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Aim: The purpose of this study was to determine the utility of community-based imaging to reduce use of inpatient surgical resources and enforce social distancing at the outset of the COVID-19 pandemic., Method: A prospective evaluation of community-based CT for patients presenting to Christchurch general practitioners with acute abdominal pain from April to November 2020. Eligible patients were discussed with the on-call general surgical team, and then referred for CT abdomen rather than hospital assessment. The positivity rate of CT scans, the 30-day all-cause hospital admission rate, and the proportion of patients where community scanning altered management setting and the number of incidental findings, were all assessed., Results: Of 131 included patients, 67 (51%) patients had a positive CT scan. Thirty-nine (30%) patients were admitted to hospital within 30 days, 34 (87%) of whom had a positive CT scan and were admitted under a surgical specialty. Ninety-two (70%) patients did not require hospital admission for their acute abdominal pain, thirty-three (35%) of whom had a positive CT scan. There were three deaths within 30 days of the community CT, and the setting of the community CT did not contribute to the death of any of the cases. Forty patients (30%) had incidental findings on CT, 10 (25%) of which were significant and were referred for further investigation., Conclusion: Community based abdominal CT scanning is a feasible option in the management of acute abdominal pain. While trialed in response to the initial nationwide COVID-19 lockdown in New Zealand, there may be utility for acute community-based CT scanning in regular practice., Competing Interests: Nil.

Aims: Teleconsultation has been widely utilised during the COVID-19 pandemic. It allows clinicians to provide healthcare social distance restrictions. This study investigates its safety and limitations in different specialties and the possibility of incorporating telemedicine into future practice., Methods: This was a qualitative study of 151 hospital-based specialists in New Zealand. An electronic questionnaire was sent via email addresses. These included participants' demography and their experience of using teleconsultation during the pandemic. The safety and suitability of teleconsultation were assessed with time efficiency, data security concerns, missed clinical information and specialist's ability to examine patients., Results: This study found that 92.7% of hospital-based specialists used teleconsultation during the pandemic. More specialists reported the efficiency was similar or greater with teleconsultation and most patients could be seen via teleconsultation appointments. Limitations of these were due to poor physical examination and poor non-verbal cues sensing. There is a general preference for physical consultation., Conclusion: Teleconsultation is used widely across many specialties during the pandemic. Despite limitations identified with teleconsultations and preference for physical consultation, doctors are prepared to provide teleconsultations in the future beyond the pandemic. In appropriately selected patients, especially in non-procedural specialties, teleconsultation will have an increasing role in healthcare., Competing Interests: Nil.

Background: Patients with inflammatory bowel disease (IBD) undergo surveillance for an increased risk of colorectal cancer. Advances in endoscopy have rendered most previously invisible dysplasia visible, leading to changes in guidelines around surveillance and management of dysplasia. This study aims to assess New Zealand endoscopists' (i) understanding of current guidelines, (ii) uptake of advanced techniques and (iii) management of dysplasia., Methods: A digital survey of New Zealand endoscopists was undertaken. Invitations were sent to members of New Zealand gastroenterology and surgical societies. Questions were asked regarding demographics, surveillance interval, risk stratification, endoscopic technique and dysplasia management., Results: Fifty of the 322 invitees completed the survey (15.5%). Over 80% used techniques meeting the guideline recommendations. The majority (77%) of endoscopists take random biopsies in addition to targeted. Endoscopically resectable polypoid low-grade dysplasia was typically managed with surveillance (93%) but this dropped to less than half for high-grade dysplasia and less than a third for non-polypoid high-grade dysplasia (inconsistent with guidelines)., Conclusions: Current New Zealand endoscopists' practice appears to be aligned with international guidelines in terms of screening interval, risk stratification and technique. However, New Zealand endoscopists are less likely to offer a patient surveillance for endoscopically resectable dysplasia., Competing Interests: Nil.

Aim: The aim of this study was to describe the demographics, mechanisms of injury, management and outcomes in patients who suffered splenic trauma in Christchurch, New Zealand., Methods: A retrospective study included all splenic injury patients admitted to Christchurch Public Hospital between January 2005 and August 2015., Results: A total of 238 patients were included, with a median age of 26 years (4-88.7). Of these, 235 patients had blunt injuries. Eighty-nine had high-grade injuries. Yearly admissions of splenic trauma patients have gradually increased. A total of 173 (72.7%) patients were managed with observation; 28 patients (11.8%) had radiological intervention and 37 patients (15.5%) had splenectomy. Patients who died were significantly more likely to be older (median, 46.5 vs 25.2 years, p=0.04) and to have been admitted to ICU (100% vs 32%, p=<0.001)., Conclusion: Splenic injuries have shown a steady increase in the last decade. Splenectomy rates have decreased in favour of non-operative techniques. Radiological intervention with splenic artery embolisation was successful in all selected patients with high-grade injuries., Competing Interests: Nil.

Aim: Melanoma of the anorectum is a rare malignancy which is particularly aggressive compared to cutaneous melanoma. Due to its presenting symptoms, location and rarity there is often a delay in diagnosis. The purpose of this paper is to raise awareness of anorectal melanoma in New Zealand by presenting our institution's experience of four cases., Methods: The presentation, management and outcomes of four cases are described. A review of the literature surrounding anorectal melanoma was also carried out., Results: The four cases (3 male, 1 female, aged 30-87 years) all presented with haemorrhoidal symptoms of anal discomfort and/or outlet rectal bleeding. Three patients had metastatic disease at presentation, and the remaining patient was found to have a concurrent lymphoma which was treated with chemotherapy before he underwent excision of the melanoma. Surgical excision is the mainstay of treatment and recent literature suggests transanal excision of the primary tumour to have equivalent overall survival to abdominoperineal resection., Conclusion: Anorectal melanoma is rare tumour with a poor prognosis. Patients are commonly misdiagnosed as having haemorrhoids; therefore a high index of suspicion is needed to enable early diagnosis. Metastatic disease is common at presentation, and the key prognostic indicator. Local control can be obtained with transanal excision, avoiding the morbidity of abdominoperineal resection. Adjuvant therapies available at present provide little survival advantage.

Aims: The aim of this study was to determine the direct and indirect costs of Crohn's disease (CD) in paediatric and perianal patients in Canterbury in one year., Methods: A retrospective cross-sectional analysis was performed. Paediatric CD patients and adult patients with perianal CD were recruited over a three month period. Interviews were conducted to obtain information regarding demographic, socioeconomic factors, and indirect costs. Hospital clinical notes were reviewed to determine direct health care utilisation and costs., Results: Forty-nine patients (24 paediatric and 25 perianal CD) were enrolled. In one year the total costs per patient for paediatric CD were $14,375 with direct and indirect costs comprising $12,583 and $1,792, respectively. The total costs per patient for perianal CD were $20,366 with direct and indirect costs comprising $18,261 and $2,105, respectively. Extrapolating these data across New Zealand, the total cost of paediatric and perianal CD in one year is approximately $25.9 million and $36.7 million, respectively., Conclusions: Paediatric and perianal CD are high-cost diseases with significant costs borne by patients and their families. Expensive pharmaceuticals comprise a significant proportion of the costs: increased access to these drugs might decrease hospital admissions and prevent work absenteeism and loss of carer productivity.