Malignant neoplasms of Meckel's diverticulum; an evidence based review.

An up to date published literature has shown that Meckel's Diverticulum (MD) are discovered incidentally and are benign, malignant transformation is unusual with reported incidence to be only 0.5%-3.2%. The research available on this rare tumour remains scanty, mainly consisting of case reports and case series with many researchers reporting on their own clinical experience and often disagree on not only its epidemiology, but also more so on its surgical indications. In addition to the above there is no agreed standard formal grading and staging classification for primary MD tumour that can not only help assess the tumour in a systematic way, but also advise on a standard treatment plan that is to be followed after emergency surgery. Hence, the aim of this article is to systematically review the latest evidence on these rare types of malignant neoplasm originating from MD, and conclude the best management options when encountered with such situations.

How to diagnose an acutely inflamed appendix; a systematic review of the latest evidence.

Acute appendicitis is the most common condition that presents with an acute abdomen needing emergency surgery. Despite this common presentation, correctly diagnosing appendicitis remains a challenge as clinical signs or positive blood results can be absent in 55% of the patients. The reported proportion of missed diagnoses of appendicitis ranges between 20% and 40%. A delay or mis-diagnosis of appendicitis can result in severe complications such as perforation, abscess formation, sepsis, and intra-abdominal adhesions. Literature has shown that patients who had a negative appendectomy suffer post-op complications and infections secondary to hospital stays; there have even been reported cases of fatality. It is therefore crucial that timely and accurate diagnosis of appendicitis is achieved to avoid complications of both non-operating as well as unnecessary surgical intervention. The aim of this review is to systematically report and analyse the latest evidence on the different approaches used in diagnosing appendicitis. We include discussions of clinical scoring systems, laboratory tests, latest innovative bio-markers and radiological imaging.

Pathophysiology, clinical presentation and management of diversion colitis: a review of current literature.

INTRODUCTION: Diversion colitis is a non-specific inflammation of a de-functioned segment of intestine after diversion of the faecal stream. AIM: The aim of this study was to review the current level of knowledge about diversion colitis. METHODS: A literature search of relevant literature in the English language was carried out on PUBMED, MEDLINE and EMBASE. The following keywords were used: diversion colitis; disuse colitis; proctitis; colonic bacterial flora; stoma; de-functioned colon; faecal diversion; short chain fatty acids and lymphoid follicular hyperplasia. RESULTS: In total 35 articles met the inclusion criteria. 22 were case series, 9 were case reports, 2 were retrospective analysis and 2 were prospective randomized controlled studies. Diversion colitis is invariably present in all diverted segments of the colon. It is usually asymptomatic but can present with tenesmus, rectal discharge, bleeding per rectum and abdominal pain. Major macroscopic changes include mucosal nodularity, erythema and friability. Microscopic features are predominantly those of lymphoid follicular hyperplasia, apthous ulceration and chronic inflammatory changes, mostly limited to sub mucosa. Treatment modalities include surveillance for asymptomatic patients, restoration of bowel continuity for severely symptomatic cases and the use of short chain fatty acid (SCFA) enemas in selected cases. CONCLUSION: The clinical presentation of diversion colitis varies significantly. In symptomatic patients short chain fatty acid enema may help. Further prospective studies are required for evaluation.