bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-BN30 Retroperitoneal biloma: a case report of spontaneous retroperitoneal bike leak and collection
Authors: Bickerton Robert , Godden Amy , Bointas Georgios , Bakhet Marize , Bingham George , Gonzalez Hector 
Published: December 2021

Abstract

Background
Retroperitoneal biloma is a rare complication of gallstone disease. Only a handful of cases have been reported in the literature with various mechanisms postulated. Here, we report a case of spontaneous retroperitoneal biloma arising from gallbladder perforation.

Methods
An 87-year-old female patient presented with right upper quadrant pain in the context of known gallstone disease. Inflammatory markers and liver function tests were deranged. Cross sectional imaging found acute cholecystitis and a gallbadder neck perforation with an impacted 2cm proximal common bile duct (CBD) stone.
A cholecystostomy was placed and she improved clinically. However, inflammatory markers remained high, and a subsequent computed tomography (CT) found a large collection in the retroperitoneum.

Results
The retroperitoneal collection measured 14cm x 7cm, and there had been evidence on prior CT scans of retroperitoneal inflammation. It was urgently drained under ultrasound guidance and found to contain bilious content. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) was unable to retrieve the CBD stone, but left stents either side of the stone. The patient clinically and biochemically improved. She was discharged and had an elective ERCP, which successfully retrieved the stone, with a plan for urgent elective laparoscopic cholecystectomy.

Conclusions
Here, we report an interesting case of retroperitoneal biloma successfully managed with ultrasound-guided drainage.
Perforation of the distal CBD can result in retroperitoneal bile leak, but the proximal CBD stone in this case would have likely prevented passage of bile. A more likely cause is adhesion of the gallbladder neck to the posterior parietal peritoneum due to chronic inflammation, with subsequent perforation and release of bile into the retroperitoneum. This has previously been described in the literature. Regardless of mechanism, knowledge of the potential for this rare complication is important for anticipating and appropriately managing complications of gallbladder perforation.
P-BN38 Patient Outcomes Following Laparoscopic Cholecystectomy after a Diagnosis of Gall Bladder (GB) Polyp over 10 Years
Authors: Richardson Tom , Karunanithy Vithurshanan , Kumar Akshay , Thomas Sudeep , Khan Saad 
Published: December 2021

Abstract

Background
Gall Bladder (GB) polyps are elevations of the GB wall that project into the lumen. They are a rare incidental radiological finding with prevalence of 0.3% to 9.5%. Although the majority of these may be pseudopolyps correct follow up and management is essential as to ensure that true polyps, which may be malignant or have malignant potential, are not missed. We conducted a retrospective study assessing patient factors that may predispose to the finding of true polyps. Patient outcomes including histological findings as well as ongoing symptoms and further investigations or emergency attendances were also assessed.

Methods
Patients were identified for this retrospective ten year cohort study using International Statistical Classification of Diseases and Related Health Problems (ICD 10) code K 82.8, other specified diseases of gall bladder. Patients with other diagnoses such as gall bladder dysfunction were excluded after review of electronic patient record (EPR) (Sunrise, Allscripts). EPR allowed for review of emergency attendances, clinic letters, investigations and histological results for those diagnosed with a gall bladder polyp. Analysis was performed with Microsoft Excel.

Results
35% patients had a laparoscopic cholecystectomy and the average wait time for surgery was 19 months but only 11% of patients were found to have true GB polyps on histology. Other histological findings included chronic cholecystitis (96%), cholesterolsis (33%) and stones 35%. Only 12% of those booked straight to laparoscopic cholecystectomy re-presented post operatively compared to 37% of those operated on after a period of surveillance. Patients booked straight for laparoscopic cholecystectomy, or diagnosed with polyps &gt;10mm in size, were statistically more likely to have a true GB polyp (P &lt; 0.05), however, gender, ethnicity, and whether an isolated polyp or multiple were diagnosed made no statistical difference to detection of a true polyp (P &gt; 0.05).

Conclusions
From this series of patients true polyps are most likely to be identified if it is larger than 10mm at diagnosis and operated on straight away. 96% of all patients, however, displayed histological features of chronic cholecystitis. This suggests that proceeding to laparoscopic cholecystectomy straight from diagnosis of a GB polyp can be justified. Only 1patient in our cohort returned normal GB histology.. Following diagnosis of a GB polyp, the option of operation versus surveillance should be discussed wirth individual patients and decisions based on assessment of risks and benefits should be made. Further research will help identify those with a predisposition to high-risk true polyps.
P-BN39 The perils of MRCP requesting and early associations of data quality and likelihood of a diagnostic result
Authors: Jones Callum , Barton Helena , Pathak Samir , Rees Jonathan 
Published: December 2021

Abstract

Background
MRCP (Magnetic resonance cholangiopancreatography) is used most to assess the biliary tree for stones or strictures. Recently, MRCP availability has increased, and it is extensively used to detect of common bile duct (CBD)stones although very frequently no stones are seen. Indeed, the currently recruiting sunflower RCT aims to determine the clinical and cost effectiveness of expectant management versus MRCP in patients undergoing laparoscopic cholecystectomy at low or moderate risk of common bile duct stones. However, it is critical when requesting an investigation that adequate information is provided. This work aimed, to describe the adequacy of information provided and correlate this with the MRCP result. We hypothesised that the less information that was provided the more common a normal result would be.

Methods
For a three month period (January 2021 to April 2021) all MRCP requests to detect the presence of a CBD stone were reviewed and data obtained from the Radiology CRIS (CDN Radiology Information System, CDN, Sydney, Aus.). The requesting information was compared to three pre-defined criteria (CBD diameter, presence of gallstones and LFT details) that were agreed as the optimal information that a reporting radiologist would require. The number of key pieces of information for each request and whether the request identified a CBD stone were identified. The proportion of MRCPs detecting a CBD stone was calculated according to the number of key pieces of information provided.

Results
56 patients were identified, of which 16 (29%) patients had CBD stones. In 24/56 (43%) patients the presence of gallstones on a previous ultrasound was provided, 14/56 (25%) of patients had information about LFTs including bilirubin and a trend in LFTs was not stated for any patient (0/56; 0%). The rate of stone detection was calculated by the number of pieces of information provided. The rate was 71% (5/7) when all 3 pieces of data were provided, 31% (2/13) when two piece of information were provided, 30% (8/27) when a single piece of information was provided, and only 11% (1/11) when none of the specified data were provided.

Conclusions
It is uncommon for adequate clinical information to be provided in MRCP requests and in 16% of request no key information was provided. The LFT results were frequently omitted and the trend in LFTs never stated. The more key data provided in the request saw a higher proportion of MRCPs where a CBD stone was identified. We recommend that maximal clinical information is mandated for MRCP request perhaps using mandatory fields on electronic requesting systems and that these systems are also used to facilitate recruitment to clinical trials such the Sunflower RCT.
P-BN47 Acute cholecystectomy in elderly - Age is not a limit
Authors: Gupta Aayush , Rashid Muhammad Umair , Rupasinghe Namal , Adjepong Samuel , Rink James , Kirby George , Jain Rajesh , Riera Manel , Parampalli Umesh , Pattar Jayaprakash 
Published: December 2021

Abstract

Background
Acute or hot cholecystectomy (AC) has been established as a safe and efficacious modality of managing acute biliary pathology. However, it has been performed with caution in the elderly (defined by the world health organisation as patients over the age of 65). The NICE guidance in this area does not preclude this practise on elderly patients. Our acute cholecystectomy service treats patients of all ages according to performance status and fitness for surgery rather than age we audited our results in this age group.

Methods
All patients over the age of 65 who underwent acute cholecystectomy in the dedicated emergency cholecystectomy lists were audited from the period starting 31st December 2019 to 31st June 2021. Patient demographics, co-morbidies and surgical factors were recorded. The primary outcomes measure was in hospital stay and re-admission, secondary outcome were complications and perioperative mortality.

Results
41 elderly patients underwent AC during the audit period, (male 18: female 23). Majority of patients had acute cholecystitis 30(73%). The median inpatient stay following surgery was 2 days(range 2-5 days) and the median admission to surgery time was 6 days (range 5-12 days). Only 3(7%) patients had a subtotal cholecystectomy. There was only 3 complications from surgery which were all between a clavien-dindo score of 2 and 3. There were 3 readmission in the immediate post-operative period. There was one 30-day mortality which was from necrotising pancreatitis as a result of ERCP and not from the operation.

Conclusions
Acute cholecystectomy in this age group appears to be safe and effective way to treat acute biliary pathology and compares similarly to the outcomes in the younger groups.
P-BN51 Subtotal cholecystectomy: risk factors and patient outcomes
Authors: Lucocq James , Hamilton David , Scollay John , Patil Pradeep 
Published: December 2021

Abstract

Background
A subtotal cholecystectomy (SC) is indicated when a total cholecystectomy (TC) cannot be achieved without the risk of causing significant harm, the most feared complication being a bile duct injury. The aims of the present study were to identify patients at risk of SC, to compare the peri- and post-operative course between SC and TC and to compare outcomes between fenestrated and reconstituting subtypes.

Methods
All planned laparoscopic cholecystectomies across three surgical units over a population of 493,000 between 2015 and 2019 were considered. Data were collected retrospectively using electronic databases and included pre-operative, operative and post-operative data over a 100-day follow-up period. Variables associated with SC were identified using multivariate logistic regression. Outcomes following SC were compared with TC using univariate analysis, specifically chi-squared and Mann-Whitney U tests. The subtype of SC was documented and outcomes were compared between groups.

Results
The rate of SC was 3.4% (94/2768). Variables positively associated with SC included male sex (OR-2.33;p&lt;0.001), age≥60 (OR-1.79;p=0.009), 2 previous admissions (OR-1.76;p=0.043), ≥3 previous admissions (OR-3.10;p=0.003), emergency cholecystectomy (OR-2.01;p=0.002); cholecystitis (OR-4.92;p&lt;0.001) and pre-operative ERCP (OR-2.23;p&lt;0.002). Patients with SC versus TC were more likely to suffer intra-operative complications (RR-13.1;p&lt;0.001), post-operative complication (RR-6.7;p&lt;0.001), require post-operative imaging/intervention (RR-4.0;p&lt;0.001) and be re-admitted (RR-4.2; p &lt; 0.001). The rate of bile duct injury was 0% in SC patients. The rate of post-operative bile leak was higher where the cystic duct was left open versus closed (RR-2.9;p=0.03) and in fenestrating SC versus reconstituting SC (35.7% versus 0%;p=0.002). Drain duration was reduced in reconstituting SC (p &lt; 0.001).

Conclusions
The risk of SC can be explained by a number of patient specific factors and the risk should be emphasized in these patients during the consent process and should influence surgical decision making. The morbidity following a subtotal cholecystectomy is markedly higher than that of a total cholecystectomy but can be performed without significant risk of bile duct injury. Reconstituting SC and closure of the cystic duct reduces rates of post-operative bile leaks and duration of drains.
P-BN54 The outcomes after a Laparoscopic subtotal cholecystectomy
Authors: wintrip Dorothy , Thomas Christophe 
Published: December 2021

Abstract

Background
Laparoscopic subtotal cholecystectomy (LSC) is a recognised option when the “critical view” cannot be safely delineated. It carries a high morbidity rate as there are increased frequencies of a bile leak occurring however reducing the risk of bile duct injury. LSC can be further divided into fenestrating or reconstituting cholecystectomy, the later entails closing the remnant. The literature state reconstituting cholecystectomy reduced rate of bile leak. We reviewed our cases to analyse the complication rates of LSC and there outcomes.

Methods
A retrospective review of patients who underwent a laparoscopic subtotal cholecystectomy (LSC) using electronic records between January 2015 to March 2021.
A total of 160 patients, with a mean age of 65, 51% male and 49% female.

Results
76% of LSC were performed as an emergency. Mean operation length was 96min and the mean blood loss 92ml. Complications occurred in 50% of patients.
Post operatively 22% underwent an ERCP and the re-operation rate was 9%.
The mean length of stay was 8 days.

Conclusions
Based on our results LSC carry a high rate of bile leak with the majority requiring intervention in the form of ERCP or laparoscopy and wash out. A reconstituting cholecystectomy, closing with an endoloop of suture seems to slightly reduce the rate of bile leak. LSC are only performed when managing a difficult gallbladder with a dense/ inflamed Calot's triangle. There were no mortalities associated with a LSC.
P-EGS06 Evaluating the impact of COVID-19 on the trend of emergency laparoscopic cholecystectomy
Authors: Agrawal Simrita , Sellahewa Chaminda 
Published: December 2021

Abstract

Background
Since the spread of the new SARS-CoV2 coronavirus in March 2020 to the UK, contradictory recommendations on the practice of laparoscopic cholecystectomies fuelled some debates among surgeons. The British Intercollegiate General Surgery Guidance recommended laparoscopic cholecystectomy as the treatment of choice for acute cholecystitis during the COVID-19 pandemic. Contradictorily, the Royal College of Surgeons of England warned about the unknown risk of viral infection and the release of pressurised gas from laparoscopic surgery. The audit aimed to identify the differences in surgical care before and during the pandemic to study their impact on patients.

Methods
Retrospective patient data was obtained from September 2019 to September 2020 to include data six months before the pandemic and six months during the pandemic. The data obtained had the patient hospital number, fitness for cholecystectomy, decision made regarding surgery, date of admission and date of surgery.

Results
178 patients before COVID-19 and 242 patients during COVID-19 were admitted with gallstone disease. Before COVID-19, 60.67% (n = 108) patients were fit and consenting for surgery. Of these patients, 60.19% (n = 65) were discharged for surgery later and 39.81% (n = 43) had inpatient emergency surgery. During COVID-19, 71.49% (n = 173) patients were fit and consenting for surgery. However, 87.86% (n = 152) were discharged for surgery and only 12.14% (n = 21) had inpatient surgery. The average time from admission to surgery increased from 8 days to 51 days during COVID-19. Although majority of inpatient surgeries were performed within eight days, the percentage performed was fewer during COVID-19.

Conclusions
The COVID-19 pandemic significantly affected emergency laparoscopic cholecystectomies performed in the hospital with a substantial increase in the average time taken from admission to surgery. More emergency laparoscopic cholecystectomies should be included in the weekly elective lists, design for dedicated emergency cholecystectomy lists and increase utilisation of the CEPOD theatres along with staff availability are required to achieve the emergency cholecystectomy service as guided by the Royal Colleges.
P-EGS12 An observational study investigating the differences the COVID-19 Pandemic had on admissions, methods of injury in a tertiary trauma centre in a major UK City
Authors: Mwangi Brian , Smith Stella 
Published: December 2021

Abstract

Background
During March 2020 the country was plunged into a nationwide lockdown. Despite this, there remained a steady stream of trauma admissions. COVID changed a lot about how many medical specialties worked and we wanted to explore the effects on our patient population, and compare it to the experience of other hospitals.

Methods
We analysed existing data on admissions to the Emergency Department that were referred to the trauma service between the 12th of March to the 24th of May; encompassing the lockdown and the two weeks either side. This data was compared to that of the year beforehand. We compared ages, sexes, mortality, methods of injury, and disposition.

Results
Admissions fell, 193, compared to 271 (∼3:1 M:F). Both cohorts featured more younger people, but there was a drop-off in the number of older folk post-COVID; 6 of 9 centiles of the over 60s showed a fall in admissions of at least 14%. Those admitted to the Major Trauma service (ISS 9+) remained the same. Regarding the methods of injury, the most common presentations remained road traffic accidents, stabbings and falls &lt;1m, contributing to 71 and 72% total admissions before and after COVID respectively. However, there were fewer patients falling from heights of &gt; 2m (OR 0.5), and fewer recorded assaults (OR 4.0). Penetrating injuries were separated into “stabbings” and “others”. There was a significant increase in non-stabbing penetrating injuries (OR 4.6), a majority of which were self-inflicted. The rate of self harm during the lockdown showed a similar increase, from featuring in 8% of total presentations to 15% of admissions (OR 1.87). The hospital restructured considerably between the sample dates such that dispositions are not possible to compare meaningfully. Rates of patients sent straight home from the ED were similar (OR 1.0).

Conclusions
Overall, the lockdown had a moderate impact on patient numbers and demography. The data implies that the measures did small amounts to deter people from the roads and from interacting with each other in assaults and stabbings. Older people were less likely to present traumatically. The isolation may have led to a masking of mental health issues leading to a significant increase in self harm, which may present opportunities for restructuring of services in any the event of further major lockdowns.
These conclusions are limited by the data, and next steps would include gathering more detailed mortality data.
P-EGS13 Risk Factors of Bleeding Gastroduodenal Ulcer Among Patient Undergo Emergency Upper Endoscopy in Hospital Melaka
Authors: Yunus Mohammad Alif , Hassan Najihah Farhana , Haris Ahmad Amirul Hafiz , Samad Abdul Rahim , Razali Faris Suhaimi , Ismail Yahya 
Published: December 2021

Abstract

Background
Bleeding gastroduodenal ulcer has been one of the leading causes of admission in surgical or gastroenterology departments all over the world, requiring immediate intervention with high associated mortality exceeding 10%. We analyzed few important risk factors that lead to this potentially ill condition.

Methods
Data from a number of 548 patients who underwent emergency upper endoscopy were collected retrospectively from June 2020 till June 2021 in Hospital Melaka.

Results
From our data collection of emergency upper endoscopy performed, 111 patients had findings of high-risk ulcer (Forrest Ia, Ib, 2a and 2b). From these 111 patients, the most common presentation was low hemoglobin value (&lt;10g/dL), with 43.6%. Presentation of melena encountered the second most common symptom (26.3%), while fresh per rectal bleeding counts the less common symptom (1%). Forrest Ib ulcer showed the commonest diagnosis found during endoscopy (45.5%), followed by Forrest IIa ulcer (34.5%), Forrest IIb ulcer (16.4%), and Forrest Ia ulcer (3.6%). There were 27 participants who undergo repetitive endoscopy. For Helicobacter Pylori infection, there were 367 patients (66.7%) underwent the test during endoscopy, which showed 187 patients detected (51%) with H.Pylori positive. We identify other risk factors which lead to this fatal condition such as, patient’s comorbidities including liver disease, renal disease and their medications, blood investigations including hemoglobin level, platelet count, total white cell count, total bilirubin, Alanine Transaminase (ALT), serum urea and creatinine.

Conclusions
It is a must to identify important risk factors for bleeding gastroduodenal ulcers to prevent morbidity and mortality, and to initiate emergency intervention medically and surgically. From this study, it was a great move for us to make further research on how these risk factors affecting our management of patients.