Background: The aim of this study was to determine the diagnostic accuracy of the faecal immunochemical test (FIT) for detecting colorectal cancer in symptomatic patients. Methods: This was a prospective study of patients with bowel symptoms. Stool samples were collected during rectal examination. The HM-JACKarc assay (Kyowa Medex, Tokyo, Japan) was used to quantify faecal haemoglobin (Hb); positive results were those with at least 10 g Hb/g faeces. Two-by-two tables and receiver operating characteristic (ROC) curve analysis were used to determine diagnostic accuracy; 2 and Mann-Whitney U tests were used to compare other parameters. Results: A total of 928 patients were included (M : F ratio 1 : 1⋅5; median age 72 (i.q.r. 64-80) years). The overall prevalence of colorectal cancer was 5⋅1 per cent. The FIT had sensitivity of 85⋅1 per cent, specificity of 83⋅5 per cent, positive predictive value of 22⋅6 per cent and negative predictive value of 99⋅0 per cent. ROC analysis of FIT for diagnosing colorectal cancer gave an area under the curve value of 0⋅89 (95 per cent c.i. 0⋅84 to 0⋅94). Significant bowel pathology was detected more frequently in FIT-positive patients (35⋅1 per cent versus 7⋅1 per cent in FIT-negative patients; P < 0⋅001). There were sex differences in FIT positivity (23⋅7 per cent in men versus 17⋅4 per cent in women; P = 0⋅019); the sensitivity of FIT for colorectal cancer in women was also low. False-negative FIT results were found mainly in women referred with iron-deficiency anaemia, who were found to have caecal cancer. Conclusion: FIT effectively excluded colorectal cancer in symptomatic patients. Integration of FIT into the diagnostic pathway for colorectal cancer would direct resources appropriately to patients with a greater likelihood of having the disease.

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Many different pathological processes can present as an incarcerated inguinal hernia. We present an unusual case of sigmoid diverticular abscess presenting as a left incarcerated inguinal hernia and review the literature on this subject. This was treated with open drainage of the abscess cavity and laparotomy with segmental sigmoid resection and primary anastomosis.

Pneumatosis intestinalis (PI) is defined as the presence of gas within the serosal or mucosal layer bowel wall. This sign is usually found upon radiographic imaging and is most commonly secondary to acute gastro-intestinal ischaemia. Fifteen per cent of cases can present with a primary condition called pneumatosis cystoides intestinalis (PCI). PCI is usually a benign condition and patients are usually asymptomatic. Portal venous gas (PVG) or the presence/accumulation of free gas within the hepatic portal vein. It is most commonly associated with acute bowel ischaemia, and when seen in the presence of ischaemia the mortality rate is between 75 and 90%. Other associations include mechanical causes (e.g. obstruction), chemotherapy, liver transplant and diverticulitis. Benign PI has previously been described with PVG, but usually in the presence of other associated conditions such as AIDS, malignancy or chemotherapy. Some examples have been described without these associations, but not with free intra-peritoneal air. We describe a case of PCI and PVG with pneumoperitoneum, investigations and ongoing management.