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SOLITARY giant diverticulum of the sigmoid colon is a rare disease of which there are only 8 other published cases, none of which presented initially as an abdominal emergency.This report concerns a further case with an acute presentation requiring emergency treatment. CASE REPORTA 72-year-old female patient presented in May, 1967, with a z-day history of intermittent, colicky, central abdominal pain of sudden onset, which had become more severe on the day of admission, and was associated with the the erect position (Fig. 2) revealed that this shadow contained a definite fluid level. There was no radiological evidence of intestinal obstruction.Leucocyte count was I 1,900 per c . m . ; haemoglobin 11.8 g. per IOO ml.; blood-urea and electrolytes were within normal limits. Urine contained a few red cells and epithelial cells and was sterile.A laparotomy was performed 6 hours after admission through a right paramedian incision. The only abnormal finding was a thick-walled cystic swelling 20 cm. in diameter arising from the antimesenteric border of the apex of the sigmoid colon (Figs. 3, 4), which contained a small amount of faecal fluid. There was a communication between the lumen of the swelling and that of the sigmoid onset of fever. There was no history of vomiting, no change in bowel habit, no recent weight-loss, but she had had long-standing frequency of micturition and nocturia. There was no relevant past medical history. On examination she was flushed and moderately dehydrated but otherwise looked well. Temperature was 1 0 2~ F., pulse-rate IOO per minute, and blood-pressure 130/9o mm. Hg. Her tongue was dry and coated.On abdominal examination there was central distension. On palpation there was a central, regular, spherical, tender, immobile mass approximately 20 cm. in diameter. This was associated with generalized tenderness, guarding and rebound tenderness, and an absence of bowel-sounds. Percussion note over the mass was tympanitic. Rectal examination was normal. Plain radiography of the abdomen in the supine position revealed a large, round, gas-filled shadow 20 cm. in diameter (Fig. I)

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A previous paper,' evaluated some potential hazards in a 'crash induction' technique using thiopentone and suxamethonium. For elective surgery, many anaesthetists use a long-acting muscle relaxant both for intubation and maintenance relaxation. Although rarely reported, similar techniques are also employed in the presence of a 'full s t o m a~h ' .~ This paper describes a technique of induction by rapid injection of pancuronium and thiopentone. A standard timing of laryngoscopy and intubation is used, based on loss of lid reflex as a guide to the circulation time.The technique was developed by the authors using premixed thiopentone and pancuronium for fit patients undergoing elective surgery and later for those at risk from a 'full stomach'. This work was not published, since the current formulation of pancuronium no longer mixes with thiopentone, but the safety and consistency of the results encouraged us to adapt the protocol to the present study. Material AnaesthetistsFive junior anaesthetists, on the basis of long experience, proven competence and willingness to use the technique were selected to assist the authors in the investigation.