bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThP4.8 - Establishing a Hot Gallbladder Pathway: An Optimal and Advantageous Intervention
Authors: Cui Xiangmei , Zaman Osama , Naqvi Mushal 
Published: September 2024

Abstract

Introduction
NICE, AUGIS and Tokyo guidelines recommend early laparoscopic cholecystectomy (ELC) in symptomatic gallstone disease. We highlight our implementation of a hot gallbladder (HGB) pathway, dedicated to HGB cases in a district general hospital with a 550-bed capacity.

Methods
To implement a HGB service we established a formal evidence-based SOP alongside two theatre lists and six clinic slots a week. Ongoing retrospective data collection allowed us to analyse the efficacy of our interventions between January and December 2023 (n=244).

Results
In our cohort, biliary colic remains the commonest diagnosis (51.2%) versus acute cholecystitis (27.5%), with female predominance (80% v 20%). Prior to HGB pathway introduction in April (January–March, n=73), 13.7% underwent HGB surgery. After HGB pathway implementation (May–Dec, n=171), 28.7% had HGB surgery with a mean waiting time of 9.6 days from admission. There has additionally been an 18% decrease in patients awaiting cholecystectomy since HGB pathway implementation. Significant delays exist in obtaining an MRCP (8.48 days) and ERCP (5.87 days) when required. Complication and readmission rates were consistent with those published in literature.

Conclusion
Establishing a HGB pathway facilitated earlier treatment for patients and notably decreased the numbers awaiting cholecystectomy. Significant delays in obtaining MRCP/ERCP could be improved with dedicated MRCP or ERCP slots. Favourable patient outcomes alongside the almost double NHS tariff payments given to ELC compared to elective cholecystectomy, provides incentive for hospitals to implement HGB lists.
ThP4.14 - Updated surveillance guidance for Intra-ductal Pancreatic Mucinous Neoplasm (IPMN) – a 10-year cohort study in a tertiary care Surgical unit
Authors: Davis George Neelankavil , Shah Faizan , Jain Shubham , Dorkeh Da-costa , Ganesh Radhakrishnan , Ghazanfar Mudassar 
Published: September 2024

Abstract

Aims
To investigate the adequacy of current frequency of surveillance of IPMN in a single tertiary surgical unit

Methods
This was a retrospective cohort study over a 10-year period (2013-2023), patient age range 30-85 years old. The data collected included gender, age at diagnosis, size(mm) of largest cyst, high risks(HRF) or worrisome features(WRF) and interventions required.
Analysis undertaken pertaining to the incidence of IPMN with malignant potential as well as progression of disease on surveillance.

Results
Total of 61 patients. On presentation - Cyst size &lt;1cm – 51%, 1-2cm- 33%, 2-3cm- 16%. &lt;1cm group - no growth on surveillance scans and no interventions required. 1-2cm group - 35% had HRF, 25% of which underwent surgical intervention. 15% showed WF of which 33% required surgical intervention. 2-3cm group - 20% of patients with WF showed growth in cyst size. 40% of patients with WF - underwent surgery.

Conclusion
The malignant potential of IPMN correlates with the initial cyst size. Guidelines recommend that cysts &lt;1cm should be under 2-yearly surveillance. However, when compared to those with cyst&gt;1cm, none of the patients with cyst size&lt;1cm displayed progression.
Therefore, we propose that for patients with an initial cyst size of less than 1cm, who are above the age of 70 and/or Performance status (PS) =&gt;2 – no active surveillance is required. If the PS &lt;2 and patients are less than 70 years old, we recommend 5-yearly surveillance. For patients with cyst size &gt;1cm, we recommend adhering to the current guidance. With this revised guidance, already scarce resources may be better utilised.
ThP5.13 - Lessons learnt from a neuroendocrine tumour presenting as choledocholithiasis
Authors: Kumar Anusha , Bath Michael , Hussein Halil , Nair Manoj 
Published: September 2024

Abstract
A 79 year old male presented to A&E with obstructive jaundice. A computerised tomography (CT) scan of his abdomen and pelvis showed intra- and extra-hepatic duct dilation, a small calculus within the lumen of the common bile duct (CBD), and gallbladder distension. His liver function tests were deranged, with an alkaline phosphatase of 280IU/L. Successful stone retrieval was achieved by endoscopic retrograde cholangiopancreatography (ERCP), with an interim CBD stent inserted. Within the same admission, the patient underwent an uncomplicated emergency cholecystectomy. Histological analysis highlighted moderate chronic inflammation and fibromuscular hyperplasia, cholesterolosis, and ruled out dysplasia or malignancy.
Four weeks later, the patient re-presented with septic obstructive jaundice. A repeat CT scan identified a dilated CBD of 2.2cm, suggesting an occluded stent. On ERCP for stent removal, ampulla narrowing was identified, hence concurrent brush cytology was performed. Due to clinical suspicion, a CT Positron emission tomography (PET) was requested, which identified metabolically active disseminated malignancy, likely pancreatic in origin, and with nodal, liver, and likely peritoneal metastases. A Ca 19-9 subsequently came back raised at 157 kIU/L. Liver biopsy confirmed a poorly differentiated neuroendocrine carcinoma (NEC) with intermediate features between small and large cell NEC.
In such cases with discrepancies between treatment success and lack of biochemical improvement, a low threshold of suspicion for further investigation and oncological consideration is imperative.
ThP5.15 - "Unusual Impaction: A Rare Case of Gallstone Ileus''
Authors: Anwar Kehkashan , Abdel-Halim Mostafa 
Published: September 2024

Abstract

Introduction
Gallstone-related mechanical gastrointestinal tract obstruction is infrequent, manifesting in only 0.3%-0.5% of cholelithiasis cases. Typically, stones exceeding 2 cm find themselves lodged in the terminal ileum. However, in Bouveret's syndrome which is observed in 1 to 3% of instances the impaction occurs in the duodenum causing gastric outlet obstruction. The epidemiology and prevalence of gallstone impaction in the proximal jejunum remain inadequately documented, making this a rare case.

Case Report
An 83-year-old patient with known cholelithiasis and choledocholithiasis presented with acute abdominal pain and vomiting a week after undergoing ERCP, sphincterotomy and partial duct clearance. The presence of repeated bilious vomiting prompted investigation with abdominal CT scan. This revealed an approximately 4.5 cm gallstone impacted in the proximal jejunum, prompting emergency laparotomy which confirmed that the stone was impacted 10-15 cm from the dudeno-jejunal junction. Jejunotomy, stone extraction with primary closure was performed. Post-operative recovery was uneventful.

Conclusion
This case demonstrates gallstone impaction in the proximal jejunum causing bowel obstruction and necessitating emergency intervention. Timely diagnosis and prompt surgical intervention led to a successful outcome. The case highlights the need for awareness and consideration of the entire spectrum of possible gallstone-related complications in the acutely presenting patient with gall stones.
ThP6.5 - Anorectal Abscess and Diabetes Mellitus: An Overlooked Association?
Authors: Ramdin Ashling , Smith Christopher , Marsden Max , Agboro Stephen , Chatzikonstantinou Michail 
Published: September 2024

Abstract

Aims
Patients with anorectal abscesses often require treatment from Emergency General Surgery. Prior European epidemiological studies report 6% of patients with anorectal abscesses have diabetes mellitus (DM). This study primarily quantified prevalence of DM, and secondarily, adherence to the WSES-AAST anorectal emergencies guidelines, which recommend routine HbA1c and serum glucose testing.

Methods
A retrospective analysis identified all surgically managed patients with anorectal abscesses at an urban DGH over a two-month period from 1st December 2023. Data were collected on demographics, existing DM status, HbA1c and blood glucose testing from the electronic health record.

Results
The study included 17 patients, 59% male (10/17), with a mean age of 45 years (range 20-72). Among the group, 4/17 (24%) had a known DM diagnosis. Only 2/13 (15%) without a pre-existing DM diagnosis underwent DM testing. No new cases of DM were diagnosed. HbA1c and serum glucose testing were performed more commonly in patients with known DM compared to those without a prior diagnosis, but not significantly (3/4 vs 2/13, p=0.09).

Conclusions
The proportion of anorectal abscess patients with DM in our study is markedly higher than previously reported in the literature. Compliance with DM testing guidelines is poor, and the causes are uncertain. Routine DM screening for anorectal abscess patients could lead to earlier detection and improved outcomes. The actual incidence of newly detected DM in this patient group remains unknown due to inadequate testing, underscoring the need for further research to evaluate the real-world benefit and cost-effectiveness of following diabetes detection guidelines in these patients.
ThP6.13 - A closed loop clinical audit on adherence of weight-based and renal function-adjusted venous thromboprophylaxis prescribing to local guidelines in emergency general surgical patients
Authors: Hassan Merna , Krahelski Oliver , Arbis Alexander 
Published: September 2024

Abstract

Aims
to audit adherence of venous thromboembolism (VTE) prophylaxis according to local trust guidelines in a single-centre emergency general surgery department, adjusting doses based on weight and renal function (creatinine clearance). Following initial audit of practice, intervention to improve local practice was implemented with informative posters and teaching sessions, aiming to improve overall adherence to guidelines and limit risk of complications from incorrect dosing.

Methods
A two-cycle snapshot audit of VTE prophylaxis prescribing was conducted in a district general hospital emergency general surgery department against local guidelines concerning VTE prophylaxis. All current inpatients admitted under general surgery were included in the study reviewing baseline characteristics including age, weight, and creatinine clearance.

Results
The first cycle audited the adherence of departmental practice against guidelines in 57 inpatients. 49 (86.0%) were prescribed VTE prophylaxis in accordance with local guidelines. Of the 8 patients who did not adhere to guidelines, 5 (62.5%) had no VTE prophylaxis prescribed, while 3 (37.5%) had incorrect doses prescribed for their weight or renal function. The second cycle audited 43 inpatients. 39 (90.7%) adhered to guidelines. All re-audited patients had the correct VTE prophylaxis prescribed, although there was no VTE prophylaxis prescribed in 4 (9.3%) patients. There were no bleeding or thromboembolic complication in any patients over the course of admission in both cycles of this audit.

Conclusion
Adherence to local guidelines concerning VTE prophylaxis was increased following intervention. This eliminated VTE prophylaxis prescribing errors, although did not improve the amount of VTE prophylaxis prescription omissions.
ThP7.10 - Perioperative Temperature in Relation to Theatre Temperature in Orthopaedic Trauma Patients in a District Hospital in NHS
Authors: Arifuzaman Mohammed 
Published: September 2024

Abstract

Aim
To understand the relation between intraoperative hypothermia and theatre temperature in Orthopaedic trauma list.

Method
Prospective analysis of patients listed in the trauma list at a busy district general hospital in NHS. The data collected included duration of surgery, preoperative temperature, pre induction temperature, intra-operative, post procedure, temperature in recovery and temperature post recovery, and mean ambient theatre temperature. Statistical calculations were performed on StatsDirect3 software.

Results
A total of 100 patients were included in the study from 1 Aug 2023 to 30 September 2023. Intraoperative hypothermia (core body temperature &lt;= 36) was 21%. Preoperative temperature (p=0.033) and preinduction temperature (p&lt;0.001) was statistically significant factor in influencing the intraoperative temperature. Theatre temperature was an independent predictor of intraoperative hypothermia on regression analysis (p&lt;0.001).

Conclusions
Theatre temperature of 19.5 to 20.5 °C results in a core body intraoperative temperature of 36.3 to 37.3°C. Temperatures below 19.5 results in higher incidence of hypothermia. Preinduction temperature of 36.4°C results in intraoperative temperature of 36°C and a preinduction temperature of 37.1°C leads to intraoperative temperature of 36.7°C. This indicates that preoperative warming as well as a theatre temperature of 19.5 to 20.5 °C will help in reduction of the intraoperative hypothermia.
ThP7.18 - Post-operative management and outcomes in emergency laparotomy - an audit of the updated 2023 NELA Standards in a busy district general hospital
Authors: Adegboye Oluwatobi , Vucicevic Aleksandar , Zadeh Reza Arsalani 
Published: September 2024

Abstract

Background
The updated NELA Standards, encourage pre-operative decision-making, were published and utilised from April 2023. Our busy district general hospital has not been audited against these updated standards.

Methods
Single-centre, retrospective audit of emergency laparotomies between April 2023 and December 2023. Patients were included if the NELA risk score was ≥5% (‘high-risk’) or if they were deemed ‘high-risk’ based on clinical judgement. Demographic, management, and outcome data were collected from the local NELA database and EPR. The primary outcome was the proportion of ‘high-risk’ patients directly admitted to critical care. The secondary outcome was to investigate differences between high-risk patients admitted to critical care and those admitted to ward care using length of stay (LOS) and 30-day observed/expected (O/E) mortality ratio.

Results
112 laparotomies were performed and 43 (38%) were deemed ‘high-risk’. Of ‘high-risk’ patients, the median age was 73 (44 - 95), 56% were male, and the median mortality risk was 10.5% (3.1% – 62.7%). 38 ‘high-risk’ patients were directly admitted to critical care. They had a median LOS of 14 days (3 – 72) and 7 died within 30 days with an O/E mortality ratio of 1.12. None of the 5 patients admitted directly to the ward died and they had a median LOS of 8 days (3 – 39).

Conclusion
The mortality risk score is a tool for post-operative management in emergency laparotomy but appropriate clinical judgement can prevent excessive care and preserve critical care beds.
ThP8.12 - To do or not to do-Temporal artery Biopsy in Giant Cell arteritis
Authors: Brandao Mayra , Valenti Domenico , Turner Tulin , Gambhir Raghvinder Pal Singh 
Published: September 2024

Abstract

Aims
Temporal artery biopsy (TAB) remains the gold-standard diagnostic test for giant cell arteritis (GCA). Our aim is to evaluate the correlation between initiation of corticosteroid therapy, timing of biopsy, and histological diagnosis of GCA through TAB. Moreover, analyse the usefulness of this practice.

Methods
Operative notes of TABs performed by a Vascular Surgery department at a teaching hospital between August 2021 and January 2023 were reviewed. We looked into the relationship between histological findings and the timing of corticosteroid treatment initiation prior to TAB.

Results
A total of eight patients had a TAB, with a male-to-female ratio of 2:6. The median age of the patients was 68-years-old (range 53-84). TABs were performed within 16 days of the referral (range 2-16). All were performed on elective theatre lists and none on emergency theatre lists (CEPOD). All patients had started corticosteroids by the time they had TAB, with a median duration of 11.5 days before TAB (range 2-16).
The histopathology report was positive for active GCA in 1 case (12.5%) where the TAB was performed on day 3. In another performed on day 16, histopathology showed signs of healed inflammation (12.5%). In all other cases the report was negative (75%). All patients completed a full weaning course of steroids regardless of histological findings.

Conclusion
GCA is a systemic inflammatory vasculitis. Prompt initiation of high-dose corticosteroids is the mainstay management to reduce risks of ischaemic-related complications. Our work suggests the timing of biopsy is a key determinant of histological diagnosis of GCA.
FP1.6 - Prospective analysis of outcomes of colorectal resections in the over 75 age group. A single centre study
Authors: May Victoria , Ramsay George 
Published: September 2024

Abstract

Objectives
Cancer is a disease of ageing. Additionally, the population of the UK is getting older. Therefore, colorectal operations in the elderly population is becoming more frequent. Herein we analyse the outcomes of patients over 75 who have had elective or emergency colorectal surgery in a single Scottish Healthboard.

Methods
A prospective review was conducted of 408 patients aged 75 years and over who underwent elective or emergency colorectal surgery in our region between 2018 and 2023 was performed. Patient characteristics, operative intervention, short- and long-term post operative outcomes were noted.

Results
Of 408 Colorectal surgery patients, 303 were elective and 105 were emergency cases. Of these cases, 40.6% (n = 123) of elective cases and 28.6% (n = 30) of emergency patients did not experience any complications. Of these patients, 8.6% of emergency patients went from being independent to requiring full care. Emergency patients (n = 34, 32.4%) demonstrated a higher mortality rate at one year than elective cases (n = 59, 19.5%).

Conclusion
Colorectal Surgery in patients aged 75 years and older are associated with poor post operative outcomes, functional decline, and increased mortality. Whilst these findings are intuitive, the scale of functional decline is important to discuss with future patients when counselling future patients for such procedures.
FP1.12 - How many Colorectal cancer patients had negative Faecal Immunochemical Testing (FIT) within the previous 1 year?
Authors: Taufik Abdulahad , Johnston Dorothy , Coulston Rachael , McElvanna Kevin , Neill Adrian 
Published: September 2024

Abstract

Introduction
Colorectal cancer (CRC) accounts for approximately 10% of all cancer diagnoses and 9.4% of all cancer deaths worldwide. Since its introduction, quantitative faecal immunochemical testing (qFIT) has become a vital tool in bowel cancer screening and triaging of symptomatic patients. Our trust has seen a 20% increase in lower gastrointestinal referrals over a 12-month period.
The aim of this investigation was to identify how many patients with a negative qFIT were diagnosed with CRC within 12 months and if there is potential to downgrade referrals with negative qFIT.

Methods
This retrospective study reviewed new CRC diagnoses in one hospital trust, diagnosed from January to December 2022, who were referred as symptomatic red flag referrals. All patients in this timeframe had records reviewed for qFIT performed within the 12 months prior to their diagnosis. A negative qFIT test was defined as lab result of &lt;7ugHb/g.

Results
Two hundred and forty-seven patients were diagnosed with CRC from January to December 2022. One hundred and three patients did not have a documented qFIT within the timeframe and therefore were excluded from analysis. One hundred and forty-four cases were further reviewed, of which 14 (9.7%) had a negative qFIT within the 12 months before diagnosis.

Conclusions
This audit does not support the downgrading of Red Flag referrals based on a negative qFIT result. Further analysis is needed to ascertain how best to triage symptomatic referrals for colorectal cancer with a negative qFIT to help cope with an increasing burden of Red Flag referrals.
FP2.9 - Colonoscopy perforation: a single centre study
Authors: Gok M A , Bughio M , Zaidi M , Mathieson N O M , Sadat M M , Khan U A , Riaz Komal 
Published: September 2024

Abstract

Aim
Colonoscopy is increasing utilized as a diagnostic & therapeutic tool. Colonoscopy perforation is reported to occur in 1/1500 (diagnostic colonoscopy), 1/500 (polypectomy) & 1/50 (EMR) procedures. The aim of the study is to evaluate the management of colonoscopy perforation at a single centre.

Methods
Colonoscopy is carried out on patients with colorectal cancer trigger symptoms (altered bowel habit, rectal bleeding, weight loss, abdominal pain, anaemia, ano-rectal symptoms, etc), family history screening, colorectal cancer & polyp surveillance. This is cohort study carried out since 2012 to December 2023 on all colonoscopy perforations carried out at a single centre.

Results
N = 22 Age (yrs) 70.8 ± 3.4 Sex (M:F) 4 : 18 BMI (kg/m2) 25.3 ± 1.8 ASA 2 Sigmoid Perf site (n) 13 LOS (days) 6 ± 6.5 Deaths (n) 30 day 3 60 day 3 90 day 3 IBD (n) 3 DD (n) 11 WCC (x109/L) 11.3 ± 1.4 CRP (mg/L) 100.1 ± 25.7 Lactate (mmol/L) 1.3 ± 0.7 Op time (mins) 119.0 ± 15.3 Bx 6 Polypectomy 5 Colonoscopy 21 (9 incomplete) Flexi siggy 1 Sedation 16 Entonox 5 GA 1 Xray 10 CT scan 22 Conservative 9 Surgery 13 Stoma (n) 6 Lap 2 Lap open 2 Open 9

Conclusion
Colonic perforation during colonoscopy is increased in: polypectomy (especially right colonic), therapeutic EMR, diseased bowel (IBD inflammatory bowel disease, diverticular disease), & in challenging colons. The management of colonoscopy perforation should individualized with early clinical & radiological diagnosis. Site and size of colonic perforation determines management. Good bowel preparations, minimizes contamination and therefore allows safe conservative management of small colonoscopy perforation.
FP2.13 - Do we really need Antibiotics for Simple Uncomplicated Diverticulitis? Results of Meta-Analysis of Randomised Controlled Trials
Authors: Sokhal Balamrit Singh , Mostafa Omar Ezzat Saber , Ramasamy Sadhasivam , Spyridon Roditis , Hajibandeh Shahab , Hajibandeh Shahin 
Published: September 2024

Abstract

Aims
Acute uncomplicated diverticulitis (AUD) is a common cause of acute abdominal pain. Recent guidelines advise selective use of antibiotics in AUD patients. This meta-analysis aimed to compare the effectiveness of no antibiotics versus antibiotics in AUD patients.

Methods
This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify randomised controlled trials (RCTs) involving AUD patients which compared the use of antibiotics with no antibiotics. Pooled outcome data was calculated using random effects modelling with 95% confidence intervals (CI).

Results
Five RCTs with 1934 AUD patients were included. 979 patients were managed without antibiotics (50.6%). Patients in the no antibiotic and antibiotic groups had comparable demographics (age, sex and body mass index) and presenting features (temperature, pain score and C-reactive protein levels). There was no significant difference in rates of complicated diverticulitis (OR: 0.61, 95% CI :0.27-1.36, p=0.23), abscess (OR: 0.51, 95% CI: 0.08-3.25, p=0.47) or fistula (OR: 0.33, 95% CI: 0.03-3.15, p=0.33) formation, perforation (OR: 0.98, 95% CI: 0.32-3.07, p=0.98), recurrence (OR: 0.96, 95% CI: 0.66-1.41, p=0.85) need for surgery (OR: 1.36, 95% CI: 0.47-3.95, p=0.37), mortality (OR: 1.27, 95% CI: 0.14-11.76, p=0.82) or length of stay (MD: 0.215, 95% CI: -0.43-0.73, p=0.61) between the two groups. However, the likelihood of readmission was higher in the antibiotics group (OR: 2.13, 95% CI: 1.43-3.18, p=0.0002).

Conclusion
There is no significant difference in baseline characteristics, clinical presentation and adverse health outcomes between AUD patients treated without antibiotics compared to with antibiotics.