Minerva

An 84 year old frail woman presented with abdominal discomfort and altered bowel habit. A barium enema examination showed that the whole of her colon had entered the thoracic cavity through a hiatus hernia. She did not undergo treatment because of her age and multiple medical comorbidities. This case shows that a large hiatus hernia may not necessarily result in intestinal obstruction.

B Sriharsha, senior house officer, J Sathianathan, locum consultant surgeon, G Watson, consultant radiologist, Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP

In many countries colorectal cancers are second only to lung cancer as a cause of death from cancer. Prevention is by screening, reduction in exposure to chemical and other environmental agents, and chemoprevention by long term treatment with non-steroidal anti-inflammatory drugs. In studies of patients with arthritis results have shown that the risk of developing bowel cancer and mortality from the disease is lower among those taking such drugs (Cancer Investigation 2002;20:1002-11). The problem is the high frequency of side effects, and the search for safer alternatives continues.

Once colorectal cancer is diagnosed the outlook is still not very good, but in the past 20 years operative mortality has fallen substantially. A study from France of 4745 patients …