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A 45-year-old man was referred to our surgical clinic for investigation of rectal bleeding and anal discomfort. His medical history indicated he was HIV positive. His CD4 count was 360 × 106/L and his viral load was undetectable. No abnormalities were found on perianal inspection. Digital rectal examination revealed a mass-like lesion with some irregularity producing a circumferential stricture. Rigid sigmoidoscopy showed a mass in the distal rectum. Colonoscopy showed a rectal stricture extending from 11 cm to 8 cm from the anal verge (Fig. 1). The scope could pass through the stricture. Although this was not a fibrotic stricture, the circumferential nature of the lesion created a strictured appearance. The remaining colon and ileum were endoscopically normal. Biopsy specimens of the stricture showed ulceration superimposed on an atypical lymphoid infiltrate. There was mild to moderate acute and chronic inflammation in the lamina propria with no evidence of dysplasia or malignancy and no indication of cytomegaloviral infection on immunohistochemical stain. Blood measurements were noncontributory. Pelvic MRI showed diffuse, up to 3 cm, thickening of the rectum for a distance of 10 cm from the anal verge. The MRI scan favoured an inflammatory process over a malignant lesion in view of the long segment of involvement and inflammatory changes. The infectious disease service was consulted, and because LGV was suspected clinically he was started on doxycycline. Serologic examination confirmed LGV.

Abstract Background Wait times for gastroenterologists in Canada continue to exceed recommended targets. Electronic consultation (eConsult) may reduce the need for face-to-face gastroenterologist visits. Objective The goal of this study was to identify the cases submitted to gastroenterologists though the Champlain BASE™ (Building Access to Specialists through eConsultation) eConsult service and explore their impact on primary care physicians’ (PCPs) courses of action. Methods Gastroenterology cases submitted between June 2013 and January 2015 were categorized using a modification of the International Classification for Primary Care (ICPC-2) taxonomy. Question type (e.g., diagnosis or management) was classified using a validated taxonomy. Results Of the 121 gastroenterology consults reviewed, 33% were related to hepatology, 23% to GI symptoms, and 13% to specific luminal diseases. Among hepatology eConsults (n=40), 47% pertained to abnormal liver function testing. Overall, 51% of eConsults were related to diagnosis, 30% to management, 9% to drug treatments and 7% to procedures. PCPs received a reply within a median of 2.9 days. Only 25% of cases resulted in a face-to-face referral. Conclusions The eConsult service provided timely, highly regarded advice from gastroenterologists directly to PCPs and often eliminated the need for a face-to-face consultation. An evaluation of the most commonly-posed questions could inform future continuing medical education activities for PCPs.