bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TU.688The fate of the rectal stump following subtotal colectomy for acute colitis
Authors: Lucocq James , Porter Darren , Muthukumarasamy Girivasan 
Published: October 2021

Abstract

Aims
Acute severe colitis requires surgery in approximately thirty percent of cases. Subtotal colectomy with end ileostomy is the standard procedure with distinct advantages to a laparoscopic approach. Controversy surrounds the optimal short and long-term management of the distal rectal stump. This study reviews the clinical outcomes and the fate of the rectal stump in this patient cohort.

Methods
Analysis of prospective data of patients who underwent emergency subtotal colectomy for severe acute colitis between 2010 and 2020 in a tertiary referral centre.

Results
Sixty-six patients underwent subtotal colectomy (median age, 40years; M:F, 1.3:1). Subtotal colectomy was performed for failure of medical therapy during an acute episode of severe colitis (56%), for fulminant colitis (40%), or for colonic strictures (4%). In 98% percent of patients the rectal stump was closed at the level of the recto-sigmoid junction and in 2% a mucous fistula was formed. 73% of patients opted for no further surgery, but 27% underwent a completion proctectomy, most commonly performed because of rectal stump bleeding. The median follow-up was 6.25years, during which 17% of those with a completion proctectomy underwent an ileo-pouch anal anastomosis (IPAA).

Conclusions
Subtotal colectomy with closed rectal intra-peritoneal stump and end ileostomy is the procedure of choice in severe acute colitis refractory to maximal medical therapy or fulminant colitis. Given the patient dissatisfaction and morbidity associated with mucous fistula, this procedure should be abandoned. Pelvic dissection should not be performed at the time of the emergency subtotal colectomy given the risk of morbidity.
EP.TU.713A review of mobile device stands to facilitate virtual surgical skills teaching
Authors: Measuria Radheswari , Yau Jih Dar , Loubani Professor Mahmoud 
Published: October 2021

Abstract

Aims
To assess optimal overhead video camera stand for virtual surgical skills teaching.

Methodology
Based on the assumption that most surgical trainees have an internet-enabled mobile device with a camera, an overhead device mounted on a phone stand is a ubiquitous set-up for trainers and trainees to demonstrate surgical skills to each other virtually.
On 4th December 2020, to reflect affordability and accessibility, phone stands under £15 were purchased from an online retailer, Amazon. Data regarding their design characteristics were collected and studied. Each product was independently reviewed in a simulated setting by two investigators.

Results
11 stands were identified with prices ranging from £5.99 to £14.99, with an average of £9.20.
Clamp phone holders were the most secure in camera stability but were less adaptable to a variety of device sizes. Table-clamp and broad-based phone stands were sturdier than tripod-based holders.
Fit-for-purpose phone stand designs were linked with smaller space occupied at set-up, greater maximum height for camera and more intuitive set-up. Products with smaller box dimensions, which were associated with storability, allowed them to be portable and have lower costs of delivery.

Conclusion
The ideal features for a phone stand are a clamp or stand for the base and a clamp phone holder, with reasonable cost and storability.
Phone stand 4 was the most favourable candidate based on this review; however, further user feedback is required from trainees and trainers to select an ideal design suited for virtual surgical skills teaching.
EP.TU.838Educating the ITU Nursing Staff during the COVID-19 Pandemic: A Quality Improvement Project
Authors: Devarakonda Sreekar , Korula Pritish John 
Published: October 2021

Abstract

Aims
The nursing staff always plays a crucial role in the management of patients. This pandemic had put the ITUs under an undue burden, and the nurses faced an altogether new challenge. There was extensive use of various oxygen delivery systems and fastly emerging guidelines. So, there is an increased demand for the nursing staff to stay abreast with the situation. Hence a teaching program was organized for the ITU nurses.

Methods
Five academic sessions were conducted as a part of the first cycle of QIP in November 2020 under the guidance of nursing tutors and ITU consultants. These topics covered the respiratory system, including Severe Acute Respiratory Illness, Non-invasive and Invasive ventilation techniques, and ARDS. Feedback forms were collected and analysed after each session, which focused on the usefulness and relevance of content, teaching style, and the overall confidence in the topics.

Results
Audit of the feedback forms showed globally positive feedback and improvement in understanding amongst the nursing staff. Also, the confidence of nurses in these topics increased abundantly. Many of them expressed interest in attending similar sessions in the future.

Conclusions
Keeping the nursing staff up-to-date with the latest management guidelines is quintessential for patient safety. More so during this pandemic, where academic activities are becoming scarce, and protocols are rapidly changing. Further sessions on relevant topics will continue to enhance learning.
EP.TU.888Aortic dissection: Causes of delay in diagnosis and transfer, implications for patients, and how to improve
Authors: Blakley Megan , Poots Catherine , Ahmed Alsir , Joseph Jijin 
Published: October 2021

Abstract

Background
Aortic dissection is a common differential in patients presenting with chest pain. In Northern Ireland, there is one hospital with a cardiac surgical unit. Therefore, patients are diagnosed in district general hospitals and then transferred for intervention.
Over the past number of years it has been noted that there can be delays in the diagnosis and transfer of patients with aortic dissection to the cardiac surgery service. This study aims to identify any common reasons for this and develop a way to improve.

Methods
Patients operated on for aortic dissection from 2014-2019 in the Royal Victoria Hospital Belfast were included. Their notes and electronic care records were analysed, looking at time of initial presentation, time of diagnosis, and time of arrival to theatre.

Results
61 cases were analysed. Among those with delays in diagnosis, many were initially admitted medically or to cardiology wards for work up of their chest pain. When a medical cause was not found, scans were performed demonstrating aortic dissection. Some patients were discharged from ED after initial presentation and the diagnosis was found on re-presentation. There were delays in reports of some scans. Delay in diagnosis was a more common feature than delay in transfer.

Implications
Delay in diagnosis or transfer of these patients affects their prognosis. As a result of this study a pathway has been developed regarding diagnosis, initial medical management, and transfer of these patients and it is hoped this will be implemented in hospital departments in Northern Ireland in the future.
EP.TU.972Torsion of the gallbladder: a rare disease
Authors: Taylor Roland , Reid David 
Published: October 2021

Abstract

Gallbladder torsion was first described as early as in the 19th century but there are only about five hundred cases reported in literature. This rare disease predominantly affects elderly women with a median age of 77 years.The female to male ratio is 4:1. Though the exact etiology is unknown, certain anatomical variants of the gallbladder are thought to increase one's predisposition to the condition. Gallbladder torsion is very difficult to diagnose preoperatively and even with all the advancements in imaging techniques, only about a quarter of cases are diagnosed preoperatively. Most cases like the index case are diagnosed during surgery

Aim
To review the diagnosis and management of gallbladder torsion in 78 year old female patient who presented acutely to our unit.

Method
Discussion on the presentation, assessment, imaging and preoperative findings to as well as the management plan adopted.

Results
A review of intraoperative findings, postoperative recovery of the patient and literature on gallbladder torsion.

Conclusion
Since the first case of laparoscopic cholecystectomy for torsion in 1994, 105 further cases have been reported. Of this, 28% were managed by laparoscopic surgery whilst 8% resulted in a laparoscopy converted to open procedure. one case of ERCP detorsion has been reported. A high index of suspicion together with improved imaging techniques can help to significantly improve the preoperative diagnosis of gallbladder torsion. Early operative management usually results in a good prognosis. Innovations imaging techniques to help improve preoperative diagnosis will be discussed.
EP.FRI.5 Defining measurable data points for Emergency Surgical care
Authors: Pearson Katherine , Kowalska Aleksandra , Jannoo Shalaina , Bailey Ian , Elberm Hassan , Berry David 
Published: October 2021

Abstract

Aims
Service provision and assessing the impact of future innovations can best be assessed by accurate data collection.

Methods
We have devised a simple dataset and implemented prospective data collection detailing patient referral source and outcome (consecutive days from 19.08.20 to 06.01.21) of Acute Surgical admissions.

Results
2706 patient episodes.

Conclusions
These baseline figures demonstrate referral source and outcomes. Traditional Emergency Department referrals via the Surgical Registrar result in a noticeable difference in admission rates compared with novel pathways such as ASU Direct which allows admission from ED without discussion. These data are essential to facilitate proper evaluation of service delivery, the impact of novel pathways and would allow units to compare / combine results.
EP.FRI.48 Right iliac fossa pain in females: more than appendixes and ovarian cysts; Haemorrhagic Cyst in the Canal of Nuck: A Case Report
Authors: Davis Heather , Marshall Caitlin , Nahid Md Abu Kamal , Shah Ankur 
Published: October 2021

Abstract

Case report
A 43-year-old woman presented with acute onset migratory right iliac fossa pain, on a background of intermittently painful right groin swelling. CT demonstrated differential diagnosis of appendicitis besides an ovarian cyst. Diagnostic laparoscopy was undertaken with a view to diagnosis and treat possible appendicitis, ovarian cyst and inguinal hernia. To our surprise, a haemorrhagic nuchal cyst was seen intraoperatively, and duly aspirated. Post-operatively she recovered well and was discharged the same day.

Introduction
The Canal of Nuck is a small evagination of parietal peritoneum which accompanies the round ligament through the inguinal canal, in females. It is obliterated in the first year of life. When this remains patent, it can fill with fluid and result in the formation of cysts (akin to hydroceles in patent processus vaginalis).
In current literature there are only sixteen case reports of Nuck hydroceles in adults, with only one haemorrhagic cyst reported.
These are typically diagnosed in children, but occasionally present in women (aged 35.18 ± 3.27) with groin swelling and are frequently misdiagnosed as hernias. It is only when these woman are taken to theatre, that the correct diagnosis is discovered.

Conclusion
This case highlights the importance of considering Canal of Nuck cysts when women present with groin swellings, to ensure quick diagnosis and appropriate management is delivered under the correct speciality.
EP.FRI.101 Paediatric Appendicitis Score (PAS): A local trial of a risk prediction pathway
Authors: Lim Jie , Darwich Ayman , Paul Saati , Malik Afaq , Verma Keshav 
Published: October 2021

Abstract

Introduction
Right iliac fossa (RIF) pain remains the commonest acute general surgical presentation in children. Our centre had been an outlier compared with the national average in terms of negative appendicectomy rates. Thus, we designed and implemented a local pathway for risk stratification and management of children with RIF pain.

Methods
The first phase was a retrospective analysis of all appendicectomies performed between April 2018 and March 2019, in children aged five to seventeen years old. Pre-operative inflammatory markers, clinical signs, and histology findings were analyzed. Second phase involved designing a pathway utilizing Paediatric Appendicitis Score (PAS), a ten-point scoring system when assessing children with RIF pain. The final phase was a prospective analysis of appendicectomy results performed between August and November 2019, after implementing PAS pathway.

Results
92 cases were recruited in the first phase (mean age 12.3). 22 cases were analyzed in the final phase after implementing PAS pathway (mean age 10.9). Our negative appendicectomy rates had reduced from 25% to 15.4%. In addition, we found that 96% of positive appendicectomies had either raised inflammatory markers (WCC or CRP), raised PAS (Score of ≥ 4), or both.

Conclusion
There is noticeable difference in our negative appendicectomy rates since the introduction of PAS pathway. A diagnosis of appendicitis in a child with normal inflammatory markers and PAS score seemed unlikely. Our goal is to continue utilizing the PAS pathway in our department in order to reduce unnecessary surgeries in children.
EP.FRI.121 Unusual sites of colorectal cancer metastases – A complete systematic review
Authors: Alfred Joshua , Altaf Kiran , Titley-Wilson Gabriella , Shah Maya , Williams Ruby , Ahmed Shakil 
Published: October 2021

Abstract

Background
While colorectal cancer (CRC) usually metastasizes to liver, lungs and central nervous system, spread to more unusual sites is rarely reported in literature. We aimed to investigate unusual colorectal metastases (UCRM), their clinical course and disease progression.

Methods
MEDLINE, EMBASE and Cochrane Library were searched by independent reviewers to identify clinical studies to date that reported UCRM and relevant demographic/clinical data were extracted.

Results
We identified 349 patients, involving 28 sites (bone, musculo-skeletal, skin, brain/spinal cord, head, eye, oral mucosa, thyroid, mediastinum, heart, bronchus, breast, biliary/GI tract, stomach, pancreas, spleen, adrenal, urinary tract, inguinal canal, ovaries, vagina, vulva, testes, spermatic cord, prostate, penis) with male preponderance and median age of 59 years (IQR=54.5-65). These were diagnosed at a median interval of 18 months (IQR=6-36)) after a median follow-up of 12 months (IQR=6-22.5). More were metachronous (n = 210) with recurrence rate of 15.75%. Primary CRC staging revealed T3 in 61% (28%-T4), equal distribution of N0/N1 (38%/37%) and M0 in 85%. 74% of primaries were surgically resected (96%=adenocarcinomas) and 54% underwent adjuvant therapy. UCRM were resected in 45% of cases and showed same histology as primary. 30% had chemotherapy. Only 8% were palliated. Overall morality was 35.24%.

Conclusion
This is the first comprehensive review looking at clinical course and outcomes of patients with UCRM. Most of these developed in patients with primary T3/N0 staging. Outlook of these patients is comparable to those with usual metastatic disease. Judicious and rigorous surveillance is the key to early detection and timely management.
EP.FRI.181 Beyond the adenoma- carcinoma sequence. A review of the morphogenetic basis of colorectal cancer
Authors: Daniel Sudin , Patil Sangram , Iype Satheesh 
Published: October 2021

Abstract

Introduction
Looking beyond the adenoma carcinoma sequence researchers have discovered alternate morpho-genetic routes, and tumour biomarkers in colorectal cancer. This has caused a paradigm shift in the management, resulting in improved diagnosis, prevention, and delivery of tailored treatment aiming at specific molecular pathways.

Aims, Methods
This review summarises

Methods
PubMed, Google Scholar, NLM searches based on aims and key words were conducted. Further, academically and clinically relevant searches were made if more information was required. When required, references of articles were also retrieved.

Results
The two main theories regarding the morphological origins of colorectal cancer are the adenoma carcinoma sequence and the De-novo origins. The underlying genetic models are the (i) chromosomal instability pathway (CIN), (ii) the microsatellite instability pathway (MSI) and (iii) the CpG Island methylator phenotype (CIMP) pathways. Though unique, the pathways communicate with each other. The genetic fingerprinting of colorectal cancers has an impact on their tailored management and consequently a through grounding in the basics are essential for those in gastrointestinal subspecialties.

Conclusions
Two morphologically distinct pathways and three unique genetic mechanisms have been described. There are significant interactions between them. Behaviours of sporadic and inherited colorectal cancer, their treatment and prognosis depend on our understanding of these mechanisms and the availability of targeted therapies to assist surgical resection.
EP.FRI.277 A Young Lady with Lower Abdominal Pain. Eosinophillic Enteritis; an uncommon cause for a common symptom
Authors: Lefroy Rebecca , Kalatzis V , Brookes Alastair 
Published: October 2021

Abstract

Aims
Abdominal pain presents frequently to the acute general surgical take with a huge variation in nature and, most importantly, in cause. The large number of common diagnoses are frequently discussed however, we present the case of a young lady with the uncommon diagnosis of eosinophilic enteritis as a primary presentation of lower abdominal pain. Here we present her case and review the current literature surrounding this condition and the group of conditions causing eosinophilia in the gastrointestinal tract.

Methods
A search of PubMed was performed, looking for research published within the last 50 years, regarding human subjects and published in English. This identified 16 review papers and 18 case reports. From these, current recommendations regarding investigation, diagnosis, management and follow up was assessed. We reviewed our case using clinical notes, clinic letters and investigations to evaluate our management of this case.

Results
Our case represents an unusual case where not only did our patient suffer eosinophilic enteritis (the least reported of these group of conditions) but they also underwent surgery to reach diagnosis. Our review of the literature revealed that although our lady presented in an unusual fashion, this may well have prevented months of investigation.

Conclusions
Eosinophilic enteritis is a rare condition, unusually seen or managed by surgeons. An awareness of this diagnosis and group of conditions is useful in the acute surgical setting as another differential for a common presentation. In our presented case, multidisciplinary management resulted in a swift diagnosis and favourable outcome for this patient.
Ep.Fri.329 Severe Acute Pancreatitis in Pregnancy Secondary to Hypertriglyceridemia – A Case Report and Literature Review
Authors: Fadipe Toks , Narayanasamy Sangara Narayanan , Thomas Pradeep 
Published: October 2021

Abstract

Background
Hypertriglyceridemia is a common and well characterized physiological phenomenon in pregnancy. Rarely does it complicate the pregnancy causing acute pancreatitis (APIP). The majority of APIP cases arise secondary to gallstones. Hyperlipidaemia induced pancreatitis is a rarer cause with relatively worse outcomes with increased incidences of preterm delivery and pseudocyst formation.

Case Report
A 38-years-old woman at 29 weeks gestation presented with epigastric pain. The initial investigations revealed raised inflammatory markers, elevated amylase and hypertriglyceridemia. A diagnosis of APIP was made, prompting transfer to ITU. Foetal compromise necessitated an emergency Caesarean delivery. Post-partum, her clinical condition improved with NG feeding, bezafibrates and IV antibiotics. Her baby was transferred to a nearby tertiary neonatal unit with no immediate complications.

Discussion
Hyperlipidemia induced APIP requires intensive treatment. Various medical treatments for hypertriglyceridemia, such as fibrates and insulin infusions, have been described. Plasmapheresis in severe cases may benefit reducing the triglycerides level. Considering maternal and foetal morbidity and mortality, early diagnosis and multidisciplinary input is required to treat and reduce complications.

Conclusion
APIP is a serious and rare complication of pregnancy. The current lack of consensus on treatment of APIP warrants further inquiry, to minimise poor neonatal outcomes. The merits of routine screening for gestational hypertriglyceridemia are yet to be elucidated; the morbidity associated with APIP, coupled with its rising incidence justify a targeted screening programme.

Keywords
Pancreatitis, Pregnancy, Hypertriglyceridemia.
EP.FRI.422 Over 100,000 COVID-19 deaths calls for a radical reform of health and care system in the UK
Authors: Bodapati Shruti , Gambhir Raghvinder 
Published: October 2021

Abstract

Aim
With over 100,000 deaths due to COVID 19 and still counting, is it a wake-up call to overhaul our health and care system.

Methods
Review of NHS England, Office of National Statistics (ONS) and Public Health England (PHE) data to determine where the deaths occurred and what role did the primary care, secondary care, play in delivering the service.

Results
The data shows that it took 40 weeks to get to the first 50,000 deaths and just another 10 weeks to add another 50,000 deaths. Among the OECD UK ranked number 1 for deaths due to COVID 19. 69.9% of deaths occurred in hospitals, 24.1% in care homes, while 4.9% occurred at homes. The primary care effectively remained shut for face to face consultation, effectively leaving people to manage themselves at home on their own or reach A & E when things got worse. The hospitals where overwhelmed and coped by shutting out all elective work and converting normal wards to COVID wards and that is where the maximum deaths occurred. There were over 80000 excess deaths above the five-year average.

Conclusion
We may have been underprepared for the first wave but had the PPE and plans to battle the second wave yet we had the highest mortality in Europe. Is it a price we paid for our disjointed health and care system. There is a need for radical changes to prepare for future disasters.
EP.FRI.477 Neutrophil-To-Lymphocyte Ratio (NLR) as a Predictor of Acute Appendicitis
Authors: Tasleem Sadia , Gulnaz Nadia 
Published: October 2021

Abstract

The most common reason for an acute surgical assessment of the abdomen is acute appendicitis with a rate as high as 30 %There is a lifetime risk of 8.6% and 6.7% in men and women respectively. The common age for presentation is between that of 5 and 4.4 while 28 is the median age.
The objective of this study was to determine the diagnostic accuracy of (NLR) neutrophil-to-lymphocyte ratio to prognosticate severe/ complicated appendicitis by taking histopathology of the appendix as a gold standard.

Methodology
This cross-sectional validation study was conducted at the department of surgery and western vascular institute, University College Hospital Galway, Ireland retrospectively for a period of 6 months in 2016 And approximately 186 cases with appendicitis were enrolled in the study.

Results
The mean age of patients in this study was 29.15±9.54 years, the ratio of male to female was 1:1.7. The sensitivity, Specificity was 97.1% and 25.2% respectively and the diagnostic accuracy of NLR was 38.7% taking histopathology as the gold standard.
We observed that the sensitivity, specificity, and diagnostic accuracy of NLR changes with the duration of symptoms in days, the sensitivity, specificity, and diagnostic accuracy of NLR was 100%, 17.0%, and 28.7% respectively for &lt;3days and 92.3%, 93.75% and93.1% respectively for &gt;3 days.

Conclusion
According to our study results the (NLR) neutrophil-to-lymphocyte ratio is a highly sensitive tool to predict severe/ complicated appendicitis by taking histopathology as the gold standard, but with the low value of diagnostic accuracy in terms of specificity.