stimulation produced relaxation of the internal sphincter. Anal sphincter pressures are reduced after low anterior resection. The external anal sphincter and the nerve supply to the internal anal sphincter appear intact. A direct injury to the internal sphincter is postulated.