bluuebunny/crossref_metadata_2025 huggingface dataset:
FP2.8 - Emergency CRC Resections: A single centre cohort Study
Authors: Gok M A , Bughio M , Akhmal Y , Khan S , Sadat M M , Khan U A , Riaz Komal
Published: September 2024

Aims

According to NBOCA, 20% of cases of CRC’s are emergencies, associated with high rates of post-operative morbidity and death (11.3 % within 90 days, NBOCA annual report 2023). Emergency CRC commonly presents as obstruction and perforation, less commonly with other constitutional symptoms. Aim of study is to assess surgical outcomes in emergency malignant CRC resections.

Methods

Cohort study carried out from Jan'2008 to Jan'2023. Descriptive demography & post-operative surgical outcomes were analysed in all emergency CRC resections. All elective CRC resections were recruited as controls.

Results

Em CRC (n = 365) Elective CRC (n = 1349) Mann Whitney U test (p value) Age(yrs) 70.0 70.5 NS Sex(M:F) 193 : 172 764 : 585 NS ASA(median) 3 2 < 0.0001 BMI(kg/m2) 25.7 26.7 < 0.0005 Op time(mins) 134.1 186.1 < 0.0001 LOS(days) 11 7 < 0.0001 Complications (n) Leaks 7 59 NS Ileus 68 207 NS HAP 53 132 NS Anaemia (Tx) 8 47 NS Wound infections 41 115 NS Collections 29 67 NS Sepsis 31 55 NS Mortality (n) 30 day 32 26 NS 60 day 46 38 < 0.01 90 day 54 44 < 0.005 TNM stage (n) 0 10 16 1 20 351 2 107 456 3 158 446 4 45 52 Survival rates 1st year 71.1 92.3 5th year 48.3 77.1 10th year 41.1 68.5 Logrank p < 0.05 15th year 39.5 65.1

Conclusions

Emergency CRC patients had a worse pre-operative functional limitation (ASA 3), prolonged hospitalization, greater 90-day mortality rate, thus poorer survival. Despite national bowel cancer screening initiatives, emergency CRC presentations remain a challenge. Our study supports prompt diagnosis and early surgical intervention.
FP3.12 - Peri-operative causes of lap-Open Malignant Colorectal Resections: A cohort study
Authors: Gok M A , Bughio M , Zaidi M , Mathieson N O M , Sadat M M , Khan U A
Published: September 2024

Aims

Laparoscopic CRC resection has evolved as main surgery in colorectal malignancies (66 % NBOCA report 2022). Lap-open conversion reported in < 21 % cases. Aim of study is to assess causes of lap-open conversions at a single centre.

Methods

Cohort study carried out from Jan'2008 to Jan'2023; evaluations of demographics & postoperative outcomes in lap-open CRC resections. Laparoscopic and open colorectal CRC resections were recruited as controls

Result

Lap-open (n = 121) Laparoscopic (n = 839) Open (n = 751) Kruskal-Wallis test (p value) Age(yrs) 69.2 70.0 71.0 NS Sex(M:F) 86 : 35 454 : 385 415 : 336 < 0.005 ASA(median) 2 2 2 NS BMI(kg/m2) 27.6 26.3 26.6 < 0.01 Operation time(mins) 235.1 191.4 146.5 < 0.0001 Elective(CRC(n) 113 774 462 < 0.0001 Emergency CRC(n) 8 65 289 < 0.0001 Complications(n) Leaks 4 27 35 NS Ileus 16 124 134 NS HAP 17 74 94 < 0.05 Anaemia(Tx) 7 60 28 < 0.05 Wound infections 21 60 74 < 0.001 Collections 8 39 49 NS Sepsis 8 34 44 NS LN harvest(median) 17 18 16 < 0.001 LOS(days) 8 6 10 < 0.0001 Mortality(n) 30 days 1 22 35 < 0.05 60 days 2 34 48 < 0.05 90 days 2 39 57 < 0.001 Survival rates 1styear 94.1 90.8 83.5 5thyear 81.2 7.2 63.1 Logrank 10thyear 77.2 70.0 54.1 p < 0.005 15thyear 77.2 68.9 50.0

Conclusion

Lap-open conversion rate was 12.6 %. Lap-open conversion resulted in prolonged operation and hospitalization, survival was unaffected. Causes of lap-open conversions characterized into pre-operative cause (high BMI, multiple operations, comorbidities), intra-operative causes (access, adhesions, fatty mesentery, tumour factors, anatomical difficulties, equipment failure).
FP4.2 - Does colonic endoscopic tattooing affect radiological staging?
Authors: Reid Rebecca , Magee Conor , Wilson Jeremy
Published: September 2024

Aim

Evidence exists of radiological upstaging of rectal cancers due to fibrosis caused by endoscopic tattooing. We review investigated whether endoscopic tattooing for colonic lesions resulted in subsequent radiological upstaging.

Methods

A retrospective review was performed of patients endoscopically diagnosed with colonic cancer and undergoing surgery over three years at a single centre. This included patients who underwent both CT imaging prior to, and after colonoscopy with biopsy +/- tattoo. Radiological and operative staging was subsequently compared.

Emergencies, those with no colonoscopy or pre-operative imaging and rectal cancers were excluded. Data were obtained from Somerset register and electronic care records. Data were analysed using chi squared test.

Results

A total of 175 patients were included. 49 patients had CT imaging prior to their colonoscopy, 51 patients had colonoscopy and biopsy prior to imaging; a further 75 patients had biopsy and tattoo prior to imaging. Patients with pre-endoscopy imaging were considered the control group, and patients with biopsy only were calculated separately as they were considered potential confounders (Table 1).Table 1:UpstagedDownstagedSame stagingPre-endoscopy imaging191713Biopsy only131622Tattoo and biopsy212727

Overall, there was no significant difference between groups (p=.429), although 7 reports specifically mentioned potential impact of recent biopsy and tattoo affecting image interpretation.

Conclusion

Our results do not suggest biopsy or tattooing alters pre-operative staging, although it is possible that radiologists may have evolved their interpretation to account for any potential differences.
FP4.14 - The Efficacy of Performing A Quantitative Faecal Immunochemical Test (qFIT) As A Predictor of Colorectal Cancer Before A 2-Week Wait Referral
Authors: Curtis-Lopez Carlos , Craddock Charles , Gomm Timothy , McCullough Jonathan , Moore Jonathan
Published: September 2024

Aim

2-week wait (2ww) Colorectal cancer (CRC) referrals have risen along with increased use of colonoscopy, potentially exposing patients to repeated invasive investigation. Current guidelines recommend the use of quantitative faecal immunochemical testing (qFIT) in primary care to prioritise patients for investigation. This study aims to characterise 2ww CRC referrals in a London hospital.

Method

This is a retrospective quality improvement study, analysing primary care 2ww CRC referrals in October 2022 in a London hospital. Data collected included referral symptoms, completion of a qFIT prior to referral, previous exclusion of CRC, and subsequent investigation outcome.

Results

Of 173 patients referred on the CRC 2ww pathway in October 2022, 21% did not require further investigation. 16% of patients had undergone a colonoscopy within 12 months excluding CRC. Only 61% of referrals included a qFIT. 71% of these were qFIT positive, and 11% were diagnosed with CRC. The overall CRC detection rate was 2.2%, all with qFIT >200. The PPV of qFIT for CRC was 5%, and 53% for polyps.

Conclusion

39% of this patient cohort were referred without qFIT. Those who are qFIT negative or have had CRC excluded in the past 12 months may not require investigation on a 2WW pathway, may be suitable for investigation with lower priority, and may not need invasive investigation at all. Although the use of qFIT has been nationally recommended to prioritise the urgency of investigation, this study suggests this has not been universally adopted. Wider use of qFIT before 2ww referral may guide the use of resources and aid diagnosis and management of patients with symptoms of CRC.
FP4.16 - Impact of Clinician Factors and Judgement Biases on Delayed Referrals and Diagnosis of Colorectal Cancer (CRC)
Authors: Kewlani Bharti , Tjhin Yovita , Pawa Nikhil
Published: September 2024

Aim

Colorectal cancer (CRC) is the 4th most common cancer in the U.K. contributing to 10% of cancer-related fatalities. Despite clear NICE referral guidelines, there are various patient-, clinician- and system-related delays in referrals to the lower gastrointestinal (LGI) services. Our article investigated clinician-associated biases that govern the timeliness of referral to the LGI services.

Method

Our article is a narrative review. We searched Embase and Ovid Medline databases using a range of terms. Results yielded 36 articles relevant to our topic.

Results

GP referrals make up 44%-69% of suspected CRC referrals. Yet, national data highlights that emergency presentations range from 14%-30% nationwide, indicating missed opportunity in the primary care setting. Cognitive bias was commonly seen and included GP’s poor familiarity with referral criteria and failure to recognise red flags. Patient cultural and demographical biases played a significant role in decision-making often leading to misappraisal, with the patient’s age being the most common factor. Younger patients were less commonly referred onto the 2-week-wait (2ww) pathway, and faced an average delay in diagnosis of a month with 1.4 times more visits to care providers. In addition, information and communication biases were a recurring theme in the literature which discussed the effects of inadequate histories and physical examinations on missed diagnosis and delayed referrals.

Conclusions

Unintentional bias delays CRC referrals resulting in a substantial proportion of patients presenting as an emergency with advanced stage cancer that has poorer outcome. We need to increase awareness of these biases and find ways to negate their effects in clinical decision-making.
FP5.12 - Write what you know: A retrospective documentation audit
Authors: Ibanga Unyime , Lingam Gita , Sivarajah Vernon
Published: September 2024

Aims

The Royal College of Physicians (RCP) stipulates that every patient entry in the notes should be; dated, timed and signed by the author (name and designation included). Additionally, the content should have a standardised structure and layout with a chronological order to reflect a continuum of patient care. This audit aimed to assess the percentage of patient documentations that were compliant with these standards.

Methods

We retrospectively evaluated inpatient documentations for general, colorectal and vascular surgery for one week within a district general hospital setting. The data was obtained from electronic documentations. We assessed inpatient documentation for all relevant criteria as per RCP guidelines. Inpatient documentation included; the admission notes, post take ward round, daily ward rounds and inter-speciality discussions.

Results

A total of 88 patient related entries were reviewed. Of these 89.8% were dated. 42.0% of the entries were timed, with inter-specialty discussion having the highest percentage of recorded times. 93.2% had a standardised structure. The structure of admission entries was the most consistent with standards. 6.8% and 3.4% had the authors designation and signature respectively.

Conclusion

Clear informative documentation is pivotal for safe and effective patient care. Failure of patient documentation to meet the stipulated standards was established in this audit. Factors including inadequate junior doctor training, pace of ward rounds and reliance on electronic noting systems are potential reasons for poor compliance. Capitalising on opportunities to educate junior doctors is paramount in improving patient care.
FP6.10 - Improving Compliance & Implementation of WHO Surgical Safety Checklist At a Tertiary Level Hospital in India: A continuous process
Authors: Sinha Akatya , Kadam Sameer
Published: September 2024

Aim

To complete an audit on the level of compliance with the WHO surgical safety checklist in surgical operating theatres at a Tertiary level hospital in India.

Method

A total of 40 general surgeries were observed at the operating theatres at a tertiary-level hospital in India to confirm the practice of the WHO surgical safety checklist. The study was conducted for 1 month in September 2021. The results were compared with standard guidelines and further analyzed. Interventions were carried out through a series of rigorous departmental meetings and discussions with the medical and nursing staff. A re-audit was conducted.

Results

Of all the operations audited, 45% Sign-In and only 1% Sign-Out were performed in the first cycle. After the re-audit, a significant change was reported as the Sign-In improved to 80%, and a 55% Sign-Out was conducted. The Time-Out was observed to increase from 15% to 65%. Compliance in the final third cycle showed improvement in Sign-In at 95%, Sign-Out at 85%, and Time-Out at 90%.

Conclusion

Though in the first cycle of our audit, the compliance to the SSCL was found to be suboptimal, significant improvement was demonstrated in the second cycle and eventually in the final third cycle bringing it closer to 100% compliance, after rigorous awareness programs and training sessions. Compliance with all items in the checklist and active participation by all medical and nursing staff is mandatory for the successful implementation of the Surgical safety checklist.
FP7.2 - Single centre experience of laparoscopic management of acute small bowel obstruction
Authors: Subramanian Atreya , Swaminathan Christie , Singh Anurag , Adhya Sushmit , Gulab Adil , Sajid Muhammad
Published: September 2024

Objectives

The objective of this article is to present a single-centre experience of laparoscopic emergency surgery reporting outcomes by laparoscopic management of acute small bowel obstruction (ASBO).

Methods

A retrospective review of case notes to evaluate postoperative outcomes. 119 patients were included in this study of laparoscopic management of ASBO and data analysis was performed with SPSS software.

Results

There were 119 patients with primary aetiologies of adhesion bands (49.5%/59) and hernia (31.9%/38) were noted. Mortality and morbidity outcomes – 15 patients had minor complications, 37 had major complications and 3 patients had post-operative mortality. The average length of stay (LOS) was 10.86 days. The LOS Subgroup analysis showed that 13.8 days were average for adhesiolysis and 6.7 days for the hernia.

Discussion

On comparison with the published data global data suggest minor complications of 12.6 % (14% in this single-centre experience), major complications of 34 % (31 % in this single-centre experience) and mortality of 0.6% (2.5 % in this single-centre experience).

Conclusion

This study shows that this centre has comparable mortality and morbidity outcomes when compared to the global trend, but these outcomes.
FP7.12 - A Three-Year Retrospective Analysis of Variables and Their Relationships as Outcome Indicators Following Emergency Laparotomies in Octogenarians: Insights from a Single Institutional Experience
Authors: Haji Altaf , Zehra Sadaf , Zohdy Mohamed , Piramanayagam Bala , Marimuthu Kalimuthu , Selvam Lourdusamy Arul
Published: September 2024

Aim

This retrospective study aims to evaluate the morbidity and mortality outcomes associated with emergency laparotomies in individuals aged 80 years and above, referred to as octogenarians. Against the backdrop of the National Emergency Laparotomy Audit's data from the Eighth Year (2020–2021), which indicates a slight increase in overall in-hospital mortality rates across all age groups, the specific focus on octogenarians intends to provide insights into the unique challenges and outcomes experienced by this elderly population undergoing emergency laparotomies.

Methods

This retrospective analysis focused on emergency laparotomies in octogenarians between June 2020 and June 2023, comprising 62 cases out of 370. Using a standardized proforma, data was collected and statistical analysis was done with SPSS.

Results

In this study involving 62 elderly patients (mean age 84) undergoing emergency laparotomies, common diagnoses included Adhesional Small Bowel Obstruction and Large Bowel Obstruction due to Diverticular Disease. Despite the absence of geriatrician involvement, the overall mortality rate was 21%, emphasizing the potential impact of geriatrician reviews. While factors like sepsis and bowel resection did not significantly influence outcomes, the study identified associations between ASA Score, diagnosis type, and predicted mortality rate with patient survival. Complications and comorbidities, such as AKI and atrial fibrillation, were linked to increased mortality.

Conclusion

In summary, emergency major abdominal surgery poses significant risks, particularly for frail and elderly individuals with multiple co-morbidities. Recognizing frailty as an independent risk factor is crucial. While assessing frailty is complex, open discussions with patients and families about the substantial surgery-related risks are imperative. Establishing realistic expectations is vital for informed decision-making and patient-centered care.
FP7.19 - PIXEL: Patient Information and eXplanation following Emergency Laparotomy
Authors: Silva Louise , Amy Hillier , Williams Hayley , Cornish Julie Ann
Published: September 2024

Aims

80% of patients that survive an emergency laparotomy (EmLap) report that they would have preferred more information on “what to expect” during their recovery; information is often delivered on a variable adhoc inpatient basis. This work aims to assess the robustness of a multi-disciplinary prepared patient information leaflet (PIL), by use of a patient questionnaire, and the Ensuring Quality Information for Patients (EQIP) toolkit.

Methods

A 21-page PIL was prepared by the EmLap MDT at our institute. The PIL’s objective was to outline common issues encountered during recovery, factors that could aid recovery, and signpost relevant resources. POLO enrolled patients (ClinicalTrials.Gov:NCT05281627) were asked their opinion by completion of an 8-point questionnaire at their 12-month follow-up. The PIL was also scored using the EQIP tool by an independent healthcare professional.

Results

30 patients took part. 66.6% were female; average age was 63 years. 100% patients felt the PIL was easy to understand; 96.6% felt it covered all appropriate content. When asked about the length of the PIL: 93.3% felt the length of the leaflet was just right; 6.7% felt that the leaflet was too long. The PIL was found to be 93.3% compliant with the EQIP tool.

Conclusions

This is the first study to demonstrate the robustness of a PIL concerning EmLap recovery, suggesting it can be applied to a national audience. It is accepted that the leaflet is long; future iterations may benefit from being in a different format e.g. visuo-audio.
FP7.20 - Peri-orbital burns: A 5-Year Review of the Epidemiological Characteristics and Outcomes at a Regional Burns Centre in the UK 2019 – 2023
Authors: Hassan Rawan , Clements Jamie , Black Claire , Fogarty Brendan , Hodgins Nicholas , Rashid Abid
Published: September 2024

Background

Burn injuries are a major cause of global morbidity. Despite being infrequent, peri-orbital and ocular burns can have significant implications on a patient’s vision and overall quality of life. In Northern Ireland, the current epidemiological landscape of peri-orbital burns is not clear. This study aimed at assessing the incidence of peri-orbital and ocular burns and the management outcomes of patients admitted at the regional burns unit in Northern Ireland 2019-2023.

Methods

Patients admitted to the regional burns unit in Northern Ireland between January 2019 and September 2023 with periorbital burns were identified from the burns unit electronic records, the burns unit database and hospital image database.

Results

Over 5 years, 100 patients with facial burns were treated, including 60 patients with eyelid burns. 71% were males and 29% were females with a mean age of 47 years. The mean burn size was 14% total body surface area. The burn depth varied; 55% superficial partial thickness, 22% mixed, 17% full thickness and 6% deep dermal. Majority of burns were flame burns 64%. In total, 7 patients sustained corneal burns, one patient responded to steroids, one underwent amniotic membrane grafting, one lost complete vision in both eyes, one had physical debridement and topical antimicrobials and three patients required periorbital reconstruction to maintain eye closure.

Conclusion

60% of Facial burns were associated with eyelid burns, the majority of which were caused by flame burns and were managed conservatively with wound cleaning, physical debridement, and application of topical antimicrobials. Despite being rare, complete loss of vision was associated with mortality among our patients.
EP120 - A Retrospective Review of Pregnant Patients Referred to an Emergency General Surgery Service
Authors: Gahunia Sukhpreet , Bhobe Dhruvi , Kenington Cleo
Published: September 2024

Aims

To gain insight into the journey and outcomes of pregnant patients referred to an emergency general surgery service.

Methods

Surgical handover lists from Jan 2021-Dec 2023 were reviewed to identify pregnant patients referred to the service. Data was collected from the electronic patient record on demographics, timeline, imaging, diagnosis, management and subsequent delivery method if pregnancy reached term.

Results

There were 91 referrals of pregnant women to the emergency general surgery service over the 3 year period. 80% were for abdominal pain. 64% of patients received a documented review by a general surgery consultant, and 35% received a documented review by an obstetric consultant. For those presenting with abdominal pain, 79% had imaging other than plain film, the most common being ultrasound abdomen (75%). 5% of patients had an MRI abdomen and pelvis, and 4% of patients had a CT abdomen and pelvis. Of the 21 patients treated for a confirmed abdominal surgical diagnosis who had a documented delivery, 29% required emergency c-sections. In comparison, out of 17 patients who had either non-surgical pathologies or extra-abdominal surgical pathologies, excluding pregnancy-related complications, 0 went on to have emergency c-sections. This is statistically significant (p=0.0241).

Conclusion

The investigation and management of an acute abdomen in pregnancy poses a number of unique challenges. Our dataset, though small, has hinted at unacceptable rates of consultant review and under-utilisation of cross-sectional imaging. Furthermore, there is the suggestion that patients with confirmed abdominal surgical pathology may be at increased risk of delivering via emergency c-section. There is a need for further research into this patient population.
EP218 - A closed-loop audit on the assessment of the documentation of frailty at admission in emergency general surgery admission at a tertiary care hospital
Authors: Singh Anurag , Siby Jayas , Kaur Mandeep , Sajid Muhammad
Published: September 2024

Background

NHS frailty guidelines advise that frailty score should be documented at the first time of contact for patients aged 65+ years. The Aim of this quality improvement project (QIP) was to assess the adequate documentation of frailty at the time of first encounter by the general surgery department for patients aged 65+ years.

Method

Data was collected for October 2022 for the first cycle and January and February 2023 for the second cycle. Data collection was done from an electronic database in the trust and patient notes maintained throughout the admission.

Results

136 patients were included in the QIP for the first cycle. 3/136 (2.2%) patients had documented frailty at the first encounter. These findings were discussed in the clinical governance meeting, followed by a teaching session for the junior doctors. A specific section was added in the documentation as a reminder for the team to document the frailty upon the first encounter.

212 patients were included in the second cycle and documentation of frailty improved to 39/212 (18.4%).

Conclusion

There was a lack of documentation, which improved after the intervention advised by QIP. A teaching session for new junior doctors is planned at the induction session, to strengthen the importance of frailty documentation.
EP369 - Abscess as unplanned returns to theatres in Emergency General Surgery
Authors: Salam Ammara , Patel Bhavnisha , Alabri Badar , Osunlusi Oluwafemi , Waraich Naseem
Published: September 2024

Aim

Unplanned Return to Theatre (URTT) impacts patient care along with financial and legal implications on hospital resources. This can be reduced by identifying the contributing factors and measures taken to rectify them. This study was conducted at District General Hospital in England, aims to review the incidence of URTT in Emergency General Surgery and identify the preventable causes.

Method

A retrospective review was conducted for all Emergency General Surgical Procedures done between 1st January 2019 to 31st January 2021. The data was obtained from the Hospital data softwares Fusion and Bluespier, in addition to the paper notes. The operations were classified as index operation, followed by the number of returns and the indication for the URTT.

Result

A total number of 1578 emergency general surgery operations were performed during a period of 25 months (Jan 2019 to January 2021). The unplanned return to theatres (URTT) were 85 (5.3%), with a 90-day mortality of 16. Among these, 29.4% (25) URTT were abscess. The major reason (66%) for this URRT was inadequate drainage requiring redo/debridement. The other reasons were laying open of fistula/seton placement (30%) and stoma formation (4%). Level of operating surgeon was Consultant (8%), Registrar/Core Trainee (64%) and missing data (28%).

Conclusion

Abscess is a frequently performed operation in Emergency General Surgery. Knowledge of anatomy with adequate incision ensuring good drainage of the abscess can prevent URTT for abscess, improving patient outcomes and cost benefits.
EP376 - Portal Pyaemia and Fungal Septicaemia Associated with Mesenteric Venous Pneumatosis - Improving Patient Outcomes
Authors: Kumar Anusha , Bath Michael , Hussein Halil , Nair Manoj
Published: September 2024

An 82 year old female presented to A&E with a 1 week history of lower abdominal pain, fever, and nausea. She had a known history of sigmoid diverticulosis, however had not had any previous abdominal surgery, and had no other past medical history of note.

At presentation she was in septic shock, requiring vasopressor support to maintain her blood pressure. Her abdominal examination revealed left iliac fossa tenderness, however no features of peritonism. Initial investigations revealed a White Cell Count (WCC) 49.3x10^9/L, a C-Reactive Protein (CRP) 191mg/L, and an ALP of 434IU/L. A CT scan of the abdomen and pelvis confirmed acute sigmoid diverticulitis, with radiological features suggesting gas tracking along the inferior mesenteric vein (IMV).

An emergency Hartmann’s procedure was performed, and intra-operatively pus was evidence draining directly from the IMV. Pre-operative blood cultures and intra-operative tissue cultures grew Escherichia coli, for which the patient was treated with intravenous meropenem post-operatively. She was transferred to Intensive Care Unit and stepped down to the ward on post-operative day 5. Within the first 48 hours post-operative, the WCC had risen to 64x10^9/L, however within 72 hours of commencing anti-fungals, this dramatically decreased to 16x10^9/L. After this, her recovery was swift, and was discharged shortly after.

In the context of acute diverticulitis, any radiological evidence of gas within the portal venous system is likely secondary to portal pyaemia. Urgent operative intervention for source control remains the mainstay of management, with consideration of anti-fungals imperative.
EP392 - Different modalities used in the investigation of anorectal lesions: a case report and discussion
Authors: Saraee Danial , Pai Deepak , Kaur Geetinder
Published: September 2024

Introduction

Endoanal ultrasound scan (EAUS) /MRI rectum followed by early open/endoscopic, resection/biopsy for histology are important to plan management of all anorectal lesions. Here, we report an incidentally found inter-sphincteric lesion investigated with both EAUS and MRI scans, followed by excision.

Case report

A 55-year-old patient presented with post-menopausal bleeding and was investigated with an MRI pelvis which confirmed the causative subserosal fibroid. An incidental 15x12 mm focal soft tissue lesion at 2 o’clock between the internal and external anal canal sphincters was also picked up by the consultant GI radiologist. Her colonoscopy was normal but her digital rectal examination revealed a palpable submucosal elongated pea shaped lump at 2 o’clock. A lower GI specialist nurse performed an EAUS which suggested the lesion to be at 10 o’clock. At examination under anaesthetic (EUA), the mass in the inter-sphincter anal canal was confirmed at 2 o’clock, and excised after careful dissection from its intersphincteric location; histology confirmed a leiomyoma. The patient recovered well from the procedure.

Discussion

MRI and endoanal ultrasound are key imaging modalities in the diagnosis of rectal masses. EAUS provides more accurate assessment of depth of tumour invasion compared to MRI, and its relation to the anal sphincters; however, the scans are highly operator-dependent, as we found, and need to be interpreted with the benefit of clinical examination.

Conclusion

MRI and EAUS are complimentary in investigating rectal masses; however clinical examination, (especially under anaesthetic), as well as histology, gives the best information to plan subsequent management of common and unusual lesions (such as this) in the anorectum.
EP395 - Pneumatosis Cystoides intestinalis: difficulty in diagnosis and investigation: a case report
Authors: Christie Joshua , Saraee Danial , Khadka Subodh , Kaur Geetinder
Published: September 2024

Background

Pneumotosis cystoides intestinalis (PCI) is a rare condition characterised by the presence of intramural air or cystic lesions within the submucosa/subserosa of the small or large bowel (pneumatosis coli or PC). In the majority, it is an incidental finding and managed conservatively. Occasionally, it can create a dilemma regarding diagnosis, investigation and management. We present one such patient to illustrate this.

Case report

A 59-year old male presented as an emergency with abdominal pain. A CT KUB suggested free air surrounding the sigmoid colon? perforation. Following review, a subsequent contrast -CT confirmed PCI but no free peritoneal air. He was managed conservatively and discharged. He re-presented a few times to the ED with similar complaints and scans. He was then seen electively in a colorectal OPD and advised a colonoscopy and CT scan. This CT did not report the PCI. The colonoscopy was difficult, incomplete and consistent with PC with inflammation. Histology from cautiously taken biopsies was reported normal.

Results

On review in MDT, the need for investigating his symptoms versus serious concerns regarding a repeat colonoscopy and the relative contradiction to virtual CT colonoscopy were discussed. Finally, a qFIT test was performed, reported negative and the provisional diagnosis of IBS was reached, the patient reassured and discharged on conservative medical management.

Conclusions

This case highlights the rare condition of PCI and the various modes of presentation. It emphasises the importance of accurate CT diagnosis in the emergency setting and the use of qFIT to guide cautious elective colonoscopy/biopsies if indicated.
EP421 - The multidisciplinary management of acute pancreatitis at a district general hospital – an NCEPOD audit
Authors: Jones Thomas , Heppell Cara , Chatzikonstantinou Michail
Published: September 2024

Aim

To assess adherence to NCEPOD Acute Pancreatitis 2016 guidelines in order to optimise the multidisciplinary care of patients presenting with acute pancreatitis.

Methods

A retrospective case-based audit was conducted of the last 10 admissions with acute pancreatitis. Data on demographics, investigations and management were collected and audited against the NCEPOD evidence-based recommendations.

Results

The average age was 54 years (33-84) and 70% were male. The cause of the acute pancreatitis was identified as gallstones in 40%, alcohol in 30% and was unknown in the remaining 30%. All patients with alcoholic pancreatitis were referred to alcohol support services. 80% of all patients had significant co-morbidities at presentation: in 63% of patients these were well-controlled; of those uncontrolled, none received onwards referrals. Nutritional assessment only occurred in 10% of patients.

Conclusions

Our audit showed that we successfully identified a cause of acute pancreatitis in 70% of patients and involved alcohol services in 100% of alcoholic pancreatitis cases. This demonstrates good organisational infrastructure in managing these patients. However, despite the highlighted importance in the NCEPOD report, patients were not appropriately referred to dietitians or other medical specialities. We have therefore developed a series of multi-disciplinary team teaching sessions and an admission proforma to address these areas of the report and improve compliance. A second audit loop will be conducted to demonstrate impact.
EP530 - Facial Features after Weight Loss (FACE-WL) Study: A Protocol for a 1- year Multicentre Longitudinal Prospective Study
Authors: Wong Zhen Yu , Pouwels Sjaak
Published: September 2024

Introduction

Obesity is a pressing public health concern and various effective interventions have been implemented for weight loss in patients with obesity. The effect of weight loss is not restricted to only limbs and trunks but the changes in the anatomy of the face and facial structure have received limited attention. In view of the paucity of studies examining facial feature changes after weight loss, the FACE-WL study aims to examine the facial changes for patients post weight loss.

Methods

The FACE-WL study is a multicentre 1-year longitudinal prospective cohort study, within a real-world routine clinical care setting aiming to recruit 500 patients after losing weight via either conservative, medical or surgical management. Photos of patients’ faces would be taken pre-intervention (T0) and post intervention after 3 (T1), 6 (T2), 9 (T3) and 12 months (T4), coincide with normal follow-up care visits. Photographs will be analysed using the Emotrics software, which automatically identifies facial landmarks and computes differences in position. Participants’ sociodemographic data, health-related quality of life, clinical outcome, and surgical data if applicable will be completed by the study team at the baseline visit and subsequent follow-up visit.

Ethics And Dissemination

Its results will be disseminated through manuscripts in clinical/academic journals and presentations at professional conferences, and through participant and stakeholder communications.
EP552 - Colonoscope Incarceration in an Inguinal Hernia: A Case Report
Authors: Kakos Christos , Curry Heather , Khan Khurram S
Published: September 2024

Aim

We report a rare case of incarceration of a colonoscope within left inguinal hernia, highlighting the unusual circumstances and challenges faced by colonoscopists.

Case presentation

An 83-year-old male patient with a known left inguinal hernia underwent an urgent colonoscopy for positive quantitative faecal immunochemical test, anaemia, weight loss and fatigue. The patient had declined any form of analgesia/sedation for colonoscopy. Scope guide was used during the procedure. Initially, a proximal sigmoid loop was negotiated successfully. The colonoscope reached the mid transverse colon but the procedure became uncomfortable for the patient. There was an obvious loop on the scope guide which could not be reduced despite various manoeuvres. An attempt to apply external pressure to allow progression revealed a large left inguinal hernia containing a loop of the colonoscope. Thus, it was decided to discontinue the procedure, however, unexpectedly, during withdrawal, the colonoscope became lodged. Attempts to manually reduce this were very uncomfortable for the patient, therefore, intravenous access was gained to administer sedation & analgesia. Another colleague was summoned to assist with manual reduction while simultaneously withdrawing the colonoscope allowing for reduction of the hernia and removal of the colonoscope. The patient was kept overnight for observations and was discharged home the following day. Subsequently CT colonography confirmed large left inguinal hernia containing sigmoid colon.

Conclusion

This case delves into the intricate details of the incident, exploring the contributing factors, such as the patient's medical history and the nature of the hernia. We discuss ways to avoid this complication in the future as well as suggest a technique for resolution of the complication.
EP553 - Omental Infarction mimicking acute cholecystitis - A Case Report
Authors: Curry Heather , Kakos Christos , Khan Khurram S
Published: September 2024

Introduction

Spontaneous torsion and infarction of the omentum is a rare presentation with a variety of clinical presentations. We report a middle-aged male patient who presented with signs and symptoms mimicking acute cholecystitis.

Case Presentation

A 47-year-old man presented with an 18-hour history of right upper quadrant (RUQ) pain. Pain was constant, worse on movement and inspiration. On examination, he was exceptionally tender in the RUQ with positive Murphy’s sign. Initial investigations showed a mild inflammatory response, and the working diagnosis was acute cholecystitis. An abdominal ultrasound scan demonstrated a thin-walled gallbladder, free from gallstones and no evidence of acute cholecystitis. Given the patients ongoing severe pain and examination findings, a CT scan of abdomen and pelvis with contrast was performed. This demonstrated an oval shaped area of localized omental fat stranding in the RUQ, suggestive of omental infarction. The patient was managed conservatively with analgesia and discharged once symptoms were adequately controlled.

Discussion

Torted, infarcted omentum is a rare cause of acute abdominal pain. It is more frequently observed in 40–50-year-olds with male predominance. Most commonly it mimics symptoms and signs of acute appendicitis. However, this is a rare case mimicking acute cholecystitis. In this case, the necrotic segment was adherent with the anterior abdominal wall, causing significant pain and tenderness. When the clinically presentation of acute cholecystitis is not reflected by abdominal ultrasound, cross sectional imaging should be obtained to ensure definitive diagnosis is established in timely manner.
EP554 - Sigmoid Diverticular Perforation Mimicking Boerhaave Syndrome – A Case Report
Authors: Ong Hui-Ling , Ghita Ryan , Khan Khurram S
Published: September 2024

Introduction

Subcutaneous emphysema is a rare presenting complaint and can represent severe underlying pathology. Atypical occurrences of abdominal emphysema in diverticular perforations have been reported but emphysema within the thorax and neck due to sigmoid perforation is rare. We present an elderly male patient who presented with neck surgical emphysema secondary to diverticular perforation.

Case presentation

A 78-year-old man presented with two days history of shortness of breath and two weeks history of abdominal pain worse on coughing, newly hoarse voice, one episode of vomiting and fever. His past medical history included palliative malignant melanoma, ischaemic heart disease, asthma and chronic kidney disease. At presentation, he was tachycardic and had 95% oxygen saturation. Physical examination revealed extensive upper body subcutaneous emphysema and tender lower abdomen. Admission blood tests showed white cell count of 9.8 x 109 and C-reactive protein of 148mg/L. Urgent contrast CT scan with oral contrast excluded oesophageal perforation but demonstrated perforated sigmoid diverticulum. Due to the patient’s extensive co-morbidities and limited intra-abdominal contamination, he was managed conservatively.

Discussion

The patient initially had CT chest with IV contrast followed by CT with oral contrast, encompassing the abdomen and pelvis, leading to the accurate diagnosis. The presumed path of gas tracking from the perforation through the diaphragmatic hiatus contributed to the delay in reaching the correct diagnosis. In cases where patients present with subcutaneous emphysema in the upper body, particularly when CT thorax with oral contrast has ruled out oesophageal perforation, clinical suspicion for intra-abdominal causes should persist. Despite the presence of significant surgical emphysema, this patient demonstrated a favourable response to conservative measures.
EP612 - Laparoscopic repair of sciatic hernia: A demonstrative case on minimally invasive technique
Authors: Saravanan Nivetha , Pannu Arslan , Ravi Krish
Published: September 2024

Background

Sciatic hernias are rare pelvic hernias that pose significant diagnostic and therapeutic challenges. A minimally invasive approach to repairing these defects offers the potential for reduced morbidity and quicker recovery. This report aims to highlight the feasibility, safety and provide an illustrative demonstration of the laparoscopic repair of a sciatic hernia.

Methods

A 72-year-old asymptomatic female diagnosed with a sciatic hernia underwent elective laparoscopic hernia repair as a day case. The preoperative evaluation, surgical technique and operative outcomes are detailed.

Results

A right-sided sciatic hernia containing a loop of the small bowel was diagnosed on cross-sectional imaging. Laparoscopically, a pre-peritoneal space in the right ovarian fossa was established, the hernia defect was delineated, and repair was performed using a polypropylene mesh prosthesis. No intraoperative or immediate postoperative adverse outcomes were reported. The patient was discharged on the same day, experiencing minimal discomfort, with a plan for outpatient follow-up. The literature on sciatic hernia repair is limited, and multiple operative techniques have been described. This report includes a step-by-step pictorial description of the laparoscopic sciatic hernia repair.

Conclusion

Laparoscopic repair of sciatic hernias can be performed safely and effectively, offering advantages such as reduced pain and faster recovery. This case underscores the importance of considering laparoscopic approaches for managing complex and rare hernias in the elderly population, emphasising tailored surgical planning and skilled execution.
EP631 - Do patients with acute diverticulitis need to be in the hospital? - Implementation of an @Home treatment pathway to reduce admissions
Authors: Batra Suketu , Winterborn Rebecca , Saunders Lucinda , Pullybank Anne
Published: September 2024

This abstract was published in Volume 110, Supplement 10, December 2023 ASGBI Emergency General Surgery Symposium. 1st November 2023. Glasgow, UK, and can be accessed at https://academic.oup.com/bjs/article/110/Supplement_10/znad388.019/7455168
Moving beyond the mean: an analysis of faecal corticosterone metabolites shows substantial variability both within and across white-tailed deer populations
Authors: Sutton Nicholas M , Suski Cory , Payne Keegan , O’Dwyer James P
Published: September 2024

Glucocorticoid (GC) levels have significant impacts on the health and behaviour of wildlife populations and are involved in many essential body functions including circadian rhythm, stress physiology and metabolism. However, studies of GCs in wildlife often focus on estimating mean hormone levels in populations, or a subset of a population, rather than on assessing the entire distribution of hormone levels within populations. Additionally, explorations of population GC data are limited due to the tradeoff between the number of individuals included in studies and the amount of data per individual that can be collected. In this study, we explore patterns of GC level distributions in three white-tailed deer (Odocoileus virginianus) populations using a non-invasive, opportunistic sampling approach. GC levels were assessed by measuring faecal corticosterone metabolite levels (‘fCMs’) from deer faecal samples throughout the year. We found both population and seasonal differences in fCMs but observed similarly shaped fCM distributions in all populations. Specifically, all population fCM cumulative distributions were found to be very heavy-tailed. We developed two toy models of acute corticosterone elevation in an effort to recreate the observed heavy-tailed distributions. We found that, in all three populations, cumulative fCM distributions were better described by an assumption of large, periodic spikes in corticosterone levels every few days, as opposed to an assumption of random spikes in corticosterone levels. The analyses presented in this study demonstrate the potential for exploring population-level patterns of GC levels from random, opportunistically sampled data. When taken together with individual-focused studies of GC levels, such analyses can improve our understanding of how individual hormone production scales up to population-level patterns.
An evolving roadmap: using mitochondrial physiology to help guide conservation efforts
Authors: Thoral Elisa , Dawson Neal J , Bettinazzi Stefano , Rodríguez Enrique
Published: September 2024

The crucial role of aerobic energy production in sustaining eukaryotic life positions mitochondrial processes as key determinants of an animal's ability to withstand unpredictable environments. The advent of new techniques facilitating the measurement of mitochondrial function offers an increasingly promising tool for conservation approaches. Herein, we synthesize the current knowledge on the links between mitochondrial bioenergetics, ecophysiology and local adaptation, expanding them to the wider conservation physiology field. We discuss recent findings linking cellular bioenergetics to whole-animal fitness, in the current context of climate change. We summarize topics, questions, methods, pitfalls and caveats to help provide a comprehensive roadmap for studying mitochondria from a conservation perspective. Our overall aim is to help guide conservation in natural populations, outlining the methods and techniques that could be most useful to assess mitochondrial function in the field.
Exploring near-infrared spectroscopy and hyperspectral imaging as novel characterization methods for anaerobic gut fungi
Authors: Neurauter Markus , Vinzelj Julia M , Strobl Sophia F A , Kappacher Christoph , Schlappack Tobias , Badzoka Jovan , Rainer Matthias , Huck Christian W , Podmirseg Sabine M
Published: September 2024

Neocallimastigomycota are a phylum of anaerobic gut fungi (AGF) that inhabit the gastrointestinal tract of herbivores and play a pivotal role in plant matter degradation. Their identification and characterization with marker gene regions has long been hampered due to the high inter- and intraspecies length variability in the commonly used fungal marker gene region internal transcribed spacer (ITS). While recent research has improved methodology (i.e. switch to LSU D2 as marker region), molecular methods will always introduce bias through nucleic acid extraction or PCR amplification. Here, near-infrared spectroscopy (NIRS) and hyperspectral imaging (HSI) are introduced as two nucleic acid sequence-independent tools for the characterization and identification of AGF strains. We present a proof-of-concept for both, achieving an independent prediction accuracy of above 95% for models based on discriminant analysis trained with samples of three different genera. We further demonstrated the robustness of the NIRS model by testing it on cultures of different growth times. Overall, NIRS provides a simple, reliable, and nondestructive approach for AGF classification, independent of molecular approaches. The HSI method provides further advantages by requiring less biomass and adding spatial information, a valuable feature if this method is extended to mixed cultures or environmental samples in the future.