bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.FRI.615 Assessing the reliability of the Adult Appendicitis Score in managing patients with suspected acute appendicitis
Authors: Zheng Carry , Lee Shiela , Brown Steven , Kanakala Venkat 
Published: October 2021

Abstract

Aims
To evaluate the effectiveness of using a clinical prediction tool in the management of suspected acute appendicitis

Methods
Retrospective data was collected on patients undergoing appendicectomy at a single tertiary centre from November 2019 to June 2020. Inclusion criteria were all patients aged 18 and above undergoing diagnostic laparoscopy for suspected appendicitis. Exclusion criteria were all patients that had a pathological finding other than appendicitis at laparoscopy. The pre operative AAS score at first presentation was calculated and patients grouped into low(0-10), intermediate(11-15), and high(16 and above) risk. These groups were then compared to the histological findings.

Results
A total of 74 patients were included, 44 male and 30 female. The age range was from 18 to 83, with a median age of 36. Of 10 patients in the low risk group, 4 (40%) had appendicitis on histology. 36 out of 40 (90%) patients in the intermediate risk group had appendicitis and 100% of the 24 patients in the high risk group. Pearson’s coefficient showed a significant correlation between the AAS risk (low, intermediate, and high) and the histological diagnosis of appendicitis (r = 0.48, p = 0.000016).

Conclusions
Our study did show a positive correlation between the AAS risk stratification and histological diagnosis. Based on our findings we would recommend the adoption of this score in assessing patients with suspected acute appendicitis and minimising the negative appendicectomy rate.
EP.FRI.623 Outcome of Rectus Sheath Catheters for Post Operative Analgesia in Patients Undergoing Laparotomies and Elective Colorectal Resections
Authors: Darwish Nourelhuda , Dhahri AdeelAbbas , Anad Adam , Sanwu David , Ivanov Bogdan 
Published: October 2021

Abstract

Aims
Multimodal analgesia combining regional and local analgesia and avoiding opioids are part of most ERAS protocols aiming to achieve good pain relief. We aim to examine the effectiveness of using rectus sheath catheters (RCSs) for pain relief in patients undergoing laparotomy surgery and wither this have affected the postoperative (30-day) outcome and the need of opioids.

Methods
This was a retrospective study involving patients who underwent midline laparotomy surgery, including elective colorectal resections in the period between 01/07/2020 and 23/12/2020.

Results
A total of 71 patients were included in the study, of which 40(56.33%) had RSCs while 31(43.66%) did not. Morphine was required for 24(60%) of those with RSCs and for 18 patients (58.06%) with no RSCs. PCA was used in 5 (12.5%) of those with RSCs and in 10 (32.25%) of those without RSCs. Of patients requiring non-PCA morphine, mean total morphine doses were 6.4 in patients with RSCs and 4.89 in patients with no RSCs.
Of patients with RSCs, (22.5%, 9/40) developed chest infection within 30 days (average onset at day-11) compared to (25.8%,8/31) of the other group (average onset at day-5). 20% (8/40) of the patients with RSCs had atelectasis postoperatively compared to 29.03% (9/31) of those who did not. The Average postoperative stay was 13.65 days and 21 days for those with and without RSCs, respectively.

Conclusions
Using RSCs did not reduce morphine usage, However, it is associated with lower incidence of chest infection and atelectasis in addition to shorter hospital stay.
EP.FRI.758 Management of Small Bowel Obstruction: A Retrospective Audit
Authors: Baggaley Alice , Clements Caterina , Tudyka Vera 
Published: October 2021

Abstract

Aims
How does management of small bowel obstruction (SBO) at a district general hospital in London compare with current recommendations from the BMJ Best Practice algorithm and the National Audit for Small Bowel Obstruction (NASBO)?

Methods
This retrospective audit captured patients admitted with SBO over a four-month period. Two authors searched the general surgery admission lists and extracted hospital numbers. A total of 59 patients were identified initially but nineteen of these patients were subsequently excluded, leaving 40 to be analysed. Inclusion criteria involved age 18 or over and SBO proven on imaging.

Results
The majority of the obstructions were secondary to adhesions (65%), with 10% due to hernia, 7% due to inflammatory bowel disease and 5% due cancer. All but one patient underwent computed tomography (CT) and in 90% of cases this was performed within 12 hours of initial assessment. For those who underwent a period of conservative management, 64% received a water-soluble study. Seven patients had immediate surgery within 12 hours of admission, and 5 patients proceeded to surgery after failed conservative management. Of the patients who failed conservative management, only one was operated on after the 72 hours.

Conclusions
Access to CT was excellent, as was time to theatre when the decision was made for immediate surgery. There was not a difference in access to imaging or theatre given the time or day of the week. Use of water-soluble studies in conservative management could be increased and the time to this study could be formalised.
EP.FRI.874 Laparoscopic Assisted Submucosal Excision of an Intussuscepted Colonic Lipoma through a Colotomy; A New Technique
Authors: Ejtehadi Farshid , Jesudoss Abraham , Hassan Adil Mubarak , Mohammed Elsamoual , Vivekanandan Shanmugam , Vijay Vardhini 
Published: October 2021

Abstract
Lipomas are the most common non-epithelial tumours of the colon. Nevertheless, symptomatic colonic lipomas are a rare entity in adults. Intussusception is the commonest complication of submucosal lipomas and often presents with absent, non-specific or intermittent symptoms, hence the diagnosis is challenging.
In non-emergency situations, most patients undergo computed tomography scan as well as endoscopic evaluation of the colon prior to any surgical intervention. While successful endoscopic excision of lipomas has been reported, segmental resection of the colon is most commonly practiced. To the best of our knowledge, this is the first report of laparoscopic assisted submucosal excision of an intussuscepting colonic lipoma through a colotomy.
We present the case of a young female patient with few weeks history of intermittent abdominal pain associated with nausea. She had previously undergone various investigations including colonoscopy and was awaiting an elective left hemicolectomy. She presented to our Emergency department with subacute large bowel obstruction. A CT scan confirmed the diagnosis of colo-colic intussusception due to a large descending colon lipoma. The patient underwent a laparoscopic assisted procedure - following laparoscopic colonic mobilisation, submucosal excision of the large lipoma was performed through a colotomy placed through the taenia on the opposite wall. The mucosal defect and colotomy were closed following the excision. The patient recovery was uneventful and histopathology of the specimen confirmed the diagnosis.
EP.FRI.925 Time to look back at NASBO 2017. Have we learned any lessons from NASBO trial in treating patients with small bowel obstruction?
Authors: Majeed Talal , Thapa Anjali , Sommereux Lauren , Patten Alan , Pourikkou-James Marriane , Ishak Rafik 
Published: October 2021

Abstract

Introduction
SBO is a common surgical presentation but despite advancements in surgical and diagnostic skills, patient’s outcome remains poor. SBO need multidisciplinary approach and needs careful decision making at each step of its management. There were no standard protocols to treat these patients until NASBO report 2017 1, with guidelines for step-wise approach to diagnose, treat and follow up patients presenting with SBO.

Aims
This study is an assessment of our local services to evaluate if we are compatible to NASBO guidelines and what we need to do to improve patient outcomes.

Study design
A retrospective observational cohort study was done in a busy emergency surgery unit in North West with highest rate of emergency laparotomy (NELA 2019)2, on patients presented with proven SBO during year 2018.

Methods
Clinical, nutritional and radiological assessment, conservative or operative management, clinical outcomes and complications were compared to the national data from 131 hospitals reported in NASBO 2017.

Results
136 patients (median age 72) with 59% patients treated with non-operative approach while 41% had surgery (almost half of them were treated conservatively initially).
Imaging and nutritional assessment and complication rate were well within the target range.
HDU admission rate was 16% and 30-day mortality was 8% of which 3% were treated palliatively for malignancy and severe comorbidities.

Conclusions
Our results are similar in clinical performance and management when compared to national average. Certain areas like laparoscopic approach, ERAS, nutritional assessment and elective HDU/ITU admissions have been identified as areas to improve.
EP.FRI.960 USS appraisal in females of child bearing age presented with possible appendicitis
Authors: Hatem Fady , Mostafa Samir , Chamali Basel , Ivanov Andrea , Ross Rebecca , Sonsale Aniket , Kaldas Foad 
Published: October 2021

Abstract

Aims
Appendicitis remains the most common acute surgical condition. No standard guidelines for the use of imaging studies, and there is a discrepancy between the published data regarding accuracy of these modalities and our practical findings. Yet the growing number of USS reported as “appendix not visualized” has led us to rethink about the value of USS in acute appendicitis.

Methods
A retrospective single centre study for all females (15-45 years) underwent emergency appendectomy for suspected acute appendicitis. Analysis of preoperative clinical, radiographic and postoperative histopathological data was done.

Results
632 cases analysed over 18months, out of those 238 (37%) were females (15-45 years). USS was done in 129(54%) cases. 25(10.5) cases had both USS and CTAP. 32(13%) cases had only CTAP. The mean rate of appendix visualization in the USS was 30%(71cases) two thirds reported by radiologist versus one third by sonographers. Our negative appendectomy rate dropped from 25 to 15% after a positive scan.

Conclusions
Traditional preference for ultrasound in the UK compared to CTAP in young population is mostly due to the potential hazards of irradiation, but USS commonly does not visualise the appendix in our practice (70%), and has low sensitivity and specificity for appendicitis. However, following a positive USS, NAR dropped to 15%. Radiologists had a higher visualization rate of appendix compared to sonographers. Commitment to improve the performance of ultrasonography by allocating adequately timed sessions to the most experienced radiologists and increasing the use of low dose CT scans are possible solutions.
EP.FRI.976 ERAS after malignant colorectal resections: A single centre experience
Authors: Gok M A , Smart C J , Sadat M M , Ward S J , Khan U A 
Published: October 2021

Abstract

Aims
ERAS employs a multi-modal rehabilitation aids post-op recovery following colorectal resections. ERAS applied in both laparoscopic + open surgery. This study aims to assess effectiveness of ERAS at a single centre.

Methods
A retrospective study at East Cheshire NHS Trust, since 2008. Descriptive demography & post-operative features were collected for all elective colorectal resections.

Results

Conclusion
ERAS associated with longer operative time (p &lt; 0.05) (laparoscopic surgery), a shorter hospital stay was achieved (p &lt; 0.05). Delayed ERAS occurred in 26.2 % of cases & can result in delayed discharge. Early ERAS deviations occurred in the presence of major surgical complications (ileus, anastomotic leaks, collections). Despite post-operative cardiac & pulmonary events, ERAS was maintained. A targeted rehabilitation programme especially in the elderly patients can lead to earlier recovery.
EP.FRI.986Life threatening bleeding duodeno-jejunal flexure GIST successfully managed with surgery- Case report
Authors: Atkins William , Perera Duranka , Ayantunde Abraham 
Published: October 2021

Abstract

Introduction
Gastrointestinal stromal tumours (GISTs) are sarcomas and the most common non-epithelial cancers of the GI tract.

Patient
A 77-year old man with life threatening melaena, drop in haemoglobin from 109 to 71 in 24 hours and hypotension. Co-morbidities included COPD, chronic microcytic anaemia, type 2 Diabetes mellitus and hypertension. Anaemia for 9 years had been investigated with OGD and colonoscopy showing no pathology. Calculated Rockall score was 6. An Urgent Oesophagogastroduodenoscopy showed normal findings with no source of bleeding identified.
An urgent CT angiography demonstrated a vascular blush at duodenojejunal (DJ) flexure identified as the source of bleeding. Four units of was blood transfused preoperatively. The bleeding source was not embolisable.
He underwent an initial diagnostic laparoscopy to confirm the site of the lesion and ascertaining whether resection and anastomosis would be visible. Findings at laparoscopy included a DJ flexure lesion. A midline mini-laparotomy, wedge resection of the lesion with a hand-sewn anastomosis was performed. He had a prolonged hospital stay with gastroparaesis and high nasogastric tube output.
Histology showed a well-demarcated, lobulated bland spindle cell lesion. The tumour is composed of cells with mainly blunt ended nuclei. There is strong positive staining to CD117 and DOG-1. There is focal positive staining to Desmin and SMA. The tumour is negative for S100 AND but Pankeratin.
Overall, MDT felt that this was a 30mm DJ flexure GIST with less than 5 mitoses per 50mm2. R1 achieved resection but with a low risk (4.3%) of recurrence based on the histological characteristics.
EP.FRI.997 Recognising frailty: the scale of the problem
Authors: Martin Laura , Chapman Susan , Broadbent Elizabeth , Payne Christopher , Beecroft Christina 
Published: October 2021

Abstract

Aim
To assess compliance with frailty scoring in acute surgical admissions.

Method
Data including age, admitting speciality, whether the frailty score was completed and the recorded score if completed, were collected for all admissions to an acute surgical unit over a 7 day period in November 2019.

Results
The average age of the 139 patients was 56.25 years (range 16-89). Frailty scoring was completed in 53 patients (38.1%); 8 patients (15%) met the criteria for frailty. Sixty-four patients (46%) were aged over 65 years, 26 (40.6%) had the score completed and 7 (27%) met the frailty criteria. Of 36 patients (26%) aged 75 or over, 16 (44.4%) were scored and 6 (37.5%) met the frailty criteria. Scoring was most frequently completed in patients admitted under the Vascular Surgery team (52.9% compliance) with a mean score 3.8.

Conclusion
Worsening frailty is associated with increased morbidity and mortality in acute surgical admissions. The 7-point Clinical Frailty Scale has been added our acute surgical admission document and should be completed for every patient. Our compliance with scoring is a long way from our recommended 100%, with compliance with assessing frailty across age groups similar, despite the increased rates of frailty seen in older age groups. Poor compliance with frailty assessment may hamper future progress with the management of the frail, older surgical patient. We are planning documentation changes, staff education sessions and to appoint frailty ‘champions’ with a repeat audit of compliance to assess the effects of these changes.
EP.FRI.999 Case report of a Low Grade appendiceal mucinous neoplasm (LAMN) and review of literature
Authors: Da Costa Kimberly , Sabanathan Sivakumaran 
Published: October 2021

Abstract
A mucocele refers to an appendix that has dilated due to progressive accumulation of mucus within its lumen. Appendiceal mucocele is a rare cause of an acute abdomen. They represent 0.2-0.7% of all appendix specimens. LAMN account for less than 0.3% of appendicectomy specimens.
We present a 38 year old man with an acute RIF’s pain who went on to have CT scan which revealed a mucocele of appendix but did not show any features of perforation or pseudomyxoma peritonei. He had a laparoscopic converted to open appendicectomy. The proximal 2 cm of appendix was oedematous but normal calibre. Histology revealed a low grade appendiceal mucinous neoplasm (LAMN) that was completely excised.
The mucocele of the appendix was first described by Rokitansky in 1842. Appendix mucocele may come as a consequence of obstructive or inflammatory processes, cystadenomas or cystadenocarcinomas. Appendiceal mucinous neoplasms commonly presents in the sixth decade of life and our patient was much younger in comparison. Several literatures suggest the value of preoperative CT imaging in obtaining diagnosis and also in planning further treatment. Appendicectomy or a right hemicolectomy is treatment of choice based on presence or absence of following factors 1. Perforated mucocele 2. Involvement of the base of the appendix. 3. Positive lymph nodes of mesoappendix and ileocolic. Patients with malignancy or pseudomyxoma peritonei are likely to require cytoreductive surgery, heated intraoperative intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy.
EP.FRI.1020 The necessity of colonoscopy to rule out colorectal malignancy after computerised tomography proven diagnosis of acute diverticulitis
Authors: Barman S , Meney L , Boyle C , Collison C , Shalli K 
Published: October 2021

Abstract

Introduction
The current Royal College of Surgeons commissioning guideline on colonic diverticular disease suggests that patients should undergo endoscopic evaluation of the colonic lumen after an episode of computed tomography (CT) proven acute diverticulitis to rule out malignancy. The necessity of routine endoscopic assessment of CT proven diverticulitis remains debatable.

Aim
To establish whether routine endoscopic assessment should be carried out for patients after an episode of acute diverticulitis.

Method
Data was collected retrospectively from all patients diagnosed with acute diverticulitis on CT and who subsequently had follow up endoscopic assessment from January to July 2019.

Results
Total number of patients were 64.Median age of the cohort was 58.Of all patients, 48 had diagnosis of uncomplicated diverticulitis whereas 16 patients had diagnosis of complicated diverticulitis on CT scan. All patients had follow up colonoscopy after an acute attack with following findings: 2 patients had no pathology, 56 patients had diagnosis of only diverticulosis, 4 patients had both diverticulosis and polyps and 2 patients had bowel cancer. All 4 cases of polyps had benign pathology and uncomplicated diverticulitis on CT scan. Two bowel cancer patients, one had complicated diverticulitis with thickening of proximal sigmoid and the other patient had abnormal sigmoid colon suggestive of malignancy on CT scan.

Conclusion
Recent meta-analysis showed no difference between diverticulitis and normal population group in terms of risk of bowel cancer. Routine colonoscopy may not be appropriate in patients with acute uncomplicated diverticulitis but endoscopic assessment after an episode of complicated diverticulitis is necessary.
EP.FRI.1067 Exploring the Patient Journey and Social Care following Emergency Laparotomy in the Elderly: A Systematic Review of Qualitative Studies
Authors: Chan Anthony , Goldsmith Paul , Watson Andrew , Stathakis Panos , Smith Stella , Macutkiewicz Christian 
Published: October 2021

Abstract

Aims
Frailty is associated with high morbidity following emergency laparotomy. Objective scores such as P-POSSUM are well recognised in predicting outcomes such as morbidity and mortality. Qualitative factors affecting recovery and rehabilitation are less established. This review explores the lived experiences of elderly patients following emergency laparotomy to identify factors to improve post-hospital care.

Methods
A systematic review of the medical and nursing literature was performed using MEDLINE, Web of Science Core Collection and CINAHL Plus in January 2020. Qualitative and phenomenological studies were identified using keywords ‘emergency’, ‘laparotomy’, ‘abdo*’ and ‘surgery’. Cancer studies were excluded. Themes were extracted for ‘lines of argument’ synthesis to build a general interpretation of findings. The review is registered with PROSPERO (CRD42019159751).

Results
The search identified 569 unique citations of which 551 were excluded after screening and 17 excluded following full-text review. One study was included (Thomsen et al, 2014) exploring postoperative care for 18 patients following emergency abdominal surgery. Thematic analysis was limited to the hospital setting. Patients described Critical Care as a safe environment for recovery and rehabilitation because of higher nursing ratios. Patients placed emphasis on ready access to staff and timely interventions which was particularly poor on surgical wards. Specific barriers, particularly patient concerns regarding recovery, were not explored.

Conclusions
This review highlights the importance of easy access to staff and inpatient services following emergency laparotomy but demonstrates the lack of qualitative evidence exploring the lived experience of the immediate post-discharge period that impacts on rehabilitation back to normal activities.
SP1.1.4The Walking Thread – What happens to fistula-in-ano patients who are lost to follow up? A Service Improvement Study
Authors: Murgitroyd Ellen , Wilson Blair , Kremel Darja , Anderson David 
Published: October 2021

Abstract

Aims
Management of perianal abscess and resultant fistula-in-ano remains controversial. Studies suggest that 1/3 of idiopathic cryptoglandular abscesses can result in fistula-in-ano. Our current practice is to incise and drain primary abscesses and for patients to return as necessary. Known fistula patients will be appointed for Examination Under Anaesthetic (EUA) at 6-12 weeks. Does this result in best management or do they become “elective emergencies”?

Methods
A retrospective audit of management of fistula-in-ano over 4 years was conducted, utilising precollected data of Cryptoglandular abscesses, excluding inflammatory, radiation or malignant causes. Patients lost to follow up were analysed including presentation, fistula diagnosed at first or subsequent attendance, number of operations, number of attendances and seton placement.

Results
512 patients underwent operations for cryptoglandular abscess causing fistula-in-ano between 2013 and 2017. 10% (N = 50) were lost to follow up despite documented follow up plans for 32. Of these, 18 were elective attendances, 14 emergency. 24 of the 32 had a Seton sited prior to being lost to follow up.

Conclusions
The various presentations (emergency, elective, clinic) and waiting lists mean these patients are presenting as emergencies whilst awaiting follow-up. Many are simply lost to follow up, with Setons in-situ. We propose a fortnightly hot-clinic system, run by second on-call registrars to assess and manage these patients. This would provide an elective clinic to allow single point of access to fistula-in-ano patients ensuring prompt follow-up and reduction in unnecessary EUA, as well as improving senior colorectal trainees exposure to perianal disease and its management.