Case 1

• 21 year old male office worker

• GP referral, “IBS not responding to Rx

• 3 month history of abdominal discomfort, worse after eating, can keep him awake

• Wight loss of ½ stone

• Intermittent loose motions

Case 1

• Average build

• Slightly pale

• Abdomen not distended

• Mild tenderness in lower half

• No mass palpable

• Anus normal ,∑ - normal rectal mucosa

Case 1

• How would you investigate him?

Case 1Case 1

Case 1

• What is the diagnosis?

–Confirmatory investigations?

• How would you manage the patient?

Case 2

• 30 year old anaesthetic registrar

• Presented as emergency:

–acute abdominal pain and vomiting

• 3 month history of abdominal discomfort

• Wight loss of ½ stone

• Loose motions

Case 2

• Unwell

• Fever 380 c

• Distended abdomen

Tender,guarding

Case 2• AXR

Case 2

• Laparotomy

• Small bowel obstruction

• Adhesions right iliac fossa to

• Inflamed appendix and ileocaecal area

• What operation?

Case 2

• Laparotomy

• Small bowel obstruction

• Adhesions right iliac fossa to

• Inflamed appendix and ileocaecal area

• Appendicectomy performed (non specific acute inflammation)

Case 2

• Next 4 months continued abdominal pain

• Diarrhoea persists

• Further weight loss

• Frightened to eat

• What investigations?

Case 2

• What is the diagnosis?

• What management?

• Medical?

• Surgical?

Case 3

• 18 year old trainee chef

• Feels tired

• 6 month history of abdominal pain and diarrhoea

• Bowels opened up to 6 times per day

• Mucus in stool

• Occasional blood with motion

Case 3

• Pale, clinically anaemic

• Tall and thin

• Abdomen soft, mild tenderness in left iliac fossa

• No mass palpable

• Anus – small tags only

• Rectal mucosa “normal” – slightly red

Case 3

• Hb – 10.6

• Platelets – 635

• WCC – 8.9

• CRP – 87

• Barium enema

Case 3

•Isolated left colonic strictureDistal sigmoid and rectum normalProximal colon “looks normal”

Case 3

• How would you manage this patient?

Case 3

• What operation would you perform?

Case 3

• Represents January 2006

• Acute anal abscess

• Large tags

• Abscess partially draining from 2 sites

• EUA

• Chronic fistulous abscess posteriorly

• Ulcerated anal canal

• Active rectal inflammation

Case 3

Case 3

• How would you manage this patient now?

Case 4

• 56 year old female

• Previous resection for ileo-colic Crohn’s disease

• Previous anal abscess x 2

• Now presents with increasing anal and labial pain

• Miserable

Case 4

• How would you manage this patient

–Further investigations

–Treatment