The addition of gum chewing to a standardized postoperative regimen did not reduce the period of postoperative ileus or shorten length of stay following open surgery for left-sided colorectal cancer.

SummaryPatients with long-standing ulcerative colitis have an increased chance of developing a carcinoma of the colon, especially when the inflammatory process involves the entire colon, but no case of a carcinoid tumour of the colon occurring in a patient with ulcerative colitis has been reported. Case reportThe patient, a 54-year-old teacher, was admitted with signs and symptoms of a large bowel obstruction. He had a one-week history of central abdominal colicky pain radiating to the right iliac fossa associated with increasing constipation and abdominal distension. He had not vomited, but had been nauseated and anorexic for a few days.Twenty years before, he had been investigated at the same hospital with sigmoidoscopy and barium enema and a diagnosis of ulcerative colitis had been made. In keeping with the accepted treatment at that time, he was started on a low residue diet. Since then, he suffered several attacks each year of blood-stained diarrhoea which were commonly precipitated by stress.On examination he was dehydrated. The abdomen was distended with obstructive bowel sounds. The rectum was empty and sigmoidoscopy showed an injected granular mucosa which was biopsied. A diagnosis of large bowel obstruction was made which was supported by plain films of the abdomen. In view of his dehydrated condition, intravenous fluids were given over the next 18 hr, before laparotomy. Through a right paramedian incision, the cause of the obstruction was found to be an encircling tumour of the descending/sigmoid colon. There was gross distension of small and large bowel and a perforation of the transverse colon, which was localized by omentum wrapped around the site of perforation. The large bowel itself was friable. The small bowel was decompressed with a Savage's decompressor and the hole closed with catgut and interrupted black silk sutures. A total colectomy with an ileostomy was performed, and the rectum brought out through the wound as a mucus fistula.His progress was uneventful until the eighth postoperative day when he developed a small bowel fistula. His condition gradually deteriorated despite intensive intravenous and low residue feeding and a further laparatomy, and he died on the thirty-fourth day after his admission. PathologyThe rectal biopsy taken at sigmoidoscopy on the day of admission showed a minimal increase in chronic inflammatory cells. There was considerable glandular loss indicative of previous damage, together with oedema of the lamina propria, an increase in plasma cells and slight polymorph infiltration indicative of a non-specific active inflammation (Fig. 1).Examination of the operative specimen showed the tumour to be a carcinoid tumour. It had penetrated the full thickness of the bowel wall and had infiltrated the serosal fat (Fig. 2). Elsewhere the bowel showed a variable appearance. In some areas the mucosa showed no abnormality. In others there was severe transmural acute or chronic inflammation associated with extensive ulceration and some areas where the circular and longitudinal ...

Summary Isolated perforation of the gall bladder as a consequence of blunt abdominal injury is rare. A single case is described which illustrates several features which may characterize this lesion.