Manish Chand

Intussusception in colorectal cancer.

Adult intussusception is a rare occurrence and, unlike in childhood, is usually associated with an underlying tumor. Although computed tomography (CT) imaging can identify an intussusception and point toward a cause, diagnosis is challenging if it is only intermittent. When an intussusception presents in the context of a known bowel cancer, it is possible to attribute nonspecific abdominal symptoms to the malignant process. Herein, we describe 2 cases of retrograde intussusception caused by cecal tumors that were not identified on preoperative CT scanning, only to be found during surgery. Both patients presented with intermittent severe abdominal pain and weight loss, which is not usually a feature of cecal cancer without metastases. These cases highlight the difficulty of diagnosing intermittent adult intussusception and that atypical abdominal pain might herald an otherwise occult colorectal cancer.

A diagnostic dilemma following risk-reducing surgery for BRCA1 mutation - a case report of primary papillary serous carcinoma presenting as sigmoid cancer.

BackgroundWomen that carry germ-line mutations for BRCA1 or BRCA2 genes are at an increased risk of developing breast, ovarian and peritoneal cancer. Primary peritoneal carcinoma is a rare tumour histologically identical to papillary serous ovarian carcinoma. Risk-reducing surgery in the form of mastectomy and oophorectomy in premenopausal women has been recommended to prevent breast and ovarian cancer occurrence and decrease the risk of developing primary peritoneal cancer.Case presentationWe present a case report of a woman with a strong family history of breast cancer who underwent risk-reducing surgery in the form of bilateral salpingo-oophorectomy following a mastectomy for a right-sided breast tumour. Following the finding of a BRCA1 mutation, a prophylactic left-sided mastectomy was performed. After remaining well for twenty-seven years, she presented with rectal bleeding and altered bowel habit, and was found to have a secondary cancer of the sigmoid colon. She was finally diagnosed with primary papillary serous carcinoma of the peritoneum (PSCP).ConclusionPSCP can present many years after risk-reducing surgery and be difficult to detect. Surveillance remains the best course of management for patients with known BRCA mutations.

A Simple Case of Appendicitis? An Increasingly Recognised Pitfall

Acute appendicitis is the most common presentation of the acute abdomen in the UK. Although in most cases this is an easily reached diagnosis, presentation is not always typical and there are certain other conditions which may mimic appendicitis. Diagnostic adjuncts usually provide the additional information required to make a confident diagnosis; however, in some circumstances, the safest and most reliable course of action is appropriate surgical intervention. A case report is presented of a 43-year-old woman who presented with history of peri-umbilical pain migrating to the right iliac fossa. Following further investigation, with routine blood tests, plain radiographs, ultrasound examination of the abdomen and pelvis, and CT scanning not pointing towards a definitive diagnosis, she eventually underwent a diagnostic laparoscopy which revealed primary omental torsion. An open omentectomy was performed and 2 months on she remains well.

Gender Determined Flexible Sigmoidoscopy Planning

The most common investigation carried out in UK hospitals to investigate bright red rectal bleeding is a flexi- ble sigmoidoscopy (FS). The role of flexible sigmoidoscopy in colorectal screening has not yet been fully ascertained and colonoscopy remains the investigation of choice for the diagnosis of colonic pathology. However, FS is a simple, quick, sensitive and specific investigation to diagnose and even treat some left sided colorectal lesions. We investigated whether there was any difference between male and female patients undergoing FS in terms of duration and extent of procedure, and describe for the first time a significant increase in time taken to complete the examination in females. As eleven males may be scoped in a similar time to ten females this may have bearing on service efficiency.