ABSTRACT
BACKGROUND & AIMS: Globally, there has been a concerning rise in the incidence of young-onset cancers. The aim of this study was to provide trends in the incidence and survival of gastrointestinal adenocarcinomas (oesophagus, stomach, pancreas, and colorectal) in South Australia over a 27-year period. METHODS: This is a cross-sectional analysis of a prospective longitudinal database including all cases of gastrointestinal adenocarcinomas prospectively reported to the South Australian (State) Cancer Registry from 1990 to 2017. RESULTS: A total of 28,566 patients diagnosed with oesophageal, stomach, pancreatic, or colorectal adenocarcinoma between 1990 and 2017 were included in the study. While the overall incidence for gastrointestinal adenocarcinomas in individuals >50 years has decreased since 2000 (IRR of 0.97 (95% CI 0.94-1.00; p = 0.06)) compared to 1990-1999, the rate amongst individuals aged 18-50 has significantly increased (IRR 1.41 (95% CI 1.27-1.57; p < 0.001)) during the same reference time period. Although noted in both sexes, the rate of increase in incidence was significantly greater in males (11.5 to 19.7/100,000; p < 0.001). The overall survival from adenocarcinomas across all subsites improved in the >50-year cohort in the last decade (HR 0.89 (95% CI 0.86-0.93; p < 0.001)) compared to 1990-1999. In individuals aged 18-50 years, there has only been a significant improvement in survival for colorectal cancer (HR 0.82 (95% CI 0.68-0.99; p < 0.04)), but not the other subsites. A lower overall survival was noted for males in both age cohorts (18-50 years-HR 1.24 (95% CI 1.09-1.13; p < 0.01) and >50 years-HR 1.13 (95% CI 1.10-1.16; p < 0.001), respectively) compared to females. CONCLUSIONS: This study from South Australia demonstrates a significant increase in young-onset gastrointestinal adenocarcinomas over the last 28 years, with a greater increase in the male sex. The only significant improvement in survival in this cohort has been noted in colorectal cancer patients.
ABSTRACT
INTRODUCTION: Ileorectal intussusception is a rare condition in adults in which the distal ileum, caecum, variable lengths of ascending and transvers colon, and associated mesentery invaginate into the rectum. PRESENTATION OF CASE: We present the case of a 56 year old man who presented to our hospital for investigation of vague symptoms including small volumes of bright red rectal bleeding and colicky abdominal pain. He was found on CT scanning to have an extensive ileorectal intussusception and extensive liver metastasis. An emergency laparotomy was performed due to the concern of bowel ischaemia. No evidence of bowel ischaemia was found. The intussusceptum was carefully reduced and an extended right hemicolectomy with a primary anastomosis was performed. The patient recovered well and was discharged home six days post operatively. DISCUSSION: Intussusceptions are rare in the adult population. They may not present with the classical triad of crampy abdominal pain, vomiting, and bloody stools and radiological imaging plays a key role in diagnosis. Intussusception in adults is usually secondary to malignancy and operative management needs to take into account the risk of upstaging the disease. In the face of pre-existing metastasis, preserving bowel length should be considered; however, there is no high level evidence to guide decision-making. CONCLUSION: Intussusception is a diagnosis that needs to be considered in the adult population. Diagnosis largely depends on radiological imaging, especially CT scanning. The operative management is variable and should be determined on a case by case basis.
ABSTRACT
Omental infarction can be difficult to diagnose preoperatively as imaging may be inconclusive and patients often present in a way that suggests a more common surgical pathology such as appendicitis. Here, a 40-year-old Caucasian man presented to casualty with shortness of breath and progressive right upper abdominal pain, accompanied with right shoulder and neck pain. Exploratory laparoscopy was eventually utilised to diagnose an atypical form of omental infarction that mimics cholecystitis. The vascular supply along the long axis of the segment was occluded initiating necrosis. In this case, the necrotic segment was adherent with the abdominal wall, a pathology not commonly reported in cases of omental infarction.
