bluuebunny/crossref_metadata_2025_split huggingface dataset:
FTP7.9 Not all necrotising pancreatitis are the same: does aetiology affect the extent pancreatic necrosis? A single-centre retrospective study
Authors: Di Mauro Davide , Njere Ikechukwu , Shams Ola , Wajed Shahjehan , Reece-Smith Alex , Manzelli Antonio 
Published: August 2023

Abstract

Aim
To assess the extent of pancreatic necrosis (PN) on abdominal computed tomography (CT) in patients with acute gallstone pancreatitis (GP) and alcohol-induced pancreatitis (AIP).

Methods
Patients ≥ 18-year-old with first-time onset of GP, AIP and PN on CT scan, from January 2010 to September 2018, were included. Extent of PN on CT, organ failure rate, admission to the intensive care unit (ICU), were compared between GP (group 1) and AIP (group 2). PN extent was described as: localised – right or left of the midline; diffuse – across the midline; more/less than 50% of the pancreas.
Analysis of continuous and categorical data and multiple logistic regression were conducted. Significance was set at p&lt;0.05.

Results
One hundred-two consecutive patients, 66 in group 1, 36 in group 2, were included. Overall, diffuse PN occurred in 34.3% of cases, more frequently in group 1 (42.4% vs 19.4%, p=0.03). Single/multiorgan failure developed in 50 patients, 57.6% belonged to group 1 (p=0.03). Predictors of organ failure were diffuse pattern of PN (OR 2.70, 95% CI 1.03 to 7.03, p=0.004) and PN ≥50% (OR 5.50, 95% CI 1.39 to 21.6, p=0.01). Admission to ICU was required in 27 subjects; PN ≥50% predicted ICU admission (OR 8.93, 95% CI 2.68 to 29.73, p=0.0004). The median hospital stay was 12 days (range 1-265), longer in group 1 (12.5 vs 10.5, p=0.02).

Conclusions
Diffuse PN occurred more frequently in patients with GP. A larger extent of PN predicted the onset of single/multiorgan failure and admission to the ICU.
FTP7.12 Percutaneous Cholecystostomy use at ESHT
Authors: White Annabelle , Ahmed Elmurtada , Al-Robaie Basim , Klimovskij Michail 
Published: August 2023

Abstract

Aim
Percutaneous Cholecystostomy is a well-recognised adjunct to antibiotic therapy in management of acute calculous cholecystitis – often as a temporising measure to definitive surgery. Multiple guidelines exist advising on patient selection and timing of insertion, however little evidence exists on managing these following insertion, timing of interval cholecystectomy, and investigations prior to removal.

Method
A closed-loop retrospective review of all patients undergoing radiologically guided PC insertion between 01/06/2015-31/05/2017 (Cycle 1) and 01/11/2021-01/12/2022 (Cycle 2) at ESHT. Data collected included patient demographics, time from diagnosis to PC, duration of admission and PC in situ and investigations prior to removal.

Results
43 patients across both cycles, with average age 72, (median 74, range 50-92). Cycle 1 consisted of 26 patients, whereas Cycle 2 had 17 patients. Duration of admission was longer in Cycle 1 (Average: 10 vs 8.5, Median: 9.5 vs 6, Range: 3-21 vs. 1-26 days). Time from admission to PC insertion was similar (Average: 2.7 vs. 3, Median: 2 vs. 1, Range: 0-12 vs 0-25 days). Duration of cholecystostomy in situ was longer in Cycle 2 (Average: 26 vs. 41, Median: 21 vs. 32, Range: 7-95 vs 1-196 days). 53% (n=17) of patients in Cycle 2 underwent a cholecystogram prior to removal vs. 12% (n=3) in Cycle 1.

Conclusions
We identified considerable heterogeneity within practice surrounding the insertion and removal of PC at ESHT. Considering this we are introducing a trust-wide “Cholecystostomy Management” Pathway to standardise our practice, and “Cholecystostomy Passport” for patients outlining this and providing safety netting information and emergency contact details.
FTP7.13 Do additional preoperative investigations delay the time to resection in patients with pancreatic cancer? Results from the Recurrence After Whipple’s (RAW) study
Authors: Russell Thomas , Labib Peter ,   RAW Study Collaborators, Aroori Somaiah 
Published: August 2023

Abstract

Aims
Suitable patients with a resectable pancreatic cancer should undergo timely pancreatoduodenectomy (PD) as the disease is aggressive and recurrence rates are high. This study aimed to investigate whether selected preoperative investigations resulted in a delay to surgery.

Methods
Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective study of PD outcomes (29 centres from eight countries, n=1484). Patients were excluded if: they had staging data missing, they underwent neoadjuvant chemo-/radiotherapy, or if radiological staging was performed for another malignancy. The median time from radiological staging to PD was calculated in patients who underwent selected preoperative investigations and compared to those who did not undergo the investigation.

Results
In the 595 included patients, the median time from (most recent) preoperative computed tomography (CT) to PD was 32 days (IQR: 32) and 25%, 5%, 34%, 10% and 60% underwent preoperative magnetic resonance imaging (MRI), positron emission tomography (PET)-CT, endoscopic ultrasound (EUS), staging laparoscopy and/or biliary stenting (PBS), respectively. MRI (32 vs 31 days, p=0.55), PET-CT (40 vs 31 days, p=0.08) and EUS (28 vs 32 days, p=0.99) were not associated with an increased median time to PD. However, staging laparoscopy (43 vs 29.5 days, p=0.009) and PBS (39 vs 20 days, p&lt;0.0001) were.

Conclusions
In our multicentre study of PD outcomes, preoperative MRI, PET-CT and EUS did not delay the time to resection. However, staging laparoscopy (median difference: 13.5 days) and PBS (median difference: 19 days) did, so these investigations/interventions should only be performed when there is a strong indication.
FTP7.14 A systematic review and meta-analysis evaluating the role of single-dose preoperative versus extended use of antibiotics therapy following acute cholecystectomy
Authors: Kaur Mandeep , Singh Anurag , Sains Parv , Singh Krishna , Sajid Muhammad 
Published: August 2023

Abstract

Laparoscopic cholecystectomy (LC) during index admission for acute cholecystitis is considered a preferred mode of treating gallstone disease. The objective of this study is to evaluate the role of single dose pre-operative prophylactic antibiotics versus extended antibiotics therapy up to 5th post-operative days in these patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis.

Materials and methods
RCTs reporting the use of single dose pre-operative prophylactic antibiotics versus extended antibiotics therapy up to 5th post-operative days following acute cholecystectomy were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.

Results
The search of medical databases yielded 4 RCTs on 949 patients undergoing acute cholecystectomy. There were 481 patients in in single dose pre-operative antibiotics group whereas 468 patients received extended doses antibiotics therapy. In the random effects model analysis, the extended use of post-operative antibiotics in patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis does not confer any extra benefit [risk ratio 1.05, 95%, CI (0.73, 1.51), Z = 0.25, P=0.80] in terms of reducing the infective complications. There was no heterogeneity (Tau2 = 0; Chi2 = 0.40, df = 3; (P = 0.94; I2 = 0 %) among included studies.

Conclusion
Post-operative extended use of antibiotics in patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis does not demonstrate extra benefit to reduce infective complications.
27 Neuroendocrine tumour of the breast: A case report & Literature review
Authors: Shafique Muhammad Salman , Bhatti Hamza Waqar , Hazma Muhammad , Farooqui Marryam Riaz , Chaudhary Noman Ahmed , Rauf Fatima 
Published: August 2023

Abstract

Introduction
Neuroendocrine differentiation in breast carcinomas was first described by Feyrter and Hartmann in 1963, based on positive silver staining in mucinous carcinomas of the breast. NEBC are heterogeneous group of rare breast tumours which account for &lt; 0.1 % of breast tumour and &lt; 1% of neuroendocrine tumours.

Case
A 65-year-old female presented with a 12 x 10 cm non-tender hard globular slightly mobile mass in upper medial /inner quadrant of right breast with overlying 2 cm scar mark and bilateral axillary lymphadenopathy. Mammography revealed a BIRADS-4 lesion and FNAC showed atypical cells. Octreotide Scan showed that the mass was neuroendocrine in origin. Further CT imaging showed no other site for metastasis. She was managed with a Right sided modified radical mastectomy (MRM) after multidisciplinary team (MDT) decision. Biopsy of the Lesion showed ER, PR receptor & synaptophysin receptor positivity, negative Her 2-neu status, ki-67 proliferation index of 10% & grade II NET.

Conclusion
Primary neuroendocrine tumours of the breast are infrequent tumours that appear in women aged 60–70 years. Their diagnosis is complex as they lack defining clinical and radiological characteristics. Their low incidence makes it impossible to establish an optimal treatment protocol.
56 Epidermoid cyst mimicking appendiceal mucocoele
Authors: Silvestre Stefania , Bose Sayantan 
Published: August 2023

Abstract

Background
Congenital epidermoid cysts found in internal organs are thought to arise from displaced or implanted ectoderm during embryonic development. Their histogenesis differs from that of acquired cysts which are associated with trauma or iatrogenic implantation. Epidermoid cysts related to caecum or appendix are rare. The present case describes the largest caecal epidermoid cyst reported in the English literature so far in a patient with no previous history of surgery or trauma.

Case report
A man in his late thirties presented with a three-week history of dull right-sided abdominal pain. Physical examination revealed right flank fullness and subsequent CT scan showed a large right-sided cystic mass adjacent to caecum. The appendix could not be visualised separately and the mass was thought to be either an appendiceal mucocoele or an inclusion cyst. Cryptorchidism was excluded. Due to concerns of possible mucocoele that could lead to pseudomyxoma peritonei, laparotomy was performed and the cyst was excised intact with an ileocaecectomy. The specimen weighed 1.8kg and was 120 x 105 x 95mm in size. Histological findings were consistent with an epidermoid cyst inseparable from caecum and appendix, visibly distinct from the appendiceal wall stretching over it.

Conclusion
Epidermoid cysts related to caecum or appendix are rare benign lesions. In the present case, the cyst was safely excised via an open ileocaecetomy, based on its location and concern for an appendiceal mucocoele. Ileocaecectomy or segmental colectomy with primary anastomosis can be safe surgical management options for caecal cysts in an otherwise healthy patient.
117 Double Trouble: Rapunzel Syndrome Presenting with Closed-Loop Intestinal Obstruction Between Two Synchronous Trichobezoars
Authors: Arshad Rabia , Arshad Daneyal , Aamir Suman , Basharat Fauzia , Khan Huma , Hanif Muhammad 
Published: August 2023

Abstract

Background
Trichobezoar formation is a rare phenomenon associated with certain psychiatric conditions like trichophagia and is more frequent in young women. Rapunzel Syndrome denotes a gastric trichobezoar which extends into the duodenum. We report a rare case of dual isolated trichobezoars, a gastric and an ileal trichobezoar, causing sub-acute closed-loop intestinal obstruction between the two bezoars.

Case presentation
A 15-years old girl presented to the emergency department with history of generalized abdominal pain and distention for two days. She had nausea, loss of appetite, absolute constipation followed by vomiting.She was tachycardiac, had abdominal distention with an ill-defined upper abdominal mass and absent bowel sounds. CT-scan abdomen revealed a giant trichobezor in stomach tailing into duodenum and a separate small rounded mass in ileum with dilated bowel loops. Mid-line laparotomy was done. Per-operatively a giant gastric trichobezoar(22x8cms) was extracted after gastrostomy, which completely occupied the stomach and extended into the duodenum. Another large ileal trichobezoar(6x5cms) was also removed via enterotomy at 2 feet proximal to the ileo-cecal junction. Hence a markedly distended closed loop was formed between the two obstructing trichobezoars. Enterotomies were closed using vicyrl2.0. Feeding was started on post-operative day-3 & she was discharged on day-5. She developed complete wound dehiscence after 2 weeks which was surgically closed. Patient was consulted for nutritional and psychiatric evaluation and for management of trichophagia.

Conclusion
Trichobezoars usually present with vague abdominal symptoms and can rarely cause intestinal obstruction. Invasive intervention such as laparoscopy or laparotomy becomes necessary for such large obstructing trichobezoars. Psychiatric follow-up and management are crucial to prevent its recurrence.
194 An uncommon cause of small bowel obstruction with perforation after a caesarean section
Authors: Loganathan Santhosh , Chapman Stephen , Newman Chris 
Published: August 2023

Abstract
The incidence of small bowel obstruction after any abdominal surgery is 9%, whereas it is only 0.1% after a C-Section. Small bowel obstruction secondary to herniation of a segment of the small bowel beneath the intact rectus sheath and between the rectus muscle is extremely rare. Reviewing the literature revealed that less than five cases were reported.
Here we present a 39-year-old female six days post caesarean section presented with abdomen pain, distension, and not opening bowels. The blood investigations showed White blood cells 15.42x109/L and C-reactive protein 286mg/L. She was hypotensive and tachycardic. On clinical examination, the abdomen was distended and peritonitic. The Computed tomography of the abdomen and pelvis with contrast showed there is small bowel obstruction with multiple loops of proximal dilated bowel with a transition point within the pelvis and in midline a small inferior umbilical or incisional hernia containing a knuckle of small bowel with a moderate amount of pneumoperitoneum and free fluid. She underwent an emergency laparotomy and was found to have four quadrants of purulent peritonitis. In addition, a 3cm defect in the midline peritoneum allowed herniation of approximately 30cm of small bowel into preperitoneal space between the recti with ischaemia and perforation at the neck of the hernia. She had small bowel resection anastomosis, and the peritoneal defect was formally closed to prevent re-herniation of bowel loops.
The NICE guidelines recommend not closing the peritoneum during the c-section. However, this case is an example of severe postoperative morbidity, which could be avoided by peritoneal closure.
209 Giant Mesenteric Lipoma: an atypical presentation of an unlikely hero
Authors: Mitchell Robert , Kamel Faddy , Hagger Robert , Patel Kunal 
Published: August 2023

Abstract

Background
Mesenteric lipoma’s are a rare and benign mesenchymal tumour originating from mature adipocytes within the gastrointestinal tract. In most cases, they do not cause symptoms. A search of English literature revealed less than 100 reported cases. In those who are symptomatic, presenting symptoms are variable. We present an unusual case of a mesenteric lipoma aiding in the diagnosis of a colorectal cancer.

Case report
A 77 year old lady presented to her GP with chronic abdominal pain. On examination she appeared to have lost weight. Her initial investigations showed a new anaemia. Her FIT was negative. A CT Colon showed a 3.5cm flat lesion in the caecum. Histology, obtained via colonoscopy, proved this to be an Adenocarcinoma. The patient underwent a Laparoscopic converted to open right hemicolectomy. Intraoperatively the caecum was found in the pelvis with a pedunculated lipoma originating from the mesentery overlying the ileocolic artery. Post-operative histology showed a fully resected Adenocarcinoma as well as a 200mmx90mmx20mm giant mesenteric lipoma.

Discussion
We hypothesis that this patient’ presenting symptom of abdominal was unlikely to be due to the colorectal cancer. It is feasible that her pain was secondary to the compressive effect of the lipoma on the caecum and terminal ileum. Without symptoms, it is unlikely the patient would have presented to her GP and the malignancy would likely not have been found at such an early (and resectable) stage.

Conclusion
The mesenteric lipoma was likely the unsung hero for this patient.
219 Chronic Fungal Sinusitis: Pre and Post COVID-19, A single UK Tertiary Centre study
Authors: Kamyab Arya Anthony , Ansley William , Munroe-Gray Tiffany , Little Sarah , Jaikaransingh Dominic 
Published: August 2023

Abstract

Aims
Anecdotal evidence suggests an increase in the incidence of cases of Chronic Fungal Sinusitis pre- and post-Covid 19 Pandemic. We aimed to audit our patient incidence of fungal sinusitis pre- and post-COVID-19 pandemic, alongside auditing our management of these cases against national guidelines. Objectives: 1. To assess the incidence of Chronic Fungal Sinusitis pre- and post-COVID-19 pandemic at a single UK Tertiary centre 2. To audit the management of Chronic Fungal patients against national guidelines pre- and post- COVID-19 pandemic.

Methods
All Chronic Fungal Sinusitis patients at a UK Tertiary centre NHS Trust from the years 2018 to 2022 were collected. 2. Incidence of Chronic Fungal Sinusitis pre- and post-COVID-19 pandemic was assessed. 3. Patient notes were assessed for demographic, species of fungi, management, and patient outcomes. 4. Patient management was audited against national guidelines.

Results
Post-COVID-19 pandemic there was a higher incidence of patients presenting with Chronic Fungal Sinusitis 2. National guidelines were adhered to at the Hospital Trust pre/post-COVID-19.

Conclusion
Based on limited data from a single tertiary UK centre there appears to be a relationship between COVID-19 and the increase in the incidence of Chronic Fungal Sinusitis. However, larger multi-centre studies with a greater sample size need to be assessed to accurately assess this trend
274 Human Factors in Surgery: The experience of the junior doctors
Authors: Ong Chon Sum , Dawson Kestra , Lala Anil 
Published: August 2023

Abstract

Introduction
Healthcare is a dynamic and complex sociotechnical system. Human factor principles have been recognised to improve care delivery and patient safety.

Aim
To determine if the workload among foundation doctors working in the surgical department was excessive leading to burnout and to propose solutions.

Method
A retrospective audit was performed in a general surgical department at a District General Hospital. Data were collected for 3 months in 2022 from the patient record system.

Results
There were 7 consultant-led teams in the surgical department comprising a surgical registrar and senior house officer. 6 of them have a foundation doctor each. The number of on-calls (13-hour shift from Monday-Thursday or Friday-Sunday) has a median of 5. In August, the cumulative patients under the care of a team ranged from 57 to 300. In September, the number ranged from 77 to 277. In October, the number ranged from 98 to 302.

Conclusions
The number of patients under the care of different teams varied greatly which signified some foundation doctors might have more workload. The workload should be ideally consistent and sustainable to optimise patient care. The next step would to be assess their burnout risk using Maslach Burnout Inventory (MBI). With the data, the aim would be to create measures for decreasing or sharing the cognitive workload. If the occupational stressors are not addressed, the rippling effect could be detrimental to both the healthcare workers and patients.
307 Intraluminal Migration of Gossypiboma and rectal expulsion an unusual Case- Case Report
Authors: Ayubi Azaz , Rauf Sidra , Ajaz Hamda , Mujahid Sheeza , Riaz Ilyas , Javed Nosheela 
Published: August 2023

Abstract

Background
Gossypiboma refers to foreign body retained in the body at the end of operation and can be in the form of gauze, sponge or any form of textile resulting in grave consequences for both the patient and the surgeon.

Case Summary
A 23-year-old female presented with complain of generalized abdominal pain along with non-bilious vomiting since 10 days. She also had relative constipation since four days. Her past surgical history was unremarkable except for three elective lower segment caesarean sections at another hospital. Upon abdominal examination, she had a scar of pfannenstiel incision along with 3x4 cm swelling in umbilical region with positive cough impulse. Her bowel sounds were exaggerated. DRE was unyielding. Clinical diagnosis of subacute intestinal obstruction was made and she was managed conservatively. Ultrasound abdomen showed dilated gut loops with hyperperistalsis. It also revealed a defect measuring 8.5 cm in the supraumbilical region of anterior abdominal wall through which fat content was seen protruding. She was advised contrast enhanced CT abdomen, developed diarrhoea and later on expelled the surgical sponge per rectally. After passage of surgical sponge, condition of patient improved and symptoms resolved.

Discussion
Diligent efforts are required to prevent this human error by ensuring meticulous sponge count, use of radio-opaque sponges, adjunctive use of WHO safety checklist and introduction of new advancements like tagging system in our healthcare system.

Conclusion
Gossypiboma is under-reported due to reluctance of institutions to report it to governing body. Reporting of such dreadful complications of surgery and analysis of their root cause should be done to prevent such events from happening.
325 Modified Abdominal Assess for Laparoscopic Cholecystectomy in Obese Population: Our Recommendation
Authors: Shrestha Anuj , Pangeni Anang , Shrestha Ashish Kiran , Basu Sanjoy 
Published: August 2023

Abstract

Background and Aim
Conventional Umbilical access can be time consuming, surgically challenging due to inadequate ‘Critical View of Safety’ and pneumoperitoneum maintenance for high BMI patients undergoing laparoscopic cholecystectomy (LC). Assess the feasibility, safety and outcome of our modified access for patients of BMI ≥30.

Method and Technique
Prospective study of consecutive patients undergoing LC in a large DGH (2007-2022) that included age, sex, BMI, ASA, grade of operation with stay and complications were analysed. Group A: Veress needle pneumoperitoneum through Palmer’s point. After 2 litre (minimum) insufflations, optical port introduced at intersection of two imaginary lines: a 15cm oblique line starting from where the right mid-clavicular line cuts the right lower costal margin and directed medially meeting the other vertical line running 3cm to the right of midline. Remaining ports standard.
Group B (BMI &lt;30): Conventional umbilicus entry.

Results
Group A: 543 with Female: Male 4:1 (436:107), Age 49* (16-82) years, BMI 36*(30-65), ASA 2 * (1-3), Grade 1 * (1-4), Operating time 50* (15-200) mins, PO stay 0* (0-15) day. One conversion, 2 bile leaks, 5 collections and 4 wound infections.
Group B: 1168 with Female: Male 3:1 (861:307), Age 53* (16-89) years, BMI 26 * (17-29), ASA 2* (1-3), Grade 1* (1-4), Operating time 45 *(15-240) mins, PO stay 0* (0-12) day. Ten conversions, 3 bile leaks, 5 collections, 8 wound infections, and 6 wash outs.

Conclusion
Modified LC abdominal access for obese patients allows safe quick entry with excellent ‘Critical view of Safety’ for a good outcome.
* Median