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Publication Optimising MRI small bowel techniques(Elsevier, 2019-08) Sinha, Rakesh; Stephenson, J. A.; Rajesh, A.; South Warwickshire University NHS Foundation Trust; University Hospitals of Leicester NHS Trust; Clinical Radiology; Medical and Dental; Sinha, R.Magnetic resonance imaging (MRI)-based techniques have emerged as the preferred technique for the diagnostic evaluation of the small intestine, particularly in the adult population. The lack of ionising radiation makes MRI ideal for use in younger patients or in cases that require repeated follow-up investigations. Imaging of the small intestine may be carried out using the intubation (enteroclysis) or the ingestion (enterography) techniques. Enterography examinations are more acceptable to patients and may provide similar diagnostic accuracy compared to intubation methods. In this review, methods of improving and optimising MRI of the small intestine are described.Publication Follow-up of colorectal cancer and patterns of recurrence(Elsevier, 2021-08) Haria, P. D.; Baheti, A. D.; Palsetia, D.; Ankathi, S. K.; Choudhari, A.; Guha, A.; Saklani, A.; Sinha, Rakesh; Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, Mumbai, India; South Warwickshire University NHS Foundation Trust; Radiology; Medical and Dental; Sinha, RakeshColorectal cancer is one of the commonest cancers detected as also amongst the most common causes of cancer death. Survival has improved due to better disease understanding and treatment; however, a substantial proportion of patients recur after curative intent therapy. In this article, we will discuss the imaging features of recurrent colorectal cancer and the role of the radiologist in its management.Publication Guidelines for the investigation of chronic diarrhoea in adults : British Society of Gastroenterology, 3rd edition(BMJ Publishing Group, 2018-04-13) Arasaradnam, Ramesh P; Brown, Steven; Forbes, Alastair; Fox, Mark R; Hungin, Pali; Kelman, Lawrence; Major, Giles; O'Connor, Michelle; Sanders, Dave S; Sinha, Rakesh; Smith, Stephen Charles; Thomas, Paul; Walters, Julian R F; University Hospitals Coventry and Warwickshire NHS Trust; South Warwickshire University NHS Foundation Trust; Radiology; Medical and Dental; Sinha, RakeshChronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). This document has undergone significant revision in content through input by 13 members of the Guideline Development Group (GDG) representing various institutions. The GRADE system was used to appraise the quality of evidence and grading of recommendations.Publication Colonic thickening on computed tomography - does it correlate with endoscopic findings? A protocol for systematic review(BioMed Central, 2016-12-13) Chandrapalan, Subashini; Tahir, Faraz; Sinha, Rakesh; Arasaradnam, Ramesh; University Hospital of North Midlands, Stoke-on-Trent; South Warwickshire University NHS Foundation Trust; University Hospitals Coventry and Warwickshire NHS Trust; Radiology; Medical and Dental; Sinha, RakeshBackground: Colonic mural thickening is often a finding in standard computed tomography (CT) scans of the abdomen. It often presents clinician with a dilemma on when a further endoscopic evaluation is needed, especially in the absence of guidelines. The aim of this systematic review is to evaluate the significance of bowel wall thickening and to assess its correlation with endoscopy. Methods: This systematic review will be reported in accordance with the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. The search strategy will initially be developed in MEDLINE and adapted for use in EMBASE, MEDLINE, NHS evidence and TRIP. Two reviewers will independently conduct a study selection, data extraction and risk of bias assessment for the screened studies. Data synthesis will be conducted using Review Manager software 5.3. The outcome of any dichotomous data will be presented as relative risk with confidence intervals. Discussion: It is extremely useful for the practising clinician to know which patients need further endoscopic evaluation. Even though there are several studies on this issue, none of them have attempted to produce a systematic review. We hope this systematic review will provide a substantiate evidence for future clinical practice. Systematic review registration: PROSPERO CRD42016039378. Keywords: Colon; Computed tomography scan; Endoscopy; Mural thickening.Publication Acute scrotal swelling following perforated rectal carcinoma with abscess formation(Oxford University Press, 2016-06-06) Chauhan, Vishnusai; Newman, Matthew; Sinha, Rakesh; South Warwickshire University NHS Foundation Trust; Colorectal Surgery; Radiology; Medical and Dental; Chauhan, Vishnusai; Newman, Matthew; Sinha, RakeshA 59-year-old cachectic male was referred to the surgical outpatient department with intermittent haematochezia and a longstanding change in bowel habit with associated weight loss and anaemia. Following investigation, he was diagnosed with a large rectal tumour with multiple metastases. 7 days later, the patient presented again with fevers, bilious vomiting, abdominal pain and distension. On examination, he had a generally tender abdomen,= although no peritonism, but an enlarged, extremely tender hemiscrotum with no cough reflex. Imaging revealed a perforated rectum and subsequent abscess formation, which tracked via an unusual anatomical route to present as scrotal swelling.Publication Sarcopenia and the clinicopathological outcomes in laparoscopic rectal surgery(Oxford University Press, 2020-12) Yershov, Danylo; Zafar, Shahbaz; Sinha, Rakesh; Francombe, J.; Andhalgaonkar, K.; Ramcharan, Sean; South Warwickshire University NHS Foundation Trust; General Surgery; Medical and Dental; Yershov, Danylo; Zafar, Shahbaz; Sinha, Rakesh; Francombe, James; Andhalgaonkar, K.; Ramcharan, SeanAims: Models for predicting outcomes in rectal cancer surgery are inconsistent and improving their accuracy for individualised care is needed. While radiologically determined sarcopenia (low lean muscle mass) is associated with poorer outcomes from chemoradiotherapy, there were no studies on its effect on minimally invasive surgery. We therefore examined its relationship with the clinicopathological outcomes of laparoscopic rectal cancer resections. Methods: The prospectively accrued database was used to identify rectal cancer resections performed over a 2-year period. Of the 90 rectal cancers patients, 45 underwent laparoscopic resections and the data on clinicopathological features were collected. The CT scans were examined retrospectively to determine their sarcopenia score (graded 1-4), defined by the quartiles of the HUACs (Hounsfield Unit Average Calculation) of the average area of both psoas muscles. Results: Low sarcopenia scores (<2) were associated preoperatively with age (r=0.305, p=0.043), WHO performance status (r=0.479, p<0.001), and type 2 diabetes mellitus (r=0.379, p=0.01). They also correlated postoperatively to Clavien-Dindo Morbidity Scores of 2 or more (r=0.316, p=0.046; OR 1.27, p=0.043), low TME grades (r=-0.316, p=0.046; OR 0.78, p=0.012) and conversion to open surgery (r=0.305, p=0.043; OR 1.61, p=0.049). Conclusions: Sarcopenia is a useful marker in laparoscopic rectal cancer resections and therefore requires further evaluation towards improving model predictions of surgical outcomes.Publication Colorectal cancer(Elsevier, 2021-12) Sinha, Rakesh; South Warwickshire University NHS Foundation Trust; Radiology; Medical and Dental; Sinha, RakeshAn editorial introducing a special issue of Clinical Radiology focused on colorectal cancer.Publication Zinner syndrome : an unusual cause of bladder outflow obstruction(Oxford University Press, 2017-02-17) Shah, Sonali; Patel, Ramesh; Sinha, Rakesh; Harris, Maya; South Warwickshire University NHS Foundation Trust; Gastroenterology; Radiology; Urology; Medical and Dental; Shah, Sonali; Patel, Ramesh; Sinha, Rakesh; Harris, MayaZinner syndrome is a rare condition comprising a triad of unilateral renal agenesis, ipsilateral seminal vesicle obstruction and ipsilateral ejaculatory duct obstruction. The mutual embryological origins of the seminal vesicle and the ureteral bud result in both anomalous genital and urinary tracts. We present the case of a 39-year-old patient where the initial presentation of this condition was bladder outflow obstruction. In this paper, we discuss the embryological origin of this condition, the range of imaging tools used to diagnose Zinner syndrome and the inherent benefits and shortcomings of each modality.Publication Therapeutic emergency laparoscopy for small bowel obstruction secondary to a congenital peritoneal band(MA Healthcare, 2022-04) Arambepola, Devika; Blades, Hannah; Sinha, Rakesh; Sarma, Diwakar R.; South Warwickshire University NHS Foundation Trust; Homerton University Hospital Foundation Trust; General Surgery; Radiology; Medical and Dental; Arambepola, Devika; Sinha, Rakesh; Sarma, DiwakarA case report on therapeutic emergency laparoscopy for small bowel obstruction secondary to a congenital peritoneal bandPublication Systematic review and meta-analysis : does colonic mural thickening on CT correlate with endoscopic findings at colonoscopy?(BMJ Publishing Group, 2018-06-26) Chandrapalan, Subashini; Tahir, Faraz; Kimani, Peter; Sinha, Rakesh; Arasaradnam, Ramesh; County Durham and Darlington Foundation Trust; Queen Elizabeth Hospital Birmingham; University of Warwick; South Warwickshire University NHS Foundation Trust; University Hospitals Coventry and Warwickshire NHS Trust; University of Coventry; Radiology; Medical and Dental; Sinha, RakeshBackground: Colonic mural thickening (MT) is often reported on standard CT examinations of the abdomen and pelvis. It often presents a dilemma for the clinician on whether any further evaluation is needed, especially in the absence of any set guidelines. Objective: To evaluate the significance of colonic MT and to assess its correlation with colonoscopy. Methods: The search strategy was initially developed in Medline and adapted for use in Embase, Medline, NHS Evidence and TRIP. Studies were included if they had reported colonic MT and subsequent colonoscopy in adults. Results: A total of 9 cohort studies examining 1252 patients were selected having undergone both CT and colonoscopy. Of the 1252 patients with MT, 950 had an abnormal colonoscopy. In the presence of MT, the pooled positive predictive value (PPV) of having any abnormal findings at colonoscopy was 0.73 (95% CI 0.60 to 0.84). The pooled PPV for colorectal cancer, in the presence of MT reporting suspicion of cancer, was 0.63 (95% CI 0.49 to 0.75), and MT suggestive of inflammation confirmed at colonoscopy was 0.97. Conclusion: The probability of having an abnormal colonoscopy in the presence of MT identified on CT is high, especially for inflammation. Asymptomatic cancers may also be detected; hence, further endoscopic confirmation is reasonable when a finding of MT is demonstrated on CT examinations. Small sample sizes of the available studies and lack of data on the description of MT detected are the main limiting factors in this review. Trial registration number: CRD42016039378. Keywords: colon; colonoscopy; computed tomography; mural thickening.