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The authors demonstrate the effective drainage of presacral sepsis following low anterior resection surgery using the novel approach of both the Heald anal stent and a Foley catheter combined. The Heald stent was placed trans-anally without the need for anaesthetic and an 18Fr Foley was placed through this. A presacral collection was drained through the stent, allowing the patient to be discharged after a week without the need to return to the operating theatre. The Heald stent may be used to successfully drain a presacral collection by double decompression of the rectum and the presacral space.

We describe the novel use of a cannula in decompressing a large tension pneumoperitoneum secondary to perforated sigmoid diverticulum, in which the patient did not subsequently require an emergency laparotomy. Needle decompression was successfully used as part of a conservative regimen, thus avoiding potentially high-risk surgery.

Distension of the rectum following transanal endoscopic microsurgery (TEMS) increases rectal intra-luminal pressure and may promote pelvic sepsis by contaminating the rectal defect. We describe the first use of a Heald anal stent to decompress the rectum following TEMS. Transanal endoscopic microsurgery (TEMS) is an increasingly popular method of resecting rectal neoplasms with minimal morbidity and mortality. Following excision of the lesion, the defect in the rectal wall is usually repaired by a continuous suture. However there is no evidence to suggest defect closure is superior to leaving this to heal by secondary intention. Distension of the rectum post-operatively increases rectal intra-luminal pressure and may promote pelvic sepsis by contaminating the rectal defect.

Thorough examination under anaesthetic of the rectum and anus demands an adequate view of the perineum. Traditionally patients are placed in the Lloyd-Davies position when anorectal access is required. However, in male patients, the scrotum may obscure the perineum making it difficult to perform an adequate examination...