bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.FRI.50 Morbidity of presumed temporary loop de-functioning stomas in patients with colorectal cancer
Authors: Alfred Joshua , Macdonald Siobhan , Kalaiselvan Ramaya , Bruce Susanna Schuster 
Published: October 2021

Abstract

Objectives
The incidence of parastomal hernia (PSH) can be up to 80% of patients who have a stoma following abdominal surgery (1). Surgical intervention is required in 70% of patients due to pain, obstructive symptoms or stoma appliance issues (2). This study aims to show the morbidity related to a presumed temporary loop stoma.

Methods
This was a retrospective cohort study of all left-sided colorectal cancer resections undertaken in a single centre. Electronic healthcare records and Picture Archiving and Communication System (PACS) were used to gather data on patient demographics, operative details and details of de-functioning stoma fashioned. Morbidity related to de-functioning stoma was determined based on hospital admissions and length of inpatient stay related to stoma, complications in relation to the stoma, return to theatre, stoma reversal and fate of stoma site.

Results
147 patients (87 M; 60 F, median age 69 (23-93)) underwent left sided colorectal cancer resections at a single centre. In total, 50 de-functioning loop stomas were fashioned (49 loop ileostomies and 1 loop colostomy.) At a median follow-up of 23 months (8-44), prior to reversal, 12 PSH were identified. 38 of the de-functioning stomas were reversed at a median time of 11 months (1-44), 5 of which were emergency procedures due to obstruction (n = 3) or high output (n = 2). There were 9 stoma related re-admissions identified in 7 patients.

Conclusion
Presumed temporary defunctioning loop ileostomies in Low anterior resections is associated with significant morbidity, but low risk in terms of life-threatening complication.
EP.FRI.56 Spectrum of Clinical Presentation, Radiological Findings and Management of Tuberculosis on the Surgical Floor - An Experience from a Tertiary Care Hospital in Pakistan
Authors: Bhatti Hamza Waqar , Farooqui Marryam Riaz , Khalid Ayesha , Janjua Saad Ullah Sarfaraz , Khan Huma Sabir , Hanif Muhammad 
Published: October 2021

Abstract

Aim
Abdominal tuberculosis has varied presentation and can be confused with other conditions. The aim of the study is to assess and evaluate various clinical presentations and management of intestinal tuberculosis presenting to our tertiary care hospital.

Methods
This 3-year descriptive study was conducted on patients with diagnosed intestinal tuberculosis (by histopathology) in Surgical Unit-II, from Jan 2017 to Jan 2020. Detailed history and clinical examination were performed in all the cases. Investigations like Blood CP and ESR, Albumin, Ultrasound abdomen, X-Ray abdomen were carried out in all the cases. Preoperative assessment of anatomical site and variety of lesions were also noted. Per-operative findings and procedure performed was recorded.

Results
A total of 85 patients with diagnosis of intestinal tuberculosis were admitted and operated. Diagnosis was confirmed by histopathology. Among these, 35 (40.7%) were male, and 50 (59.3%) were female. Variable clinical presentations were seen. Majority of patients 76(89.3%) had abdominal pain 55 (64.8%) had vomiting. Most common per-op findings included strictures 42 (50%), intestinal perforation 35 (40.7%) and multiples tubercles in abdomen 24 (28.7%). Most common procedures performed were ileostomy 45 (52.8%) and right hemicolectomy 28 (33.3%). X ray and Ultrasound findings were positive in 79(91.6%) and 67 (79.6%) cases only respectively.

Conclusion
High clinical suspicion is required for diagnosis of TB. Intestinal perforation, and strictures were the commonest lesions. Definitive surgical procedure like ilecolostomy and right hemicolectomy are the main surgical options.
EP.FRI.86 Spontaneous haemoperitoneum due to acute hemorrhagic pancreatitis in a child: A Case report
Authors: Tan May Ting , Rahman Mohammad Mahbub Akhter , Sasapu Kishore 
Published: October 2021

Abstract

Introduction
Hemoperitoneum resulting from acute pancreatitis (AP) is rare. It is more commonly associated with chronic pancreatitis. Seldom, it has been associated with paediatric population. Here we report a case of spontaneous hemoperitoneum due to acute hemorrhagic pancreatitis in a child presented with the clinical features suggestive of acute appendicitis.

Presentation of the case
A 9-year old girl presented with abdominal pain and clinical features consistent with perforated appendicitis, underwent diagnostic laparoscopy. This revealed hemoperitoneum due to acute hemorrhagic pancreatitis with fat saponification in the omentum around the splenic flexure. She was stable postoperatively and was transferred to a tertiary paediatric unit for further management.

Discussion
The incidence of paediatric AP is increasing at 1/10,000 children per year. The definition of paediatric AP is based on the Atlanta criteria in adults. Biliary condition, systemic illness, and medications remain the main causes of AP in children. Intravenous fluid therapy with crystalloids remains the mainstay of treatment.

Conclusion
A high index of suspicion is required to reach the diagnosis as symptoms are commonly comprised of abdominal pain, irritability, nausea, vomiting, and epigastric pain. USS is the investigation of choice. Majority of the patient recovers completely with a recurrence reported only on 15-35% of the cases.

Key Statement
Inclusion of amylase or lipase to be considered in the routine workup if there is a suspicion of an alternate diagnosis. Diagnostic laparoscopy remains a viable option for patients presented with features of peritonism to establish a diagnosis.
EP.FRI.99 Penetrating Abdominal Trauma: Comperative Study Between Operative and Conservative Management
Authors: Shalaby Amr , Ibrahim Mohammed , El Faioumy Tarek , Elmessiry Mohamed 
Published: October 2021

Abstract

Aim
to Assess the feasibility and safety of selective non-operative management in penetrating abdominal injuries and to identify a protocol for selection of patient candidates for non-operative management.

Methods
In this comparative study 40 abdominal stab victims (admitted to Emergency Department) were selected during a 6 months period where 20 patients were suitable for non-operative management according to strict selection criteria whereas the other 20 patients were operated according to clinical and/or radiological indications or on basis of department protocol, the results were compared in view of final outcome.

Results
In our study, 15 patients were assigned for operative management according to selected clinical and/or radiological indications only 3 of them (20%) had non-therapeutic laparotomies, On the other hand, five patients were explored on basis of department protocol in violation of our indications for exploration; four of them (80%) were non-therapeutic. So, the rate of non-therapeutic laparotomies was significantly higher when done mandatory without selected clinical and radiological indications.

Conclusion
Assessment of vital signs together with abdominal examination are the most important and dependable tools in decision making in penetrating abdominal trauma patients. Patients with shock on admission (but responding to resuscitation), proved low grade solid organ injury (by CT), and proved intraperitoneal collection (by US or CT) could be managed conservatively regarding that they remain vitally and clinically stable. If failure of conservation occurs, it is usually during the 1st 24 hours after admission.
EP.FRI.178 Audit of rejected radiological referrals at Ninewells Hospital, Dundee: Reasons and outcomes
Authors: Patil Aishan , Scollay John 
Published: October 2021

Abstract

Background
Rejected radiology requests in emergency-settings can be time-consuming for clinical and radiological staff; and can delay or even affect patient management plans and outcomes. Inappropriate or duplicate radiological requests additionally can be resource-wasting (according to data from Fairfield Independent Hospital, BUPA, St. Helen’s) - the approximate costs / scan are £160 for Ultrasound, £450-£675 for CT, £350- £525 for MRI.

Methods

Results
Commonest reasons for rejection:

Conclusions
EP.FRI.183 Laparoscopic management of strangulated paracaecal hernia causing small bowel obstruction. Case report and review of the literature
Authors: Al-Ardah Mahmoud , Sisodia Heena , Clarke Michael 
Published: October 2021

Abstract

Background and Aim
Paracaecal hernia is a rare type of internal hernia usually presenting with a picture of small bowel obstruction. In this report we present a case of strangulated paracaecal hernia managed laparoscopically with aim to spot the light on this rare type of internal hernia.

Case Report
A 68- year- old lady was admitted with colicky lower abdominal pain, vomiting and abdominal distention. CT scan of her abdomen and pelvis demonstrated multiple dilated small bowel loops with a transition point in the right iliac fossa. The patient was taken to theatre where she underwent laparoscopic reduction of a strangulated paracaecal hernia. The patient had uneventful post-operative recovery and was discharged home on day four post-operatively.

Conclusion
Despite being a rare cause for small intestinal obstruction, it should be part of the differential diagnosis especially in the absence of previous abdominal operations. Early recognition and prompt surgical treatment is the key to prevent complications. Laparoscopic approach is feasible if expertise is available.
EP.FRI.196 The Giant Hoqweed as a rare cause of chemical burns: A Case Series
Authors: Lim Su Kwan , Clements Jamie , Khan Khalid 
Published: October 2021

Abstract

Introduction
The Giant Hogweed (Heracleum mantegazzianum) is a rare cause for chemical burns in humans and animals and is acquiring growing recognition in mainstream media as a relevant public health concern.
Injuries attributed to this plant range from innocuous superficial irritation to full-thickness chemical burns. A vast majority of cases will resolve with conservative measures and effective first aid, but these case series demonstrate the clinical course of more severe injuries.

Description
We present a case series of 2 patients requiring admission to the Royal Group Hospitals for management of mixed thickness hogweed burns. Injuries were sustained by two separate infestations of giant hogweed in the Western Trust Area. Both patients responded to observation and conservative measures, namely effective analgesia, UV light protection, topical hydrocortisone, and dressings.

Discussion
Cutaneous burns induced by giant hogweed are caused by contact with its photoactive sap containing plant furocoumarins. On exposure to sunlight, the sap initiates a damaging process known as phytophotodermatitis (PPD). This process can be managed effectively with topical steroids; however, prolonged contact and subsequent sun exposure may lead to more severe skin damage. In extremely rare instances, damage may progress to full skin thickness burns warranting operative intervention.
EP.FRI.199 Impacted common bile duct stone managed by hepaticoduodenostomy
Authors: Weledji Elroy 
Published: October 2021

Abstract
The management strategy of common bile duct stone will depend on personal experience, equipment availability, time and the availability of other departmental expertise. For a distally impacted common bile duct (CBD) stone in a low resource setting, an open approach will entail either leaving the stone where it is and carry out a choledochoduodenostomy, or removing the stone through a transduodenal sphincteroplasty. The latter has a significant risk of causing an acute pancreatitis. A case report of a hepaticoduodenostomy performed on a 40-year-old black African man for a retained, impacted distal CBD stone in a low resource setting with a good outcome is presented. The impacted CBD stone had complicated an open cholecystectomy for acute cholecystitis by causing the dehiscence of the cystic duct stump as a result of distal biliary obstruction. A bypass procedure such as a hepaticoduodenostomy may be an alternative to the traditional choledochoduodenostomy in the management of the retained, impacted distal CBD stone especially in the presence of sepsis. A wide side- to-side hepaticoduodenostomy (&gt;3cm d) is a safe and definitive procedure for the decompression of lower CBD obstruction and has good long-term results with infrequent complications including reflux cholangitis, hepatic abscess, stone recurrence, pancreatitis and the ‘sump’ syndrome. This case demonstrates that a hepaticoduodenostomy is safe and effective in rescuing the adverse sequelae of an impacted distal CBD stone in a low resource setting.
EP.FRI.300 Equine related trauma: a 20-year district general hospital experience
Authors: Dick Lachlan , Yule Michael , Green James , Young Jamie 
Published: October 2021

Abstract

Introduction
Although a popular recreational and competitive sport, horse riding carries risk of injury. We aimed to characterise demographics, injury patterns and outcomes of patients with an equine-related injury over a 20-year period.

Methods
Patients were identified through local coding. Data relevant to the study aims were extracted. Statistical analysis was used to determine any association between patient demographic with injury pattern or outcome.

Results
Of the 701 patients included, 71.3% were female and the mean age was 34.9 years. Simple head injury (25.4%) and upper limb fracture (21.3%) were the commonest injuries. Abdominal visceral injury occurred in 1.6% with 2 patients requiring laparotomy and splenectomy. Overall, operations were performed in 32.8%. Open reduction and internal fixation was the commonest procedure (42.4%). 30-day mortality was 0.3% and 3.1% required transfer to a tertiary centre. Older patients were more likely to have a rib (46.3 vs 33.5 years, p = &lt;0.05) or lower limb fracture (37.9 vs 34.5 years, p = 0.04) whilst upper limb fractures were seen in younger patients (30.3 vs 36.1 years, p = &lt;0.05). There was no statistical difference with other injury patterns or gender.

Conclusion
Although mortality is rare, a significant proportion of patients sustain injury requiring surgical intervention. Given the predisposition towards orthopaedic injury, adequate rehabilitation facilities need to be available. Continued development and promotion of safety equipment are also required to reduced incidence.
EP.FRI.353 Repeat Amylase in Acute Pancreatitis
Authors: Osinkolu Ifeoluwa 
Published: October 2021

Abstract

Introduction
Acute pancreatitis is a common reason for acute surgical admission, with an annual incidence of 56 per 100,000 UK population. Studies have demonstrated that whilst serum amylase measurement is useful as a diagnostic tool, it has no correlation with disease severity, and its measurement after diagnosis has limited value.
The aim of this audit was to review the practice of obtaining repeat serum amylase levels in patients diagnosed with acute pancreatitis in two district hospitals within the same health board. Secondary outcome was to gain up-to-date demographic information on the patient cohort.

Methods
This was a retrospective study, which reviewed records of those patients admitted with pancreatitis over a one-year period (January 2019 – December 2019). Electronic records were evaluated to check if serum amylase was repeated after diagnosis. Data on demographics, underlying cause and the use of CT for diagnosis were also collected.

Results
174 patients were admitted during the study period, of which 53% (92) had their serum amylase inappropriately repeated. 14% (24) of cases were diagnosed using CT imaging. There was a 0.74:1 male to female ratio with an average age of 53. 51% of cases were caused by gallstones, 15% were caused by alcohol and 28% of cases had no identified cause.

Conclusions
Validated scoring systems remain the accepted method of predicting acute pancreatitis severity. This study highlights the frequent practice of inappropriately repeating serum amylase measurement in patients already diagnosed with acute pancreatitis. It also highlights the importance of CT scanning as a diagnostic tool.
EP.FRI.362 Improving Prescribing and Minimising Delay in Administration of Potassium Replacement Therapies: Surgical Audit on Management of Hypokalaemia in Emergency Surgical Unit at a District General Hospital in UK
Authors: Park Ji Young , Mai Dinh Van Chi , Tenovici George 
Published: October 2021

Abstract

Aims
Surgical patients are prone to hypokalaemia due to gastrointestinal losses1. Hypokalaemia prolongs ileus2 and thus prompt management is essential. No current guideline on hypokalaemia focuses on surgical patients. We aimed to identify the prevalence of hypokalaemia in emergency surgical patients as well as measure timeliness and appropriateness of replacement.

Methods
We retrospectively reviewed adult emergency surgical admissions exceeding 48 hours between 05/05/2020 and 15/07/2020. A sub-group analysis assessed the timing of intravenous replacement and duration taken to normalise potassium (3.5 mmol/L). We used another NHS trust’s guideline3 as standard for appropriate potassium replacement.

Results
Of 110 surgical admissions, 26 cases were hypokalaemic. Of these, 15 had initially normal potassium level. Three cases were likely iatrogenic secondary to inappropriate fluid prescribing. Mean potassium in the hypokalaemic group was 3.2 mmol/L (80.8% mild vs. 19.2% moderate). Mean length of stay was 11.3 days for hypokalaemia versus 6.54 days in normokalaemic cases. Mean duration of hypokalaemia was 2.13±1.45 days. Potassium replacement was prescribed correctly in only 50% of cases (23% not prescribed; 25% insufficient; 2% incorrect) and of these correct prescriptions, 46% were not actually administered. When intravenous replacement was given, there was a mean 3.55-hour delay between lab result and administration.

Conclusion
The majority of hypokalaemic cases developed during admission. Only 27% of these patients had correct potassium replacement in terms of both prescription and administration. Consequently, we have created a local guideline for hypokalaemia in surgical patients to standardise both prevention and management.
EP.FRI.496 Does hospital volume effect time to theatre in patients undergoing emergency laparotomy? A retrospective analysis of NELA data
Authors: Tucker Stefan , Dick Lachlan , Bairstow Fiona , Green James , Young Jamie 
Published: October 2021

Abstract

Aims
Delays to theatre in patients undergoing emergency laparotomy are associated with poorer outcomes. It is unclear whether hospital volume impacts arrival to theatre within a time appropriate to urgency. We aimed to determine the association between hospital laparotomy volume and time to theatre for patients undergoing emergency laparotomy.

Methods
The National Emergency Laparotomy Audit aggregate hospital reports from years 1 – 6 were used to extract data relevant to the study aims. Hospitals were categorised into high, medium and low volume using inter-quartile ranges, with each year counting as a single episode. Statistical analysis was used to determine if there is a difference in arrival to theatre within a time appropriate to urgency.

Results
A total of 751 episodes were included, representing 193 high volume, 370 medium volume and 188 low volume hospitals. The mean proportion of patients arriving to theatre within a time appropriate to urgency were 81.5%, 83.5% and 85.3% respectively. There was no statistical difference between low to medium volume hospitals however, there was when comparing medium to high volume (p = &lt;0.05) and low to high volume (p = &lt;0.05) hospitals.

Conclusion
Hospitals with low and medium emergency laparotomy volumes have fewer delays to theatre. Whilst it is likely to be multifactorial, it is important for hospitals to have efficient patient pathways in place to reduce delays.
EP.FRI.500 Establishing a protocol of management of acute bowel obstruction in a tertiary hospital in the Middle East
Authors: Alanany Amr , Moshref Leena , Gergi Patrick , Alotaibi Abdulrahman , Malaekah Haifaa , Abouleid Ayman 
Published: October 2021

Abstract

Aim
To establish a protocol of management of acute bowel obstruction in a tertiary hospital in the Middle East.

Method
An online search in PubMed, Cochrane reviews and Google Scholar for the period between 2010 and 2020 was performed to identify all published guidelines and recommendations for the management of acute bowel obstruction including the keywords small/large bowel or intestinal obstruction, adhesive obstruction, complete/ partial obstruction and conservative/ surgical management of bowel obstruction.

Results
A protocol of management of acute bowel obstruction has been developed, reviewed and approved by different concerned departments in the hospital. The indicators to monitor the implementation of the protocol had been approved by the Quality and Risk Management Committee of the hospital.
The protocol is divided into 7 sections. These sections include:1) ER assessment with all essential clinical, laboratory and radiological investigations required going hand in hand with resuscitation, hydration, pain control and antibiotic prophylaxis.2) Surgical assessment by senior trainee who will liaise with consultant surgery on call. 3) Radiological assessment guidelines done by senior Radiologist to review the CT scan. 4) Admission criteria. 5) Risk prediction scorings with involvement of critical care team if indicated. 6) Surgical management guidelines with rapid access to operating theatre if indicated. 7) Non- surgical management guidelines including conservative, radiological and endoscopic management.

Conclusion
Multidisciplinary team approach is essential for the management of acute bowel obstruction. Hospital agreed guidelines and protocols can reduce the significant morbidity and mortality associated with common clinical conditions hence improving patient’s care.
EP.FRI.508 Improving Antibiotic Stewardship on General Surgical Wards
Authors: Clark Mhairi , Crumley Andrew , Wilson Michael 
Published: October 2021

Abstract

Aims
Good antibiotic stewardship is a core part of patient care. It has been shown to reduce antibiotic resistance and improve overall patient outcomes. The primary aim was to improve compliance with national antibiotic prescribing guidance. In doing so, we sought to improve documentation of antibiotic duration; reduce the duration of intravenous antibiotics and gentamicin courses; and length of stay in hospital.

Methods
50 general surgery inpatients at a district general hospital over a 2-week period were included in cycle 1. All eligible patients on antibiotics were included. Patients were excluded if under 18 years; discharged within 24 hours; or on antibiotics for prophylaxis. Intervention was a poster and education sessions with prescribers. Cycle 2 gathered data from a further 50 patients from the same wards over 10 days.

Results
There were improvements in documentation of antibiotic duration (from 1% to 52%, p = 0.001); prescription of antibiotics in line with guidance (from 74% to 90%, p = 0.0376) and number of patients on intravenous antibiotics (reduced from 89% to 72%, p = 0.0307). Duration of gentamicin courses also improved: from 23% patients getting more than 72 hours of gentamicin, to 0% post intervention. Length of stay was also reduced, however was not statistically significant (4.98 days to 4.10 days, p = 0.259).

Conclusions
This simple audit intervention improved antibiotic stewardship on surgical wards, which is an essential part of overall care for patients. Future work could be done to further improve on this, including a prompt via electronic prescribing and targeted interventions in other clinical areas, e.g. ICU.