bluuebunny/crossref_metadata_2025 huggingface dataset:
1052 Intussusception of the Appendix in a Young Adult with Cystic Fibrosis: An Important Differential Diagnosis of Abdominal Pain in Cystic Fibrosis Patients?
Authors: Venkatasami M , Cobby E
Published: November 2022

Background

Cystic fibrosis (CF) is commonly associated with gastrointestinal manifestations from infancy to adulthood. Intussusception in the paediatric CF population is widely reported, whereas in the adult, distal intestinal obstruction syndrome (DIOS) is common affecting 20%, of which, intussusception is rare and appendiceal intussusception is rarer, affecting 1%.

Case-Description

A 20-year-old male with CF presented with 3 days of right iliac fossa pain and diarrhoea. On admission, he was hypotensive and afebrile. Clinical examination revealed tenderness of the right flank with a palpable mass in the right iliac fossa.

Serum investigations showed mildly raised inflammatory markers.

Contrast CT of the abdomen-pelvis confirmed intussusception of the appendix into the ascending colon.

Histological analysis of the appendix further demonstrated intussusception, with intraluminal mucinous material. Fascinatingly, no transmural inflammation was present.

The patient underwent a laparotomy-open appendicectomy. Interestingly, intraoperative findings showed the intussusception resolved, no longer requiring surgical reduction.

Patient postoperative recovery was complicated by pneumonia for which he was transferred for specialist CF respiratory care and thereafter, discharged.

Discussion

Literature review highlighted a paucity of data, with 10 reported cases of appendiceal intussusception in adult CF patients.

Interestingly, we report the intussusception had reduced by the time of operation. This is in-keeping with previous case reports of transient intussusception which spontaneously resolved.

Conclusion

From this rare case presentation, we have learnt it is imperative to carry a high index of suspicion for gastrointestinal manifestations in CF patients where acute appendicitis is seen less often and differential diagnoses like DIOS and intussusception should be considered.
1053 Primary Acinic Cell Carcinoma in a Young Female: A Case Report
Authors: Venkatasami M , Harrison K
Published: November 2022

Background

Acinic cell carcinoma (ACC) is a rare, low-grade tumour, accounting for about 5% of all primary salivary gland malignancies. ACCs predominate in the parotid gland, seen in the fifth and sixth decades of life and has a female predilection. Well-differentiated and low-grade tumours are associated with a favourable prognosis.

Case Description

We report a case of a 16-year-old female, presenting with a right parotid lump, slowly increasing over the last year. Clinical examination revealed a 1.5cm right parotid nodule with no facial nerve involvement and presence of cervical lymphadenopathy. Past medical history was unremarkable.

Findings

Radiological investigations revealed a well-circumscribed lobulated lesion in the anterior right parotid gland with presence of reactive lymph nodes bilaterally.

Differential diagnoses included Warthin's tumour, which would have been unusual in this age group, and the patient underwent a right partial parotidectomy.

Histological examination showed a multinodular appearance with some marked granular cytoplasm with oncolytic and lymphoid infiltrate. Immunohistochemistry was negative for S100, positive with DOG-1. There were widespread PAS-D-resistant granules throughout the tumour cells, with ki67 proliferation index of approximately 5%.

Results

The tumour was completely excised, and the patient made a full recovery and considered to have a good long-term prognosis.

Conclusion

This is an unusual case of ACC seen in this age group and gender, where less than 4% of cases of ACC have been reported in patients younger than 20. It is important to consider differential diagnoses of salivary gland pathology, such as ACC in the young female patient.
373 Evaluation of the Use of Water-Soluble Contrast Enema (CE) and Flexible Sigmoidoscopy (FS) prior to the Reversal of a Loop Ileostomy
Authors: Elzaafarany A , Nordin MN , Narayan P , Day A
Published: November 2022

Aim

To evaluate the routine use of CE and FS to check integrity of anastomosis prior to reversal of a loop ileostomy.

Method

This is a single centre retrospective observation study. All patients who underwent reversal of a loop ileostomy following low anterior resection for rectal cancer over period of five years, were involved in this study. All patients have CE and FS to check the patency of the anastomosis prior to reversal of ileostomy. The primary outcome was to investigate if routine CE adds clinically relevant information to a routinely performed FS by analysing concordance and diagnostic test accuracy. Secondary outcome to evaluate the accuracy of FS and CE in diagnosis of anastomotic stricture

Results

116 patients who had reversal of ileostomy had both CE and FS. Out of these, 110 (94.8%) had normal findings on CE and FS. Six patients had abnormal findings on either CE or FS.

Two patients (1.7%) had anastomotic leak shown on CE study, despite normal findings on FS.

One patient (0.8%) had a leak shown on both FS and CE.

One patient (0.8%) had a leak shown on FS despite a normal CE study.

Two patients (1.7%) had strictures shown on FS and stenosis on CE radiological reports.

Conclusions

The discrepancies between Ce & FS are minimal. Although it has been suggested in previous studies that CE is of little value, the concurrent use of FS as well as CE is useful in identifying any trivial leak pre-reversal of ileostomy, and that will be valuable in decision making.
513 Surgical Complications Following Reversal of Ileostomy
Authors: Elzaafarany A , Nordin MN , Skervin A , Grabham J
Published: November 2022

Aim

To identify the rate of patients who develop complications of Grade 3b or above according to Clavien-Dindo classification following reversal of ileostomies within 30 days from time of the operation.

Method

This is a retrospective observation study of a single cohort. 147 patients who underwent reversal of Ileostomy following Anterior Resection of Rectal cancer, over a period of three years, were involved in the study. The primary outcome is the 30 days adverse events rate of grade 3b or above of Clavien-Dindo classification following reversal of ileostomies. Secondary outcome is identifying risk factors for developing these complications: age, gender, ASA, comorbidities, BMI, pre-operative haemoglobin, interval between primary surgery and reversal of ileostomy, duration of operation, type of anastomosis, surgical experience.

Results

Out of 147 patients who underwent Reversal of Ileostomy, eight patients developed complications of Grade 3b or above. Five cases involved anastomotic leak requiring resection of anastomosis and ileostomy formation. One patient had an abdominal wall haematoma requiring evacuation of haematoma in theatre. One patient had a bleeding from anastomosis, required laparotomy and resection of anastomosis. One patient developed aspiration pneumonia followed by respiratory distress, multi-organ failure and died.

Conclusions

The rate of patients who develop complications of Grade 3b or above following reversal of ileostomies within 30 days from the time of the operation, in our centre is low and is comparable to published literatures. Methods to minimise these complications should be further evaluated including proper pre-assessment of these patients in outpatient clinic to identify those of high risk for surgery.
533 Readmission Rates After Elective Colorectal Cancer Surgery and Its Comparison to National Bowel Cancer Audit in 2019 (NBOCA 2019)
Authors: Elzaafarany A , Tawfik A , Igbekele T , Day A
Published: November 2022

Background

The NBOCA 2019 showed an overall 10.8% of patients had an unplanned readmission within 30 days of surgery (for both elective and emergency colonic resection (NBOCA, 2019).

Aim

To identify readmissions rates after elective colorectal cancer surgery in our hospital and comparing it to NBOCA 2019. Identifying reasons for readmissions.

Method

A single centre, retrospective, observational study was performed between January 2018 – January 2019. We included patients that required readmission to hospital following elective colorectal resections for cancer. Data was collected on patient demographics, primary operation, histopathology, stage, neo-adjuvant chemo/radiotherapy, date, and reason of readmission.

Results

Total of 123 patients had elective resection for colorectal cancer.13.8% (17/123) of these patients required readmissions. 70.6% (12/17) readmitted with 30 days of discharge, 29.4% (5/17) beyond 90 days of discharge. 58.8% (10/17) Of the operations that needed readmission were performed laparoscopically, with the most common primary operation resulting in readmission was LAR (52.9%, 9/17). Tumour grades using Dukes classification were A 41.1% (7/17), B 11.8% (2/17), C 35.2% (6/17), D 5.9% (1/17). Neo-adjuvant chemo/radiotherapy was given in 29.4% (5/17) of patients. Overall, the most common reason for admission was small bowel obstruction (SBO) and abdominal/pelvic collection, each by 23.5% (4/17), followed by wound dehiscence (11.8%, 2/17) and SSI (both deep and organ related) (11.8%, 2/17).

Conclusions

13.8% of patients who underwent elective colorectal surgery for cancer were readmitted within 30 days of discharge. Further study is required to investigate more contributing factors to readmission, in order to formulate strategies to help prevent them.
564 Late Presentation of Colorectal Neuroendocrine Neoplasia Is Associated with a Poor Prognosis
Authors: Goan R , Camilleri-Brennan J
Published: November 2022

Introduction

Although neuroendocrine neoplasms (NENs) arising from the colon and rectum are generally slow growing and present early, a minority demonstrate aggressive growth and present late with metastatic disease. The aim of this study is to analyse the clinical presentation, management and prognosis of patients presenting with advanced colorectal NENs.

Method

Data were collected from dedicated databases on patients with colorectal NENs who presented to our hospital between January 2015 and February 2021. Patients who presented with appendiceal NENs were excluded.

Results

13 patients with colorectal NENs were identified, of whom 3 patients (23%) had advanced disease at diagnosis. These 3 patients, 2 males (78 and 82 years old) and 1 female (71 years old), presented with weight loss, anorexia and altered bowel habit, with one patient also having rectal bleeding. The site of the primary was in the rectum (2 patients) and in the sigmoid colon (1 patient), the histology being poorly differentiated neuroendocrine carcinoma. All 3 patients had liver metastases at presentation, with 2 having lung and lymph node metastases as well. Due to their advanced disease, these patients’ treatment was carried out with palliative intent. All three patients passed away within a year of diagnosis.

Conclusion

Poorly differentiated colorectal NENs with distant metastases were associated with a poor prognosis. Management involves a multidisciplinary team. The use of somatostatin analogue therapy and palliative chemotherapy are options for symptom control.
600 Acute Appendicitis as an Early Manifestation of Colorectal Cancer for Patients Aged 40 Years and Above
Authors: Yip CR , Lim ST , Ali S , Teoh WY , Vitone L
Published: November 2022

Aim

Presence of underlying colorectal cancer with acute appendicitis is not unfamiliar in medical literature. However, there remains no clear guidance in the follow-up care post-appendicectomy. This study aims to investigate whether acute appendicitis can be an early manifestation of colorectal cancer in older adults and determine the need of routine pre-operative CT imaging and post-operative colonoscopy as a follow-up screen for early detection of colorectal cancer.

Method

This is a retrospective study comprising 1236 patients, aged 40 years and above, who underwent appendicectomy between January 2006 to September 2021. Results of radiological investigation pre-appendicectomy and colonoscopy post-appendicectomy were reviewed. Patients who were diagnosed immediately and subsequently following appendicectomy were recorded and analysed.

Results

Of the 1236 patients underwent appendicectomy, 636 (51.5%) were male and 600 (48.5%) were female (Median age 53 years; range 40–96 years). Out of 412 (33.3%) patients who had CT imaging, only one revealed sigmoid tumour which was later confirmed as moderately differentiated adenocarcinoma. 71 (5.7%) patients had colonoscopy post-appendicectomy. Among these, two were diagnosed with caecal cancer. A total of 22 (1.8%) patients were diagnosed with colorectal cancer: 13 adenocarcinoma, 5 carcinoid tumours, 3 low-grade mucinous carcinoma peritonei and 1 lymphoma. 15 (1.2%) were diagnosed at the time of appendicectomy, whereas the remaining 7 (0.6%) were diagnosed between 6 months to 11 years post-appendicectomy.

Conclusion

Preliminary finding suggests this is an area that warrant further study. Patients aged 40 years and above may benefit from colonoscopy following appendicectomy to exclude the possibility of underlying colorectal cancer.
980 Readmissions Within 30 Days of Discharge Following Single Stoma Formation
Authors: Plonkowski A , Allison C , Philipson P , Brady R
Published: November 2022

Background

Patients who have stoma surgery are at higher risk for readmission following discharge. Some may benefit from closer post-discharge surveillance to detect complications earlier and provide timely treatment to avoid readmission. However, there are a paucity of contemporary tools to identify those at higher risk of readmission following discharge after stoma surgery. Here, we aimed to determine factors associated with readmissions, within 30 days of discharge, following stoma surgery.

Method

Retrospective review of all patients who underwent a single stoma formation at a single tertiary colorectal service (2019–2021).

Results

423 patients underwent 220 ileostomy and 203 colostomy formation surgeries. Overall, 87 (20.6%) patients were readmitted within 30 days of discharge. The rate of readmission in those with IBD (n=87) was 18.4%, cancer (n=208) 20.7%, diverticular disease (n=45) 17.8% and vascular disease (n=19) was 36.8% (p>0.05). There was no association between readmission and gender, aetiology, smoking, weight, or discharge to social care. The only comorbidity associated with increased readmission was chronic heart failure (p=0.05), no other comorbidities were associated with increased readmission. There was an increased incidence of readmission in patients with post-operative stoma-specific complications (bleeding p=0.02; high-output stoma p=0.01) and in patients who received loop ileostomies compared to other stoma types (34.0% versus 18.6%; p=0.01). There was a protective effect in those given nutritional supplements post-operatively (p=0.04).

Conclusion

Readmission following single stoma formation is related to variables that potentially provide the means to triage, risk score and potentially predict readmission. Further work is being undertaken to develop and prospectively to validate a model.
994 The Evolving Role of Interventional Radiology in the Management of Diverticular Abscesses: A Review of Practice at University Hospital Waterford Over 10 Years
Authors: Murphy B , McLoughlin M
Published: November 2022

Background

Historically, intra-abdominal sepsis was managed conservatively, or with operative intervention, which is associated with significant morbidity and mortality. Image-guided drainage of abscesses or collections provides a useful alternative and has become more common with the increasing prominence of Interventional Radiology, offering faster recovery, reduced length of hospital stay and cost of treatment. Modern procedural tools, techniques and expertise allow high levels of percutaneous drainage success. The scope of practice has widened to include targets which previously wouldn't have been amenable to drainage.

Aim

To quantify the use and benefit of IR drainage for complicated diverticulitis at University Hospital Waterford over the past ten years. The size and location of collections drained throughout the ten years was observed. Length of hospital stay for each mode of management (conservative, percutaneous drainage and surgical) was used as an endpoint to assess morbidity.

Method

Using NIMIS, all CT abdomen/pelvis reports containing the words “abscess” or “collection”, and “diverticul” over the past 10 years was compiled. These patients were categorised by their management, into groups of conservatives, percutaneous drainage, surgical intervention, or a combination of these. NIMIS was used to determine who underwent IR drainage. T-pro, theatre logbooks and patient notes were used to determine who had surgical management, and iPMS was used to assess length of hospital stay.

Results

IR drainage has become more common year-on-year in UHW and was shown to be more effective for all abscess sizes as compared with conservative management, as outlined in the table shown
998 Improving Accuracy of Tumour Site Identification During Colonoscopy; a Retrospective Analysis
Authors: Jeilani M , Hassan M , Riad M
Published: November 2022

Aim

Colonoscopy is essential for accurate pre-operative colorectal tumour localisation. Due to variable colonic length and lack of internal landmarks, tumour site identification can be difficult, posing risks of inappropriate operations being offered. To avoid this, we must correctly identify the tumour site on endoscopy in >95% of patients as per BSG guidelines. In 2019, accuracy levels compared to radiology and histology fell significantly short of this standard. We therefore made improvements to our endoscopy database and displayed relevant guidelines in endoscopy rooms. Here, we evaluate improvement in accuracy of endoscopic tumour localisation after implementation of these initiatives.

Method

Retrospective study of results of all colonoscopies (214) showing suspicious lesions at our trust in 2020, compared to results of counterpart radiology and histology tests, and audited against the BSG standard of >95% accurate identification of tumour position by colonic segment.

Results

Accuracy of endoscopic tumour localisation was 92.2% and 92.3% compared to histology and radiology respectively. Although this does not meet the national standard of >95%, it is a significant improvement from the year prior - 80.2% and 78.8% compared to histology and radiology respectively. The greatest degree of error appears in the rectum, often being confused with recto-sigmoid and sigmoid.

Conclusions

Guideline reminders and database improvements were crucial to increased accuracy. However, clearer definition of colonic territories is required to avoid confusion when attributing localisation. We recommend following the American guidelines in which the term ‘recto-sigmoid’ is abolished in favour of a boundary 15cm from the anal verge that represents the division between rectum and sigmoid.
1037 The Use of Fluorescence Angiography with Indocyanine Green in Colorectal Surgery – A District General Hospital Experience
Authors: Adegbola S , Ghafoor H , Kirmani N
Published: November 2022

Introduction

Indocyanine green (ICG) fluorescence imaging is used in a variety of procedures in in colorectal surgery. It optimises intraoperative vision of anatomical structures by improving blood and lymphatic flow. ﻿Traditionally, the vascularization of the colonic stump is subjectively evaluated by the surgeon based on the colour of the bowel wall, the bleeding of the colonic stump, and pulsation of the terminal artery. ICG aims to improve objectivity of this assessment.

Aim

To assess the feasibility and efficacy of ICG in colorectal operations and report on initial experience since introduction in November 2021.

Method

Retrospective review of prospectively collected database of all patients undergoing colorectal operations with intraoperative ICG use for any indication. Data collected included patient demographic details including age/gender/comorbidities; operative details including indication/type of surgery, 30day-complications, details/outcome of intraoperative ICG use.

Results

During the study period ten patients underwent colorectal surgical procedures with intra-operative use of ICG. Surgical options included resectional surgery (right hemicolectomy/transverse colectomy/anterior resection) and reconstructive surgery (reversal of hartmann's operation). Majority were done for colorectal cancer and one for inflammatory bowel disease. ICG was reported useful in all cases in demonstrating vascularity in anastomoses/resection margins. One notable case demonstrated decreased ability of discerning ICG uptake in the presence of tattoo pigmentation (preoperative tumour marking). No adverse events were reported.

Conclusion

The ICG assessment of colonic vascularization was simple, feasible, with no adverse events in our cohort. Our experience suggests caution is required when interpreting ICG readings in the presence of colonic tattoo.
128 Trends in Diseases of Vestibular Function - a Retrospective Study into the Diagnosis of Different Types of Vestibular Disorders in Admitted Hospital Patients in England 2014–2020
Authors: Bodimeade C
Published: November 2022

Aim

The vestibular system is a sensory organ of the inner ear contributing towards balance, orientation, and coordination. Symptoms of vestibular dysfunction are a common presentation to hospitals in England.

Method

Using the NHS Digital website and accessing the Hospital Admitted Patient Care Activity datasets, we identified episodes of “Disorders of Vestibular Function”. This definition was further broken down into seven sub-types of different vestibular disorder. The data covers all NHS funded work in English hospitals resulting in admission. Using a 6-year period between 1st April 2014–31st March 2020 trends in number of admitted patients were recorded.

Results

There was an 84% increase in the number of patients admitted to hospital for diseases of vestibular function. From 6,473 admissions in 2014, to 11,960 in 2020. The largest increase was seen in patients admitted with Benign Paroxysmal Positional Vertigo (BPPV) with an increase of 4,154 admissions, equivalent to a 126% rise. The trend was progressive and consistent year on year. All other conditions such as vestibular neuritis, other peripheral vertigo and unspecified vestibular disorders increased, however diagnoses of Ménière's disease fell 2%. Patients with BPPV had the highest average age upon diagnosis.

Conclusions

There is a clear need to investigate the drivers of the increase in number of diagnoses and admissions. Hypothesised reasons include an ageing population, improved diagnostics, or coding errors. It may also be a result of increasing hospital attendances and a decrease in see and treat of patients with BPPV in A&E.
308 Fine Needle Aspiration Cytology vs Ultrasound Guided Core Biopsy in the Diagnosis of Parotid Neoplasia: An Up-to-Date Review
Authors: Karunaratne N , Hurry K , Westley S , Ramesar K , Williams M , Howlett D
Published: November 2022

Aim

Parotid tumours account for 80% of salivary neoplasms. Regarding diagnostic techniques, fine needle aspiration cytology (FNAC) has long been the technique for tissue sampling and can be optimised with ultrasound or presence of a cytopathologist. USCB differs in that it obtains a core of tissue which allows preservation of the tissue architecture. The authors performed a literature review to provide an update on current practice and outcomes of both techniques

Method

A literature review of EMBASE, Medline, PubMed and Google Scholar were conducted. Regarding USCB, four systematic reviews and meta-analyses were identified, alongside three other studies that were not included within these papers. Regarding FNAC, three systematic reviews and meta-analyses were identified, alongside seven other studies, not included within these papers, using optimised FNAC in sample sizes of over fifty.

Results

USCB has higher sensitivity, specificity, and lower non-diagnostic rates than optimised fine needle aspiration cytology (FNAC). It also has a significantly higher sensitivity for the detection of malignancy. Complications post-USCB are uncommon, with only one reported case of tumour seeding and no cases of permanent facial nerve dysfunction. The technique is less operator dependent than FNAC, with less variation in results between institutions.

Conclusions

USCB can be considered as the optimum tool of choice for diagnosis of parotid neoplasia. This would particularly be the case in centres utilising FNAC with high non-diagnostic rates or reduced diagnostic accuracy when compared to USCB published data or in centres establishing a new service.
464 Local Extension of a Solitary Extra Medullary Nasal Plasmacytoma into the Orbit
Authors: Sandhar P , Gill C , Khanna A
Published: November 2022

Aim

Extramedullary plasmacytoma are rare neoplasms, which mainly occur in the head and neck, the most common site being the nasal cavity or septum. Patients may present with epistaxis, nasal obstruction, or rhinorrhoea. Extension into the orbit is rare but can lead to visual disturbances.

Method

This case report pertains to a 69-year-old female patient who initially presented with a 6-week history of recurrent sinusitis, with left sided cheek pain and diplopia.

Results

A CT and MRI scan was performed, which showed opacification of the left maxillary, ethmoid and sphenoid sinuses with bony destruction of the medial and anterior maxillary walls and into the anterior soft tissues. The mass was completely obstructing the left nasal cavity extending into the inferomedial orbit. Staging CT scans also showed nodal disease in the neck.

Biopsy with histology was positive for CD138, with diffuse proliferation of plasma cells of varying maturity and atypia. Additionally, mono IgG kappa was also positive as was CD45 suggestive of a lymphoid neoplasm. Bone marrow biopsy and PET scan confirmed there was no systemic involvement.

Radiotherapy was initiated after the patient recovered from COVID -19. A repeat MRI scan 6 weeks post radiotherapy showed a partial response with reduction in the size of the tumour, resolution of the intra-orbital extension and disappearance of paraprotein.

Conclusions

This case report illustrates need for earlier consideration of EMP diagnostically to reduce the risk of conversion of the plasmacytoma to multiple myeloma, which is a known possibility and to ensure minimal delay in the commencement of treatment.
492 Calcific Tendonitis of the Longus Colli: A Rare Cause of Neck Pain
Authors: Bryce A , Douglas C , Williamson A
Published: November 2022

Cervical tendonitis of the Longus Colli muscle (CTLC) is a rare but clinically significant cause of neck pain. It can mimic other more serious pathologies in the retro-pharygneal area and requires sufficient investigation for diagnosis.

This case presented with a fit and well 54-year-old gentleman suffering from progressive left sided neck pain, stiffness, and odynophagia. His imaging demonstrated a prevertebral fluid collection of unclear aetiology and an area of calcification just below the anterior arch of C1. Along with the differential diagnosis of calcific tendonitis of longus colli, the fluid collecting inferior to C1 could have represented a retropharyngeal abscess - a potentially life-threatening infection. This patient required input from multiple specialities to safely reach diagnosis and exclude more significant pathology.

Although CTLC represents a benign and perhaps under-recognised condition, this case highlights the importance of considering other differential diagnoses and multidisciplinary management in a patient presenting with limited neck movements.
573 The Changing Microbiology of Paediatric Neck Abscesses: Implications for Antibiotic Therapy
Authors: Kawar L , Deshpande A , Kubba H
Published: November 2022

Aim

To provide an update on the microbiology, sensitivity rates and antibiotic prescribing patterns of drained superficial neck lymph node abscesses at Scotland's largest paediatric tertiary centre. Findings were compared to historical data from our institution. Analysis of the microbiology and epidemiological trends of paediatric neck abscesses is helpful for both antimicrobial stewardship purposes as well as to enhance the literature, given that paediatric-related conditions tend to be less well characterised when compared with adults.

Method

A retrospective case series of paediatric patients undergoing incision and drainage of a superficial neck lymph node abscess at the Royal Hospital for Children in Glasgow, 2018–2021. Patients were only included if they had culture and sensitivity testing performed on a sample obtained intra-operatively, were prescribed antibiotics, and were aged 16 years or younger.

Results

Thirty-nine abscesses were identified. Methicillin-susceptible Staphylococcus aureus remains the commonest organism (28%), followed by Streptococcus pyogenes (13%). Their prevalence is significantly lower in comparison to historical data. This was met by a shift towards a variety of rarer micro-organisms. 82% of patients were administered a drug regimen containing co-amoxiclav. Only 3 children required a change in their antibiotics.

Conclusion

Our case series highlights a fall in the yearly rate of drained neck abscesses. There was a significant change in causative micro-organisms, including a decrease in Staphylococcus aureus and an increase in the Streptococcus anginosus group. We recommend the use of co-amoxiclav empirically. In abscesses showing no clinical improvement, second-line options such as clindamycin, cefotaxime and vancomycin should be considered.
715 Implementation of Enhanced Recovery After Surgery (ERAS) in Total Laryngectomies
Authors: Lim KH , Dorris C , Thomson A , Ardis M , Devlin B , Gray G
Published: November 2022

Aim

The Enhanced Recovery After Surgery (ERAS) protocol for total laryngectomies was first implemented in our tertiary head and neck centre from November 2019. It includes pre-operative carbohydrate loading and an early swallow test which facilitates recommencement of oral intake to improve outcomes. Protocol adherence rate and patient outcomes were measured to determine the effectiveness and benefits of ERAS in laryngectomy patients.

Method

22 total laryngectomy patients from November 2019 to September 2021 were enrolled onto the ERAS protocol, 18 primary and 3 salvage cases. An analysis of the respective patient cohorts was performed to determine adherence to the ERAS protocol and outcomes such as complications and length of inpatient stay were measured.

Results

19 patients (86%) received pre-operative carbohydrate loading successfully, while 3 patients were contraindicated due to background of diabetes. Early swallow test was performed in 59% of patients. Potential reasons for delay were stoma dehiscence or clinical suspicion of neo-pharyngeal leak. 59% of primary cases were deemed medically fit for discharge within the target timeframe of 12–14 days whereas no target was set for salvage cases due to expected poor healing. Main complication in primary cases was neo-pharyngeal leak followed by stoma dehiscence with 28% and 11% respectively.

Conclusion

Limitations of our study include small sample size due to the COVID-19 pandemic. Despite its infancy, the ERAS protocol has achieved good outcomes in early recommencement of oral intake post-laryngectomy and encouraging early safe discharge from hospital. Future plans include establishment of Prehab Clinic and application of ERAS to neck dissection patients.
935 Case of Bad Breath in a Child
Authors: Bhatti D , Khan A
Published: November 2022

4-year-old girl with a two-year history of speech and language delay was referred to the Speech and Language Therapy Service by her health visitor. Additionally, she had a history of asthma, recurrent glue ears, head lice, poor dentition, a persistent malodorous nasal discharge, and halitosis. Her hyper-nasal speech sounds indicated soft palate dysfunction. Subsequent assessment in the cleft clinic resulted in a diagnosis of non-cleft velopharyngeal insufficiency. At the time of her elective pharyngoplasty, the anaesthetist and surgeon were overwhelmed by the foul smell emanating from her nose and mouth. As such, an intraoperative nasal endoscopy was undertaken to examine her vestibules. A calcified cigarette filter (Figure 1) was found impacted deep within the patient's right nostril and was removed prior to the pharyngoplasty. It was later discovered that the malodorous nasal discharge and halitosis had plagued the child since the age of 18 months. Moreover, she had undergone a number of clinical assessments within the primary care setting. However, the combination of head lice, foul smell, and her uncooperative demeanour made examination difficult, and her symptoms were inappropriately attributed to tooth decay and periodontal disease.
1010 Audit of Acute Management of Sudden Onset Sensorineural Hearing Loss and Streamlining of Local Management Pathway
Authors: Kruczynska A , Cordiner P , Maini S
Published: November 2022

Aim

Sudden onset sensorineural hearing loss (SSNHL) presents infrequently to ENT services in Aberdeen Royal Infirmary. Although ENT UK guidelines are in place for the management of SSNHL, the practicalities of organising these cases within our department can be challenging to junior staff leading to variation in time to review and timings of intervention. We Aimed to assessed current local practice in comparison compare it to national ENT UK guidelines

Method

Retrospective audit of 6 months data set recording management pathway of patients presenting with SSNHL to Rapid Access Clinic of Royal Aberdeen Infirmary Hospital. Electronic patient records were searched for: time of referral, duration of symptoms, times to first ENT review, intervention and audiogram, and timings and management during subsequent reviews.

Results

Seven patients meeting the inclusion criteria were identified and included in the audit. Average times from referral were calculated including time from referral to intervention (1.47 days), from referral to first ENT review (3.82 days), from referral to first audiogram (4.43 says). Average time from presentation to starting oral steroids was very efficient of just 0.33 days and average time from symptom onset to oral steroids initiation was 7.5 days suggesting late patient presentation.

Conclusions

The data gather helped our department to reinforce management pathway of SSNHL as per ENT UK guidelines and improved the way urgent audiograms are organised in the hospital. It also emphasised the importance of performing tuning fork test to determine the nature of hearing loss when audiogram is not immediately available.
1031 Survival Outcomes for Larynx-Preserving Therapy Compared to Total Laryngectomy in Advanced Laryngeal Tumour: A North-East of Scotland Cohort
Authors: Ahmeidat A , Shakeel M
Published: November 2022

Aim

Advanced laryngeal tumours (stage III and IV) management remains uncertain. This study aims to investigate whether choice of organ-preservation treatment (radiotherapy or radiochemotherapy) or surgical intervention (total laryngectomy with/without adjuvant therapy) affects survival in the North-east of Scotland cohort.

Method

Laryngeal cancer data was prospectively collected and maintained at a tertiary care centre at NHS Grampian Scotland. This data was retrospectively analysed for overall and disease specific survival. Death from laryngeal cancer was recorded from death certificates. Statistical analysis with Cox regression was used to estimate hazard ratios for sex, smoking status, age, staging, tumour site, and treatment choice in the advanced laryngeal cancer cohort.

Results

A total of 311 laryngeal cancer patients were identified. 49 patients were stage III and of which 35 (71%) received organ-preserving treatment and 14(29%) underwent total laryngectomy. The corresponding numbers for 65 stage IV patients were 13 (20%) and 52 (80%) respectively. On cox regression for overall survival, reduced survival was associated (p<0.05) with choice of organ preservation and stage IV disease, fully adjusted HRs (95%CI) were 2.57 (1.42–4.66) and 3.00(1.08–8.34) respectively. For disease specific survival, no variables were found to be significant. Median follow up time from date of diagnosis to death was 1.56 years.

Conclusions

Organ preserving intervention was associated with a worsened overall survival in the advanced laryngeal cancer cohort. This study suggests that primary surgical intervention remains a key element in the treatment of advanced laryngeal cancer and future bigger cohort studies may be needed to evaluate this relationship.
347 Management of Acute Sigmoid Volvulus in NHS Grampian
Authors: May V , Drever K , Ramsay G
Published: November 2022

Aim

The Emergency General Surgery guidelines from the ACPGBI were recently published and recommend that definitive management should be planned on index admission with sigmoid volvulus. However, the evidence base for these recommendations was low. We aim assess the current practice of Sigmoid Volvulus (SV) in a Single Scottish Health board.

Method

A retrospective review of patients with acute SV managed at two hospitals between 2011 and 2021 was conducted. Individuals were identified through inpatient coding and case notes reviewed electronically. Operative intervention, colonoscopic decompression and short- and long-term outcomes were noted.

Results

Of 105 patients treated, 41 were female. The mean age at presentation was 73.2 (range: 38–94 years). In total, 70 patients (66.7%) underwent decompression alone and 35 (33.3%) were treated with surgical intervention. There was no difference in mean age, number of co-morbidities and number of previous operations between the two groups. Of the decompression group, 35 (50%) presented on a single occasion. However, the mean number of re-presentations was 3.3 (range 2–29) and the mean time to re-presentation was 136.5 days (range 5–1224 days). There were no recorded inpatient deaths following surgical intervention.

Conclusion

The most common method of acute SV management has been decompression on its own. There were no differences observed in patient demographics between the intervention groups, suggesting that there are no set criteria to determine method of intervention. However, representation remains commonplace and operative intervention had few complications indicating a likely required increase in definitive surgical approaches.
367 Can We Justify Routine Group & Screen Testing Prior to Appendicectomies? - A Single Centre Analysis
Authors: Deb R , Deb G , Pore N , Sheth H , Raje D
Published: November 2022

Aim

Numerous sources have suggested that routine preoperative Group & Screen (G&S) testing prior to cholecystectomies1–4, breast surgery5 and gynaecological procedures including Caesarean sections6 may be unnecessary because perioperative blood transfusion incidence remains low.

This project aimed to understand whether routine pre-appendicectomy G&S testing can be justified by analysing blood transfusion incidence for appendicectomies completed at our hospital. To further comment on their relevance to clinical practice, we also aimed to investigate any potential delay to surgery that G&S tests may pose, and their cost implications.

Method

For all appendicectomies undertaken at our hospital from 2018 to 2021 (n = 257), we noted if the patient received a blood transfusion anytime during their admission. The date and time of G&S sample collection and of the surgery were recorded, including any documentation of delays to surgery.

Results

0% of appendicectomies between 2018 – 2021 required a blood transfusion during the admission. On average, 3.9% of appendicectomies per year were delayed due to preoperative G&S testing with an average delay to surgery of 78.71 minutes.

The total cost of G&S tests undertaken for appendicectomy patients between 2018 – 2021 was £5768.03.

Conclusions

It is difficult to justify routine pre-appendicectomy G&S testing when our data suggests such a low risk of blood loss necessitating transfusion, and that these tests delay treatment. This may warrant pre-appendicectomy risk stratification to streamline G&S testing. Additionally, should an emergency occur, uncrossmatched blood is readily accessible and poses minimal risk to patients7.
474 Should We Be Concerned of Oesophageal Injury in Traumatic Pneumomediastinum? – A Review of the Past 11 Years in an UGI Specialist Centre
Authors: Shehata Z , Shetty V
Published: November 2022

Aim

Pneumomediastinum is a known radiological finding after major trauma, however its significance and required investigative workup is not standardized. Furthermore, there is little evidence to suggest that traumatic pneumomediastinum is indicative of oesophageal injury. Our study set out to investigate the rate of oesophageal injury for these patients at our centre, and the relevant investigative work up that is required.

Method

Medical records were retrieved our trust (Major Trauma Centre 2012 – present, UGI Centre 2009 - present) to include trauma patients with radiological pneumomediastinum admitted between 2010–2021. Demographics, mechanism of injury, length of stay, and other significant findings were collected retrospectively using the electronic patient record.

Results

The data search retrieved 38 patients with traumatic pneumomediastinum. 1 patient was excluded due to incomplete records. Road traffic collisions were the most common presentation (18 patients), followed by falls (13 patients), penetrating trauma (3 patients), assault (2 patients), and workplace injury (1 patient). The median length of stay was 6 days, with 2 inpatient deaths. 1 patient had a confirmed tracheobronchial injury on initial imaging which was managed conservatively in a cardiothoracic centre, while 6 other patients underwent further oral contrast CT for suspected oesophageal injury. No patients in our dataset had a confirmed oesophageal injury.

Conclusions

Oesophageal injury is rarely seen in traumatic pneumomediastinum and is usually secondary to other chest injuries causing air leak into the mediastinum. Oral contrast CT is the recommended investigation to exclude oesophageal injury.
482 Spontaneous Pneumomediastinum Case Series: Lessons Learnt in Assessment and Management
Authors: Manku B , Krishnamoorthy A , Thomson L , McLaughlin E
Published: November 2022

Aim

Spontaneous pneumomediastinum (SPM) is usually a self-limiting condition in clinically stable patients with no obvious causative factor. SPM can be difficult to distinguish from important secondary causes such as tracheobronchial injury or oesophageal perforation. Therefore, thorough clinical history and examination is of paramount importance. We aim to highlight lessons learnt from our experience to improve rapid diagnosis and clinical management of these patients.

Method

Patients were identified through hospital records between October 2019 – December 2021. Data was collected on clinical presentation, precipitating events, radiological confirmation of SPM and compared with current reported literature.

Results

11 patients were identified, 8 males (72.7%), 3 females (27.3%) with a mean age of 29 + 17 years. The most frequent symptom was retrosternal chest pain 27.3%; and vomiting the most common precipitating event (54.5%). Mean white cell count was 14×109/l on admission. All patients underwent plain film chest radiography, and subsequent computerised tomography of thorax, abdomen and pelvis. Patients underwent gastroscopy selectively, showing no acute pathology. Mean length of stay was 4.6 days. No patients required operative intervention or any other intervention beyond antibiotics. No complications or recurrence were found in patients at follow up.

Conclusion

SPM is a self-limiting condition with low morbidity and mortality. If life-threatening causes have been excluded, SPM can safely be managed expectantly at a local level, without the need of transfer to tertiary centres and prolonged hospital admission. We propose a structured approach to aid in the management of SPM and help address these challenges.
651 Timeliness of Ultrasound Investigation in Patients Presenting with Acute Abdominal Pain – Single-Centre Audit
Authors: Hakeem A , Mateescu D , Chedid Y , Chattopadhyay D
Published: November 2022

Aim

To identify patients delays in ultrasound investigation in patients who present with acute abdominal pain; patients who require ultrasound investigation to decide if they require admission or can be safely discharged home.

Method

Patients who presented to Bedford Hospital Accident and Emergency department with acute abdominal pain and an ultrasound was requested were included in the analysis. The indication was divided into 3 main categories (Upper abdominal pain, post-cholecystectomy, and other pathology). Data were analysed in relation to admission and discharge. Patients who had outpatient ultrasounds were excluded from the study. Mean and standard deviations were used for the delays.

Results

A total of 322 patients were included in the study, 160 (49.7%) patients were due to cholelithiasis or upper abdominal pain, 158 (49.1%) were due to other pathologies, 4 (1%) were post-cholecystectomy ultrasounds. The mean admission to ultrasound request was 1.77 (±5.48) with 290 (90.1%) being requested within 2 days of admission. Mean days from request to ultrasound being performed was 1.37 (±4.04) with 299 (93.1%) performed within 2 days.

Conclusions

The study concluded that the average time from ultrasound being requested to being performed in patients with acute abdominal pain was 0–2 days, this shows that the ultrasound is performed appropriately and there are minimal delays.
687 How Effective Is the ‘HOT Laparoscopic Cholecystectomy Pathway’ in Reducing Time to Surgery?
Authors: Sutharsan G , Chandra S , Said A , Dighe S
Published: November 2022

Aim

To evaluate whether the introduced ‘HOT laparoscopic cholecystectomy (LC) pathway’ has been effective in reducing outpatient (OP) time to surgery.

Method

All patients (March-October 2021) who had a LC at either Darent Valley Hospital or Queen Mary's Sidcup were identified via an extensive database search. Patient demographics, clinical diagnosis, number of presentations, in-patient (IP) vs OP LC and days to surgery were recorded. The results were descriptively analysed and compared to findings of the audit in 2020.

Results

During the study, 216 LCs were recorded, of which 31% took place as an IP and 69% occurred as an OP. Amongst the CEPOD list, 80% had a LC within 8 days of admission, in accordance with NICE guidance. 139 OP LC requests were noted, 75% included “HOT LC” in the ‘to come in” (TCI) request, with an average time to OP LC of 35 days, compared to 54 days for requests which did not include “HOT LC” in the request. This was significantly quicker than the wait time of 84 days in 2019, prior to the implementation of the pathway.

Conclusions

Introduction of the ‘HOT LC pathway’ in conjunction with greater operative capacity across 2 hospitals has resulted in earlier management of gallbladder disease and subsequently reduced length of hospital admission. Furthermore, inclusion of “HOT LC” in the TCI request significantly reduces delay in OP LC. In light of these findings, the use of the pathway should be encouraged with emphasis on the inclusion of “HOT LC” in the TCI request.