Background: Patients with inflammatory bowel disease (IBD) are at increased risk of venous thromboembolism (VTE) during hospitalisation and potentially post-discharge. Aims:To determine the incidence and risk factors for post-discharge VTE in IBD patients and create a point of care predictive model to assess VTE risk. Methods:Hospitalised IBD patients were identified from our institutional discharge database between 2009 and 2016, and were assessed for VTE by chart review. Risk factors for VTE within 3 months of discharge were determined by univariable and multivariable logistic regression. A point of care model was created using variables from the univariate analysis with P < 0.05, and internally validated by bootstrap methods.Results: Sixty-six of 2161 eligible discharges (3%) were associated with VTE within 6 months of hospitalisation. The median time to event was 37 days (range 3-182 days).On multivariable analysis age >45 years (OR 3.76; 95% CI 1.80-7.89) and multiple admissions (OR 2.62; 95% CI 1.34-5.11) were independently associated with VTE risk. Our final model incorporated age >45 years, multiple admissions, intensive care unit admission, length of admission >7 days and central catheter and was able to discriminate between discharges associated with and without VTE (optimism-corrected c-statistic, 0.70; 95% CI 0.58-0.77). By limiting treatment to a high-risk group, extended thromboprophylaxis could be avoided in 92% of discharges with a miss rate of 1.6% (32/1982 discharges). Conclusion: Patients with IBD remain at risk of VTE after hospital discharge. Our model may help clinicians stratify which patients will benefit most from extended thrombophrophylaxis. Admission characteristics Multiple admissions, n (%) 341 (15.8) LOA, median (IQR) 7 (4-11) Intensive care unit, n (%) 51 (2.36) Admission flare, n (%) 1370 (63.4) MRDx IBD, n (%) 1035 (47.9) Any surgery, n (%) 679 (31.4) Abdominal surgery, n (%) 554 (25.6) Central catheter, n (%) 261 (12.1) Peak CRP, median (IQR) 37.9 (11-91.4) Albumin, median (IQR) 28 (22-38)Abbreviations: CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; CRP, C reactive protein; IBD, Inflammatory bowel disease; IQR, interquartile range; LOA, length of admission; MRDx, most responsible diagnosis; SD, standard deviation; TNF, tumour necrosis factor; VTE, venous thromboembolism.

Background Schwannomas are rare tumours that pose a significant management challenge in the abdomen, retroperitoneum and pelvis. No data are available to inform management strategy. Methods A collaborative international cohort study, across specialist sarcoma units, was conducted to include adults presenting between 2000 and 2017 with histopathologically confirmed schwannomas within the abdomen, retroperitoneum or pelvis. Results Of 485 patients across 12 centres, 38 (7·8 per cent) were discharged without follow‐up, 199 (41·0 per cent) underwent early resection and 248 (51·1 per cent) had radiological monitoring. Of these 248 patients, 96 (38·7 per cent) eventually had surgery, giving an overall resection rate of 60·8 per cent (295 of 485). At baseline, median tumour volume was 90·1 (i.q.r. 26·5–262·0) cm3. The estimated growth rate was 10·5 (95 per cent c.i. 9·4 to 11·6) per cent per year, and was consistent in the short term (within 2 years of diagnosis) and long term (beyond 2 years) (ρ = 0·405, P = 0·021). A decision to operate was more common in symptomatic patients (P < 0·001) and for rapidly growing tumours (growth rate more than 20 per cent per year) (P = 0·025). R0/R1 resection was achieved in 91·6 per cent of patients (263 of 287). Kaplan–Meier long‐term recurrence rates after R0/R1 resection were 2·3 and 6·7 per cent at 3 and 5 years respectively. Conclusion Specific recommendations include: indications for early surgery, prediction of growth from radiological monitoring, promotion of selective submacroscopic resection and cessation of postoperative imaging surveillance.

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Background Accurate tools to distinguish Crohn’s disease (CD) from cryptoglandular disease in patients with perianal fistulas without detectable luminal inflammation on ileocolonoscopy and abdominal enterography (isolated perianal fistulas [IPF]) are lacking. We assessed the ability of video capsule endoscopy (VCE) to detect luminal inflammation in patients with IPF. Methods We studied consecutive adults (&gt;17 years) with IPF who were evaluated by VCE after a negative ileocolonoscopy and abdominal enterography between 2013 and 2022. We defined luminal CD by VCE as diffuse erythema, three or more aphthous ulcers, or a Lewis score greater than 135. We compared rates of intestinal inflammation in this cohort to age- and sex-matched controls without perianal fistulas who underwent VCE for other indications. We excluded persons with pre-existing IBD and exposure to non-steroidal anti-inflammatories drugs or immunosuppressive treatments. Results A total of 45 patients with IPF underwent VCE without complications. Twelve patients (26%) met our definition of luminal CD. Luminal CD was more common in patients with IPF than controls (26% vs. 3%; p &lt; 0.01). Among patients with IPF, male sex (OR, 9.2; 95% CI (1.1-79.4), smoking (OR, 4.5; 95% CI, 0.9-21.2), abscess (OR, 6.3; 95% CI (1.5-26.8), rectal enhancement on MRI (OR, 9.0; 95% CI (0.8-99.3) and positive anti-microbial serology (OR, 7.1; 95% CI, 0.7-70.0) were more common in those with a positive VCE study. Conclusions VCE detected small intestinal inflammation suggestive of luminal CD in approximately one quarter of patients with IPF. Larger studies are required to validate these findings.

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