Researchers and practitioners with an interest in General Surgery.
We present results of the first year of our Bowel Cancer Screening Program (BCSP), which was initiated and backed by the Right Honourable Minister for Health, Dr John Cortes, in Gibraltar in March 2014.
The Gibraltar Bowel cancer screening Program is offered by immunochemical Faecal Occult Blood testing (iFOBt) to the population between 60 and 74 years every 2 years. All FOB positive and double inconclusive patients are invited for a screening colonoscopy. Any patient with positive findings ranging from anal fissure, to haemorrhoids, colon polyps and colo-rectal cancer are referred to the colo-rectal surgery service for treatment and follow-up. All negative colonoscopy patients are referred back to the BCSP, for repeat iFOBt every 2 years.
Between April 2014, 1980 iFOBt kits were sent out to patients. Compliance was 62% with 1228 kits returned. With a higher sensitivity threshold for the iFOBt, 104 patients tested positive or were double inconclusive (8.46%). All these patients were offered colonoscopy.
56 patients underwent colonoscopy, with a completion rate of 91.1 %( 51 colonoscopy). Completion was established by CT colonography in 5 patients. 21 patients had polyps (37.5%), 6 had cancer (10.7%). All polyps were adenomatous, and 5 cancers were T1 No Mo, with one cancer T2 N1 Mo.
In conclusion, a population based bowel cancer screening program is an excellent pathway for early detection of colorectal cancer and pre-cancerous lesions.
We present a series of 3 cases of Meckel`s Diverticulum within a period of 4 weeks. Each case had a unique presentation.
Case 1: A 26 year old man presented with symptoms and signs suggestive of acute appendicitis. His white cell count was 11,000, but no pyrexia. On examination he was tender in his lower abdomen, maximally in the right iliac fossa. At laparoscopy he had serosanguinous fluid in his pelvis and an inflammed mass within the small intestine. At laparotomy he was found to have an inflammed Meckel`s diverticulum (photos). This was resected with a GIA60.
Case 2: A 52 year old patient presented with an acute abdomen of sudden onset. He had previously been fir and well. He underwent a laparotomy where he has found to have free bilious coloured fluid within the peritoneal cavity. He was found to have a spontaneous perforation of a Meckel`s diverticulum with gastric metaplasia.
Case3: A 59 year old patient presented with acute small intestinal obstruction. He had a past history of a laparotomy following a stab injury 40 years ago. At laparotomy he ameckel`s diverticulum adherent to the anterior abdominal wall vausing small intestinal volvulus and obstruction( photos). This was resected using GIA 60.
