bluuebunny/crossref_metadata_2025 huggingface dataset:
FP2.4 - Assessment of Outcomes Reported in Elective Colorectal Cancer Surgery Research for Elderly Patients: A Scoping Review
Authors: Bhattacharya Yagnaseni , Xavier Hepsi , Ramsay George , Poobalan Amudha , Brazzelli Miriam
Published: September 2024

Aim

This scoping review aimed to identify outcome measures for assessing the impact of elective colorectal cancer surgery on elderly patients, given their higher surgical risk and mortality rates. Conventional surgery-specific outcomes, like 5-year mortality rates, may not be appropriate, necessitating a focus on postoperative quality of life. The challenge lies in determining optimal outcomes to assess the effects of colorectal cancer resections in the elderly.

Methods

A comprehensive literature search of major electronic databases from inception to March 2023 was conducted. Studies exploring frail or elderly individuals with colorectal cancer undergoing elective surgery and reporting postoperative outcomes were included. Outcomes were classified as surgery-specific versus geriatric-specific and summarised using a narrative synthesis. The type and rate of surgery-specific outcomes were tabulated.

Results

Of 1366 identified citations, 16 studies focused on geriatric-specific outcomes and 66 exclusively on surgery-specific outcomes. Nine of the 16 ‘geriatric-specific outcome’ studies reported discharge destination, with home discharge being predominant. Postoperative delirium ranged from 8.2% to 18.1% in six studies. Four studies explored geriatric syndromes and three analysed activities of daily living. Three studies reported a significant improvement in quality of life. The 66 ‘surgery-specific outcome’ studies assessed mortality (N=61); length of stay (N=40); postoperative complications (N=47); readmission (N=18); reoperation (N=16); and survival (N=42).

Conclusion

Geriatric-specific outcomes are underreported, despite their importance in guiding patient management. Elderly patients require adequate information about their recovery after surgery to manage their lives better. Future research must address this gap to improve care for the elderly undergoing elective colorectal cancer surgery.
FP3.2 - Pre-Treatment Neutrophil–Lymphocyte/ Lymphocyte-Monocyte Ratios: Are They Useful Prognostic Biomarkers In Locally Advanced Rectal Cancers?
Authors: Chaudhury Madhu P , Lim William , Manatakis Dimitris , Mitchell Peter J , Kearsey Chris C
Published: September 2024

Aim

Examining the relationship & outcome between pre operative Neutrophil:Lymphocyte Ratio, Neutrophil:Monocyte Ratio & Lymphocyte:Monocyte Ratio in a cohort of locally advanced complex pelvic tumours, involving the rectum, where the patients underwent resection with curative intent.

Methods

The retrospective data collected from 2013 to 2022. Cases where rectum resection was not involved were excluded. The Kaplan-Meier curve was employed to estimate the survival function, with overall survival defined as the duration from the date of the first surgery to the date of death from any cause. The final data input point was last attendance at the hospital or the date of death. Disease-free survival was calculated and disease recurrence was determined based on a combination of radiological, histopathological, and/or endoscopic results.

Results

The data encompassed 72 cases. The male-to-female ratio was 1:0.85. Kaplan-Meier curves were used to calculate over-all disease free survival. Our results from Neut:Lymph ratio did not show any significant correlation in overall survival and disease free survival. For Neut:Monocytes ratio, all cases in our cohort had high ratio but this comparison was not published elsewhere for our comparison. Finally, for Lymph:Monocytes, when compared to Gawiński’s data, our disease free survival was found to be significant at p<0.0425 suggesting that the likelihood of recurrence is high. Our overall survival did not have any significant findings.

Conclusions

In all cancer cases, the neutrophil-to-monocyte ratio consistently showed high averages, raising the question of whether this ratio could potentially serve as a more effective biomarker. The analysis remains a work in progress with further variables to compare.
FP3.5 - Colonoscopy post diverticulitis – Compliance with ACPGBI guidance in a single centre audit
Authors: Castelhano Rute , Helmy Naderadel , Linzell Aoife , Davies Emma
Published: September 2024

Introduction

For decades the management of acute diverticulitis (AD) has included endoscopic evaluation to exclude malignancy. In complicated AD, the incidence of colonic neoplasia is between 7.8%-10.9% (1-5) so interval colonoscopy remains mandatory. However, in uncomplicated AD, the incidence is low, 1.6%-1.9% (1-5), therefore the routine colonoscopy may be unnecessary in this group. This audit aims to assess our single-centre compliance with the ACPGBI guidance of colonoscopy post-diverticulitis.

Methods

A retrospective single-centre audit enrolled 120 patients with CT-confirmed diverticulitis over 18 months. Patient identification involved on-call handover sheets or PACS reports containing "diverticulitis" or "complicated diverticular disease." Patient scans were reviewed, and their management was studied.

Results

Number Number Uncomplicated Surgery 0 (Hinchey 1A+1B) No surgery 90 (75%) Colonoscopy 71 (59%) No colonoscopy 19 (16%) Surgery 15 (12.5%) Complicated (Hinchey 2 or greater) No surgery 15 (12.5%) Colonoscopy 11 (9.2%) No colonoscopy 4 (3.3%) Total 120

3.3% of complicated diverticulitis did not undergo colonoscopy due to patient choice, comorbidities or frailty. Among the 82 patients who underwent colonoscopy, there was no detection of CRC, resulting in a 0% detection rate.

Conclusion

In this 120-patient cohort, the incidence of colorectal cancer was 0%, which is in keeping with the published data. 78.9% of patients with uncomplicated diverticulitis underwent colonoscopy, which may have been unnecessary. The use of faecal immunochemical testing may be beneficial as an adjunct to avoid endoscopy in this group, whilst taking into consideration individual risk factors such as age, clinical suspicion of malignancy or concerning features on imaging.
FP4.1 - Impact of adjuvant chemotherapy on the 5 Year Overall Survival for non-metastatic colon cancer patients in Bulgaria - a population wide based observational study
Authors: Ravendran Kapilraj , Balagumar Kowthaman , Raja Ahsan
Published: September 2024

Aim

Colon cancer patients who receive adjuvant chemotherapy later in life have lower survival rates. NCCN guidelines recommend the use of adjuvant chemotherapy for patients with non-metastatic colon cancer. Our study's objective was to examine how adjuvant chemotherapy affected the 5-year overall survival (OS) of patients diagnosed with non-metastatic colon cancer in Bulgaria.

Methodology

This is a retrospective population-wide observational analysis of 8968 cases that was reported as colorectal cancer (CRC) in the Bulgarian National Cancer Registry (BNCR) from 2015 to 2016. The mean and median ages of patients with right colon (RCC) and left colon (LCC) were examined. An analysis was conducted to determine the effect of adjuvant chemotherapy on the 5-year overall survival for non-metastatic colon cancer. To estimate the statistical significance, chi-squared tests, ANOVA, and the Kaplan-Meier curve with log rank were employed.

Results

In comparison to LCC, RCC had a higher mean age at diagnosis of 68.9 versus 67.41 (p-Value=<0.001). For RCC and LCC, the corresponding median ages at diagnosis were 69 and 68.

The 5-year OS for patients with non-metastatic colon cancer who received adjuvant chemotherapy was higher than for patients who did not (67.8% vs. 59%, respectively, p-Value=0.007), according to our study. Adjuvant chemotherapy was given to slightly more than 30% of patients.

Conclusion

The 5-Year OS for patients with non-metastatic colon cancer is improved by adjuvant chemotherapy, and Bulgaria should follow NCCN guidelines. The implementation of a systematic screening program can be advantageous for Bulgaria as well.
FP4.12 - Enterocolic lymphocytic phlebitis masquerading as a malignant stricture in the cecum
Authors: Agrawal Dakshita , Agrawal Rakshita , Mohamedahmed Ali Yasen , Narayanasamy Sangara , Ramasamy Sadhasivam , Husain Najam
Published: September 2024

Introduction

Enterocolic lymphocytic phlebitis (ELP) is an idiopathic form of venous inflammation which is limited to the gastrointestinal tract. It is characterised by inflammation of the veins with no involvement of the arteries. Usually, It presents with gastrointestinal symptoms such as abdominal pain, and imaging may suggest malignancy.

Case history

A 56-year-old woman presented with fresh blood in her stools, abdominal pain and diarrhoea. All blood tests were normal; however, she had a raised CRP of 105 mg/L (normal < 5 mg/L). CT abdomen and pelvis showed thickening in the transverse colon and intussusception of the terminal ileum into the caecum. She was treated conservatively and discharged when symptoms resolved with an outpatient colonoscopy. The colonoscopy was incomplete due to an unresolvable sigmoid loop; CT colonography showed caecal wall thickening, which was suggestive of caecal malignancy. Following the MDT discussion, the patient was booked for a right hemi-colectomy. The right hemicolectomy specimen histology showed no malignancy, and lymphocytic phlebitis of the submucosal, subserosa and mesenteric veins, but the arteries were normal; hence, a diagnosis of enterocolic lymphocytic phlebitis was made.

Conclusion

ELP is a rare idiopathic form of venous inflammation localised to the gastrointestinal tract, which can occasionally present similar to bowel malignancy. The diagnosis is usually confirmed with a histopathology assessment. We present this case in light of its rarity to add to the literature on this entity.
FP7.3 - Acute Appendicitis and Lung Metastasis – A rare combination
Authors: Arora Ankita , Kouvatsou Ariadni Maria , Ali Oroog
Published: September 2024

Background

Lung cancer is the third most common cancer in the UK. Although widespread metastasis is common, metastasis to the appendix is rare. Here we present a case of acute appendicitis secondary to lung metastasis.

Case Presentation

An 84-year-old man was admitted with a two-day history of right iliac fossa and suprapubic pain. He was known to have previous lung cancer treated with radical radiotherapy. Bloods on admission revealed elevated inflammatory markers with WCC 14.73 x 109/L and CRP 71.1mg/L. A Computed tomography was performed which showed acute appendicitis with perforation. An emergency laparoscopic appendicectomy was performed which showed a mid-appendiceal perforation with a localized abscess cavity. His recovery was uneventful, and the patient was discharged on postoperative day 2. Histological analysis revealed an adenocarcinoma in the appendicular lumen and within the muscle wall extending to the serosal surface. Immunochemistry profile was positive for CK, CK-19, TTF1 and Napsin A favoring a diagnosis of lung adenocarcinoma which was rationalized in the lung MDT. The patient remains under the respiratory physicians for close follow up.

Discussion

Lung metastasis to the appendix causing acute appendicitis is uncommon, with only twelve cases of appendiceal metastasis reported in the literature, ten of which presented with a perforated appendix. It may be considered as a differential for the cause of perforated acute appendicitis especially in patients with background of lung cancer.
FP7.17 - Appendiceal Foreign Bodies in Adults: A Systematic Review of Case Reports
Authors: Elmansi Abdalla Hashim E , Nour Hussameldin M , Qasim Muhammad , Magsi Abdul Malik , Sajid Muhammad S
Published: September 2024

Adults can accidentally swallow foreign bodies (FBs) with food. In rare occasions, these can lodge in the appendix lumen causing inflammation. This is known as foreign body appendicitis. We conducted this study to review different types and management of appendiceal FBs. A comprehensive search on PubMed, MEDLINE, Embase, Cochrane Library and Google Scholar was performed to detect appropriate case reports for this review. Case reports eligible for this review included patients above 18 years of age with all types of FB ingestion causing appendicitis. A total of 64 case reports were deemed to be eligible for inclusion in this systematic review. The patient mean age was 44.3 ± 16.7 years (range, 18-77). Twenty-four foreign bodies were identified in the adult appendix. They were mainly lead shot pellet, fishbone, dental crown or filling, toothpick, and others. Forty-two percent of the included patients presented with classic appendicitis pain, while 17% were asymptomatic. Moreover, the appendix was perforated in 11 patients. Regarding modalities used for diagnosis, computed tomography (CT) scans confirmed the presence of FBs in 59% of cases while X-ray only managed to detect 30%. Almost all of the cases (91%) were treated surgically with appendicectomy and only six were managed conservatively. Overall, lead shot pellets were the most common foreign body found. Fishbone and toothpick accounted for most of the perforated appendix cases. This study concludes that prophylactic appendicectomy is recommended for the management of foreign bodies detected in the appendix, even if the patient is asymptomatic.
EP3 - Reducing general surgical inpatient falls: an allied health professionals’ perspective
Authors: Zhu Limeng , George Jayan
Published: September 2024

Aims

Understand the current view of inpatient falls on a general surgical ward from allied health professionals. Identifies ways to reduce inpatient falls in general surgery.

Methods

Staff from two acute surgical wards were surveyed in December 2023. Seven questions used Likert scales (1-to-5, 1=Not preventable at all/significantly reduces the risks of falls/not confident at all/unimportant 5= Entirely preventable /significantly increases the risks of falls/very confident/important). One question focused on recent fall involvement. Modal values were taken. Data was inputted using Google Docs and analysed in Microsoft Excel.

Results

13 responded (5 nurses, 4 health care support workers, 4 sisters). 7/13 had been involved in a fall in the last six months.

Staff felt that the current post-inpatient fall proforma slightly reduces further falls risk.

Factors that staff felt significantly increases the risks of falls were reduced mobility, delirium, falls history and impaired cognition.

Factors that staff felt significantly reduces the risk of falls were, identifying patients at risk of falls, measuring lying and standing blood pressure, identifying the level of supervision for patient mobilisation, therapy assessment, initiating geriatric/falls review of high-risk falls patients, medication review, education of patients on avoiding falls and early senior clinician involvement in falls.

Most staff felt mostly confident (4) knowing how to reduce the risk of falls and managing falls.

Conclusions

Most staff are comfortable managing falls. The falls proforma needs further development incorporating areas identified in this study to help reduce inpatient falls.
EP39 - Retrospective study of delays in reversal of loop ileostomy – reasons and outcomes during the COVID era
Authors: Chen Michelle , Yoong Kevin , Liew Amos , Weeratunga Senali , Tay Yeng Kwang
Published: September 2024

Aims

Formation of loop ileostomy is common after anterior resection to reduce the sequele of an anastomosis leak.1-5 Delays to reversal of ileostomy is associated with complications.

Methods

Retrospective study between 1 July 2017 – 30 June 2023. Patients were included: >18 years old, loop ileostomy formed as part of anterior resection surgery (benign and malignant). Exclusion criteria: loop ileostomy performed during other colonic resections, patients with inflammatory bowel disease, defunctioning ileostomy for obstructions.

Primary outcome measures included complications associated with delayed closure of loop ileostomy and readmissions after reversal surgery. Secondary measures included reasons for delay to surgery, complications prior to reversal surgery, and morbidity and mortality associated with it.

Results

135 patients were included. 85.9% of patients experienced delays in reversal surgery. Those without delays in surgery had higher rate of stoma-related complications (p=0.002). Delays were due to a long waitlist (p<0.01) and adjuvant chemotherapy (p=0.598). There was no significant differences in the delays to surgery during COVID pandemic.

Delays were associated with higher rate of wound infection (6.04%), post-operative ileus (12.07%), anastomotic leak (1.72%), and Clostridium difficile (C.diff) infection (3.45%). Handsewn end to end anastomosis was associated with a higher proportion of post-operative ileus compared to the stapled side to side anastomosis group.

Conclusion

Reversal of ileostomy within 6 months of index surgery after adjuvant therapy could potentially reduce post-operative complications, and alleviate the burden on our healthcare system in the long run. A stapled side to side anastomosis should also be considered.
EP72 - Spontaneous Hepatic subcapsular Biloma Secondary to Choledocholithiasis with concurrent calculous cholecystitis
Authors: Haji Altaf , Zehra Sadaf , Elhassan Ali , Haider S I , Marimuthu Kalimuthu , Piramanayagam Bala , Harding James , Zohdhy Mohamed , Shuker Yahia
Published: September 2024

Introduction

The term "Biloma," introduced in 1979 by Gould and Patel, denotes an encapsulated extrahepatic bile collection primarily caused by iatrogenic or traumatic injuries1. Spontaneous Biloma, a rare non-traumatic occurrence, involves the spontaneous perforation of extrahepatic or intrahepatic bile ducts. In our case report, the spontaneous Biloma developed because of an abrupt increase in bile duct pressure secondary to biliary obstruction because of choledocholithiasis 2.

Case Report

We present an 85-year-old male with calculous cholecystitis and concurrent choledocholithiasis, leading to acute severe cholangitis. There was no history of surgery, instrumentation, or trauma. He exhibited hemodynamic instability and acute renal failure. Diagnostic tests revealed raised inflammatory markers and deranged liver and kidney functions. CT scans unveiled a large subcapsular liver collection compressing the parenchyma (Figure a &b), alongside dilated intrahepatic biliary radicles, common bile duct, and choledocholithiasis.

Treatment

Nowadays, treatment for spontaneous Biloma is nonsurgical. Urgent endoscopic drainage and percutaneous transhepatic cholangiogram (PTC) – (Figure c) were performed, followed by ERCP, sphincterotomy, and stone removal (Figure d) once the patient stabilized3. Subsequent CT scans indicated resolution of the subcapsular collection (Figure e). During recovery, the patient experienced a small pulmonary embolism, managed conservatively.

Conclusion

This case underscores the rare occurrence of spontaneous hepatic subcapsular Biloma associated with choledocholithiasis in an elderly patient. Timely intervention with endoscopic and radiological procedures proved effective, leading to resolution of the Biloma and successful management of causative pathology.
EP112 - An Unusual Case of Seed Bezoars Intestinal Perforation
Authors: Shafique Muhammad Salman , Bhatti Hamza Waqar , Farooqui Marryam Riaz , Hanif Muhammad
Published: September 2024

Introduction

Seed bezoars are a distinct subgroup of phytobezoars, caused by the accumulation of indigestible vegetable or fruit seeds in the intestinal lumen. Intestinal obstruction due to plant seeds is seldom encountered because of their relatively smaller size, and intestinal perforation is even rarer.

Case Report

We report a case of a 64-year-old hypertensive, diabetic and cardiac patient who came to surgical emergency department with generalized abdominal pain and vomiting for 3 days. She was tachycardiac, tachypneic and hypotensive at the initial presentation. Abdominal examination revealed tense, rigid abdomen with absent bowel sounds. Bilateral air under diaphragm was seen on an erect abdominal radiograph. Laboratory workup showed leukocytosis and metabolic acidosis. Laparotomy was performed after resuscitating the patient. Operative findings revealed gross contamination and gangrenous small bowel starting from about 8 feet distal to DJ flexure till 15 cm proximal to ICJ. There was a 2 x 2 cm perforation about 8.5 feet distal to DJ flexure secondary to obstructed seed bezoar (1 each of apricot, peach, and mango pickle seeds and 4 java plum seeds). Gangrenous small bowel was resected, and loop ileostomy was fashioned. She underwent cardioversion for ventricular tachyarrhythmias during the surgery. Post-operatively, she remained on ventilatory support in ITU but could not survive due to cardiac arrhythmias.

Conclusion

Although intestinal obstruction and perforation occur rarely due to phytobezoars, this should always be considered in the differential diagnosis, and early therapeutic intervention should be considered in morbid patients.
EP118 - Chronic Vesicouterine Fistula (Youssef's syndrome) Complete Opening of Anterior Uterine Wall in the Urinary Bladder: A- very rare case
Authors: Athar Rahmatullah , Khalaj Alireza
Published: September 2024

Background

Vesicouterine fistula is an uncommon urogenital condition typically following Caesarean sections (C/S). Youssef syndrome, characterized by haematuria, amenorrhea, and urinary incontinence, poses a diagnostic challenge and demands comprehensive assessment.

Case report

We present a case of a 40-year-old woman with persistent urine incontinence and haematuria for three years post her fourth C/S.

Clinical evaluation revealed periodic lower abdominal pain, haematuria, amenorrhea, and urine incontinence. sonography was normally reported, while cystoscopy revealed a complete 5x2 cm opening between the anterior uterine wall and the posterior bladder wall, confirming Youssef syndrome.

After a course of antibiotic therapy, surgical intervention was planned. Transabdominal total hysterectomy, partial cystectomy, and repair were performed following meticulous anatomical delineation using cystoscopy. The procedure involved dissecting the vesicouterine attachment, performing partial cystectomy, and eventually total hysterectomy. Closure of the urinary bladder defect with absorbable sutures and a negative leak test concluded the surgery. The patient showed no postoperative complications, with follow-ups at 6 and 12 months indicating complete recovery without complaints.
EP278 - The undifferentiated general surgical take over 10 years: emergency imaging
Authors: Hale Emily , Bowling Kirk
Published: September 2024

Aims

The undifferentiated emergency general surgical take in July 2013 and July 2023, at a District General Hospital, was reviewed with the aim of understanding increasing pressures on the surgical and radiology departments, and subsequently identifying areas in which we could adapt to facilitate these demands.

Methods

Patients were identified retrospectively if they had been cared for by the emergency general surgical team in July 2013 or July 2023. Further information was collected from electronic notes, with a focus on admission and initial imaging modalities. Patients were excluded if information was not available electronically.

Results

Of the 395 patients in July 2013, and 594 in July 2023, 55% and 61% respectively had imaging studies within 7 days of admission. 11% (n=44/395) of patients in 2013 had abdominal X-ray without further imaging, compared to 6% (n=33/594) in 2023. Computed Tomography (CT) use increased by 35%, whilst ultrasound scanning (USS) increased only by 11%. Time from admission to scans of all types has reduced from 0.79 days (+/-0.16, p=0.02) in 2013 to 0.60 (+/-0.1, p=0.02) days in 2023.

Conclusion

Overall volume of imaging has increased slightly, although the proportion of patients being scanned is largely unchanged, with subtle variation in preferred imaging modalities. CT is marginally more common, whilst USS remains mostly unchanged. The use of abdominal x-ray without subsequent imaging has decreased, demonstrating its reducing use in clinical judgement and reliance on alternative imaging techniques. Time from admission to scan of all kinds has reduced, despite increasing demands on radiology departments.
EP296 - Developing a computer based standardised consent form for laparoscopic cholecystectomy
Authors: Carey Charles , James Stuart , Richardson Gemma , Jaunoo Shameen
Published: September 2024

Aims

Laparoscopic cholecystectomy is a common general surgical procedure with approximately 65,000 procedures performed per year. The consent process is imperative as serious life changing and life-threatening risks must be discussed with the patient before surgery. At our trust, this is currently performed with a generic consent proforma which is filled in during each consent process. We aimed to streamline this process for clinicians and ensure all risks were discussed. Further, we aimed to ensure the process was more medico-legally sound with increased legibility by removing the handwritten aspect and ensure concordance with GMC and RCS informed consent guidance.

Methods

We produced a standard computerised consent form for laparoscopic cholecystectomy. This included a diagram to aid patient explanation and sections where all the key risks of the procedure could be checked off once discussed.

Results

The consent form has proven popular with clinicians and has streamlined the consent process. It has ensured legibility of the consent form for all involved and is therefore preferable from a medico-legal perspective. It also ensures consistency for all patients undergoing the same consent process.

Conclusions

Standardising the consent process using this procedure specific form has helped clinicians cover all the necessary areas with patients before surgery and should be considered for other common operations. Producing the consent form has also been an excellent educational opportunity for trainees, who can now consider all risks associated with laparoscopic cholecystectomy using a single document.
EP298 - Assessing the use of a rapid and standardised online operation note for laparoscopic cholecystectomy
Authors: James Stuart , Carey Charles , Richardson Gemma , Jaunoo Shameen
Published: September 2024

Aims

Laparoscopic cholecystectomy is one of the most common operations performed in the UK, with approximately 65,000 procedures performed per year. The operation note is of utmost importance as is documents the procedural steps, highlights peri-operative complications, details post-operative instructions and may act as medico-legal evidence if necessary. At our centre, operation notes are written using a blank online document and we aimed to make the process of writing these documents following laparoscopic cholecystectomy easier and more efficient.

Methods

We produced a computer based, standardised operation note for laparoscopic cholecystectomy. The document consisted of spaces for key clinical information such as the staff members involved with the operation, whether the procedure was done as an elective or emergency case and the patient’s ASA score. The document also outlined the key operative steps that could be ticked off using yes/no answers, a section for white space answers for additional details and pre-written post operative instructions that could be added to.

Results

This standardised operation note was well received by colleagues and facilitates rapid and thorough documentation. It ensures all steps are documented and so reduces the risk of omissions. Furthermore, it ensures legibility should it need to be referred to in the future, ensuring medico-legal compliance.

Conclusions

This operation note is medico-legally more rigorous, ensures legibility and is easier to use for auditing purposes. Producing the document was also an excellent trainee opportunity as it encouraged consideration of the important operative steps and outlining them in a step wise format.
EP349 - Use of Pre-operative Risk and Frailty Assessment in patients undergoing Emergency Laparotomy
Authors: Grant Malika , Gourrege Anick , Janjua A Z
Published: September 2024

Aims

Formal preoperative assessment of risk of complications and death in all patients undergoing Emergency Laparotomy is recommended by NELA (National Emergency Laparotomy Audit) in the UK. In addition, frailty assessment in patients who are 65years or older and frail undergoing Emergency Laparotomy is also recommended. In a previous 2018 audit, we had recorded Preoperative Mortality Risk in 77% patients undergoing Emergency Laparotomy and Frailty was not part of our assessment in these patients.

In this audit our aim was to evaluate documentation of preoperative frailty and risk assessment in patients undergoing Emergency Laparotomy from 2019 to 2023.

Methods

Details of all patients who underwent Emergency Laparotomy at a University Hospital under care of one surgical team between January 2019 and December 2023 were obtained from theatre logbooks. Patient notes were retrospectively reviewed to see if frailty assessment and preoperative risk assessment scores were recorded. This data was collected and analyzed using Microsoft Excel.

Results

During this period, sixty-seven patients were identified. The median age was sixty-seven with an age range from four to ninety-one. Of these 38 (57%) were females. A preoperative p-possum score was documented in 59 (88.1%), 39 (58.2%) patients were 65 years or older of these 26 (66.7%) had frailty assessment carried out.

Conclusions

Our data suggests that we have over time made progress in the use of Perioperative Risk assessment scores and incorporated frailty assessment in our perioperative practice in patient’s undergoing Emergency Laparotomy. However there remains room for improvement.
EP362 - Small Cell Ca of the Gall Bladder: A rare tumour of the gall bladder
Authors: Modi Vidita , Dnyanmote Anuradha , Nirhale Dakshayani
Published: September 2024

Small cell carcinoma (SCC) of the gallbladder is an extremely rare tumour. Despite aggressive and varied treatments, its prognosis is poor.

A 53/F presented with complaints of pain in abdomen and fever since 3 days. Patient was vitally stable and tenderness present over the epigastric, Right hypochondrium and Right lumbar region. Except leucocytosis, all labs were WNL. CECT Abdomen pelvis was suggestive of suspicious Gall bladder perforation with necrotic lymph nodes in the peri-pancreatic region. The patient was taken for exploratory laparotomy and a perforated gall bladder was seen intra op and cholecystectomy was performed. Histopathology findings were suggestive of small cell carcinoma - gall bladder and IHC markers (Synaptophysin, CD56, Ki67, EMA, CK19) sent for confirmatory findings were raised. Post op PET CT shows periportal, paracaval and aortocaval metastatic lymph nodes. Chemotherapy regimen (cisplatin + itoposide) was started post op and patient is under follow up.

The incidence of SCC of the GB is approximately 0.5% of all GB cancers. Among NETs of the gastrointestinal tract, SCC of the GB compromises 0.2%. Less than 100 cases of this tumour have been documented in the English literature. Surgery is the mainstay of GB cancer treatment. Due to poor prognosis of SCC of the GB, even when curative surgery is possible, additional treatment methods such as chemoradiation should be considered.
EP372 - Initial assessment and management of patients presenting with renal colic
Authors: Khan Nida , Kumar Meena
Published: September 2024

Aims

Abdominal colic secondary to nephrolithiasis is a common presentation to the A & E. Aim of our study is to evaluate the assessment and management of these patients in the first 24 hours of presentation and compare it to standards.

Methods

Patients admitted to a single surgical unit in a tertiary care hospital with renal or ureteric colic were included in the study. British association of urological surgeon’s guidelines were used as standard. Guidelines were as follows,NSAIDs for analgesia.CT KUB should be performed within 14 hours of admission.Urine dipstick, culture, serum creatinine, electrolyte, calcium, urate, FBC, CRP, clotting screen if per cutaneous intervention is planned. Blood culture if patient is pyrexial or has signs of SIRS.

Results

Out of 41 patients, 10 (24.3%) were given NSAIDS for pain relief, 16 (39 %) had CT KUB in 14 hours of admission, while 24 (58.5%) had ultrasound abdomen as the first investigation. All patients had FBC, urea, electrolytes, creatinine, urine routine and culture sent. Serum Calcium was sent for only 9 (21.9%) patients. CRP was sent for 8 (19.5%) patients. Out of 4 pyrexial patients, blood culture was sent for 2(50%) patients.

Conclusion

NSAIDs unless contraindicated, should be used for management of pain instead of antispasmodics. Serum calcium should be sent for all patients with renal colic. Pyrexial patients with urolithiasis should have blood cultures performed. CR KUB plain should be done for all patients of urolithiasis unless a clear contraindication like pregnancy, young age exists.

Reference- https://www.baus.org.uk/professionals/baus_business/publications/133/guidelines_for_the_management_of_acute_ureteric_colic/
EP403 - Departmental Engagement in NELA AUDIT and Royal College Standards of Risk Assessment
Authors: Nelson-Sice Robert , Choo Li , Mclachlan Greta , Kyle Ewan , Burton Sarah , Wilson Iain
Published: September 2024

Aims

A review of Theatre cases to assess compliance with the ‘National Emergency Laparotomy Audit’ (NELA) and associated guidelines. This study aims to review and ensure eligible NELA patients are being recognised. Further objectives are to verify if NELA scores are calculated and documented by an ST3+ and, in addition, if frailty is assessed as per Royal College and NELA Standards.

Methods

Data was retrospectively collected. Using ‘Epic’ EPR, all theatres from 01/05/23 - 01/12/23 were filtered for Emergency Laparotomy. These cases were manually reviewed for eligibility in NELA. 101 eligible cases were investigated to assess: documentation of NELA / Ppossum, grade of documenting Doctor, and frailty assessments / referrals.

Results

39.6% of the sample had a NELA Score documented. While even fewer at 24.8% had NELA score documented correctly by an ST3+. While 61.4% of cases had a Ppossum Score documented, only 32.7% had both NELA & Ppossum Documented.

As per NELA and National Guidelines, only 38.6% of patients 65+ received appropriate assessments of frailty.

Conclusion

National Targets for the identification of NELA patients, risk assessments and frailty assessments when appropriate are not being met. Ultimately, this presents with increased risks to patients while also reducing the data set size from which national governing bodies can produce future improvements in surgical health care. Moreover, poor engagement with National Guidelines has negative implications for departmental funding. There is a large space for improvement through education and procedural change across multiple sites with subsequent follow up reaudit.
EP465 - Transfusion Associated Circulatory Overload (TACO) Audit - A prospective analysis of adherence to standards ensuring safe transfusions
Authors: Hasni Shantul , Leung Keith , Wilkins Alexander , Pellen Michael
Published: September 2024

Aims

TACO is defined as acute or worsening respiratory compromise during or up to 12 hours of transfusion, with additional features including cardiovascular system changes not explained by the patient’s underlying medical condition.

In the UK, TACO remains a major cause of Morbidity in surgical post operative patients.

The aim of this audit was to assess whether the current trust transfusion practices are synchronous with the NICE guidelines and SHOT recommendations.

Methods

We reviewed 27 incidences of transfusion during the whole month in acute general surgical ward. Patient’s notes, trust intranet and EPMA were used for data collection. The adherence to Ng24 as well as latest SHOT recommendations was checked. Following standards were taken into account:

A formal pre-transfusion risk assessment for transfusion-associated circulatory overload (TACO) should be undertaken for all patients receiving blood transfusion and mitigating actions taken. (Serious hazards of transfusion SHOT recommendation)

Patients who develop respiratory distress during or up to 24 hours following transfusion where transfusion is suspected to be the cause must be reported to SHOT.

A structured incident review should be undertaken for every case of TACO.

Weight-adjusted red cell dosing should be used. (NICE Guidelines Ng24)

Result

TACO assessment checklist was only completed for 15% of transfusions (compared to 35% nationally) while mitigation actions were only considered for 4% of patients. There appeared discordance among junior doctors regarding TACO Management.

Conclusions

Interventions like teaching sessions, information leaflets and posters, presentation for induction pack and liaison with Transfusion practitioner team to modify transfusion pathway significantly reduced inconsistencies regarding safe transfusions and immensely improved patient management.
EP492 - Fulminant Clostridium difficile infection post reversal of ileostomy
Authors: Cheong Jeremy , Quake Sharmaine , Garud Vikram
Published: September 2024

Aims

Clostridium difficile infection (CDI) is an important cause of diarrhoea in hospitalized patients, varying from mild to fulminant forms. Fulminant CDI subsequent to the reversal of ileostomy, despite negative C. difficile toxin, is rare.

Results

We present the case of a 75-year-old male with a history of atrial fibrillation, chronic obstructive pulmonary disease and hypertension, who underwent elective ileostomy reversal following an emergency laparotomy and end ileostomy for acute diverticular bleed two years prior. Initially uncomplicated, the patient developed mild CDI on postoperative day 4 with white cell count of 18.6×109/L, evolving rapidly to severe CDI by day 6, characterized by worsening abdominal pain, worsening leukocytosis (30×109/L), and acute kidney injury stage 1. Patient was started on Vancomycin and Metronidazole, Computed Tomography (CT) scan showed uncomplicated sigmoid colitis. Despite aggressive antibiotic therapy and fluid resuscitation, the patient deteriorated on day 8, presenting with fulminant CDI, hypotension, elevated lactate of 2.6 and leukocytes of 46×109/L. Subsequent CT Imaging revealed pneumatosis coli. At that point, the patient's NELA score was 53.4%. The patient was stabilised by the critical care team prior to emergency subtotal colectomy and end ileostomy due to suspected colonic perforation. Surgical finding showed transverse colon inflammation with a hepatic flexure abscess. Patient required 14-day intensive care unit stay and 13 days of ward management before he is fit for rehab.

Conclusion

This case highlights the potential for fulminant CDI post-ileostomy reversal and highlights the challenges in managing such complications, necessitating prompt recognition and interventions to mitigate adverse outcomes.
EP503 - A retrospective assessment of quantitative futility in emergency laparotomy using pre-operative frailty as the predictor
Authors: Johnston Magnus , Fourie Amy , McEwan Joanne , Apollos Jeyakumar
Published: September 2024

Background

Recent literature has proposed that emergency laparotomy in the frail population may be qualitatively futile leading to negative desired morbidity and missed opportunities for palliation. The aim of this study was to appraises the futility of emergency laparotomies within a 3 month period based on the predictor of pre-operative frailty with in a large district general hospital.

Method

Retrospective analysis of all patients undergoing emergency laparotomy in a 3 month time period in the Dumfries Royal Infirmary. Futility was defined as all-cause mortality within 3 days of emergency laparotomy and frailty based on the characteristics set out by the Rockwood frailty score. A assessment of surgical futility in emergency laparotomy was carried out based on the pre-operative frailty.

Conclusions

Increased frailty demonstrates an increase in futile emergency laparotomies. It is therefore recommended that a multidisciplinary team approach with careful assessment and consent should be made prior to any surgical intervention on this patient cohort.
EP529 - The Impact of Royal College of Surgeon (RCS) Guidelines on the Quality of Operation Notes Documentation: A Closed Loop Audit
Authors: Shafique Muhammad Salman , Fatima Sayyam
Published: September 2024

Introduction

Operation notes are an important component of a patient’s medical record. Accurate documentation of surgical procedures is essential to understand the details of the operation and the post-operative management plan. The aim of this audit was to assess the current practices of documentation of operation notes, identify shortcomings, and compare the outcomes after introduction of recommendations made by the Royal College of Surgeons (RCS) of England in 2014.

Methods

This retrospective and prospective closed-loop audit was conducted in August-September 2021 at Basharat Hospital, Rawalpindi, Pakistan. 125 operation notes were evaluated to analyze the current documentation practices. The findings of the initial audit were compared with the Royal College of Surgeons (RCS) guidelines of Operation notes documentation. A re-audit was carried out after implementation of the improved version of operation notes. A panel reviewed 125 operation notes for adherence to international guidelines.

Results

The documentation rate was increased from 37.5% to 83.3% after the completion of this closed loop audit. Documentation of timing of surgery, operative findings, complications, additional procedure performed, anticipated blood loss, closure technique and deep vein thrombosis (DVT) prophylaxis were noted to be lacking in the initial audit. Implementation of the RCS guidelines revealed an improvement in the documentation of all parameters, with documentation rates exceeding 83% and an overall improvement of 45.8%.

Conclusion

This audit signifies the positive impact of RCS guidelines on the quality of operation notes documentation. Such audits should be regularly conducted for refined documentation practices, and enhanced patient care and safety.
EP592 - A surgical case report of an epiploic hernia - A mobile right colon herniating through the foramen of Winslow
Authors: Jain Shubham , Nessa Ashrafun , Gandhi Mark , Ganesh Radhakrishnan
Published: September 2024

Introduction

An Epiploic Hernia is an extremely rare type of abdominal hernia with <0.1 % incidence where the bowel or other intra-abdominal contents herniate through the Foramen of Winslow. A case of an Epiploic hernia in a middle-aged female is presented here.

Presentation of case

A woman in her 60s was admitted to a tertiary level hospital with severe right sided intermittent upper abdominal pain associated with nausea, bloating and constipation. The symptoms were thought to be due to biliary colic and managed conservatively. Since the symptoms persisted and a computed tomography scan of abdomen was organized. CT scan showed that the caecum was in the upper left quadrant. A laparoscopy was performed and demonstrated that her right colon was mobile herniating through the Foramen of Winslow into the lesser sac. The hernia was reduced, and the bowel was viable. The patient was discharged with no complications.

Discussion

There have been case reports of small bowel as the content of the hernia with lesser occurrences of caecum, ascending colon, transverse colon, gall bladder, omentum, or Meckel's diverticulum. A caecal herniation through the Foramen of Winslow is reported only with an incidence of 0.02 %. <10 % of these Epiploic hernias are diagnosed preoperatively making it a potentially life-threatening condition if not treated promptly due to high risk of bowel strangulation and mortality of up to 50 %.

Conclusion

A high index of suspicion is needed for the diagnosis of this internal hernia and radiological investigation is fundamental in making this diagnosis for allowing prompt surgical treatment.
Lost in translation? Tracing Lullian tunes in Edward Ravenscroft’s The Citizen Turn’d Gentleman (1672)
Authors: Walsdorf Hanna
Published: September 2024

In late 17th- and early 18th-century London, English versions of the comédies-ballets by Molière and Lully were received with great applause. Yet translators had necessarily converted the rhythm, rhyme and song of the French plays, which is why most of Lully’s tunes seem to have been lost in translation, replaced by newly composed songs. Focusing on Edward Ravenscroft’s The Citizen Turn’d Gentleman (1672), this article examines source evidence suggesting that in this case some of Lully’s vocal and instrumental movements may well have survived crossing the Channel—and it also reveals that Ravenscroft must have been able to draw on eyewitness accounts of Lully as an on-stage performer in Le Bourgeois gentilhomme (1670). An Appendix briefly considers 18th-century revivals of Le Bourgeois gentilhomme and its ‘Turkish Ceremony’ in London.
Evaluating cellular roles and phenotypes associated with trehalose degradation genes in Saccharomyces cerevisiae
Authors: Chen Anqi , Stadulis Sara E , deLeuze Kayla , Gibney Patrick A
Published: September 2024

In the yeast Saccharomyces cerevisiae, 2 types of trehalase activities have been described. Neutral trehalases (Nth1 and Nth2) are considered to be the main proteins that catalyze intracellular trehalose mobilization. In addition to Nth1 and Nth2, studies have shown that acid trehalase Ath1 is required for extracellular trehalose degradation. Although both neutral and acid-type trehalases have been predominantly investigated in laboratory strains of S. cerevisiae, we sought to examine the phenotypic consequences of disrupting these genes in wild strains. In this study, we constructed mutants of the trehalose degradation pathway (NTH1, NTH2, and ATH1) in 5 diverse S. cerevisiae strains to examine whether published lab strain phenotypes are also exhibited by wild strains. For each mutant, we assessed a number of phenotypes for comparison to trehalose biosynthesis mutants, including trehalose production, glycogen production, cell size, acute thermotolerance, high-temperature growth, sporulation efficiency, and growth on a variety of carbon sources in rich and minimal medium. We found that all trehalase mutants including single deletion nth1Δ, nth2Δ, and ath1Δ, as well as double deletion nth1nth2Δ, accumulated higher intracellular trehalose levels compared to their isogenic wild-type cells. Also, nth1Δ and nth1Δnth2Δ mutants exhibited mild thermal sensitivity, suggesting a potential minor role for trehalose mobilization when cells recover from stress. In addition, we evaluated phenotypes more directly relevant to trehalose degradation, including both extracellular and intracellular trehalose utilization. We discovered that intracellular trehalose hydrolysis is critical for typical spore germination progression, highlighting a role for trehalose in cell cycle regulation, likely as a storage carbohydrate providing glycolytic fuel. Additionally, our work provides further evidence suggesting Ath1 is indispensable for extracellular trehalose utilization as a carbon source, even in the presence of AGT1.