bluuebunny/crossref_metadata_2025_split huggingface dataset:
138 Overview of the management of acute uncomplicated diverticulitis in a District General Hospital
Authors: Chu Ee Earn , Thomas Kerushan , Mostafa Mohamed , Robertson-Jones Beatrice , Rahman Atiqur , Alkhusheh Moutaz 
Published: August 2023

Abstract

Aims
Acute diverticulitis is a condition where diverticula, which is the outpouching of the large intestinal mucosa; becomes inflamed or infected. We took recommendations from ACPGBI, WSES and NICE guidelines on the management of acute uncomplicated diverticulitis and compared our practice with them in a district general hospital.

Methods
Retrospective data collection of 50 consecutive patients presented to A&E with CT-proven acute uncomplicated diverticulitis was performed. Data included demographic distribution, clinical, laboratory and radiological features on presentation, treatment history and follow-up plans.

Results
All 30 patients being admitted with antibiotics, had modified Hinchey type 1a or 1b diverticulitis. However, 12 of these patients were over the age of 65 and another four had CRP &gt;150. In the discharged group, all 20 patients had type 1a or 1b diverticulitis and almost all were discharged with antibiotics. However, 2 of these patients had CRP &gt;150 and another five of them were over the age of 65. A request for the endoscopic procedure was placed for all 50 patients however 36 of them are still on the waiting list. Almost half of these patients were discharged without any written advice on discharge about the diverticular disease.

Conclusions
After analysing the data, more than half of these admitted patients could have been managed in ambulatory care without antibiotics. Conservatively managed diverticulitis patient doesn’t need routine endoscopic evaluation. All patients should have written advice given about their condition. We are in the process of making a pathway to ensure safe and cost-effective management for patients with acute diverticulitis.
193 A rare cause of small bowel obstruction- Obturator Hernia
Authors: Loganathan Santhosh , Gul Rahman , Ahmed Tarig 
Published: August 2023

Abstract
Obturator hernias are clinically challenging to diagnose, and the incidence reported in the medical literature is between 0.05% to 2.2%. This is commonly seen in thin, elderly female patients. Computed tomography is the gold standard for diagnosis. The mortality has been reported as 12-70%. Here, we present a 90-year-old female with complaints of abdomen pain, distention, vomiting and bowels not opening for a few days. She had a background of severe frailty, poor mobility and comorbidities such as hyperlipidaemia and mild cognitive disorder. On clinical examination, her abdomen was distended on examination with diffuse tenderness. Her blood investigations were normal, apart from CRP 26mg/L. Her abdominal X-Ray showed dilated loops of small bowel in the central abdomen. Computed tomography of the abdomen and pelvis showed high-grade mechanical distal small bowel obstruction with a transition point to probably in the right iliac fossa. She had an emergency laparotomy and was found to have an obturator hernia with bruised but viable small bowel. Hernial contents reduced. Postoperatively she developed hospital-acquired pneumonia, for which she was treated with antibiotics and later discharged. It is a rare case with a high chance of getting missed on clinical examination. In case of diagnostic uncertainty, CT should be promptly performed. Knowledge about this rare acute surgical condition is required for clinical suspicion, appropriate investigation and diagnosis, as the mortality is high.
195 Small bowel obstruction through peritoneal defect herniation after a totally extraperitoneal hernia repair- A unusual complication case series
Authors: Loganathan Santhosh , Chapman Stephen , Whittaker Laura , Newman Chris 
Published: August 2023

Abstract
The rates of major complications associated with totally extraperitoneal (TEP) inguinal hernia repair are reportedly low, and intra-abdominal complications are rare. However, here we present a case series with small bowel obstruction through herniation of the small bowel into the peritoneal defect after a TEP, which is a rare complication.
The first case, a 71year old male two weeks post-TEP left inguinal hernia repair, presented with abdomen pain, vomiting, distension, and bowels not opened for three days with elevated inflammatory markers. Computed Tomography of the abdomen and pelvis (CTAP) demonstrated small bowel obstruction secondary to a loop of inflamed small bowel adherent to the anterior abdominal wall in the left inguinal region. During emergency diagnostic laparoscopy found to have a small bowel loop passing through a peritoneal defect just lateral to the medial umbilical ligament, converted to laparotomy, and small bowel resection was performed. In the second case, a 61-year-old male presented with similar complaints and elevated inflammatory markers two days post bilateral TEP. The CTAP showed dilated small bowel with a transition point in the left iliac fossa. Emergency diagnostic laparoscopy found a peritoneal defect on the left groin with small bowel herniation. The bowel-reduced back and the defect was closed with sutures.
Small bowel obstruction due to a peritoneal defect after TEP is a rare but potentially fatal complication. Therefore, the clinician should have a low threshold for surgery, as it is unlikely to resolve with conservative treatment like the adhesional bowel obstruction.
196 Long-term mortality after emergency laparotomy for malignancy – a single centre, retrospective study
Authors: Leung Chee Sian , Ng Jene , Clark Maggie , Moug Susan , MacDonald Scott 
Published: August 2023

Abstract
Emergency laparotomy (EmLap) has a variable 30-day mortality rate (8.7-14%) but less is known about the long-term outcomes. We aim to describe long-term mortality in those undergoing EmLap for malignancy, and also to explore whether those who undergo EmLap have an increased incidence of new malignancy.
A retrospective single-centre review of a prospectively maintained database of patients undergoing EmLap in 2018 at a district general hospital was performed. Inclusion criteria was per NELA guidelines. Clinical data was assessed from electronic records until December ’22.
n=86 patients were identified (Mean age-65.9years) with 33.7% having malignancy at EmLap (n=17 pre-existing, n=12 new diagnoses).
30 day, 90 day and 1 year mortality rates were 10.5%,15.1% and 23.3% respectively, and by time of follow-up, almost half died (48.8%). There was no significant difference in the 30 or 90 day mortality between malignant and benign pathologies, however, the long-term mortality was higher in the malignancy group (1 year-41.4%v12.5%, p=0.002; By-time-of-follow-up -69.0%v27.8%, p&lt;0.0001). The long-term mortality of those with new malignancy at EmLap was higher than those with pre-exisiting malignancy (83.3%v58.8%, p&lt;0.005), with no differences in short term-mortality.
n=3 patients developed a new primary malignancy by time of follow-up, including 2 females in their 70s who developed primary lung cancer, which is higher than normal expected rates for this cohort.
EmLap for malignancy has higher long-term mortality rates than for benign disease, but there is no difference in short-term mortality. There may be an association between EmLap and developing new malignancy, potentially due to the induced inflammatory response, but larger scale research with an appropriate control group is required.
226 The Liberal Use of Magnetic Resonance Cholangiopancreatography (MRCP) can be switched over to its Selective use to detect choledocholithiasis
Authors: Elhassan Ali Mohamed 
Published: August 2023

Abstract
Gallstone disease is known in 10-15% of adults in Western populations. Cholangiopancreatography (MRCP) is the investigation of choice for choledocholithiasis; however, its use is varied, and guidelines are not well defined. The National Institute for Health and Care (NICE) guidelines recommends MRCP to be done when common bile duct (CBD) dilatation ≥ 8mm or liver function tests (LFTs) are abnormal but do not quantify this further. The liberal use of magnetic resonance cholangiopancreatography (MRCP) is gaining popularity as a roadmap prior to cholecystectomy, aiming to assess primarily for the presence of migrated gallstones within the cystic duct or common bile duct, as well as providing information regarding the anatomical features of the extrahepatic biliary tree on an individualised basis .Due to these reasons MRCP’s at times are done unnecessarily which creates economic burden and restricts access to patients in real need of imaging slots
The aim of this retrospective study was to identify whether magnetic resonance cholangiopancreatography (MRCP) can be used selectively in patients with deranged liver enzymes with gallstone disease to detect choledocholithiasis, based on liver function tests (LFTs) and ultrasonography appearance.
284 Quality improvement in venous thromboembolism (VTE) risk assessment
Authors: Hammett Felix , Wilkins Alexander , Menon Rohan , Shah Murium , Chang Lydia 
Published: August 2023

Abstract

Aims
To improve the rates of venous thromboembolism (VTE) risk assessment on the elective Upper GI surgery ward in a tertiary hospital.

Methods
A standard of 95% completion of VTE risk assessment within 24 hours of admission was set, in line with our trust policy and NICE guidance. Initial data collection for one month was followed by implementation of measures to improve rates of assessment: raising the issue in our departmental governance meeting, allocation of responsibility to ward based junior doctors for daily checking and completion of assessments and prescriptions, and fortnightly snap audits to check progress. Data was collected from electronic patient records to evaluate the impact of these measures in the subsequent two months.

Results
Initially, only 75% of VTE assessments were completed. Following the interventions, compliance increased to 89% and subsequently to 98.5%.

Conclusion
VTE assessment is a mandatory requirement for all admissions with the potential for serious harm if the risk is not assessed and managed appropriately. Compliance was initially poor, falling well below our standard. Following simple interventions and active engagement from junior doctors, this was greatly improved and sustained over two months. Moving forward, we anticipate the main issue to be longevity as junior doctors rotate through the department. We recommend highlighting the issue in departmental induction and allocation of responsibility for ongoing quality improvement to rotating juniors in the role of a ‘VTE champion’. In future work we aim to assess the correlation between improved compliance with risk assessment and incidence of VTE.
320 Surgical Site Infections (SSIs)- Are you doing your part to prevent them?
Authors: Agbedare Oluwabukola , Lingam Gita , Kirmani Naveed 
Published: August 2023

Abstract

Aims
(1) To evaluate the current literature regarding prevention of surgical site infections (SSIs). (2) To assess our General Surgery department SSI rate. (3) To implement changes within the department that are reflective of current evidence/guidance. (4) To re-audit our SSI rate post implementation of changes.

Methods
Evaluated and summarised 3 studies published in 2022 relating to the use of surgical care bundles to reduce SSIs. Collected post- operative laparotomy data within 2022; primary outcome SSI prior to discharge. Secondary outcomes: organism grown on wound culture, prolongation of hospital stay and other hospital acquired infections. Trust data and literature review presented a local department meeting. Consultant Surgeon cohort concluded which changes were to be implemented (pre-closure glove change, new closure equipment set, wound irrigation, anti-microbial sutures, use of wound retractors and negative pressure wound therapy). Post-operative laparotomy wound data recollected after changes.

Results
Clear literature evidence in support of surgical care bundles. Pre-closure glove change, new closure equipment set, wound irrigation, anti-microbial sutures, use of wound retractors and negative pressure wound therapy all found to contribute to a statistically significant reduction in SSIs. Implementation of these changes led to a reduction of SSIs within the department.

Conclusions
SSIs are the most common surgical complication worldwide. They lead to increase morbidity/mortality, prolonged hospital stays and increase economic burden. Recent literature has highlighted simple measures to reduce SSIs. Implementation of these measures has led to a department wide reduction in SSIs.
359 Confidence levels in junior doctors managing paediatric surgical patients in a busy district general hospital
Authors: Leeman Charlie , George Jayan , Wafai Ahmad Hisham , Durham-Hall Antonia 
Published: August 2023

Abstract

Aims

Methods
Doctors were surveyed in December 2022. Eight questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. Five closed questions were asked, and one question focused on education methods. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
7 FY1 doctors (7/10) and 4 SHO doctors (4/11) completed the questionnaire.
2/11 have had to clerk or create a management plan for a paediatric patient.
8/11 would use guidance to prescribe for a paediatric patient.
2/11 have had teaching or e-learning to support prescribing.
3/11 have had to prescribe for a paediatric patient.
Confidence levels were low for prescribing at the start of the rotation but increased by the end of the rotation. The highest confidence modal values were 3. Confidence levels of diagnosing and managing appendicitis were higher than mesenteric adenitis.
Most doctors felt that group teaching would be the preferred educational method to increase understanding.

Conclusions
Most doctors did not receive teaching in managing paediatric patients. The highest modal value for confidence was 3. Further targeted group teaching may support increasing confidence levels.
386 MINT: Minimising Ileus through sham NuTrition
Authors: Mactier Mhairi , Parajuli Arun , Kemp Olivia , Tom Tanyaradzwa , Nicholson Gary 
Published: August 2023

Abstract

Background
Post-operative ileus is a common post-operative complication, leading to prolonged hospital stay and associated costs. Evidence suggests use of chewing gum after abdominal surgery is a safe, effective intervention to encourage gastrointestinal function and reduce post-operative ileus. The Enhanced Recovery After Surgery (ERAS) Society supports this as part of the multimodal post-operative recovery pathway.

Aim
To improve post-operative sham feeding in a tertiary colorectal unit.

Methods
Retrospective analysis of clinical notes and prescription charts was carried out between 17.4.2022-24.4.2022. Education was provided to all medical and nursing staff; posters were disseminated around relevant wards and stickers were placed at each computer base (accommodating for electronic prescribing). Prescription of chewing gum was also including in the day one post-operative checklist within the departmental ERAS booklet. Further data was collected between 3.10.2022-14.10.2022 to assess for improvement.

Results
Between 17.4.22-24.4.22, 11 patients underwent major abdominal surgery [n=11]. 0 patients were prescribed chewing gum.
Between 3.10.22-14.10.22, 17 patients underwent major abdominal surgery [n=17]. 16 were eligible for our study [n=16]. 19% patients had chewing gum prescribed [n=3]; none of which developed post-operative ileus, and all were discharged by post-operative day 9. 13% patients demonstrated evidence of post-operative ileus [n=2]; both remained inpatients at post-operative day 35.

Conclusion
Use of chewing gum is a cheap and effective way to reduce post-operative ileus and prolonged hospital stay. We wish to pursue this as routine practice in our tertiary unit. There is more work to do but this a fresh idea which deserves to be showcased.
414 Renal artery aneurysm after blunt trauma in a pediatric patient- A case report
Authors: Sabir Alifa , Rasul Laraib , Iftikhar Usama , Shahwar Ameena , Rauf Fatima , Gondal Mudassar 
Published: August 2023

Abstract

Introduction
Renal artery aneurysm is a rare complication after renal trauma. Most patients are managed with minimally invasive techniques. However, in case of risk of expansion or rupture, surgical exploration may be warranted.
Here we present a case of a 10 year old girl who presented with renal artery aneurysm after blunt trauma.

Case report
A 10 year old girl presented in ER with sudden onset abdominal pain after history of fall. Fast scan showed free fluid in abdomen and right kidney injury. CT scan of abdomen showed grade V kidney injury and right renal artery aneurysm compressing inferior vena cava anteriorly and ascending colon laterally. CT angiogram was done which confirmed a ruptured renal artery aneurysm.
Patient was initially being managed conservatively and angiography was planned. She, however, became vitally unstable and her haemoglobin level dropped. Patient was taken to operation theatre urgently. Per- operatively, a ruptured right renal artery aneurysm was found, 2cm from aorta, causing a large hematoma compressing surrounding structures and dilated renal vein. Right nephrectomy was done. Patient remained stable and was discharged with an uneventful recovery.

Discussion
Renal artery aneurysm is an extremely rare complication following blunt trauma in paediatric population. Diagnosis is difficult, hence requires high level of clinical suspicion. Angiography is the standard tool for diagnosis and management. However, in case of hemodynamic instability, operative management may be warranted.

Conclusion
Despite its rarity, renal artery aneurysm may occur in children after blunt trauma. Hence, high suspicion should be kept by the clinicians in these cases.
464 Incidence of recurrent inguinal hernias and their repairs at a large DGH
Authors: Alkaissy Riem , Tahir Muhammad-Javid 
Published: August 2023

Abstract
In the UK 100,000 hernia operations are performed annually – this includes umbilical/epigastric/incisional etc. Options of inguinal repair are either open or laparoscopic (TAPP vs TEP). Recurrence rates for Liechtenstein repairs are quoted as 5.6%. Median recurrence rates for TAPP repair are quoted as 2.3% and for TEP 0.6%. However, several meta-analyses comparing TEP/TAPP to open repairs found no significant difference in recurrence rates. At our trust, 331 inguinal hernia operations were performed between August 2021- August 2022 (post-COVID). The aim of this project was to look at the incidence of recurrent hernias and their initial repairs at our trust.
We obtained a list of all inguinal hernia repairs in our trust (across all sites) between August 2021- August 2022. We looked at the number of patients that underwent an operation for a recurrent hernia and whether that patient’s primary repair was done laparoscopically or open.
76% of total inguinal hernia repairs were performed open, compared to 24% laparoscopic repairs (72% TEP repairs). About 10% of total repairs were for recurrent hernias. 56% of those had a primary open repair and 44% had a primary laparoscopic repair. 75% of the recurrent hernias underwent a second open repair and 25% underwent a second laparoscopic repair.
We aim to repeat this study with more data (i.e. looking at pre-COVID years) and encourage our laparoscopic hernia surgeons to look into their own practice.
480 Clinical outcome of patients underwent cholecystostomies for acute gall-bladder related pathologies
Authors: Zheng Jennifer , Burford Charlotte , Gardner Alvin , Adeshina Oyinade , Whiteway James , Shah Ankur 
Published: August 2023

Abstract
Percutaneous cholecystostomy is an important and effective temporising procedure in patients with acute cholecystitis who are too unwell to undergo early cholecystectomy. We are seeing a rising number of cholecystostomies performed during the pandemic due to various reasons. However, evidence regarding drain indication, timing and management is lacking with varied practice within and between trusts. We have conducted this study to understand current practice employed at our unit and associated patient outcomes. In this retrospective study, we identified 138 patients who underwent image-guided percutaneous cholecystostomy between 1st January 2020 and 31st July 2022 in all hospitals within our trust. Data was collected from electronic records including drain details, immediate and late complications, biliary-related morbidity and mortality, subsequent re-admissions and definitive management. This is one of the largest studies ever conducted on cholecystostomies. Median length of time with a drain in situ was 35 days (IQR 28 days). 13 (9.8%) experienced minor immediate complications including pain during and after insertion, 51 (3.8%) experienced late complications including formation of cholecysto-cutaneous fistulous tracts and drain site infections. Hospital mortality secondary to biliary pathology was 6.8%. 28.6% had undergone definitive treatment at time of writing (median wait-time 23.5 weeks) and 25.6% were still awaiting a procedure. 29 (21.8%) patients had at least one re-admission related to their gallbladder pathology, with an average admission length of 15 days. No association was found between length of drain in situ and rates of complication and readmissions. The substantial mortality and readmission rates warrant a greater need for early/extra cholecystectomy lists in this era of gall-bladder pathologies.
517 A retrospective audit into the implementation of CT as the recommended first-line imaging in the investigation of suspected Acute Bowel Obstruction in a Tertiary General Surgical Unit
Authors: Solkar Maseera , Jamal Mehvish , Roy Pratik , Riyad Kallingal 
Published: August 2023

Abstract

Introduction
The NCEPOD ‘delay in transit’ report 2020 explored the management of patients presenting with Acute Bowel Obstruction (ABO), highlighting delays at all stages of patient care from presentation to management. CT scan as the first definitive imaging was a key recommendation to prevent delay in decision making. The Aim of this audit was to investigate compliance with this key recommendation and consequential delay in decision making and treatment.

Methods
Data from imaging requests for patients above the age of 16, with a provisional diagnosis of ABO from March-September 2022 was included in the study and analysed. Data analysed included: times of admission, X-ray of abdomen, CT, and time of decision to treat (TDT). The hypothetical time to decision to treat (TDT) was calculated if CT was the first investigation instead of X-Ray; the time of X-ray being performed as the potential time of performance of CT. Delays at each stage of care were calculated.

Results
Between March 2022 and September 2022, 37 patients were admitted under surgery and diagnosed with ABO. The median TDT when X-ray was done prior to CT was 7 hours 3 minutes (IQR 4 hours 32 minutes to 16 hours 42 minutes). 82% of patients required a CT after X-Ray for definitive decision making.

Conclusion
Our surgical service is yet to achieve compliance to this NCEPOD recommendation, with consequential delay in decision making. Further education and change of practice are necessary to implement this key recommendation for raising physician awareness and improve care.