Deletion of chromosome 5q and familial adenomatous polyposis An interstitial deletion of 5q was observed in two intellectually handicapped brothers with familial adenomatous polyposis (FAP). The site of this deletion was similar to that observed by Herrera et al' in a patient with

Background: While the majority of fistulas-in-ano are anatomically simple and easy to treat, a significant number are high or anatomically complex and have the potential to become a major management problem. Methods: One hundred and seven consecutive patients undergoing surgery for fistula-in-ano were studied prospectively with standardized anatomic diagrams. Results: Fistulas were classified as superficial ( 15%), intersphincteric (43%), trans-sphincteric (35%) or 'high' (7%). Within each group fistulas were considered either simple or complex (high trecks, extra tracks or other complications). Trans-sphincteric fistulas were more often complex than intersphincteric fistulas (32 vs 6%).A prior history of perianal sepsis and surgery was more frequent among the trans-sphincteric and 'high' groups. An external fistula opening within a narrow arc 30" either side of the posterior midline was almost always associated with a simple superficial or intersphincteric fistula (97%). Anterior and especially posterolaterally located external openings were frequently associated with complex fistulas (16 and 47%. respectively) and often had trans-sphincteric or 'high' tracks (58 and 56%).Goodsall's Law was more accurate for posterior (91%) and intersphincteric (93%) fistulas than for anterior (69%) and transsphincteric (68%) fistulas.Histopathology of fistula material showed unremarkable fistula-in-ano in 87% of requests. Six patients had unexpected abnormal results, including three new diagnoses of Crohn's disease. Conclusions:The presence of additional anatomic complexity should always be anticipated in trans-sphincteric fistulas. Transsphincteric and 'high' fistulas are more likely to occur in females, and in patients with previous perianal sepsis or surgery for fistula. External openings close to the posterior midline almost always underlie simple fistulas, whereas posterolateral external openings are predictive of complex fistulas.

Although segmental bowel necrosis is a recognized complication of pancreatitis, the duodenum is rarely involved. We report a unique case of acute duodenal obstruction characterized by transmural necrosis and intramural duodenal haematoma in a young man with acute alcohol‐induced pancreatitis. The patient recovered following pancreaticoduodenectorny,

Background: Familial adenomatous polyposis (FAP) has historically been treated by colectomy and ileorectal anastomosis (IRA). Preservation of the rectum allows the subsequent development of cancer in the rectum. The risk of rectal cancer following ileorectal anastomosis in the Australian population has not been published to date. Methods: An audit of the Familial Adenomatous Polyposis Registry of Western Australia was undertaken to assess patients who had undergone colectomy and ileorectal anastomosis. Fifty-five patients ranging in age from 13 to 65 years were studied. Results: Seven patients (13%) developed cancer of the rectum with a median follow-up of 10 years (range: 1-31 years). Median interval to diagnosis of carcinoma of the rectum following colectomy and IRA was 10 years. All patients who developed cancer in the retained rectum had rectal polyps. Colon cancer was present in the initial colectomy specimen in 13 patients (of these, five patients developed rectal cancer). Flat polyps were noted in five patients. Four patients with flat polyps developed cancer of the rectum. Conclusions: Total colectomy and IRA should be considered as part 1 of a staged procedure in the patient with FAP. With the exception of the patient with no evidence of rectal polyps, completion proctectomy should be undertaken within 10 years of the initial colectomy.

Serum angiotensin converting enzyme (ACE) activities were determined in patients with different types of inflammatory disease of the gastrointestinal tract, in patients with peptic ulcer, and in healthy volunteer subjects. ACE activity in serum was measured by its in vitro ability to cleave hippuric acid from the synthetic tripeptide hippuryl-L-histidyl-L-leucine. The hippuric acid so formed was quantified by high performance liquid chromatography and results are expressed as nmol hippuric acid produced/ml plasma/min. ACE activity was 27.4 +/- 7.7 (mean +/- SD, n = 37) in control subjects and was not related to age or sex. Compared to controls, patients with ulcerative colitis had similar ACE values (26.5 +/- 7.7, n = 16) while, surprisingly, there was a significant (p less than 0.01) increase in the enzyme in those with active peptic ulcers (33.8 +/- 8.8, n = 21) irrespective of whether the site of ulceration was gastric or duodenal. In a mixed group of patients with active and inactive Crohn's disease, ACE activity (24.8 +/- 7.2, n = 19) was not different from controls. However, ACE activity was significantly (p less than 0.02) depressed in active Crohn's disease (19.8 +/- 7.3, n = 8) compared to either control subjects or patients with inactive disease (28.4 +/- 6.3, n = 9). There was wide inter-patient variability in ACE levels and hence the diagnostic value of random measurements of this enzyme in Crohn's disease is limited.