Aim To assess the effectiveness of transanal irrigation (TAI) compared with posterior tibial nerve stimulation (PTNS) in severe and chronic low anterior resection syndrome (LARS). Method A two‐group parallel, open‐label randomized controlled trial carried out in a single university hospital. The study population included patients with a LARS scale score of more than 29 points who had undergone rectal surgery more than 1 year previously. These were randomly allocated, with a central randomization system, following a 1:1 sequence to TAI or PTNS. The main study outcome was to achieve a reduction of at least one LARS grade in at least 50% of the patients, for each intervention. Results A total of 27 patients (TAI = 13, PTNS = 14) were randomized. Both groups were similar with regard to confounding factors. Four patients were excluded because of intercurrent disease or early dropout, leaving 23 (TAI, n = 10; PTNS, n = 13) for analysis. Eight out of 10 and 4 out of 13 patients were downgraded with TAI and PTNS, respectively. The median LARS score decreased from 35 [interquartile range (IQR) 32–39] to 12 (IQR 12–26) (P = 0.021) for the TAI group and from 35 (IQR 34–37) to 30 (IQR 25–33) (P = 0.045) for the PTNS group. The Vaizey score fell from 15 (IQR 11–18) to 6 (IQR 4–7) (P = 0.037) and from 14 (IQR 13–17) to 9 (IQR 7–10) (P = 0.007) with TAI and PTNS, respectively, with 80% and 38% of patients, respectively, showing decreases of more than 50%. Improvement in quality of life was observed in both groups. Conclusion Both treatments improved the LARS score in this study but this was only significant in the TAI group.

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Extramedullary Hematopoiesis (EMH) is frequently seen in the liver, spleen or lymph nodes in patients with hematologic disorders such as beta-thallasemia or hereditary spherocytosis. We report the fi rst case of adrenal hematopoiesis in a patient with Chronic Myelomonocytic Leukemia. The patient was a 63 year-old man who was in the study of a thrombocytopenia. A CT and MRI demonstrated a unilateral adrenal mass with multiple splenic lesions. The patient underwent right adrenalectomy and splenectomy. Microscopic examination showed extramedullary hematopoiesis in the adrenal gland and spleen. The diagnosis of extramedullary hematopoiesis must be considered in any patient with hematologic disorders and thoracic or abdominal mass. An unnecessary procedure could be avoided.

Introduction: SNS (Sacral Nerve Stimulation) has become an established minimally invasive procedure for urinary and faecal incontinence. Minor complications related to the procedure are common; include pain, infection or migration. We present a case of a tined lead migration through the sciatic foramen. Case Report: A 72-year-old woman with faecal incontinence, who did not respond to dietary of medical treatment, underwent a sacral nerve stimulation test. Under fluoroscopic vision a tined lead was placed in S3 foramen, with an adequate motor and sensory response. In the 7th postoperative day, she reported no improvement and she referred sensory response in the thigh and leg. Radiography showed migration of the electrode through the sciatic foramen. The repositioning of the same electrode was possible with a gentle traction of the lead. Correct placement of the lead was confirmed radiologically, and the patient showed motor and sensory response in the anal area. The patient improved Wexner score from 18/20 to 4/20. Conclusion: Migration of the tined lead should be considered if loss of response in found. Repositioning of the same lead is possible in selected patients, without the need of removal of the device.

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