Metastatic spread of invasive lobular breast cancer is rare. It can have a delayed and varied presentation that can mimic other bowel pathologies, such as colorectal cancer and inflammatory bowel disease, making its diagnosis difficult. In this study, we present two patients who required colonic resection due to malignant obstruction caused by metastatic invasive lobular carcinoma of the breast.

BackgroundEarly enteral feeding and avoidance of routine nasogastric tube (NGT) placement have become standard care following colorectal surgery. However, some patients require NGT decompression post‐operatively for vomiting or distension.MethodsThis was a retrospective cohort study of all patients undergoing elective intra‐abdominal colorectal surgery at University Hospital, Geelong, from 2014 to 2018. Failure of early feeding was defined by the placement of an NGT post‐operatively, beyond the day of surgery.ResultsA total of 754 patients were identified. Of these, 28 were excluded due to protocol violations (NGT was left in situ at the end of the operation), leaving 726 patients that were included in the analysis. Overall, 156/726 (21%) patients failed early feeding. The strongest independent predictor of failure was undergoing a total or subtotal colectomy compared with all other operations (15/28 (54%) failed versus 141/698 (20%); P < 0.001). Laparoscopic surgery was independently associated with a lower risk of failure compared with open surgery (43/278 (15%) versus 113/448 (25%); P = 0.002). Risk of failure was not associated with gender, age, American Society of Anesthesiologists score, indication for procedure, presence of anastomosis or duration of surgery.ConclusionLaparoscopic surgery is associated with a lower risk of failure of early feeding compared with open surgery. Patients undergoing subtotal or total colectomy have a high rate (54%) of failure. This may assist in selecting appropriate patients for early feeding after colorectal surgery.

Acute pancreatitis can lead to pancreatic and peripancreatic collections that can spread in the retroperitoneum to varying extents based on the severity of the pancreatitis. We present here an unusual case of pancreatitis where the patient presented with an acute scrotum as a result of extension of peripancreatic inflammation to the scrotum.

Schwannomas are nerve sheath tumours that can be found throughout the body along peripheral nerves. Primary schwannomas of the colon are very rare. They are usually benign and their surgical resection is considered curative. They are, however, difficult to diagnose preoperatively and therefore tend to be overtreated with major colorectal surgery.