bluuebunny/crossref_metadata_2025_split huggingface dataset:
FP7.8 - Perioperative risk prediction for Emergency Laparotomy in Adults, using the National Emergency Laparotomy Audit (NELA) and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) risk prediction tools – an Eastern European perspective
Authors: Moscalu Andrei , Iordache Andi , Sinclair Martin , Timofeiov Sergiu 
Published: September 2024

Abstract

Background
Worldwide, emergency laparotomy (EL) is one of the most common procedures. Having an actual 30-day mortality (30-dm) of 10 to 15%, EL has a high mortality rate, particularly in patients &gt;70 years old. Preoperative risk assessment and stratification can improve outcomes. The American-College-of-Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) and the National Emergency Laparotomy Audit (NELA) risk prediction tools are the most used risk calculators, but both can under or overpredict.

Methods
This is a single-center, retrospective, cohort study that looked at the correlation between actual and predicted 30-dm using NELA and ACS-NSQIP in adults ≥18, following EL, over 2 years, in a single-tertiary-center from Romania. The primary outcome was defined as the correlation between actual 30-dm and NELA or ACS-NSQIP predicted 30-dm. Statistical analysis was performed using GraphPad-Prism 10.1.1. and Stata18.

Results
207 cases were analyzed. Male/female ratio was 1.49; age 65 years (50;77); BMI 26.25kg/m² (23.01;28.35); preoperative lactate 1.8 mmol/L (1.5;3.4); ASA grade 3 (2;4) clinical frailty score 4 (3;4); and Charlson Comorbidity Index 5 (3;8). Actual 30-dm was 31.4% with NELA and ACS-NSQIP predicted 30-dm of 5.78% (1.84;21.48) and 5.5% (1.2;24.2) respectively. NELA and ACS-NSQIP predicted 30-dm expressed a strong positive correlation, R²=0.88; p&lt;0.0001. Both NELA and ACS-NSQIP predicted 30-dm showed a significant positive correlation with actual 30-dm: R²=0.33, p&lt;0.0001; and R²=0.41, p&lt;0.0001 respectively. All data is presented as Median + IQR.

Conclusion
In a Romanian setting both ACS-NSQIP and NELA risk calculators underpredicted 30-dm, despite expressing a strong positive correlation with actual 30-dm.
FP7.10 - An audit assessing the documentation of antibiotic indication and course length on an acute surgical unit
Authors: Carey Charles , Harshen Raj 
Published: September 2024

Abstract

Aims
Documenting antibiotic indications and course lengths on drug charts at the time of prescription is recommended in numerous publications. A closed loop audit was therefore performed to assess the documentation of this information for acute general surgery patients in a district general hospital.

Methods
During the first cycle, drug charts from acute general surgery patients were reviewed and the rates of documentation for antibiotic indication and course length were assessed. To improve these measures, the results from this cycle were presented to junior doctors and cards reminding doctors to complete antibiotic documentation were made and attached to drug charts when necessary. The impact of these measures was examined during a re-audit.

Results
50 patients were assessed during cycle one and antibiotic indication and course length were documented in 54.0% and 42.0% of cases respectively. Data from a further 50 patients were collected following the presentation to junior doctors working in general surgery and the introduction of the reminder cards. Following these interventions, antibiotic indication and course length were documented in 74.0% and 68.0% of cases respectively. Co-amoxiclav and Tazocin were the most common agents prescribed across cycle 1 (64.0% and 14.0% respectively) and cycle 2 (60.0% and 16.0% respectively).

Conclusions
The documentation of antibiotic indication and course length on drug charts needed improving in this cohort. Although the presentation of the data from cycle 1 and reminder cards achieved this outcome, further improvements are required and should be assessed during future re-audits.
EP 633 - Outcomes of Patients with Liver Metastases from Colorectal Cancer who Mostly Presented as Emergencies (Obstruction and Perforation) In a District General Hospital From 2014 To 2021
Authors: Amankwah Dennis , Ezeoke Chidimma , Shamsu Zaman , Annan Pangeni , Chowdhury Ashim , Cooke Joanne 
Published: September 2024

Abstract
This abstract was published in Volume 110, Supplement 10, December 2023 ASGBI Emergency General Surgery Symposium. 1st November 2023. Glasgow, UK, and can be accessed at https://academic.oup.com/bjs/article/110/Supplement_10/znad388.013/7455145
EP165 - It is not just a perianal wart! A rare case of perianal lesion
Authors: Ng Zoe Zhen Yi , Pal Shreya , Chaston Nicola , Shrestha Ashish 
Published: September 2024

Abstract
Perianal skin lesion is a common presentation with a wide range of differentials, including thrombosed external haemorrhoids, perianal abscess, perianal warts, lipoma and sebaceous cysts. Malignant lesions such as squamous cell carcinoma are uncommon but should be considered. Hereby, we present a diagnostically challenging case of a benign looking perianal lesion that ultimately revealed a rare condition.
A 50-year old lady presented with a one-year history of perianal lump accompanied with intermittent pain, fresh bleeding and pus-like discharge. A digital rectal examination revealed a well-demarcated 4mm fleshy skin lesion, 2cm from anal verge at 7 o’clock position without surrounding area of inflammation. No lymph nodes were palpable on both groins. Differentials as mentioned above including an infected granuloma and fistula in-ano were considered. Pelvic MRI revealed a well-demarcated, benign-looking subcutaneous lesion. The lesion was excised under general anaesthesia and interestingly, the histopathology report revealed a diagnosis of Hidradenoma Papilliferum (HP) with no dysplasia or malignancy. Patient recovered well, reassured with the above findings and discharged home.
HP is an uncommon, benign tumour that occurs in the anogenital region. It is more prevalent in Caucasian middle-aged females, as illustrated in our case. A definite diagnosis necessitates histopathological examination. The management includes a local excision of the lesion, and it is associated with good prognosis, with low chances of recurrence or malignant transformation.
HP, although rare, should be included in the differentials of a perianal lump. A surgical excision or diagnostic biopsy should be performed at minimum.
EP241 - Managing Cervical Spine fracture in a district general hospital
Authors: Laulloo Sufia , Elrefaiy Ahmed , Laulloo Faqih , Kumar Vish 
Published: September 2024

Abstract

Introduction
Cervical spinal injury affects 2–3% of trauma patients and accounts for 8.2% of all trauma-related deaths. Respiratory complications are cited as the primary cause of mortality with a 14 - &gt;27 % rate in patients aged more than 65 years old.

Aim
Produce a clear set of guidelines in an aim to reduce mortality in patients &gt; 65 years presenting with cervical spine fracture.

Method
Data was retrospectively collected for patients aged &gt;65 between September 2021 and August 2022 in a district general hospital. Patients with confirmed cervical spine injury were included in the study. Data was collated and analysed using Excel.

Results
36 patients presented to ED with acute cervical spine fracture. 22 (61%) were female and 14 (39%) male with an age range of 66-98 years old. 31 (84%) patients were discussed with a tertiary centre. Complications ranged from constipation, delirium, DVT/PE, chest infections (n=5, 36%) to spinal shock (n= 3, 27%). 11 (30.6%) patients presenting with a c-spine fracture died within 30 days of admission.9 (25%) patients had an outpatient appointment booked in a tertiary centre and 13 (36%) were seen locally in the fracture clinic. 14 (39%) patients did not have any follow ups planned.

Conclusions
To mitigate in-hospital complications and improve outcomes, shared care with orthopaedics, geriatrics, and physiotherapy is being proposed for this group of patients. It would be beneficial to compare the data from the local network and aim at publishing an up-to-date set of robust guidelines.
EP264 - Dermatofibrosarcoma protuberance of the perianal region
Authors: Drmota Jan , Suseeharan Melanie , Chowdhury Ashim 
Published: September 2024

Abstract

Introduction
Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade sarcoma affecting dermis and subcutaneous fat. Typically presents as slow-growing lump on the trunk, extremities or head and neck.(1) It can be locally aggressive with a high recurrence rate.(2) Only 6 reported cases of DFSP in peri-anal region.

Case Description
A 26-year-old male presented with slow-growing peri-anal lump for over a year with intermittent localised pain and episodes of bleeding. No other symptoms or trauma to peri-anal area noted. No relevant medical or surgical history. Examination revealed an irreducible two-by-five by one-centimetre semi-pedunculated perianal lump extending from the seven o’clock to eleven o’clock position. It was firm and tethered to the skin.

Case Description
Flexible sigmoidoscopy was normal. Excision biopsy histology reported diffuse infiltration of spindle cells with storiform pattern of growth without clear margins. Immunohistochemistry analysis expressed CD34 with minimal focal expression of SMA and variable Ki-67 proliferation indexed up to 15-20% in most active areas. SOX10, S100, desmin, factor XIIIA, MNF116 and CD31 were negative. Diagnosis was DFSP. Local lower gastrointestinal multi-disciplinary arranged urgent imaging and referral to tertiary centre. Magnetic resonance imaging of the pelvis identified no definite underlying localised restricted diffusion or solid enhancing nodule. Wide local excision at tertiary centre with histopathology confirmed clear margins.

Conclusion
Patient is under follow-up locally and at the tertiary. Urgency and a singular episode of stool incontinence was reported at two-weeks follow-up which subsequently normalised. He is currently under 3-6 monthly reviews with repeat MRI prior to next appointment. Patient has returned to normal activities.
EP267 - Patient with Pneumomediastinum and Pneumoperitoneum – Importance of Human Factors
Authors: Lakshmipathy Gokul R , Ball William 
Published: September 2024

Abstract

Clinical assessment
70-year-old lady presents with one-day history of dyspnoea, chest and abdominal pain. She was recently discharged following a three-week hospital admission with fall related traumatic rib fractures and hospital acquired pneumonia. Her abdomen was soft and non-tender. CT scan with oral and IV contrast demonstrates pneumomediastinum and pneumoperitoneum with connection at diaphragmatic crura.

Management
Patient was managed conservatively however two days after admission her CRP climbed to 150 and clinical suspicion remained high. Repeat CT scan over the weekend demonstrated increase in the pneumoperitoneum and decrease in the pneumomediastinum with a collection around sigmoid colon. Trainee raised concern to consultant and a laparotomy was done. Operative findings showed perforated sigmoid colon with faeculent peritonitis of unclear cause. Hartmann’s procedure was done and patient continued post recovery in ITU.

Discussion
This case demonstrates the complex varying presentations of our elderly co-morbid population. The presence of air in thoracic and abdominal cavities with unknown cause weeks after the fall was suspicious. Hence, the team communicated well from top-down and likewise from weekday to weekend. Low threshold for escalation and high index of suspicion enabled a re-scan which proved to be life-saving for this patient. Identifying complicated cases where errors can occur is a critical first step. Clear communication among staff, accurate documentation and addressing the patient concerns enabled the surgical team to navigate the complex disease process and ensure safe patient care.
EP360 - Pitfalls in the management of transgender patients: a case report and discussion
Authors: Saraee Danial , Khadka Subodh , Kaur Geetinder 
Published: September 2024

Abstract

Introduction
There has been an increase in the number of transgender individuals in the population. In a clinical setting, this introduces potential patient safety issues from misidentification of biological sex, particularly in emergency scenarios. We report one such patient.

Case report
A 21-year-old ‘male’ patient presented with right iliac fossa pain. No surgical history was reported by the patient or GP records. Repeat medication included Testosterone gel. Bloods showed raised amylase though the clinical picture suggested appendicitis so a CT scan was done. This was reported normal but also identified normal sized uterus/ovaries! Following a sensitive discussion with the patient, ‘they’ revealed that ‘they’ were born biologically female and were on gender-affirming hormone-therapy. The patient was successfully managed conservatively.

Discussion
Our case report highlights the potential risks of misidentification of biological sex in an acute-abdomen scenario. Misdiagnosis is most critical - all gynaecological causes of abdominal pain (e.g. PID/ life- threatening ectopic-pregnancy) were missed. Due to the risk of ionizing radiation to unborn children, CT require the pregnancy status of patients with childbearing capacity, prior to the scan: this therefore should include transgender ‘males’ who have not undergone sex-reassignment surgery. There are also patient safety/ comfort issues with admission in single- sex wards.

Conclusion
It is important to identify transgender patients in order to avoid misdiagnosis and hence mismanagement. Taking detailed history including medication will help with this, as some transgender individuals may not volunteer details regarding their biological sex. Sensitive communication is vital to avoid any feeling of discrimination/stigmatisation.
EP363 - Idiopathic Granulomatous Mastits
Authors: Modi Vidita , Nirhale Dakshayani , Dnyanmote Anuradha 
Published: September 2024

Abstract

Aim
Idiopathic granulomatous mastitis (IGM) of breast is a rare condition with unknown aetiology with an incidence of 2.4 per 10,000. Treating this condition has often been a challenge and hence, this study aims at comparing the different treatment outcomes of recurrent IGM.

Method
A prospective study was conducted in our hospital. All the recurrent breast abscess with induration and biopsy proven granulomatous mastitis were included in this study for a study period of 2 years.

Result
12 patients were included in the study and were divided into two groups : recurrent breast abscess with induration of size A) less than 3 cms and B) ones with size more than 3 cms. Patients in group A underwent Wide local excision of the abscess along with induration and patients in group B underwent surgery followed by steroid therapy. Both the groups were followed up for a year and group B showed no recurrence while group A came with recurrent abscess again and had to undergo surgery followed by steroid therapy after which no recurrence was seen after one year follow up.

Conclusion
All patients of IGM require steroid therapy along with surgery for better outcome.
EP454 - Left Paraduodenal Hernia and Large Bowel Obstruction: A Case Report
Authors: Broadhurst Damian , Campbell Sandra , Jarral Fazain , Tolan Damian , Baker Richard 
Published: September 2024

Abstract

Aims
Internal hernias are uncommon and difficult to diagnose clinically. Of these, a paraduodenal hernia is the most common, but remains a rare condition. Cases reported in the literature are few and often describe small bowel obstruction as a result of small bowel herniation into the left paraduodenal space and lesser sac. Here we describe a case of left paraduodenal hernia resulting in large bowel obstruction.

Method
Written consent from the patient has been obtained to present the case and associated radiological and intra-operative images.
A 50 year old male with no surgical history presented to the general surgical team via the emergency department with a 12 hour history of epigastric pain, vomiting, abdominal distension and 24 hours history of absolute constipation.
CT showed a large bowel obstruction with a transition point in the mid transverse colon with a swirling of the mesentery and large bowel concerning for left paraduodenal hernia.

Results
Open laparotomy was the preferred approach. There was gross dilatation of the large bowel with a competent ileocaecal valve. The hepatic flexure was found herniating into the lesser sac under the ligament of Treitz. This was reduced and the large bowel decompressed via the appendix. The narrow based small bowel mesentery was expanded by dividing the mesenteric parietal peritoneum. The large defect was closed with interrupted non-absorbable sutures. The patient made an unremarkable post-operative recovery.

Conclusion
This is a rare pathology with interesting surgical anatomy and we present its radiological and intraoperative findings and operative management strategy.
EP467 - Bowel obstruction due to colonic lithobezoar in a patient with PICA
Authors: Hussain Mohammad Rizwan , Holcroft Philip , Qureshi Mohammed Tayab 
Published: September 2024

Abstract
A 16-year-old girl was admitted with complaints of abdominal distension, severe pain, vomiting, chest discomfort, and an inability to pass gas. She disclosed a history of PICA, regularly consuming brick and cement. She had no significant medical history but reported suffering from constipation for over two years. Physical examination revealed a markedly distended, tender abdomen with hyper-resonance. Digital rectal examination detected soft, breakable stool in the rectum.
A chest X-ray demonstrated massive bowel distension, causing lung compression. Clinical impression was of bowel obstruction secondary to constipation, leading to NG tube insertion, NBM status, and analgesia administration.
A CT abdomen and pelvis confirmed a markedly distended rectum with impacted faeces, proximal faecal loading, and colon dilatation consistent with severe pseudo-obstruction. Other abdominal organs were compressed but otherwise normal, with no signs of ischemia, free air, or free fluid. Patient was taken to emergency theatre for examination under anaesthesia and manual evacuation. Six litres of stool were manually evacuated, along with removal of ingested stone-like substances, leading to suspicion of lithobezoar. This was followed by a four-litre saline washout.
Postoperatively, patient received regular enemas, laxatives, and monitoring. She spent three days in the Intensive Care Unit due to persistent metabolic acidosis, necessitating ventilatory support. Afterward, she was transferred to the surgical ward, where she was monitored overnight before being discharged with laxatives and dietary advice. Patient was referred to dietitians for addressing her PICA and eating habits, with plans for psychiatric follow-up initiated through a referral from her GP.
EP551 - Assessment of Surgical Management for Mild and Moderate Acute Gallstone Pancreatitis in Accordance with AUGIS Guidelines: A Clinical Audit
Authors: Tan Eunice P J , Ng Shou Kee , Ismail Mohamed , Khan Khurram S 
Published: September 2024

Abstract

Aim
Acute Gallstone Pancreatitis (AGSP) presents as a surgical emergency with diverse clinical outcomes. The guidelines from the Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS) recommend inpatient laparoscopic cholecystectomy (LC) during the index admission or within two weeks for surgically fit patients in cases of mild to moderate AGSP. This study examines the surgical management of AGSP, evaluating adherence to AUGIS guidelines.

Methods
All patients admitted to a single surgical unit who had MRCP for AGPS from September 2020 to September 2022 were included. Electronic case notes were reviewed for demographics, comorbidities, radiological results, whether they had LC and reasons for not proceeding to LC. Severity of AGSP were graded using CT severity index. Those with severe AGSP were excluded.

Results
116 patients were identified; one was excluded. Median age was 59 years (IQR 46-73) and 79 (68.9%) were female. Median length of stay was 5.8 days (IQR 3.7-8.2).
19 (16.5%) patients had inpatient LC, 42 (36.5%) had outpatient LC, 4 (3.5%) patients declined LC, 10 (8.7%) patients were not surgically fit and in 40 (34.8%) patients there was no documentation of why LC not carried out. The median Charlson Comorbidity Index for patients where there was no documentations for not proceeding with LC was 4.5 (IQR 2.3-5.8).

Conclusion
Our study highlights suboptimal compliance with national guideline. It is essential that patients with AGSP undergo inpatient LC or receive prompt outpatient LC to mitigate the risk of recurrent AGSP. Thorough documentation becomes imperative in cases where LC is not scheduled.
EP568 - A rare case of necrotizing fasciitis caused by Streptococcus Anginosus and Staphylococcus Lugdunensis
Authors: Venkata Sujashree Yadala 
Published: September 2024

Abstract
Necrotizing fasciitis (NF) is a rare soft tissue infection involving the fascial planes, causing rapid and extensive tissue destruction. We present a unique case of NF in a patient with poor glycemic control caused by atypical pathogens.
A 66-year-old female with a recent biopsy for a wart-like lesion developed a wound infection, with greenish-black exudate. Initial observations were: temperature: 39.4 degrees, heart rate: 105, GCS: 15/15. Physical examination revealed a grossly filiform lesion below her abdominal apron measuring 7cm in diameter.
The patient was empirically treated with IV Co-Amoxiclav. Abnormal biochemistry results are shown below. Microbiological analysis revealed Streptococcus Anginosus, anaerobes and Staphylococcus Lugdunensis. CT abdomen revealed extensive inflammatory changes with gas and fluid collection and enlarged pelvic and inguinal lymph nodes. Two urgent surgical explorations and debridements, with meticulous wound care using negative pressure wound dressings (Prevena) were done. Intravenous Gentamicin, Benzylpenicillin, Clindamycin, Metronidazole and Flucloxacillin were administered for six weeks. The patient's clinical status gradually improved.
Streptococcus Anginosus, that is part of the Streptococcus Milleri group and Staphylococcus Lugdunensis, a coagulase-negative Staphylococci (CoNS) are commensal organisms of the oral and gastrointestinal tracts. These organisms possess virulence factors that facilitate tissue invasion and destruction, causing an aggressive course of NF. This case highlights the importance of considering atypical pathogens, especially in patients with predisposing factors such as diabetes and obesity. Early recognition, prompt surgical intervention and a multidisciplinary approach are essential for improving outcomes in these cases.TestResultWhite Blood Cells (WBC)22,200 [WBCs per microliter]Sodium123 [mmol/L]Chloride88 [mmol/L]C-reactive protein (CRP)318 [mg/L]Blood Glucose19.3 [mmol/L]