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Twenty-three women with obstetric rectovaginal fistulas were seen between 2010 and 2017 from a database of 116 women with obstetric injuries. This was a first vaginal delivery in 19 (82%), and 15 (65%) required an assisted delivery. The original fistula site was as follows: 9 suprasphincteric (39.1%), 10 transsphincteric (43.5%) and 4 anovulval (17.4%). Fourteen occurred within the first three weeks of delivery, with the remainder one to four months later. (Figure 1). The final assumed diagnosis based on investigation and follow-up was as follows: 13 missed fourth degree tears, 5 inadequate repairs of fourth degree tears, 2 repairs broke down from sepsis and 3 suture penetration of the anorectum during repairs. This article is protected by copyright. All rights reserved.

Distal ulcerative colitis can be treated with oral or rectal mesalazine, or both. A foam enema preparation has been developed and its efficacy investigated. The aim of this study was to evaluate the efficacy and safety of mesalazine foam enemas compared with prednisolone foam enemas in the treatment of patients with acute distal ulcerative colitis. Patients aged over 18 years presenting with a relapse of distal ulcerative colitis were randomly allocated treatment with mesalazine foam enema (n = 149 evaluable patients) and prednisolone foam enema (n = 146 evaluable patients) for four weeks. A randomised multicentre investigator blind parallel group trial was conducted. It was found that after four weeks of treatment, clinical remission was achieved by 52% of mesalazine treated patients and 31% of patients treated with prednisolone (p < 0.001). There was a trend in favour of more patients in the mesalazine group achieving sigmoidoscopic remission (40% v 31%, p = 0.10). Histological remission was achieved by 27% and 21% of patients receiving mesalazine and prednisolone respectively. Symptoms improved in both treatment groups. Significantly more mesalazine patients had no blood in their stools after four weeks of treatment (67% v 40%, p < 0.001). Prednisolone treated patients had significantly fewer days with liquid stools than mesalazine patients, with a median of 0 and 1 days respectively by week 4 (p = 0.001). In this study mesalazine foam enema was superior to prednisolone foam enema with regards to clinical remission, this was supported by favourable trends in sigmoidoscopic and histological remission rates. Both treatments were well tolerated.

Background To identify the emotional, social and psychological consequences and recovery process of anal incontinence (AI) following obstetric anal sphincter injuries (OASIS) and explore if this can be identified as a recognisable syndrome with visual representation. Methods A qualitative approach was adopted for this study. Data derived from case studies (n = 81) and interviews (n = 14) with women with AI after OASIS was used to identify the emotional, social and psychological consequences of AI after OASIS. Keywords and synonyms were extracted and the power of these statements displayed as a ‘word picture’. The validity and authenticity of the word picture was then assessed by: a questionnaire sent to a group of mothers who had experienced this condition (n = 16); a focus group attended by mothers (n = 14) and supported by health professionals (n = 6) and via interviews with health professionals (n = 12) who were involved with helping mothers with AI following OASIS. Results Women with AI resulting from OASIS have a specific syndrome – the ‘OASIS Syndrome’ - which we have uniquely visualised as a ‘word picture’. They feel unclean which results in dignity loss, psychosexual morbidity, isolation, embarrassment, guilt, fear, grief, feeling low, anxiety, loss of confidence, a feeling of having been mutilated and a compromised role as a mother. Coping relies on repetitive washing (which may become a ritual), planning daily activities around toiletry needs, sharing, family support, employment if possible and attention to the baby. Recovery and healing is through care of the child and hope generated by love within the family. Conclusions This study has identified a previously unrecognised ‘OASIS Syndrome’ and, by way of a new and unique ‘word picture’, revealed a hidden condition. There should be greater awareness by the public and profession about the ‘OASIS Syndrome’ and a mechanism for early identification of the condition and referral for management. This, if successful, would overcome the barrier of silence which surrounds this currently unspoken taboo.

Background The clinical presentation of Clostridium difficile infection ranges from asymptomatic carriage, colitis with or without pseudomembranes, to fulminant colitis. Although not common, fulminant C. difficile colitis can result in bowel perforation and peritonitis with a high mortality rate. Colectomy is often indicated in these cases. Methods We retrospectively analysed the outcome of 14 patients who underwent surgery for fulminant C. difficile colitis in the period 1996–2003 in our Unit. Results The indications for surgery were systemic toxicity and peritonitis (n = 10), radiological and clinical evidence of progressive toxic colonic dilatation (n = 3) and progressive colonic dilatation with bowel perforation (n = 1). C. difficile infection as the cause of colitis was diagnosed pre-operatively in seven (50%) patients, six of whom underwent a total colectomy and one a right hemicolectomy. Overall mortality in our series was 35.7%. Total colectomy was associated with a lower mortality rate of 11·1% (1/9) when compared with left hemicolectomy was 100% (4/4) (P = 0·01). One patient who underwent a right hemicolectomy (on the basis of deceptively normal external appearance of the rest of the colon intra-operatively) survived after a prolonged hospital stay. Conclusions Early or pre-operative microbiological diagnosis of C. difficile infection can be difficult in patients with a fulminant presentation. Those patients with C. difficile colitis, who develop signs of toxicity, peritonitis or perforation, should undergo a total colectomy as the operation of choice.

Background and aims Idiopathic constipation is a rare indication for ileostomy construction. The aim of the study was to evaluate the success of ileostomy in treatment of severe constipation. Also to analyse the surgical complications and re-operation rate to identify any factors potentially predictive of outcome. Patients and methods This retrospective study analysed the long-term outcome of 24 ileostomies constructed for constipation. The ileostomy construction was performed in 13 patients during large bowel/rectum resection, in 6 after a full laparotomy and in 5 through an abdominal wall trephine alone. We analysed the surgical complications and the re-operation rate according any factors potentially predictive of outcome. Results One (4%) patient had persistent constipation after stoma creation. Surgical complications occurred in 11 (46%): retraction in 6 (25.0%), peristomal sepsis in 3 (12.5%) and parastomal hernia in 2 (8.1%). Refashioning of the stoma was necessary in 7 (29%) patients. Previous abdominal surgery, end ileostomy, ileostomy constructed after large bowel resection or laparotomy were associated with a significantly higher incidence of stomal complications while age, duration of follow up, major complication and ileostomy created after bowel resection were associated to a significantly higher re-operation rate (P

Objective To correlate anorectal function including rectal evacuation with anorectal physiology and endoanal ultrasound in women with third degree obstetric anal sphincter injury repaired at the time of delivery. Patients and methods Forty-four women with repaired third degree tears underwent anorectal physiology, anal ultrasonography and clinical assessment using the St. Marks incontinence score (0–24). Evacuatory disturbance was assessed by questionnaire. Results There was a significant correlation between disturbed evacuation and incontinence symptoms (P =0.030). There was also a significant correlation between disturbed evacuation and internal anal sphincter (IAS) injury (P = 0.026), but there was no correlation with external anal sphincter (EAS) injury. There was a correlation between disturbed evacuation and low resting anal pressure (P = 0.013). Although IAS defects were associated with low anal pressure, only the correlation with Maximum Squeeze Pressure reached statistical significance (P = 0.018). Conclusion Women with evacuatory disturbance after repaired third degree tears have a greater level of incontinence than those whose emptying is normal. This association is related to internal sphincter injury and reduced anal sphincter pressures.

PURPOSE: Fecal diversion for sphincter repair is controversial. This randomized trial assessed whether fecal diversion would improve primary wound healing and functional outcome after sphincter repair. METHODS: Thirty-three patients with fecal incontinence requiring sphincter repair were recruited, but only 27 agreed to be randomly assigned to a defunctioning stoma (n=13) or no stoma (n=14). Patients were assessed by the Cleveland Clinic Incontinence Score (0–20) and anal physiology; the mean follow-up was 34 (range, 16–47) months. RESULTS: Incontinence score improved significantly in both groups (stoma, 13.5–7.8;P = 0.0072; no stoma, 14–9.6;P=0.0470): No difference was found between the two groups. Maximum resting pressure and maximum squeeze pressure increased significantly only in the no-stoma group (maximum resting pressure, 52.4–71.3 cm H2O; maximum squeeze pressure, 87.3–100.7 cm H2O;P

Background: Sodium picosulphate (Picolax) is considered by most British surgeons as standard preparation for colonoscopy and elective surgery. Oral sodium phosphate may be better tolerated and more efficient as bowel preparation. Methods: A randomized trial was performed to compare oral sodium phosphate (n = 76) with Picolax (n = 77) as bowel preparation for elective colorectal surgery. A parallel study randomized colonoscopy patients to sodium phosphate (n = 51) or Picolax (n = 52). Patient acceptability was measured for seven symptoms with a linear analogue score. Quality of preparation was graded by the surgeon and faecal residue was measured in resection specimens. During colonoscopy, bowel preparation has graded 0–24 using an endoscopic score. Results: Abdominal pain, nausea, vomiting, embarrassment, fear and fatigue did not differ significantly between the groups. Surgeons grade of quality was judged poor or awful in 5 of 76 in the sodium phosphate group (9%) compared with 13 of 73 in the Picolax group (18%, p = 0.084). Mean faecal residue in the resection specimen was 0.1 g/cm after sodium phosphate compared with 0.45 g/cm after Picolax (p < 0.01). The endoscopic score was significantly lower using sodium phosphate (2.0 ± 2.2) than picolax (3.1 ± 2.9; p < 0.05). Conclusions: These results suggest that oral sodium phosphate is well tolerated and superior to Picolax in elective colorectal surgery and colonoscopy.

Background: Poor pouch function is associated with impaired bile acid absorption and increased faecal loss of bile acids. Bile acid replacement therapy might therefore be of clinical benefit, provided that diarrhoea is not aggravated by therapy. Aim: To investigate the role of exogenous bile acid therapy in patients with poor pouch function after restorative proctocolectomy for ulcerative colitis. Patients and methods: Twenty ulcerative colitis patients with poor pouch function (score > 4 on a 12-point score) were recruited for inclusion to a prospective, randomized, double-blind crossover, placebo-controlled trial of ursodeoxycholic acid (10 mg/kg per day in two divided doses for 1 month). Results: A total of 16 patients completed the study. There was no significant difference in the functional score or bowel frequency following treatment irrespective of whether the active treatment was given before or after placebo. Conclusions: We conclude that ursodeoxycholic acid given over 4 weeks had no influence on functional score or bowel frequency after restorative proctocolectomy for U.C.

Background: With the aim of resolving the current controversy over the diagnosis and treatment of diverticular disease, this consensus development conference set out to summarize the actual state of the art. Methods: A multidisciplinary panel of international experts (n= 16) was selected to take part in the consensus process. Prior to the conference, all experts were asked to answer a series of questions on diverticular disease. The consensus statement compiled out of these evaluations was modified during a joint meeting of the panel members, then presented for discussion in a public session, and finally revised by the expert panel. The finalized statement was mailed to all panel members for approval (Delphi method). Results: Asymptomatic diverticulosis, diverticular disease (with actual or recurrent symptoms), and complicated diverticular disease were defined separately. No agreement was reached on whether barium enema or colonoscopy is the better choice as an initial diagnostic tool in uncomplicated cases. In complicated cases, computed tomography is recommended for diagnosis. After two attacks of diverticular disease, elective resection should be considered. For patients in whom a concomitant carcinoma cannot be excluded and those with chronic complications (fistula, stenosis, or bleeding) surgery is also indicated. Laparoscopic sigmoid colectomy is recommended only for uncomplicated and, after percutaneous drainage of abscesses, Hinchey stage I and II cases. Conclusions: Laparoscopic surgery has already begun to influence the management of diverticular disease, but the randomized controlled trials needed to support therapy decisions are largely missing.

Pouchitis occurs in 10-35% of patients in the first 10 years after pouch construction for ulcerative colitis. Pouchitis must be carefully defined and should not include patients with poor function or Crohn's disease. Most patients have only a single attack of pouchitis which rapidly resolves with metronidazole. Chronic pouchitis suggests some other abnormality of function which, if responsible for persistent poor function, may necessitate pouch excision.

A total of 168 restorative proctocolectomies have been performed without mortality during the past nine years. Morbidity from pelvic sepsis (12%), ileoanal stricture (15%), and pouch related fistulas (16%) have become less with increasing experience of the operation. Pouch excision, which occurred in 30% of the first 50 patients was undertaken in only 4% in the last 68 patients. Despite this, intestinal obstruction (18%) continues to complicate the operation. We have abandoned restorative proctocolectomy after failed ileorectal anastomosis in patients with slow transit constipation as half have now requested pouch excision because of poor results. Failure to identify Crohn's disease continues to influence the outcome: in 10 patients now known to have Crohn's disease six developed post operative fistulas, three have required pouch excision. Sexual impairment has occurred in three male patients (4%). Ten women had children after operation, eight uncomplicated vaginal deliveries occurred without impaired continence. Seven of nine patients over 60 years of age have had a successful outcome. Our data also indicate that the operation may be justified in distal disease if urgency is socially inconvenient. Frequency of defecation is usually less than three per 24 hours in patients with familial adenomatous polyposis but remains variable in those with ulcerative colitis.

In a prospective double-blind randomised trial, 200 patients undergoing elective colorectal surgery received ceftizoxime 2g with either placebo or a single dose of metronidazole 500mg followed by a single dose of ceftizoxime 2g two hours later in both treatment groups. There was no difference in the rate of wound infection (9 of 85 vs 7 of 89), distal site infection (16 of 85 vs 18 of 89) or noninfective complications between the 2 treatment groups. Duration of hospital stay was also similar for the 2 groups (mean 11.3 vs 12.3 days). The low incidence of wound infection in this study is particularly impressive, as 13 of 16 wound infections were delayed, minor superficial discharges occurring after the patient left hospital. These results suggest that intravenous ceftizoxime offers effective prophylaxis in colorectal surgery and may be used without metronidazole.

Peritonitis following staple stabilization of a flush ileostomy has not yet been reported in the literature. We report a case of iatrogenic injury to a loop of the ileum in an unrecognized parastomal hernia which caused peritonitis after stapling of a flush ileostomy.

A prospective randomised study was undertaken in 80 patients to assess the combined regimen of ciprofloxacin with metronidazole against amoxicillin/clavulanic acid with metronidazole as treatment for established intra-abdominal infection. Treatment was for five days. Seventy-eight patients were clinically evaluable (38 patients on ciprofloxacin with metronidazole and 40 patients on amoxicillin/clavulanic acid with metronidazole). The overall clinical success rate in the treatment of intra-abdominal infections was 96% for the ciprofloxacin with metronidazole group, and 90% for the amoxicillin/clavulanic acid with metronidazole group. Over half of all patients were able to change from intravenous to oral antibiotic administration within the study period. One patient receiving ciprofloxacin with metronidazole developed pruritus near the injection site.

Objective Rectal cancer in young patients is uncommon. There is little information on rectal cancer in young adults in India. The aim of this study was to determine the relative incidence of rectal cancer in young patients in India and identify any differences in histological grade and pathological stage between younger and older cohorts. Method All adult patients presenting at a tertiary colorectal unit with primary rectal adenocarcinoma between September 2003 and August 2007 were included. Patients were divided into two groups: 40 years and younger, and older than 40 years. Details regarding patient demographics, preoperative assessment, management and tumour grade and stage were obtained from a prospectively maintained database. Results One hundred and two of 287 patients (35.5%) were 40 or younger at presentation. Younger patients were more likely to present with less favourable histological features (52.0%vs 20.5% (P

A previously fit 23 year old adult male who presented with a sudden onset of profound autonomic neuropathy, for which no cause could be found, is described. The patient subsequently developed ischaemic enterocolitis that ultimately necessitated colectomy and subtotal enterectomy. Potential neural and humoral mechanisms are discussed.

Postoperative pneumoperitoneum on a plain chest radiograph is a potentially important medicolegal document of possible complication. However, pneumoperitoneum may be observed without significance after intra-abdominal procedures. Between April 2001 and March 2002, 204 consecutive open laparotomies for colorectal surgery were studied. Sixty-three patients had 97 chest radiographs taken before the twenty-fifth postoperative day. Only one patient had subdiaphragmatic air (height >20 mm) on the tenth postoperative day associated with a visceral perforation. Normal subdiaphragmatic pneumoperitoneum was observed on 11 films in 8 patients (13%). Small amounts of air (

Objective To study the long-term hernia rate and risk factors after end colostomy construction. Patients and methods 86 patients with a permanent end colostomy constructed over 5 years were examined and interviewed. There were 35 men and the mean age was 56.5 (28–87) years. Risk factors which were analysed included emergency operation, age over 60 years, obesity, steroids, cancer, infection at the stoma site, smoking and chronic obstructive airways disease. Results Para-colostomy hernia occurred in 12/86 cases (13.9%). The cumulative recurrence rose with duration of follow up. Overall 10/45 patients (22%) over 60 years developed hernia vs. 2/41 patients (4.8%) less than 60 years (P=0.02). There were no other risk factors that correlated with para-colostomy hernia. Conclusions These data indicate that the incidence of colostomy related hernia increases with follow up and is significantly higher in patients over the age of 60. Other risk factors, particularly obesity and coexisting cardiorespiratory disease, have no impact.

It is now recognised that the results of surgical treatment for bowel incontinence are frequently rather disappointing. It is wrong to raise patients expectations and push patients into surgical treatment for bowel incontinence unless they are aware of the likely outcome measures. Frequently there is deterioration in continence with age, often surgical treatments last only a short period.

There is very little satisfactory data on the natural history of diverticular disease. There are really no good long-term studies of untreated complicated disease. One third of all patients with complicated diverticular disease die of unrelated disease over the next five years and follow-up is usually incomplete.

To compare the outcome after conventional sutured loop ileostomy closure with stapled ileostomy closure.A defunctioning loop ileostomy is now widely used in colorectal surgery. Subsequent closure may be associated with early complications, particularly bowel obstruction. The results of a preliminary nonrandomized study suggested that there was no significant difference in the rate of complications between sutured and stapled closure of loop ileostomy.One hundred forty-one consecutive patients who underwent loop ileostomy between 1993 and 1998 were randomized before surgery to either sutured or stapled loop ileostomy closure. Seventy-one patients had stapled closure and 70 had sutured closure.Both groups were comparable in terms of age, sex, original operation, duration after original operation, and level of operating surgeon. Postoperative bowel obstruction occurred in 10/70 (14%) patients after sutured closure compared with 2/71 (3%) patients after stapled closure. Subgroup analysis of ileostomy closure in patients having an ileal pouch showed no significant difference in bowel obstruction between stapled and sutured closure (2/30 vs. 7/29). The incidence of other complications, readmissions, and reoperations did not differ between the two groups. The stapled closure was only 4 minutes quicker than sutured closure. The mean total hospital stay tended to be shorter after the stapled closure than the sutured closure, but this did not reach statistical significance.Bowel obstruction occurred less frequently after stapled closure, but the mean hospital stay and readmission and reoperation rate did not significantly differ between the two groups.

Stapled strictureplasty has been performed on 26 occasions in 22 patients. In contrast with sutured strictureplasty, there were no major postoperative complications. The use of staples provides a method of identifying whether recurrence is at the strictureplasty site. Stapled strictureplasty avoids an enterotomy through recurrent disease and may have advantages over conventional sutured strictureplasty.

We have examined the long-term results of pouch surgery in 154 patients initially thought to have ulcerative colitis. Pouch survival was 81% at 5 years and 72% at 10 years. Chronic sepsis was the commonest factor for pouch failure (P0.001). Re-operations were required in 60 patients (39%). Pouch salvage was used in 30 patients and was successful in 16. Function using a 12-point score was good (0-3) in 40%, moderate (4-6) in 31% or poor (6) in 29%. Quality-of-life assessment indicated that 81% were satisfied, but anxiety was associated with a poor outcome. Age over 60 years was not associated with impaired function. So far, 21 patients are thought to have Crohn's disease, of whom 5 have small bowel involvement above the pouch, 11 have had their pouch excised or are permanently defunctioned.

180 ileoanal pouches constructed over 10 years and followed for at least 2 years (154 for Inflammatory Bowel Disease (IBD) and 26 for Familial Adenomatous Polyposis (FAP)) were reviewed. 23 pouches have been excised to date, 8 remain defunctioned (pouch failure FAP 7.7%, IBD 18.8%). The reasons for excision were: ischemia (n = 6), pelvic sepsis (n = 5), severe stenosis (n = 3), underlying Crohn's disease (n = 3), poor function (n = 5) and fistula (n = 1). The reasons for defunction were: Crohn's disease (n = 1), pelvic sepsis (n = 5) and ileoanal stenosis (n = 2). The projected overall pouch survival rate (Life table analysis) at 5 years was 81% (confidence interval 74–87%). Beyond 7 years, the figures to calculate survival became unreliable (small numbers). There was a significant association between pouch failure and pelvic sepsis (Fisher's exact test P < 0.0001) and between failure and fistula formation (P < 0.02). Multiple regression analysis showed pelvic sepsis and recurrent pouchitis to be independent factors of pouch failure. Pouch failure can occur many years after initial operation. Long-term follow up is recommended.

This study reports on the outcome of four patients having ileal pouch anal anastomosis after orthotopic liver transplantation for sclerosing cholangitis complicating ulcerative colitis. There were no deaths on follow up. Early postoperative bleeding was a complication of colectomy or rectal excision in three, one of whom developed hepatic artery thrombosis and the overall complication rate was high. All patients are continent but one has chronic pouchitis (while receiving longterm metronidazole) and one patient has recurrent sclerosing cholangitis in the transplant.

PURPOSE: We report the outcome of four patients who had stimulated gracilis neosphincter for fecal incontinence to highlight functional problems, particularly in patients with impaired rectal evacuation. METHODS: The gracilis neosphincter operation consisted of a three-stage procedure in four patients with intractable incontinence, three of whom had had a pelvic floor repair. RESULTS: Despite successful muscle transposition and nerve stimulation, only one of four patients has a functioning neosphincter. One patient could not tolerate stimulation, and two were unable to evacuate the rectum. All three now have stomas, and even the functioning neosphincter patient requires regular bisacodyl (Dulcolax®; CIBA Consumer Pharmaceuticals, Woodbridge, NJ) suppositories to achieve evacuation. CONCLUSION: The neosphincter is a successful sphincter but has no role for patients who cannot evacuate from the rectum.

Over a 16-year period 34 patients underwent surgery for idiopathic megarectum or megacolon; 18 had megarectum with or without megasigmoid, one megacolon only and 15 megarectum and total megacolon (nine with a previous colectomy). Ten patients underwent low rectal or anal anastomosis without pouch formation (colodistal proctostomy, eight; coloanal anastomosis, two), eight had colonic pouch-anal anastomosis (J pouch) and 14 had an ileal J pouch after restorative proctocolectomy; one underwent subtotal colectomy with ileorectal anastomosis and one loop ileostomy alone. There was one death, from intestinal obstruction 24 months after operation. Twenty-seven of 32 evaluable patients without a stoma became fully continent following resection and sphincter-saving procedures. Three of 18 had a poor result after resection for megarectum because of recurrent constipation. One of 14 patients became incontinent after restorative proctocolectomy for megacolon and megarectum and in a further four persistent abdominal distension and pain was treated by pouch excision.

A study was carried out to evaluate the breath hydrogen test as a method of estimating small bowel transit in patients with an ileal pouch and to determine whether gut transit time influenced functional outcome. Twelve patients with an ileal reservoir and ten control subjects ingested a test meal of 400 ml chicken soup, 20 g lactulose and 50 ml dilute barium solution. Concurrent breath hydrogen testing and radiological screening was carried out until the head of the test meal reached the ileal pouch or caecum. At the time that the test meal arrived in the pouch, faecal anaerobic bacterial counts were obtained. Pouch compliance, functional capacity and anal sphincter pressures were also measured. While there was an excellent correlation between radiological and breath hydrogen measures of orocaecal transit time in controls (P < 0.001), no such relationship was found for oropouch transit. Four of the 12 patients with a pouch produced no hydrogen after test meal ingestion, while in two other such patients breath hydrogen peaks occurred when the head of the meal was in the jejunum. The magnitude of the breath hydrogen rise in patients with an ileal pouch correlated well with faecal anaerobic bacterial counts (P < 0.01). The median (95 per cent confidence interval) radiological small bowel transit time was more rapid in patients with a pouch than in control subjects: 28 (23–33) versus 72 (46–86) min (P < 0.01). Increased 24-h frequency of defaecation was associated with more rapid small bowel transit after ileal reservoir construction (P < 0.01) but correlated with neither pouch capacity nor compliance. These data show that small bowel transit time may be a determinant of ileal pouch function but that breath hydrogen estimation of gut transit time in patients with an ileal reservoir is unreliable.

Measurement of small-bowel transit time (SBTT) by breath hydrogen estimation is based on caecal anaerobic bacterial fermentation of luminal substrate. The high anaerobic counts in ileal reservoirs have led us to study the influence of SBTT on functional outcome in 12 patients (6 J pouches and 6W pouches) at a median (95% CI) of 20 (range 12–33) months following restorative proctocolectomy.

Pouchitis may be due to faecal stasis or as a result of impaired pouch emptying and high anal sphincter pressures. We have studied pouch emptying and anal manometry in the aetiology of pouchitis.

The pathogenesis of pouchitis is unknown [1], Proposed aetiological factors have included faecal stasis and bacterial overgrowth [2], recurrent Crohn’s disease [3], recurrent ulcerative colitis [4] and specific enteropathogens [5]. However, many of the cases of pouchitis described in the literature have not been fully documented using the now recognised clinical, endoscopic and histological criteria [4].

A novel technique utilizing samples of human distal ileum removed at surgery was used to study magnesium (Mg) absorption. Specimens of isolated absorptive mucosa were obtained by careful dissection of the tissue to remove the muscle layers, and were mounted in flux chambers. Mean tissue Mg concentration in human isolated intestinal mucosa was found to be within the postulated normal range for human tissue. Mucosal to serosal Mg transport was unaffected by ouabain or 2,4-dinitrophenol and sodium fluoride. Overall, the data indicate Mg absorption in distal ileum to be passive in nature, although a minor active transcellular component cannot be excluded.