There is significant prevalence of Low Anterior Resection Syndrome following oncological rectal resection. A low anastomotic height or history of radiotherapy are major risk factors.

Background: Sphincter preserving surgery for the treatment of rectal cancer is very often feasible, avoiding a permanent colostomy. It is well recognized that a large proportion of patients will experience altered bowel habit following low anterior resection (LAR). Faecal incontinence is a common symptom associated with LAR syndrome. The aim of this study is to evaluate the long-term improvement in continence and quality of life (QoL) in LAR patients treated with sacral nerve modulation. Methods: Patients with ongoing faecal incontinence for >1 year after reversal of diverting ileostomy post ultra-LAR were selected for the study. Eligible patients underwent sacral nerve modulator implantation as a two-stage procedure. Bowel diaries and the Cleveland Clinic Faecal Incontinence Score were used to measure faecal incontinence and QoL. Results: Twelve patients underwent permanent implantation of a sacral nerve stimulator. Median follow-up was 34 months (interquartile range (IQR) 20.25-62.5 months). The median improvement in faecal incontinence was 90% (IQR 76.25-98.75%) and the median improvement in patient QoL was 80% (IQR 71.25-93.75%). Patients who had previously been treated with biofeedback showed a median improvement in incontinence of 75% compared to 90% which was found in patients who had not had prior biofeedback treatment. The mean percentage improvement in patients with an internal anal sphincter defect was 80% compared to 90% seen in patients with an intact sphincter. Conclusions: The results of this study suggest that sacral nerve modulation should be more widely considered as an effective treatment strategy for patients with faecal incontinence following LAR. © 2018 Royal Australasian College of Surgeons ANZ J Surg 88 (2018) E787-E791 ANZJSurg.com © 2018 Royal Australasian College of Surgeons E790 Croese et al.

The rate of major LARS at this regional centre is 37.5%. Larger prospective multicentre studies are required to determine impact of variables such as type of neoadjuvant therapy, anastomotic techniques and progression of LARS over time.

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A 40-year-old man presented to our emergency department with a 2-month history of progressively worsening right-sided abdominal pain. The pain increases in severity in the 7 days preceding his presentation. It was constant in nature and not associated with any other gastrointestinal or systemic symptoms. He had no other medical co-morbidities and blood tests performed on presentation were unremarkable (white cell count 6.0 × 109/L and C-reactive protein 1.4 mg/L). On examination, he had a soft abdomen with an isolated focal point of tenderness in his right abdomen. There was no evidence of skin changes, puncture marks or overlying erythema at the tender area.A plain abdominal X-ray (AXR) was arranged by the emergency physicians and revealed an unexpected radio-opaque foreign body