bluuebunny/crossref_metadata_2025_split huggingface dataset:
1412 De Garengeot's Hernia Complicated by Perforated Appendicitis and Groin Abscess: Report of A Rare Surgical Emergency
Authors: Singh K , Abdelrahman A , Abdalla S 
Published: October 2021

Abstract

Introduction
De Garengeot's hernia is a rare subtype of femoral hernia which contains the vermiform appendix. Acute appendicitis in a femoral hernia is even more unusual, accounting for 0.08% - 0.13% of all cases of femoral hernias.

Case presentation
A 91-year-old woman was referred with a painful, cellulitic right groin mass. A computed tomography scan demonstrated a right-sided femoral hernia containing a loop of bowel and a collection in the right groin containing fluid and gas. The patient had early dementia but no other major medical co-morbidities. At surgery, she was found to have perforated appendicitis in a right femoral hernia. Most of the appendix and sac had fully disintegrated, forming a large abscess cavity beneath the skin in the right groin which extended down to the upper labia majora. The appendix tip was lying deep within the abscess cavity. A modified McEvedy approach was used to access the peritoneal cavity for the appendicectomy and sutured repair of the femoral neck. The groin abscess cavity was drained and managed with a negative pressure (VAC) dressing.

Discussion
De Garengeot's hernia is often difficult to diagnose pre-operatively and reporting of cross-sectional imaging may not always be reliable. Currently, there is no gold standard method for repairing these hernias. However, the modified McEvedy approach is well-described and is the preferred technique for emergent femoral hernia presentations. It provides sufficient access to manage both appendicitis and the femoral hernia. Adjuncts such as negative pressures dressings may be used to manage concomitant abscess cavities.
1431 Stoma Intubation, Isolation and Negative Pressure Wound Therapy for Complex Stoma-Associated Wounds: New Technique and Case Series
Authors: Browning N , Okocha M , Doe M , Lyons A , Sumrien H 
Published: October 2021

Abstract

Background
The use of negative pressure wound therapy (NPWT) in colorectal surgery has been demonstrated for treating perineal defects, enterocutaneous fistula and stoma dehiscence. Here we describe a technique for closure of complex stoma-associated wounds using a novel commercial intubation device alongside NPWT to protect the surrounding wound from the stoma effluent. The device has previously described for use with enterocutaneous fistula. We present two cases that have been successfully treated with this technique.

Technique and Cases
The first case is of 88-year-old women with a retracted loop ileostomy and the second a 48 year-old male with a retracted end colostomy. Both patients underwent significant emergency peristomal debridement and in both cases the commercial device was deployed to intubate the stoma. VAC foam and standard adhesive dressings were used to form a quality seal and the pressure set to 125mmHg. In both cases near complete healing was achieved to the point that standard stoma bags and management could be used.

Conclusions
This is the first description of the use of an isolation device in complex stoma associated wounds. We have found the Fistula Funnel to be highly effective in this context.
1448 Photo-Biomodulation(PBM) Therapy In Resistant Chronic Ulcers Caused By Kaposi's Sarcoma - An Effective Adjunct For Wound Healing
Authors: Kesharwani D , Thapa Magar S , Rawashdeh M , Jibawi A 
Published: October 2021

Abstract

Introduction
Photo-biomodulation (PBM), also known as low level Laser therapy (LLLT), is a novel non-pharmacological adjunct for enhancing the healing process of resistant wounds and ulcers. PBM promotes cellular proliferation and activates angiogenesis. We present a novel approach in the treatment of radiotherapy-related ulcer resistant to standard ulcer care.

Case description
A 60-year-old gentleman was referred with a complex left heel ulcer and pain following radiotherapy and chemotherapy post non-HIV related Kaposi's sarcoma resection. Conservative management failed and a below knee amputation was considered. The patient opted for an advanced therapy program. Repeated sessions of PBM were given (660 nm and 810 nm wavelength, 20Hz, 44.6 milliwatt/cm2, 26.76 Joules/cm2). The wound was covered with a novel fish skin xenograft Kerecis™ and supported with PICO™ dressing. A combination of further debridement, PBM, re-application of Kerecis™, PICO™ dressing and long-term antibiotics allowed a new vascularized layer with good pulsatile flow along wound edges to establish within 6 weeks at a rate of 4mm2/week. Achilles tendon was partially excised, and maggots were used. Full coverage of the ulcer bed with a new healthy granulation tissue was achieved in 12 weeks’ time. The pain improved dramatically, opioids were stopped, and the patient managed to mobilize independently again with occasional aids. The wound was allowed to heal with secondary intention.

Conclusions
PBM, Kerecis and best standards of wound care allowed avoiding a major amputation and healing of a malignancy-related and radiotherapy-related ulcer. PBM can be considered as an adjunct in slow / non-healing wounds for skin malignancies and radiotherapy patients.
1457 Subcutaneous Emphysema in Adolescents: A Trap for The Unwary
Authors: Sharma A , Stoner R , Fazili N , Watfah J 
Published: October 2021

Abstract

A 16-year-old, Caucasian girl presented with sudden-onset pleuritic chest pain (CP), vomiting and shortness of breath. Nil past medical history; nil medications; nil trauma/ surgery.
She was tachycardic, tachypnoeic and apyrexial with oxygen saturations &gt;96% on air. There was significant right-sided facial and neck swelling. Chest palpation demonstrated crepitations suggesting subcutaneous emphysema (SE).
Urinalysis was negative. Laboratory tests revealed leucocytosis and neutrophilia.
Chest X-Ray: SE.
CT Thorax: extensive gas within mediastinal cavity tracking along great vessels and within subcutaneous tissues with left, apical pneumothorax. Two air-filled tracts communicating between oesophagus and mediastinal cavity, ∼2cm from gastro-oesophageal junction, indicated oesophageal rupture.
Conservative management included IV Fluids, antibiotics and feeding via total parenteral nutrition. After 1-week, oral water-soluble-contrast was administered. Subsequent imaging showed no evidence of extra-luminal extravasation and she was discharged.
At 4-week follow-up, normal dietary intake was re-established with no complications.

Discussion
Boerhaave’s syndrome (BS) (described by Dutch physician Herman Boerhaave in 1724) is the phenomenon of spontaneous oesophageal perforation. The underlying mechanism is due to a sudden rise in intra-luminal pressure against a closed glottis resulting in barotrauma. BS in adolescents remains a rare entity with a paucity of reported cases. Mackler’s triad describes the classical presentation comprising vomiting, CP and SE. Non-specific presentation may delay diagnosis and a high clinical index of suspicion is required. CT thorax and water-soluble-contrast studies are diagnostic. Timing of presentation, complications and haemodynamic status dictate conservative or surgical management approach. BS carries a 20-40% mortality, and must be included in differential diagnoses of adolescents presenting with vomiting and CP.
1487 The Pied-Piper, How Gastroenteritis Led Us Astray. Fibromuscular Dysplasia: A Surgical Perspective of a Rare Vascular Disorder
Authors: Davis H , Mishra S , Adams L , Culmer C , Shrestha A 
Published: October 2021

Abstract

A 73-year-old female was admitted for abdominal pain after eating an out-of-date pie. She was treated for gastroenteritis for 48hours, after which she became unexpectedly haemodynamically unstable. Computerised Tomography (CT) suggested mesocolic arterial bleed with a large mesenteric haematoma. CT angiography confirmed false aneurysms of the middle colic artery and multiple beading of coeliac branches, small mesenteric vessels and the inferior mesenteric artery. Opinion was sought from multiple specialties, pseudoaneurysm embolisation was undertaken and steroids commenced for presumed vasculitis. Vasculitis screen was negative, and PET CT scan showed no metabolically active vasculitis. It was felt a diagnosis of fibromuscular dysplasia (FMD) was likely. Steroids have been weaned and the patient is under active observation.

Background
FMD is a rare idiopathic condition of abnormal cellular growth in medium/large arterial vessel walls. It has a frequency of approximately 0.02%, predominantly affecting middle-aged Caucasian women. It manifests mostly in renal and cerebrovascular arteries and can present as hypertension or stroke. Complications include aneurysms, stenosis and dissections. Characteristic angiographical finding is a “beads on a string” appearance. There is no current cure, but surgical or interventional involvement by angioplasty and stenting may play a role treatment.

Conclusions
This case elegantly highlights the ambiguity in diagnosis of abdominal pain in a general surgical setting; with a wide variety of differentials spanning multiple specialties, it emphasises the importance to consider rare presentations of equally rare pathologies. It is a celebration of the merits of a multi-disciplinary approach to solve complex clinical questions.
1500 Chyle Leakage Following Laparoscopic Cholecystectomy: A Problematic Post-Operative Complication
Authors: Mazumdar E , Reeves N , Witherspoon J 
Published: October 2021

Abstract

Introduction
Symptomatic choleliathiasis is a common surgical issue affecting 10% of the British population, of which laparoscopic cholecystectomy is the gold standard treatment. Asymptomatic chyle leakage post-laparoscopic cholecystectomy is an extremely rare complication.

Case Report
A 56-year-old man presents with right upper quadrant pain after recurrent episodes of acute cholecystitis. An MRCP showed small stones in the gallbladder and a stone in the distal common bile duct. The management was an urgent in-patient laparoscopic cholecystectomy. At operation, he was found to have significant gallbladder inflammation and a drain was left in-situ. On post-operative day 1, there was a triglyceride rich milky white drain fluid output, which was confirmed as chyle.

Method
The patient was asymptomatic and systematically well, so a conservative approach was taken. A strict low-fat diet resulted in resolution of the chyle leak, and the drain was removed on post-operative day 4. Follow-up at 8 weeks confirmed full recovery.

Conclusions
There are four recorded cases of such a phenomenon and is suggested it is caused by iatrogenic injury to the gallbladder fossa which may contain lymphatic vessels. The gold standard investigation is lymphoscintography, although drain fluid analysis and computed tomography imaging are more attainable investigations. Conservative management includes a fat-free diet, total parenteral nutrition and ocreotide whereas surgical management includes identifying the site of leakage and suturing it or applying fibrin glue. Lessons from this unexpected complication include treating the patient, cautiously monitoring the drain and considering surgical intervention if conservative management fails.
1521 Oral Foregut Duplication Cyst in A Neonate: A Case Report and Review of The Literature
Authors: Jefferies C , Long L , Twigg J , Carter L 
Published: October 2021

Abstract
A four-day-old neonate was referred to the Oral and Maxillofacial Surgery department by the Paediatric medical team regarding a cystic lesion associated with the child’s lingual frenulum. The lesion appeared to be affecting feeding causing a potential failure to thrive.
An MRI showed a 22 x 14 x 17 mm thin-walled oval cystic structure within the midline of the tongue/floor of the mouth. The decision was made with the family to surgically excise the lesion under a general anaesthetic. The histopathology results demonstrated the cyst to be lined with both gastric surface mucus cells and ciliated respiratory-type epithelium.
The patient was diagnosed with having an Oral Foregut Duplication Cyst (OFDC), also known as a lingual choristoma, enteric duplication cyst or heterotopic gastrointestinal cyst of the oral cavity. OFDCs are benign developmental anomalies that contain foregut derivatives. The cyst linings can contain gastrointestinal, respiratory, squamous or mixed cell types. There are only approximately 58 cases reported in the literature, demonstrating the rarity of these lesions.
OFDCs can be asymptomatic but in some neonates, they can present with difficulties feeding, swallowing and even has been shown to cause airway obstruction. If left in situ an OFDC can potentially go on to hinder speech development.
Although rare, OFDCs should be considered in a differential diagnosis of congenital oral lesions and in particular those of the anterior floor of mouth and tongue. With the use of pre-op imaging to help planning, surgical excision is both diagnostic and therapeutic.
1529 Management of A Rare Case of Bilateral Persistent Sciatic Artery Aneurysms Causing Critical Limb Ischaemia With Staged Embolisation And Femoropopliteal Bypass: A Case Report
Authors: Lau S , MacLeod C , Vesey A , Lau P F , Ghibu P 
Published: October 2021

Abstract

Introduction
Bilateral persistent sciatic arteries (PSA) are rare with an incidence of 0.001%. They represent a persistence of the embryonic axial limb circulation via the internal iliac artery. Normally the PSA involutes and is replaced by the superficial femoral artery (SFA). Failure of regression leads to a PSA with varying configurations. Up to 50% of PSAs are aneurysmal and may present with rupture or acute/chronic ischaemia, typically at 40-50 years old.

Case Report
A 74-year-old female presented with limb threatening ischaemia manifesting with rest pain, sensory deficit and early tissue loss (Rutherford IIb). She had a left femoral pulse but absent pulses distally. Pedal pulses were noted on the contralateral limb. CT angiogram revealed bilateral complete PSAs with incomplete hypoplastic SFAs (Pillet-Gauffre 2a). Both PSAs were aneurysmal; the left PSA was acutely occluded distal to the aneurysm. She underwent staged intervention with percutaneous embolisation of the left PSA, followed by femoropopliteal bypass. She was discharged six days later with good symptomatic relief at one month follow up. We are planning to treat the contralateral limb in a similar manner electively in case complications occur.

Conclusions
PSAs are commonly associated with limb threatening complications but due to their rarity there are limited reports on the management of this condition. Here we can report a good outcome in a late presentation using staged embolisation with open reconstruction.
1568 A Case of Small Bowel Intussusception Occurring Six Years After Laparoscopic RYGB
Authors: Abusheikha M N A , Arman A , Al Natsheh W A , Ayoub R M A A , Addasi R I 
Published: October 2021

Abstract

Introduction
We present a case of small bowel intussusception occurring in a female who had previously undergone Laparoscopic RYGB. Few case reports of retrograde intussusception occurring in pregnant patients with a history of LRYBG have been published. Up to our knowledge, this is the first case of this rare complication presenting in the postnatal period.

Case report
Our patient, a female in her thirties, gave birth to a healthy baby via caesarian section six years after her LRYGB. On the day following her operation, she experienced epigastric severe, progressive abdominal pain associated with nausea and vomiting. Abdominal examination showed epigastric and left upper quadrant tenderness, hypoactive bowel sounds and no palpable masses. Small bowel obstruction was suspected. A nasogastric tube was inserted and an abdominal CT scan with oral contrast was ordered. The CT scan showed multiple concentric segments of small bowel loops representing the intussusceptum pulled into the intussuscipiens, giving the classic doughnut sign. The patient was subsequently taken to theatre for a laparotomy. The mass was comprised of the biliopancreatic limb which was dilated as the common limb was retrogradely intussuscepting into it. The bowel was ischemic and remained so after manual reduction. A 45cm ischemic segment was resected and then primary re-anastomosis was done. Her postoperative course was unremarkable.

Discussion
Intussusception can present years after the original surgery, and imaging is not always reliable. Seeing as bariatric surgery is getting more popular, physicians should be well aware of this serious complication as delay in diagnosis increases morbidity and mortality.
1582 Radiolucent Foreign Bodies Presenting As IBD- The Case of An Ingested Plastic Straw Disguising as Crohn’s Disease
Authors: Wadham B , Connolly T , Satchidanand R 
Published: October 2021

Abstract
Ingested foreign bodies (FBs) occur most commonly in children or adults with impaired neurological function. Overall, 80% are thought to pass spontaneously in the faeces, with around 20% requiring endoscopy and less than 1% requiring surgical intervention. ‘Missed’ gastro-intestinal FBs are rare and often due to the lack of an obtainable history in patients with communication difficulties.
We present the unusual case of a 27-year-old female with severe learning difficulties and a complex surgical history who presented with a 2-year history of increasing abdominal discomfort due to a ‘missed’ FB. Four CT scans had misdiagnosed Crohn’s disease and the patient was due to commence immunosuppression when she developed a small bowel perforation. This was managed conservatively and follow-up imaging with a CT with oral contrast detected the FB in the ileum. The patient underwent a laparotomy with resection of a 26cm segment of ileum containing a plastic straw. Post-operatively she recovered uneventfully and is now symptom free with no evidence of IBD on histology.
This case highlights the value of oral contrast enhancement imaging in patients who don’t fit a ‘classical’ inflammatory bowel disease presentation.
1588 A Rare Case of Arteriovenous Malformation Following TMJ Arthroscopy: A Case Report and Review of The Literature
Authors: Farooq S , Sarai R , McMillan K 
Published: October 2021

Abstract
Patients undergo temporo-mandibular joint (TMJ) arthroscopy as part of the diagnosis and management of chronic pain in the TMJ. Known complications of the procedure include bleeding within the joint spaces, lacerations of the external auditory canal and local nerve damage. We present the case of a 25-year-old woman who developed an arteriovenous fistula in the right pre-auricular region secondary to TMJ arthroscopic examination. She had presented with ongoing TMJ pain necessitating further investigation with arthroscopy. Following her procedure her TMJ symptoms improved, however she developed right pre-auricular swelling of gradual onset, right-sided headaches, and pulsatile tinnitus. Due to her pregnancy of around 16 weeks this was originally linked to expansion in plasma volume and hyperdynamic circulation; however, this was later diagnosed as an extremely rare, post-operative complication of TMJ arthroscopy. Her examination revealed a pre-auricular pulsatile swelling measuring approximately 1.5 cm. Blood tests including ESR and CRP were within normal limits excluding temporal arteritis. An ultrasound scan revealed an AV fistula of the right superficial temporal artery; Her MRI confirmed single vessel supply. Following discussion in the vascular anomalies MDT, she underwent embolisation with PHIL and surgical excision via a preauricular approach. The procedure was successful, and the patient made a full recovery. The literature reports very few cases of iatrogenic arterio-venous fistulas resulting from TMJ arthroscopic surgery. Our case emphasises the importance of a multidisciplinary approach in combining embolisation with surgical excision resulting in the successful management of a rare post-operative complication.
1610 Haemangiomas of the Small Intestine: Poorly Known Cause of Abdominal Pain
Authors: Mohamed B , Soric I 
Published: October 2021

Abstract

Background
Haemangioma of the small intestine is a rare disease in adult patients and is usually located in the jejunum. The usual clinical features include abdominal pain, bleeding, and obstruction. Acute intestinal bleeding leading to anaemia is the most common presentation in most patients. Intussusception and even perforation caused by cavernous haemangioma are extremely rare

Case Summary
we report a 31-year-old male with a right upper quadrant pain, nausea, elevated CRP. ultrasound abdomen suggestive of hepatic haemgioma whereas the CT abdomen showed left upper quadrant mass. He had laparoscopy converted the laparotomy showed5*5cm small intestine mass. small bowel resection and anastomosis was done. Histology has confirmed haemangioma.

Discussion
Small bowel haemangioma accounts for 5 to 10 % of all benign neoplasms of the small intestine. It is thought to be one of the congenital benign vascular lesions. Haemangiomas are classified as cavernous, capillary, or mixed type, and the cavernous type is the most common Malignant change is quite unusual. Multiple lesions are often associated with similar neoplasms in other organs, such as the liver and skin.

Conclusions
Small intestine haemangioma are often very difficult to diagnose. Early diagnosis and appropriate intervention could provide good outcomes. Diagnostic and therapeutic measures should be taken to avoid further complications.
1613 A Case Study Implementing A Strength Training Programme with The Aim to Reduce the Risk of Osteosarcopenia And Bone Fractures
Authors: Said Noor M , Chawla M 
Published: October 2021

Abstract

Aim
Strength training induces a mechanical load, both increasing muscle mass and enhancing osteoblast activity. This results in increased muscle and bone strength, reducing the risk of osteosarcopenia. Osteosarcopenia can start after the age of 30, putting patients at increased risk of bone fractures, with an untrained individual losing 0.23kg of muscle mass per year. In this case study, we illustrate a training programme, implemented over a period of 4 weeks on an untrained individual. The aim is to set an exemplar strengthening regimen for patients to reduce their risk of developing osteosarcopenia and bone fractures.

Method
One untrained novice subject was recruited. Two physical profile measurements were taken, prior to the start of the programme and at its conclusion. These included height, weight, BMI, lean body mass, muscle circumference and 1 repetition max (1RM) for upper body strength (bench press) and lower body strength (deadlift and squat).

Results
The subject had increased strength performance with increased 1RM, or equivalent, in the deadlift (+2.9kg), squat (+3kg) and bench press (+2.5kg) He also had a small increase in lean body mass of 0.1kg and increased body circumference in all muscle groups.

Conclusions
Our study shows that a simple strength training programme performed independently can lead to improved muscle strength and increased lean body mass. We illustrated that the programme can be performed inexpensively. Forthcoming, we would like to perform a prospective cohort study with the aim to implement a standardised programme within national guidelines for fracture risk-reduction.