Bloating Volvolus difficult, surgical, slow onset Gangrene up to 60% mortality, colonoscopic perforation Skill mix Formulate local plans Perforation – look at XR [out of fashion] Abdominal examination

Batteries and foreign bodies Accidental or intentional Institutionalised and imprisoned patients Consent issues

32x70x10.7 mm

Indications for emergency endoscopy [foreign bodies] Disk battery in the oesophagus Objects lodged in oesophagus [with surgical cover] Within 24 hours Long sharp objects Other batteries over 20 mm, disk batteries outside oesophagus, magnets within endoscopic reach, objects over 6 cm Don’t remove drug packets endoscopically

500 years Royal College of Physicians