Crohn's disease presenting as left gluteal abscess.

Although abscesses and fistulae are common complications of Crohn's disease, the gluteal area is a rare site for abscess formation. The abscess results from extension of pus through the fascial plains of the pelvis and through the greater sciatic foramen into the gluteal area. This is the first reported left gluteal abscess due to Crohn's disease as pus extends across the midline to the left side. The clinical picture can be misleading and diagnosing the source of infection may be difficult. Incision of this abscess without identifying the source of infection will result in enterocutaneous fistula. Ultrasound guided aspiration of the abscess as well as treatment of metabolic deficiencies and septicaemia before definitive surgical treatment of the bowel disease will reduce the morbidity and mortality of this rare complication. The clinical picture, management of this complication and review of the literature are discussed.

Prostatectomy in a district hospital.

In order to monitor the safety and efficacy of a new service for transurethral prostatectomy, an audit was performed, prospectively, over a period of 7.25 years. Of 304 prostatectomies performed, 91% were by transurethral prostatectomy. The proportion of patients with retention was 52%, 16% were uraemic and the incidence of carcinoma of the prostate was 21%. The operative mortality rate was 1.0%. An outline of the treatment policy and the data on complications and revision operations are presented. Comparisons are made with the experience of teaching centres and other district hospitals. Transurethral prostatectomy can be performed safely in the district general hospital and is a service which is essential to the smooth running of the surgical department.

Faecal bile acid concentration of patients with carcinoma or increased risk of carcinoma in the large bowel.

Faecal 3-hydroxy bile acids were assayed enzymatically in patients with carcinoma, or at increased risk of developing carcinoma of the large bowel. No rise in bile acid concentration was demonstrated in patients with ulcerative colitis, previously resected adenoma, or resected carcinoma. Patients with carcinoma, before treatment, had faecal bile acid concentrations similar to control values, and surgery did not affect the mean level. These findings cast doubt on the importance of the 3-hydroxy bile acid concentration in the faeces in the pathogenesis of large bowel cancer.

Adrenocortical hyperactivity with disseminated malacoplakia.

A case is described of an ectopic ACTH syndrome associated with malacoplakia.