Abdominal pregnancy is a rare form of ectopic pregnancy with high morbidity and mortality for both the mother and the fetus. Diagnosis can be challenging, especially in a resource-limited setting. We report a case of abdominal pregnancy that presented to Médecins Sans Frontières field hospital in Agok, South Sudan, with abdominal pain. Examination revealed a term pregnancy and a live fetus in transverse lie. The diagnosis of abdominal pregnancy was made intraoperatively, with successful management and delivery of a healthy baby.

Chronic diarrhoea is a common condition that affects up to 5% of the population which heavily affects the quality of life for the patient. The British Society of Gastroenterology guidelines recommend that for those who suffer with chronic diarrhoea, a colonoscopy with a biopsy is recommended to exclude microscopic colitis. This retrospective audit included 147 patients who received endoscopic procedures in 2019 at Walsall Manor Hospital for chronic diarrhoea. The results show that a total of £56,797 was incurred through endoscopic and histological investigation with four patients (2.6%) diagnosed with microscopic colitis. Given the lack of diagnostic yield, there is room for advancement in the current guidelines for managing persistent diarrhoea.

Aims The aim of the study is to analyse the costs of performing diagnostic endoscopy with histopathological sampling for patients suffering with chronic or persistent diarrhoea. Methods 300 patients were identified who required an endoscopy in 2019 according to the British Society of Gastroenterology guidelines. Patient’s presenting complaint, endoscopic and histological diagnosis and follow up plans were noted. 147 patients were included into our study whose presenting complaint was solely chronic or persistent diarrhoea. Those who presented with acute diarrhoea, PR bleeding or other concomitant indication for lower gastrointestinal endoscopy were excluded. Data from the national schedule of NHS costs was used to calculate expenditure. Results The total expenditure calculated for the 147 patients was £55,973. There was a total of 126 colonoscopies and 21 flexible sigmoidoscopies performed by the department. The number of patients who received medical treatment following endoscopy was 13/147 (9%) 8 of whom had nonspecific colitis on histology. There were 29 patients (20%) who required symptomatic treatment and there were 98 patients (66%) who received no intervention or were discharged immediately and 7 patients (5%) that required surgical intervention. The total cost of procedures not leading to surgical or medical management with steroids or immunomodulators was £47733 which is 85.3% of the total expenditure. Conclusion A significantly large proportion of investigations lead to no intervention or symptomatic treatment of the patient. Given this lack of diagnostic yield and financial burden, there could be room for advancement in the current guidelines for managing persistent diarrhoea.

A young surgeon from Cairo talks about performing his firstever Caesarean section during his maiden assignment with Médecins Sans Frontières.

Aims The aim of this project is to investigate the current practice in measuring C-reactive protein (CRP) in the post-operative patients in elective general surgery, to determine the current trends in using it and its potential value in detecting post operative complications. Methods A retrospective analysis of a 100 consecutive patients admitted for elective general surgery between January and July 2021 was conducted. This included analysis of patient demographics and post-operative interventions including return to theatres and interventional radiology. The CRP levels of the patients who required interventions were compared against those who did not. Results 40 males; 60 females with a mean age of 61.1 years were included, 11% of these patients had post-operative interventions. This analysis showed CRP values were measured routinely post operatively for at least 5 days in 91% of patients. There was a rise in CRP in all patients in the early post-operative period (first three days). If CRP continued to rise after this, it was more associated with a need for post-operative interventions. Conclusions There is no diagnostic value for measuring CRP in the first three days of the post operative period, as it will always show a rise in that period. Continued rise after day 3 may indicate post operative complications. Setting up pre-determined blood tests profiles for elective surgical patients may help save time, effort and resources.