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The presentation, operative management and final diagnosis were reviewed in 28 patients with AIDS (27 men and one woman) who underwent emergency laparotomy. On clinical and radiological examination, six patients showed features of toxic megacolon, five patients had small bowel obstruction, six patients had localized peritonitis and three had perforated viscus with generalized peritonitis. The most common disease processes were acute colitis in seven patients (associated with cytomegalovirus (CMV) infection in six), intra-abdominal lymphoma in five patients, acute appendicitis in five patients (associated with CMV infection in two), and atypical mycobacterial (MAI) infection in four patients. Two perioperative deaths occurred; one in a patient with acute pancreatitis and a second with generalized peritonitis. Later deaths were due to progression of AIDS, and patient survival at 1 month, 3 months and 6 months was 89 per cent, 64 per cent and 48 per cent, respectively. Lower operative mortality than in previously reported series may be due to earlier intervention in CMV toxic megacolon. Surgery, however, conferred less benefit in patients with acute abdominal pain from MAI infection or lymphoma. With careful patient selection, emergency laparotomy may achieve worthwhile palliation in patients with AIDS.

FORMATION of diverticula in the colon is common, but no full explanation is known why they should appear, although many aetiological theories have been put forward. In this paper the relationship of the diverticula to the muscle layers and the blood-vessels of the colon will be described: the pathological complications and the presenting clinical features will also be discussed.In order to avoid misunderstanding, an arbitrary definition of diverticulosis and diverticulitis is necessary. Diverticulosis is regarded as a pathological state of the colon when diverticula protrude through the muscle-coat of the bowel-wall; diverticulitis is a condition in which inflammatory changes have occurred in and around the diverticula and symptoms are experienced by the patient.One of the earliest descriptions of a lesion that might be diverticulitis is in the 1793 edition of Mathew Baillie's Morbid Anatomy, where a condition of "schirrus of the large intestine, particularly in the sigmoid" is described. The first detailed account of diverticula of the colon is attributed to Cruveilhier, in 1849; he described small pisiform tumours, like dark-looking varices, arising between the longitudinal bands of the colon. He was the first to consider that these swellings might become inflamed, and he also noticed that fistulae between the sigmoid colon and the bladder need not necessarily be associated with cancer.Graser (1899) was the first to make any real attempt at understanding the anatomy and pathology of diverticula formation in the colon. He provided experimental evidence to show the close relation of diverticula to the blood-vessels ; he believed that an increase in pressure in the bowel was necessary, and this he attributed to constipation. Sir Arthur Keith (1910) thought that a high intracolic pressure was the primary cause, and that this was brought about by strong contractions of the taeniae, which threw the colon into circular folds; the circular muscle-coat then contracted irregularly, and the mucous membrane was forced through at weak points where the blood-vessels ran.Once the barium enema had been introduced by Abbe (1914), Case (1914) and Pfahler (1914) carried out many examinations to show where the diverticula lay along the length of the colon. In 1916 Hamilton Drummond published his classic paper, and his demonstration of the distribution of the blood-vessels around the colon has been generally accepted (Fig. 216). Besides describing diverticula emerging most frequently between the mesenteric taenia and the two anti-mesenteric taeniae, he also observed diverticula occurring between the two anti-mesenteric taeniae ; this, he suggested, might be due to an inherent muscular weakness.Spriggs and Marxer, in 1925, introduced the term 'prediverticular state' for the saw-toothed appearance of the bowel-wall that was seen on radiographs after a barium enema; they endeavoured I3 to prove that a bacteriological lesion might be responsible for this, owing to the sigmoid colon having an infective fluid residue. In 1939 Edwards co...

Summary and conclusionsThe records were reviewed of 406 patients with carcinoma of the large bowel who had been treated at the Middlesex Hospital during 1958-62. Of these patients, 180 were followed up regularly in this hospital after radical surgery, and from six months to 15 years after operation they were seen 2319 times; 71 developed a recurrent carcinoma but, of these, 41 recurrences (58%) were diagnosed at times other than those of the patients' routine outpatient appointments, although they were being regularly reviewed. Only one patient with recurrence appeared to have been cured by further surgery.For the present, adequate education of patients in the symptoms of early recurrence, with instruction to return if any of these develop, is likely to be more effective than the unsatisfactory and time-consuming routine followup still used in many hospitals. Introduction After radical surgery for carcinoma the traditional policy of reviewing patients as outpatients for the rest of their lives is

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