bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.FRI.452 Complicated Littre Hernias
Authors: Matias Mariana , Kronberga Madara , Aghahoseini Assad 
Published: October 2021

Abstract

Background
Meckel’s diverticulum is the most prevalent congenital anomaly of the gastrointestinal tract with an estimated prevalence ranging from 2% to 4%. The diverticulum is a remnant of the vitelline duct, which leads to the formation of a true diverticulum containing all the layers of the small intestine. The condition is usually clinically silent; however, it can present with unusual symptoms and signs and therefore can result in a delayed diagnosis, particularly in adults.
The aim of this study is to review the most recent literature reporting Littre hernias in adults, the diagnostic approach and its subsequent management.
This is a literature review, complemented by unusual clinical case of an adult patient who presented with a Littre hernia containing a Meckel’s diverticulum in a strangulated umbilical hernia sac, which required emergency surgery.

Method
Literature review using Web of science, PubMed and other reliable sources using the possible combinations of the following key words: Meckel’s diverticulum, Littre hernia, umbilical hernia, adults, complications, surgical treatment.

Results
The herniation of a Meckel’s diverticulum through a potential opening in the abdominal wall is defined as a Littre hernia, representing a rare complication of the diverticula. Due to their rarity, they often remain underdiagnosed, potentially leading to sub-optimal treatment and significant morbidity.

Conclusion
A Meckel’s diverticulum, despite being a rare clinical entity in adults, can theoretically be found in any hernia, with patients experiencing a wide range of potential complications.
EP.FRI.461 Management of acutely ill surgical patients NICE guidance CG50: a complete audit cycle
Authors: Kalaskar Shrinivas , Bonomoully Mathew 
Published: October 2021

Abstract

Aim
NICE CG50 guidelines are a response to evidence suggesting patients who are, or become, acutely unwell may receive suboptimal care. The guidelines suggest:
After previously unsuccessful audits a fourth re-audit was designed to re-assess compliance with the CG 50 guidelines.

Method
After implementing previous recommendations like, keeping a poster of recommendations in the handover room and making these guidelines as part of surgical induction, a re-audit was planned. A prospective random sample of 40 patients admitted during the general surgery was taken. Using the audit tool the following parameters were recorded for each patient in the sample:

Results
The compliance was 100% for patients who have had their physiological observations recorded at the time of admission or initial assessment, the percentage of patients monitored using a physiological track and trigger system, and the percentage whose physiological observations were monitored at least every 12 hours. The compliance was 95% for the percentage of patients with a clear written monitoring plan.

Conclusions
Following the interventions detailed above, there is now 95 to 100% compliance with NICE guidelines in the documentation.
EP.FRI.468 A review of the management of malignant bowel obstruction at an NHS teaching hospital
Authors: Banks Jessica , Aiynattu Sony , Ishak Rafik 
Published: October 2021

Abstract

Patients presenting with malignant bowel obstruction (MBO) due to peritoneal metastasis present a clinical dilemma for surgeons: although palliative surgery is beneficial, post-operative complications and mortality are as high as 30%. A personalised and multi-disciplinary approach is paramount when treating these patients.

Aims
This study aimed to review the management (surgical versus conservative) of patients presenting with MBO; ascertain if a multi-disciplinary approach was adopted; and compare clinical outcomes including length-of-stay, readmission rates and mortality.

Methods
All patients admitted with MBO secondary to peritoneal metastasis between January 2019 – January 2021 were identified.

Results
29 patients; 14 females, were identified with a median age 72. The median length of stay was 16 days.
All patients had a CT scan and 76% were performed within 24 hours of admission. 25/29 patients were referred to palliative care.

Conclusions
Overall mortality and morbidity in our cohort, regardless of surgical or conservative management, is consistent with existing literature. Palliative care input was sought for the majority of patients.
Management decisions should be individualised and focus on ensuring the best quality of life for the patient. All decisions should be made with multi-disciplinary input.
EP.FRI.530 ‘Emergency’ Laparoscopic Common Bile Duct (CBD) Exploration: Is this the right time to change?
Authors: Patil Sangram , Daniel Sudin , Hussain Abdulzahra , Vasas Peter 
Published: October 2021

Abstract

Aims
Common Bile Duct (CBD) stones are becoming more common on surgical emergency take and accounts for up to 20 % of patients presenting with acute biliary pathologies. The hospital stay is prolonged whilst waiting for Endoscopic Retrograde Cholangio Pancreatography (ERCP). We aim to evaluate the feasibility, safety and cost-effectiveness of emergency laparoscopic CBD exploration (LCBDE) in these patients.

Methods
A cohort of patients with CBD stones underwent emergency LCBDE between January 2016 and December 2020 at a regional hospital in the United Kingdom was retrospectively reviewed.

Results
In total, 11 LCBDE were performed on emergency list. All patients were admitted with acute symptoms of either obstructive jaundice cholangitis or pancreatitis. All procedures were performed with choledochotomy. The mean patient age was 58 years and male-to-female ratio was 2:9. 3 patients (27%) had T- tube otherwise all ducts were primarily closed. Average hospital stay was 8.5 days. 1 patient returned to theatre for retained stone of 11mm. There was no 30 days mortality. There were no readmissions. Initial analysis with small number of patients showed, performing these procedures on emergency basis not only improved patient’s overall experience but also benefitted NHS Trust by approximately £18,500 as per the National Tariff System 2020/21.

Conclusions
Emergency LCBDE is safe, feasible and cost effective. We can safely aim to increase the proportion of LCBDE performed as an emergency case, where clinically appropriate, to reduce the financial burden and improve patient’s outcome with overwhelming NHS Trust funds.
EP.FRI.552 Evaluating short term and long term outcome for patients undergoing emergency laparotomy in comparison to NELA mortality risk calculator
Authors: Darwish Nourelhuda , Mohammed Elsammoual , Warrag Ibrahim , Dhahri AdeelAbbas , Ivanov Bogdan 
Published: October 2021

Abstract

Aim
NELA is a project that was introduced in the UK since 2013, aiming to improve quality of care for patients undergoing emergency laparotomy. NELA mortality risk calculator”was launched in 2017, which estimates the risk of death within 30 days of emergency laparotomy. Our aim is to determine the short-term (30-day) and long-term (12 months) outcome in patients undergoing emergency laparotomy surgery and compare this with the estimated scores that were documented in the NELA website.

Methods
This is retrospective study involving patients who underwent emergency laparotomy surgery in the year of 2019. The primary outcome is to determine short-term (30-day) mortality.

Results
A total of 135 patients were included. The overall 30-day mortality was 8.8% (12/135). 55.77% (78/135) had NELA mortality score of &lt; 5%. Only 1 out of these (1.28%) died within 30 days. (4/78,5.12%) died in 6 to 12 months period of this group. 9 patients (11.53%) had NELA score &gt; 30%, of which 6 (66.66%) died within 30 days and 1 died within 6 months. 26.96% (48/135) had NELA scores 55 to 30%, 5 of them (10.41%) died within 30 days while 7 (14.58%) died within 6-12 months.
Patients with NELA scores more than 5% who survived the operation had higher chance of 30-day complications (25.58%, 11/43), when compared to those with scores less than 5% (11.68%, 9/77).

Conclusion
NELA mortality score has high accuracy especially if it was &gt;30%. In addition, high NELA scores are associated with increased risk of post operative complications.
EP.FRI.554 How long do patients wait for emergency laparoscopy? A local audit of service
Authors: Fraser T , Emslie K , Wheatley T 
Published: October 2021

Abstract

Aim
Anecdotal experience suggested patients undergoing diagnostic laparoscopy for appendicitis faced long pre-operative waiting periods. This project was undertaken to quantify the situation and determine how long patients were waiting for surgery. National guidelines recommend patients can reasonably wait 6-18 hours for surgery, as per NCEPOD classification of intervention (appendicitis considered to fall under urgent 2b category).

Method
A retrospective audit of 39 patients listed for diagnostic laparoscopy or appendicectomy during November 2019 was performed. Clinical notes and electronic records were reviewed to determine the timeline of clinical decision making and patient’s arrival in theatre. Operative and histopathology findings were also noted.

Results
The majority of patients (61%) underwent surgery within 18 hours of a documented decision to operate. Average wait was 17.5 hrs (mean). Longest wait was 41 hours (excluding isolated outlier). Documentation of decision to operate was noted to be poor (undocumented in 5 cases) and in some cases the patient was booked before a documented decision to operate. Variation between the operative and histopathological diagnosis of appendicitis was apparent.

Conclusions
The findings are re-assuring that once the decision was made to operate most patients had surgery within 18 hours. However, there is still room for improvement with regards to timeliness and documentation. The discrepancy between operative and histological findings highlight the challenge of diagnosing appendicitis accurately.
EP.FRI.557 A systematic review on the use of prophylactic Proton Pump Inhibitors in patients with a hip fracture and their effect on developing acute gastrointestinal haemorrhage and mortality
Authors: Doyle Finian 
Published: October 2021

Abstract

Hip fractures represent a significant burden to every Orthopaedic department. Acute gastrointestinal haemorrhage (AGIH) /stress ulceration is a postoperative complication associated with increased mortality. Stress ulcer prophylaxis such as the use of proton pump inhibitors (PPI) is an important measure to decrease this perioperative complication.

Aims
This systematic review will aim to determine whether there is any benefit for patients with hip fractures being treated with prophylactic PPI medication to prevent AGIH and whether they reduce mortality.

Methods
A systematic review of the literature was conducted according to PRISMA guidelines. Studies were identified according to the selection criteria and analysed using statistical software.

Results
A total of 3 observational studies with 3413 participants met the criteria for inclusion. Patients taking PPIs had a reduced risk of an AGIH hip fracture than those without PPI therapy (RR 0.15 (95% CI 0.04–0.57, p &lt; 0.0001).The use of PPIs in hip fracture patients shows a reduced mortality risk (RR 0.12 (95% CI 0.01–1.06, p &lt; 0.0001).

Conclusion
These results suggest that prophylactic PPI use in hip fracture patients is associated with a reduced risk of AGIH and also a reduced rate of mortality in this patient group. Orthopaedic surgeons should be aware of the risk of AGIH as a complication in hip fracture patients, knowledgeable to the factors which increase risk in their patient population and be cognisant that the prophylactic use of PPI medication is of benefit in reducing the complication of AGIH and correlates with a decreased mortality rate.
EP.FRI.574 Screening tool to improve patient referral to acute surgical care from Emergency Department
Authors: Razzaq Humayun , Rao Ahsan , Sathananthan Sharlini , Dworkin Michael , Panamarenko Ben 
Published: October 2021

Abstract

Introduction
The study aimed to audit the appropriateness of surgical referrals to general surgery; and, secondly, to devise a screening tool for use in the emergency department to screen patients that are safe to be discharged and to be seen in surgical ambulatory clinics.

Methods
The first phase of the study was an audit to check appropriateness of the surgical referrals (1st-18th February 2020). In the second part, a screening tool questionnaire was prospectively tested (1st February-24th March 2020) on the surgical referrals. The accuracy of the screening tool outcome was compared to actual patient consultation outcomes. The sensitivity and specificity of the questionnaire was assessed using an ROC curve.

Results
In the first audit, 68.9% patients were discharged on the same day with or without follow up in the ambulatory surgical clinic. In the prospective questionnaire phase of the study, there were 98 patients and the most common presentation was abdominal pain (n = 60) followed by urological symptoms (n = 11), symptoms of hernia complication (n = 10), abscess (n = 7) and testicular pain (n = 2). The sensitivity and specificity of the screening tool was 60.7% and 100%, respectively with overall accuracy being 88.82%. The area under the ROC curve was 0.80.

Conclusion
A large proportion of the patients referred to the acute surgical unit can be deferred and seen in the ambulatory clinic. The screening tool has the potential to screen patients who can be seen in the ambulatory clinic and safe to identify patients who require urgent surgical admission.
EP.FRI.752 Delay to Surgery in Acute Perforated and Ischaemic Gastrointestinal Pathology – A Systematic Review
Authors: Murray Victoria , Burke Joshua , Hughes Michael , Schofield Claire , Young Alistair 
Published: October 2021

Abstract

Aims
Patients with acute abdominal pathology requiring emergency laparotomy who experience a delay to theatre have an increased risk of morbidity, mortality and complications. The timeline between symptom onset and operation is ill-defined with international variance in assessment and management. This systematic review aims to define where delays to surgery occur and assess the evidence for previous interventions.

Methods
A systematic review was performed searching MEDLINE and EMBASE databases (January 1st 2005 to May 6th 2020). All studies assessing the impact of time to theatre in patients with acute abdominal pathology requiring emergency laparotomy were considered.

Results
17 studies were included in the final analysis. 15 unique timepoints were identified in the patient pathway between symptom onset and operation which could be classified into four distinct phases.
Time from admission to theatre (1 to 72 hours), and mortality rate (10.6-74.5%) varied greatly between studies. Mean time to surgery was significantly higher in deceased patients compared to survivors. Delays were related to imaging, diagnosis, decision-making, theatre availability and staffing. Four of five interventional studies showed a reduced mortality following introduction of an acute laparotomy pathway.

Conclusions
There is wide variation in the definition and measurement of time delays prior to emergency surgery with few studies exploring interventions. Given the heterogenous nature of the patient population and pathologies, an assessment and management framework from onset of symptoms to operation is proposed. This could be incorporated into national mortality prediction and audit tools and assist in the assessment of interventions.
EP.FRI.849 Quality Improvement Project for Management of Unstable Ankle Fracture in Scunthorpe General Hospital
Authors: Poh Jian Zi 
Published: October 2021

Abstract

Introduction
In SGH, little emphasis is placed on ankle fracture as compared to hip fracture. Hence, an audit was done to compare management of unstable ankle fracture in adherence to BOAST guidelines. It was found out that few aspects of management in A&E were inadequate. Analyzing the root cause of non-adherence to guideline can lead to better care for these patients.

Aim
Primary aim is to ensure that ankle fractures are treated effectively in line with BOAST guidelines. Secondary aim is to ensure that ankle fractures are treated in a timely manner.

Change in practice
Discussion was held between Orthopaedic consultant and A&E consultant. Firstly, poster displaying algorithm for ankle fracture management displayed in A&E. Secondly, Orthopaedics doctor would come to A&E to reduce fracture after first failed attempt.

Methods
Prospective data is collected. Patients with unstable ankle fracture who are admitted in SGH are assessed in regards to BOAST guidelines via WebV, PACS and clinical notes.

Results
Major improvement is seen in different aspects. The documentation of neurovascular assessment and skin integrity in A&E department is improved by 57%. Additional radiographs of the whole leg when clinical examination suggests a more proximal fracture of the fibula (Maisonneuve injury) was performed in 60% more patients as compared to previously. Adequacy of reduction done in A&E is improved by 25%.

Conclusion
Small changes can make a big difference. Good communication and teamwork between different departments is the best way to provide better care for patients.
EP.FRI.945 Common Factors in Patients needing Emergency Colorectal Cancer Resections
Authors: Khan Sharib Ziya , Lim Jieqi , Sasapu Kishore 
Published: October 2021

Abstract

Aim
Colorectal cancer resection is a major part of general surgical emergency workload. We aimed to identify common characteristics amongst cohort of patients needing emergency resection for colorectal malignancies.

Materials & Methods
This is a single centre study focusing on patients operated urgently for colorectal cancer between 2017 and 2018. Patients’ information was obtained from a prospectively maintained local trust database. The variables were subjected to Mann-Whitney, Chi-Square analysis and cumulative survival function plots.

Results
79 patients had emergency colorectal cancer resections. A mean age of 79 years and equal gender distribution were observed.
The male cohort was associated with older age at surgery, younger age at death, longer length of stay (LoS) and higher proportion of open versus laparoscopic surgery (all p&lt; 0.05)
We also observed longer LoS in patients who had open surgery, presence of stoma post-surgery and patients whose carcinoma was first identified and referred by a secondary care team. These latter patients were more likely to present with obstructive and pain symptoms. Histologically, they were found to have more advanced tumour and nodal staging (all p &lt; 0.05). Interestingly also, patients with T3 tumours are more likely to present with bleeding and those with T4 more likely with pain (p &lt; 0.05).
Within the 18 deceased, we found longer post-surgery LoS, higher grade of tumour and nodal involvement (p &lt; 0.05).

Conclusion
A sub-cohort of patients at higher risk of significant morbidity and mortality can be identified from patient characteristics and targeted for improving their outcomes as well as further research.
EP.FRI.971 Is routine endoscopic evaluation of the colon necessary after an episode of acute diverticulitis?
Authors: Hussain Adiba , Dhanri Akash , Sayed Rehma , Saleh Ahmed , Saha Arin , Peter Mark 
Published: October 2021

Abstract

Aim
Currently standard practice is for patients diagnosed with diverticulitis to undergo endoscopic evaluation of the colon following the acute episode. The primary aim of endoscopy is to exclude underlying malignancy which may have been undetectable on initial CT scanning. We aim to determine if endoscopic evaluation of the colon is necessary for all patients.

Methods
All patients with CT proven diverticulitis were included between May 2017 and July 2018. Medical records, CT and endoscopy reports of 154 consecutive patients were retrospectively reviewed. Based on the CT reports, diverticulitis was classified as either uncomplicated (colonic wall thickening, pericolic fat stranding) or complicated (perforation, abscess, generalised free air and/or fluid).

Results
There were 154 patients included in the study. 59% percent were male. Median age at the time of diagnosis was 56 years old. There were 114 patients with uncomplicated and 40 patients with complicated diverticulitis. 79 patients (50 flexible sigmoidoscopy, 29 colonoscopy) with uncomplicated diverticulitis and 21 patients (15 flexible sigmoidoscopy, 6 colonoscopy) with complicated diverticulitis underwent endoscopy. Of the patients that underwent endoscopy, one patient (1.3%) with uncomplicated disease and one patient (4.8%) with complicated disease were found to have colorectal cancer (both rectal). Neither of these were associated with the diverticular segment.

Conclusions
Our data shows that routine endoscopic evaluation of the colon after an episode of acute diverticulitis may not be necessary in all cases. Patient numbers in this study are small therefore further work is required to draw conclusions which could influence future clinical practice.
EP.FRI.974 NELA 30 day mortality: A single centre experience
Authors: Gok M A , Shams O , Ftaieh F , Khan U A 
Published: October 2021

Abstract

Aims
National emergency laparotomy audit (NELA) developed in 2014 in the UK, aims to improve of quality of care of patients undergoing emergency laparotomy. NELA highlights the importance of identifying high risk patients for potential significant morbidity and mortality. The aim of this study is to review the NELA 30 day mortality at a single centre.

Methods
This is a retrospective review of all 30 day NELA mortality patients since 2014 carried out at East Cheshire NHS Trust until January 2020. The NELA survivors beyond 30 days were used as controls.

Results

Conclusion
The overall NELA 30 day mortality rate was 9.8 %. NELA deaths occurred in the older, frail, multi-comorbid & high ASA status patients. Most NELA deaths occur within 90 days, whereas patient survival curve appears to plateau out beyond 90 days. P possum can be used to identify high risk patients, where early collaborative senior assessment by consultant surgeons, anaesthetists and intensivists may identify and allocate appropriate surgical intervention.
SP1.1.11Is polyp detection rate a suitable surrogate measure for adenoma detection rate in colonoscopy?
Authors: Javanmard-Emamghissi Hannah , Perry Isabel , Deb Rahul , Tierney Gillian 
Published: October 2021

Abstract

Aims
The Joint Advisory Group on GI Endoscopy (JAG) has set key quality indicators for colonoscopy, which includes an adenoma detection rate of a minimum of 15%. Given the difficulty in reporting adenoma detection rate, JAG have stated that polyp detection rate is accepted as a surrogate measure. Our aim was to assess whether polyp detection rate can be used as a substitute marker for adenoma detection, by examining the histology of samples taken as polyps to determine what proportion are truly adenomas.

Methods
The pathology department provided a registry of all histological samples taken from the colon or rectum during a one-year period April 2017 to April 2018. These samples were cross-referenced with the endoscopy report to assess which were identified as “polyps” by the performing endoscopist. The pathology report was then reviewed to determine what the histological conclusion was for each “polyp”.

Results
A total of 1601 colorectal histology samples were reviewed, taken by 32 different endoscopists. 451 of these were identified as polyps by the performing endoscopist. On histological review 153 (33.9%) were not adenomas of the colon or rectum. Common alternative histological diagnoses were hyperplastic polyp, inflammatory polyp and normal tissue. Rarer alternative histological diagnoses were melanosis coli, submucosal leiomyoma and endometriosis of the rectum.

Conclusions
Polyp detection rate which is used as a surrogate marker for adenoma detection rate is an inaccurate measure of colonoscopy quality.