What ' s known on the subject? and What does the study add? There is controversy over the use of anti-platelet and anti-coagulant drugs in men undergoing TURP with contradictory evidence on the effect of the drugs on bleeding following the operation, particularly for aspirin.

Subspecialist CR management of patients undergoing emergency left-sided colonic resection on an acute surgical unit is associated with a similar level of morbidity and mortality while safely achieving significantly higher rates of primary anastomosis and lower stoma rates.

Biological plugs offer a further option for management of the traditionally difficult foregut fistula, without major morbidity associated with other treatment modalities. It is limited to the ability to deploy the plug endoscopically.

Backgrounds Grade I and II haemorrhoids are commonly managed in colorectal practice. Management often involves rubber band ligation. The haemorrhoid energy therapy (HET) device (Medtronic, Minneapolis, MN, USA) has been developed as an alternative to rubber band ligation (RBL). This study is the first to prospectively evaluate the device versus RBL in the management of grade I and II haemorrhoids. Methods A single blind, randomized controlled trial was conducted in the colorectal outpatient department. Patients with symptomatic haemorrhoids suitable for banding were prospectively recruited and randomized. Primary outcome was post procedural pain at 1 h as recorded on a 10‐point Likert scale. Secondary outcomes were efficacy in reduction of haemorrhoidal symptom score at 12 weeks, daily average and maximum pain scores for 14 days and complications arising from the intervention. Results Thirty patients were randomized (14 HET, 16 RBL). There was no significant difference between the two group's pre‐intervention symptom score and haemorrhoidal grade. The mean pain scores at 1 h in the HET group were 1.5 ± 068 (95% confidence interval), and in the RBL group 4.64 ± 1.74 (95% confidence interval) (P < 0.05). Average (0.7 versus 2.95, P < 0.05) and maximum (1.25 versus 4.4, P < 0.05) pain were lower in the HET group on day one post procedure. At 12 weeks there was no significant difference in the reduction of haemorrhoid symptom scores between the groups (HET 2.27, RBL 1.5 (P > 0.2)). Conclusion HET causes less pain then RBL, and is at least as effective in treating the symptoms associated with grade I and II haemorrhoids in the outpatient setting.

Incarcerated inguinoscrotal hernia containing sigmoid colon cancerAn 81-year-old man presented with a large left inguinoscrotal hernia, which had been present for at least 5 years, as well as a large right inguinal hernia. He reported recent weight loss, lethargy, fatigue and significant functional decline. He had no history of bleeding per rectum, malaena or significant change in bowel habit. Clinical examination revealed a soft reducible right inguinal hernia, and a large, firm irreducible left inguinoscrotal hernia. The overlying skin of the left hemiscrotum was erythematous.Investigations revealed a microcytic, hypochromic anaemia with haemoglobin 78 g/L. Serology was consistent with poor nutrition and a catabolic state, including serum albumin of 21 g/L. Serum tumour markers were raised, with CEA 16 mcg/L (normal range 0-4) and CA125 56 ku/L (0-35).Computed tomography imaging confirmed the presence of an indirect left inguinoscrotal hernia containing distal descending and proximal sigmoid colon (Fig. 1). The herniated bowel contained a complex, heterogeneous mass measuring approximately 10 cm in maximal diameter, suspicious for colon cancer. Three ill-defined, low-density lesions within the liver appeared consistent with hepatic metastases. Preoperative colonoscopy was not performed due to anticipated difficulty of accessing the incarcerated colon, and adequate diagnostic information being attained by clinical, radiological and biochemical means. Should the hernia have been reducible, then colonoscopy would have been attempted including biopsy for tissue diagnosis.The patient underwent a high anterior resection with en bloc resection of the left spermatic cord and testicle, followed by bilateral inguinal hernia repair. This was performed via a midline laparotomy with dissection of the left pre-peritoneal plane to access the inguinal canal. The neck of the hernia was incised to enable difficult reduction of its contents, and en bloc resection with the sigmoid colon and upper rectum was performed (Fig. 2). A high ligation of the inferior mesenteric artery was performed, and a standard stapled anastomosis was formed between the descending colon and the proximal rectum. The left testicle and spermatic cord were necessarily sacrificed due to dense adhesion to the hernia sac and tumour mass, and were included in order to achieve adequate oncological clearance. Posterior mesh repair of bilateral inguinal hernias was then performed, with the inguinal region accessed in the pre-peritoneal plane through the midline laparotomy wound.Tissue histopathology confirmed the diagnosis of a moderately differentiated adenocarcinoma measuring 11 cm in diameter, with surrounding abscess and extensive inflammation and fibrosis. Local invasion was beyond the muscularis propria but not through the serosal surface, and metastatic adenocarcinoma was present in one of 28 regional lymph nodes. The left testis showed significant atrophy.Incorporating surgical and radiological staging, the patient had AJCC Stage IVA colorectal cancer (T3N...