Background: Synchronous para-aortic lymph node metastasis (PALNM) in colorectal cancer (CRC) is a relatively rare clinical entity. There is a lack of consensus on management of these patients, and the role of para-aortic lymph node dissection (PALND) remains controversial. This systematic review aims to describe the survival outcomes in colorectal cancer with synchronous PALNM when lymph node dissection is performed. Methods: A systematic review of Pubmed, Embase and Web of Science databases for PALND in CRC was performed. Studies including patients with synchronous PALNM undergoing resection with curative intent, published from the year 2000 onwards, were included.Results: Twelve retrospective studies were included. Four studies reported survival outcomes for rectal cancer, two for colon cancer and six as colorectal. Survival outcomes for 356 patients were included. Average 5-year overall survival (OS) was 22.4%, 33.9% and 37.7% in the rectal, colon and colorectal groups respectively. Three year OS in the groups was 53.6%, 46.2% and 65.7%. Conclusion:There remains a lack of quality data to confidently make recommendations regarding the management of synchronous PALNM in colon and rectal cancer cohorts. Retrospective data suggests a benefit in highly selective cohorts and therefore a case-by-case evaluation remains the standard of care.

BackgroundChronic intestinal pseudo‐obstruction (CIPO) may be a primary or secondary phenomenon and is often multifactorial. Treatment is largely directed at improving colonic motility. The use of cholinesterase inhibitors such as pyridostigmine has been hypothesized to increase acetylcholine in the bowel, improving symptoms and transit times.MethodsA systematic review of the use of pyridostigmine in CIPO was conducted using scientific and commercial search engines identifying scientific studies enrolling adult human subjects, published from 2000 to 2022 in the English language.ResultsFour studies were identified including two randomized controlled trials (RCT) and two observational studies. The studies had heterogenous inclusion criteria, dosing regimens and reported outcomes. Two studies were identified as being at high risk of bias. All studies reported improved patient outcomes with use of pyridostigmine, and low rates (4.3%) of mild cholinergic side effects. No major side effects were reported.ConclusionThe use of pyridostigmine in management of CIPO is biologically plausible due to its ability to increase colonic motility, and early studies on its role are uniformly suggestive of benefit with low side‐effect profile. Four clinical studies have been conducted to date, with small sample sizes, heterogeneity and high risk of bias. Further high‐quality studies are required to enable assessment of pyridostigmine's utility as an effective management strategy in CIPO.

patient demonstrates a unique case in which small bowel obstruction is secondary to extrinsic compression from a mesenteric haematoma, rather than progressive ischaemia secondary to a vascular injury leading to luminal stricturing.In our review of the English literature, all cases of delayed small bowel obstruction following blunt abdominal trauma have been managed operatively. [1][2][3][4][5][6][7] Operative management is clearly indicated in patients who are haemodynamically unstable or demonstrate evidence of an acute abdomen; however, there is an argument to proceed with non-operative management in stable patients. The decision to manage these patients conservatively poses a difficult clinical scenario, particularly when obstruction can occur months following the initial blunt injury. 5 Whilst we should have a high clinical suspicion for the possibility of stricture formation following mesenteric injury, which is unlikely to resolve non-operatively, it is important to manage patients according to their clinical and radiological findings. In a setting where obstruction is secondary to extrinsic compression rather than stricturing, it can be inferred that this obstruction will be relieved as the haematoma liquefies. We propose that in patients with extrinsic small bowel compression leading to obstruction, the reduced morbidity of pursuing nonoperative management is a viable option.This case demonstrates a unique presentation of small bowel obstruction secondary to extrinsic compression by a mesenteric haematoma. Despite literature indicating that patients with small bowel obstruction secondary to blunt abdominal trauma often require operative management, we highlight a patient in which conservative management with decompression resulted in a successful outcome.