An innovative approach for the early detection of oral cancer and precancer within the context of the primary health care system has been field tested in Sri Lanka. The overall compliance in accepting this particular PHC approach for cancer screening, as estimated by arrival at a referral centre manned by consultant staff, was 54.1%. Nearly 80% of those who turned up without needing an additional reminder, did so within the first 2 weeks of case finding. There was a variation in the degree of compliance depending on the primary health care worker who did the screening and referral. Compliance was greater when the screening area was nearer to the referral centre and in subjects who were diagnosed as having a more advanced stage of the disease. Certain practical considerations that contributed to noncompliance were identified. Postal reminders were seen to increase overall compliance by 10.9%.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.A 65-year old male was admitted to surgical casualty with symptoms and signs of acute intestinal obstruction. He has been a toddy drinker for more than twenty years. Distended small and large bowel shadows were noted on the supine abdominal x-ray and inflammatory markers were elevated in blood. He underwent emergency laparotomy; descending colon and proximal part of sigmoid colon were found to be necrotic, with multiple perforations and a loculated abscess in the left paracolic gutter. The necrotic bowel loops were resected and the viable distal sigmoid colon was closed and an end colostomy was created.Macroscopically, specimen consisted of pieces of large bowel, measuring up to 15 cm in length and 6 cm in diameter, with patchy areas of full-thickness soft, white necrosis of the wall, ulcers with necrotic material adherent to their bases and large perforations (Figure 1). The ulcers were typically flask shaped, with a narrow neck and broad, undermined base. Microscopically, the affected bowel wall showed ischaemic necrosis with a mixed inflammatory cell infiltrate and small clusters of dispersed amoebic trophozoites (Figure 2 and 3). Periodic Acid Schiff staining was positive. The necrosis was transmural in the areas of perforation, and amoebic trophozoites were also seen within the lumen of blood vessels.