A group of 100 consecutive patients undergoing manual dilatation of the anus between 1980 and 1983 were reviewed retrospectively by examining the clinical presentation, diagnosis, treatment and outcome. Anal fissure was diagnosed in 46 patients, 22 had either first- or second-degree haemorrhoids, and stenosis of the anal canal was identified in seven. Manual dilatation of the anus was performed on 25 patients in the absence of a diagnosis. Dilatation failed to treat 26 anal fissures successfully. Where it was employed alone in ten cases of haemorrhoids and seven of anal stenosis, manual dilatation failed to cure seven and five patients respectively. Of the patients with no diagnosis, 23 were relieved of their symptoms following dilatation. Episodes of incontinence occurred in 27 patients, 21 of whom were female. There should be a reduced role for manual anal dilatation in the treatment of common anorectal disorders.

Pyogenic hepatic abscess is an uncommon disease, and hepatic abscess secondary to gallbladder perforation is even rarer. We present a case of hepatic abscess secondary to gallbladder perforation, who presented with nonspecific clinical features. The diagnosis was made by radiological imaging and it was treated by percutaneous drainage followed by drainage of hepatic abscess and cholecystectomy. There are very few reported cases of hepatic abscess secondary to gallbladder perforation, we report one such case and also review the literature for similar cases.

Adenosine is widely used for the diagnosis and treatment of supraventricular tachyarrhythmia. We report a rare case of adenosine use associated with the development of 1:1 atrial flutter with aberrancy. The diagnosis was further complicated by a newly described ECG artifact associated with Wireless Acquisition Module (WAMTM) ECG acquisition mimicking rhythm irregularity.