Aidan G Shaw

Colorectal surgeons and biomedical scientists improve lymph node harvest in colorectal cancer

BackgroundThe aim of this study was to review lymph node retrieval from colorectal cancer resections.MethodsWe examined consecutive, single colorectal cancers excised between September 1999 and February 2007. Data gathered included patient age and gender, cancer location, total number of lymph nodes and involved lymph nodes identified. The speciality of the operating surgeon was recorded. Whether a pathologist or biomedical scientist was responsible for harvesting lymph nodes from the resected specimen was also noted.ResultsA total of 1,194 patients were identified. Increased numbers of lymph nodes identified was associated with increased lymph node positivity (p<0.001, r=0.121). Biomedical scientists identified more lymph nodes (median 15, range 12–20) within specimens than consultant pathologists (median 10, range 7–13; p<0.001). Colorectal surgeons removed more lymph nodes (median 11, range 7–15) than non-colorectal surgeons (median 9, range 7—14; p=0.002).ConclusionsThere was a significant increase in lymph node harvesting over time and this correlated with lymph node positivity. Lymph node harvest was significantly higher when the resection was performed by a colorectal surgeon and when the specimen was examined by a biomedical scientist. For accurate staging and consequent correct planning of adjuvant treatment and prognosis, resections should be performed by a colorectal surgeon and the lymph nodes harvested by a biomedical scientist.

Neoadjuvant chemo-radiotherapy and rectal cancer: can the UK watch and wait with Brazil?

Objecive  It has recently been reported that up to one‐third of patients with nonmetastatic distal rectal cancer managed with neoadjuvant chemoradiation therapy (CRT) had a complete clinical response (cCR) to treatment. In the selected cases, this has been used as the sole treatment. The aim of this study was to determine the frequency of complete pathological response for patients receiving CRT in one centre in the UK.

Osseous metaplasia in an ulcerating tubular adenoma of the colon: a case report

IntroductionHeterotopic bone is rarely found in the gastrointestinal tract. Here we report a rare case of metaplastic ossification within a benign ulcerating adenoma and review the literature concerning the aetiology.Case presentationA 63-year-old woman, who presented with a history of melaena, was found at colonoscopy to have a pedunculated ulcerating polyp. Histological examination demonstrated multiple areas of osseous metaplasia within the polyp stroma.ConclusionHeterotopic ossification in colonic adenomas is a particularly rare phenomenon, with the majority of cases occurring within malignant lesions. The suggested mechanisms for its aetiology still remain unclear.

Large bowel obstruction and perforation secondary to endometriosis complicated by a ventriculoperitoneal shunt

A 36‐year‐old lady, with a past medical history of hydrocephalus requiring a ventriculoperitoneal (VP) shunt, was admitted with symptoms and signs of large bowel obstruction. Her condition worsened and she underwent laparotomy, where she had faecal peritonitis secondary to a perforated sigmoid colon. The shunt was contaminated with faeces leading to postoperative shunt infection and meningitis. Histology of the resected sigmoid colon revealed endometriosis at the site of perforation. Endometriosis is a rare cause of large bowel obstruction and literature review has found only two other cases of perforation because of endometriosis not associated with pregnancy. No case has been reported involving the concurrent surgical management of a contaminated VP shunt. We discuss the rarity of large bowel perforation and obstruction because of endometriosis, and the complications and management of VP shunts.

Referral of patients with iron deficiency anaemia under the lower gastrointestinal two‐week wait rule

Objective  One of the 2‐week wait (2WW) criteria for suspected lower gastrointestinal cancer states that patients should be referred who have iron deficiency anaemia (IDA) without obvious cause [Haemoglobin (Hb) <11 g/dl men, <10 g/dl postmenopausal women].

The misuse of the faecal occult blood test under the lower gastrointestinal two week wait rule

Aim  To find the proportion of patients with a faecal occult blood (FOB) performed as part of the referral for the lower gastrointestinal two week wait (2WW) referral system, and whether this correlates with the cancer status.

Large bowel obstruction due to sesame seed bezoar: a case report

We report a case of a 79 year old man with a known benign anastomotic stricture presenting with large bowel obstruction. At laparotomy the obstruction was found to be caused by a large sesame seed bezoar. Seed bezoars are well known to cause impaction in the rectum but have never been previously reported to cause large bowel obstruction. We recommend that patients with known large bowel strictures should be advised not to eat seeds as this could ultimately lead to obstruction, ischaemia or perforation.

Rectus sheath haematoma or leaking aortic aneurysm - a diagnostic challenge: a case report

IntroductionA rectus sheath haematoma is a rare condition that arises from the accumulation of blood within the rectus sheath from either muscular tear or rupture of the epigastric vessels. It is a known complication of either blunt abdominal trauma, anticoagulation therapy or the repetitive contraction of the rectus muscle such as paroxysms of coughing. It remains an uncommon and elusive entity and is often clinically misdiagnosed.Case presentationAn 80-year-old British man with a known aortic aneurysm was admitted with sudden onset of right iliac fossa pain. The patient was hemodynamically stable and underwent a computed tomography scan which revealed an intact aorta and an acute rectus sheath hematoma.ConclusionTo the best of our knowledge, no case has previously been reported involving the diagnostic challenge of a rectus sheath hematoma in a patient with a known aortic aneurysm. Here we discuss the symptoms and signs of a rectus sheath hematoma, as well as the radiological modalities that could be utilized to reach the diagnosis.

Barium enema: diagnosis and an unusual discovery

A 78-year-old lady was admitted with asymptomatic iron deficiency anaemia and weight loss. Her past medical history included …