Background Colorectal cancer is the third most commonly diagnosed malignancy in Australia. Up to a third of patients who have undergone surgery with curative intent for colorectal cancer will have a recurrence of disease leading to significant morbidity and mortality. Regional Australians have disproportionately worse outcomes. Aim To identify factors associated with recurrence in colorectal cancer patients treated at a regional Australian hospital. Methods This study is a retrospective cohort analysis. Consecutive patients who have undergone curative resection at a regional public and private hospital by three surgeons from a single surgical practice for either rectal cancer or colon cancer were included. Prognostic indicators of recurrence were examined via both univariate and multivariate time‐to‐event analyses. Results Three hundred nine patients were included with 43 recurrences. Thirty presented with distant metastases, seven presented with locoregional recurrence and six presented with locoregional as well as distant recurrence. In univariable analysis, higher rates of recurrence were associated with tumour type, higher AJCC summary stage, higher preoperative levels of CA19‐9, perineural invasion, lymphovascular invasion, <12 nodes examined, positive lymph nodes and emergency surgery status. On multivariable analysis recurrence remained associated with tumours with a mucinous and/or signet cell component, positive nodes and <12 lymph nodes examined. Conclusion A combination of patient and treatment factors are relevant in determining the risk of recurrence for stage I–III colorectal cancer. This study emphasises the importance of histology in determining risk, particularly the number of nodes examined. CEA 19–9 may also be a useful pre‐operative predictor of recurrence.

Ischaemic stroke is a rare manifestation of hypercoagulability induced by underlying malignancy. It is proposed that paraneoplastic non-bacterial thrombotic endocarditis (NBTE) is the most common cause, predisposing to the formation of friable valvular lesions composed of platelets and fibrin that embolize commonly. Pancreas, gallbladder, stomach, colon and gynaecological malignancies have all been associated with NBTE. We describe a female patient who presented to our facility with syncope and limb weakness. Magnetic resonance imaging of the brain revealed ischaemic strokes in both the anterior and posterior circulation. Further investigation revealed a pelvic mass that was biopsy proven to be ovarian malignancy. Prognosis is heavily reliant on disease stage, thus diagnostic clues suggesting the possibility of underlying malignancy in the presentation of stroke should prompt a thorough investigation to exclude malignancy.

Splenic artery pseudoaneurysm is a rare phenomenon most associated with chronic pancreatitis or previous trauma. Complications can include erosion and rupture into local structures, a situation that carries a reported mortality of 10–40%. A 58-year-old male with chronic alcoholic pancreatitis and a known splenic artery pseudoaneurysm presented to the emergency department of a regional hospital with rectal bleeding and sepsis. Computed tomography revealed a peri-splenic mass communicating with the splenic flexure. The patient was taken for an emergency splenectomy and left hemicolectomy and was confirmed to have rupture of the splenic artery aneurysm into the large bowel. This case presented with comparable features reported in the literature and demonstrates that access to emergency specialist surgical services in a regional setting offers the capability to manage rare, life threatening surgical emergencies.

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Venous ulcers are common and account for the majority of lower limb chronic wounds. Complications may be serious in nature and although haemorrhage is rare, it may be rapidly fatal. The case of a female patient who presented with a spontaneous varicose ulcer haemorrhage causing hypovolaemic ischaemic colitis is described. This case exemplifies the need to identify and manage the development of venous insufficiency before progression to chronic wounds or other disease burdens which may be fatal or life-altering.