An 11-year-old girl was referred to oral medicine with persistent facial swelling. She was diagnosed with orofacial granulomatosis (OFG) and was treated conservatively for 7 years, with no evidence of systemic illness. Aged 17 she re-presented with a flare up of her OFG, watery diarrhoea and fluctuating febrile episodes. Inflammatory markers were raised and an MR enterogram revealed terminal ileal Crohn's disease. This case highlights that OFG may precede the onset of intestinal Crohn's disease.

A 63-year-old male carpenter presented with diarrhoea after returning from a holiday in Egypt with no other abdominal features. Physical examination showed generalised lymphadenopathy and splenomegaly. Blood tests including inflammatory markers were within normal limits. Microbiological stool sample analysis was unremarkable. Endoscopies of the large bowel showed patchy inflammation from the rectum to the hepatic flexure with multiple tiny polyps. Histology revealed a lymphocytic infiltrate suggestive of multiple lymphomatous polyposis. Some time later, he presented with small bowel obstruction requiring emergency laparotomy and ileostomy. After recovery from surgery he started definite treatment with chemotherapy resulting in complete remission.

completion rate. In contrast, there was no statistical difference when consultants were compared to current trainees on dedicated training lists. The observed effect is likely to reflect additional allocated time, and immediate consultant trainer availability.Procedures were grouped by first endoscopist. Extent of examination by trainee or trainer in each case is not known: assistance may have been required on a greater proportion of procedures performed on training lists.Colonoscopy completion rate is an important marker of quality. Other indicators include adenoma detection rate, comfort score, and withdrawal time.1 Inclusion of these indices would provide further comparative performance data.Trainees performing colonoscopy on dedicated training lists delivered comparable completion rates to consultants and outperformed their predecessors. Our data supports dedicated colonoscopy training prior to certification of independence.