Measuring the quality of colonoscopy at a district general hospital in south east England: adenoma detection rates and withdrawal times

s / International Journal of Surgery 10 (2012) S1–S52 S21 ABSTRACTS Background: Congenital extrahepatic portosystemic shunt the Abernethy malformation is a rare anomaly. We present a 26 year old male with right upper quadrant pain also found to have an absent portal vein, double gallbladder, double spleen, right-sided pancreas and malrotation of the gut. Method: A search was made on Pubmed for literature on Abernethy malformation and these were examined for associated abnormalities similar to those found in our patient. Results: Abernethy malformation is extremely rare. Type I describes a complete absence of the portal vein as in our patient but is more common in females. It is also associated with other abnormalities including polysplenia, cardiac anomalies as well as malrotation . Type II is commoner in males, describing a partial shunt and rarely associated with other malformations. Hepatic neoplasms are a common finding in patients with CEPS. No case with associated double gall bladder was described. After routine imaging, no definite cause for the patient's abdominal pain was found. However, several liver lesions were noted and are currently being investigated. Conclusion: A very rare case of Abernethy malformation with associated polysplenia, malrotation and we report, to our knowledge, the first instance of an associated double gallbadder. 1089 WINNER OF IJS CASE REPORTS PRIZE (JOINT 1 PLACE): A TRANSRECTAL, RETROPERITONEAL PARA-AORTIC LYMPH NODE DISSECTION USING NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY (NOTES) IN A PORCINE MODEL A.M. Howell, M.H. Sodergren, J. Clark, D. Noonan, J. Teare, G.Z. Yang, A. Darzi. Imperial College, London, UK Background: Retroperitoneal lymph node dissection is employed in highrisk clinical stage 1 nonseminomatous germ-cell tumours to detect metastases. Current methods include open and laparoscopic approaches. Transvaginal NOTES para-aortic lymphadenectomy for gynaecological malignancy has been described. We present a novel trans-rectal approach. Methods: Under ethical approval and home office license, a para-aortic lymphadenectomy was performed in an anaesthetised 55kg pig in the supine position. A rectal port was placed and the retroperitoneum was accessed through a 2inch incision in the posterior rectal wall using a flexible endoscope. The retroperitoneal space was opened using blunt dissection and CO2 insufflation. The right kidney, right renal vein and inferior vena cava were easily identified. A para-aortic lymph node was removed using conventional flexible endoscopic instruments. Results: A para-aortic lymph node was successfully excised and the histology was confirmed microscopically. Operating time was 27mins without injury to other structures encountered. Subjectively, access was straightforward and the retroperitoneal structures clearly visualised. The animal was euthanized at the end as per the experimental protocol. Conclusion: It is feasible to obtain para-aortic lymph nodes using a transrectal, retroperitoneal NOTES approach in the porcine model. This approach could provide an alternative diagnostic option for patients with suspected retroperitoneal pathology.