These are abdominal problems that usually are sudden, occurring within a few hours to a few days.  The most common symptom is abdominal pain.  Pain in the right lower abdomen could be due to appendicitis, which usually needs surgery.  In the left lower abdomen, it is most likely diverticular disease.  If thought to be inflamed (diverticulitis), antibiotics are the main stay of treatment. In complicated diverticular disease (perforation, abscess), surgery may be necessary. In females alternative diagnoses include pelvic inflammatory disease or an ectopic pregnancy.

Bowel obstruction is another emergency. The causes of this are varied. From hernias,to bowel cancer, scar tissue (adhesions) from previous surgery and complication of diverticular disease and inflammatory bowel disease. It usually manifest with constipation (no bowel opening or passing flatus), abdominal distension, pain and vomiting.  Most often, surgery is needed but in some circumstances, a tube in the stomach and fluids through the arm settles the symptoms.

Bloody diarrhoea with frequency exceeding 6 – 8 times in 24 hours can also be an emergency presentation. The frequency and consequent loss of fluids renders the patient weak. The symptoms are usually due to inflammatory bowel disease (ulcerative colitis or Crohn’s disease). Management is usually by both the physicians and surgeons working together and the Midland Gut Clinic is ideally placed to provide this, having both medical and surgical specialists. Medical therapy is the mainstay of treatment except in unusual circumstances (perforation) or when there is a failure to get better with medical therapy, then surgery is considered.

Major colonic bleeding is not common and is usually self-limiting. Occasionally, intervention radiology is necessary and rarely, surgery.