COVID-19 has been formally declared a pandemic by World Health Organization on the 11th of March 2020. 1 The effects of this on the health systems cannot be under-rated. In this unprecedented situation, perhaps one of the more under-estimated repercussions will be on medical students. There are several challenges common to all medical students such as the uncertainty in course requirements, the fear of exposure to COVID-19, the lack of guidance and the loss of learning opportunities. Nonetheless, it has also affected medical students of different levels indistinctly.Pre-clinical medical students are accessing e-learning solely while socially isolating themselves. E-Learning certainly has its merits but lacks the engaging qualities of in-person learning. The study of medicine is complex, requiring a multimodal approach with specialists providing clinical experience and guiding students out of the maze of endless archaic textbooks. Adjuncts to classroom teaching such as anatomy dissections, microbiology and histopathology labarotory work as well as the development of interpersonal skills in clinical interactions are paramount to these years. Furthermore, e-learning may present new challenges including technical issues, adaptability-struggle and computer literacy. It may be unaccessible by some, without access to on-campus wifi. To overcome this, certain universities have provided USB modems to students to increase accessibility to internet facilities. 2 Other universities have altered term outlines and exam dates. 3 These amendments in addition to technical issues that arise during exams may cause unneccesary added stress. There have also been concerns that students may be disadvantaged when exams are un-invigilated, with co-students cheating. During such times, we have little choice but to trust that students will maintain the highest standards of academic integrity.Students in clinical years are experiencing different challenges. Disruption to normal teaching and examination has left many students feeling uncertain and disoriented. The structure and length of clinical placement blocks are modified, along with semester breaks. Traditional examinations en masse are not possible. Practical assessments such as Objective Structured Clinical Examinations require alteration given the transmission risk associated with close contact of simulated patients and examiners. Most students in this group have been removed from clinical placement, leaving them without any practical teaching to rely upon.Final-year medical students face a more diverse spectrum of outcomes, albeit from a much stronger vantage point to both comprehend pandemic management and contribute to it directly. Their core study comprises almost exclusively of clinical placement with practical teaching in preparation for internship. For these students, changes to staffing and services are challenging. In Victoria, where

Metastatic disease was associated with an increased risk of anastomotic leak and a higher peri-operative mortality rate after colorectal resections for cancer. Patients with anastomotic leaks had a higher peri-operative mortality rate, but long-term survival was unaffected beyond the peri-operative phase.

The corresponding author is not a recipient of a research scholarship.

A 63-year-old man with a history of gastro-oesophageal reflux disease underwent defunctioning loop ileostomy for obstructing metastatic rectal cancer prior to receiving long-course neoadjuvant chemoradiotherapy. Four months post completion of neoadjuvant therapy, he underwent an uncomplicated elective ultra-low anterior resection with formation of colonic J pouch and first stage liver metastasectomy for bilobar liver disease. At 1 year, he proceeded to an elective closure of loop ileostomy. Unfortunately, his postoperative course was complicated by profuse diarrhoea with subsequent colonic perforation, necessitating an emergency laparotomy and ileocolic resection with end ileostomy formation. Histopathology and stool studies were consistent with Salmonella Typhi infection. At the present time, Salmonella Typhi causing toxic megacolon and subsequent colonic perforation is an uncommon phenomenon in Australia. Here, we present an unusual case and explain why bowel perforation in this instance likely had a multifactorial aetiology.