bluuebunny/crossref_metadata_2025_split huggingface dataset:
eP3 Cecal Volvulus: A Case Report of Adult Intestinal Obstruction
Authors: Kaklamanis Georgios , Aggelakoudis Apostolos , Siozos Lampros , Delis Aggelos , Voulgaris Panagiotis , Prikimiris Vaios 
Published: January 2025

Abstract

Aims
Cecal volvulus (CV) is a rare cause of adult intestinal obstruction occurring approximately 1–1.5% of all, while 11% of all volvulus-related intestinal obstructions. Its rarity and the variety of clinical symptoms may lead to a delay in the diagnosis and appropriate intervention. Early diagnosis is essential in order to reduce mortality rate.

Methods
We present a 30-years old female patient who presented with a 4-day history of abdominal pain and vomiting; she presented with abdominal distension, failed to pass feces, and flatus and diarrheas. She underwent laboratory and radiographic tests with CT findings of cecal distension, cecal apex in left upper quadrant, mesenteric whirl, ileocecal twist. The patient underwent an emergency laparotomy, where there was a perforated volvulated cecum with colonic necrosis, and a right hemicolectomy was performed with ileotransverse anastomosis.

Discussion
: CV is the axial rotation of the cecum, ascending colon, and terminal ileum. This can result either in obstruction of the affected segment of the intestine with impending vascular compromise and gangrene, which mandates a timely diagnosis and intervention. Many factors have correlated to CV, such as incomplete intestinal rotation and previous abdominal operations. It predominantly affects female patients 40-60 years old. Laboratory investigations are unspecific, and CT is sensitive for diagnosing CV and detecting complications. Right hemicolectomy is the accepted treatment.

Conclusions
CV’ rarity makes early diagnosis challenging and results in a high incidence of complications and mortality, hence a high index of suspicion and urgent intervention is needed. Surgery is the mainstay of management.
eP14 Gastrointestinal complications and laparotomy after cardiac surgery: A retrospective cohort study
Authors: French Thomas , Damaskos Dimitrios , Clinch Darja , Koutsogiannidis Charilaos-Panagiotis 
Published: January 2025

Abstract

Introduction
Gastro-intestinal (GI) complications following cardiac surgery are infrequent, but associated with high rates of post-operative mortality.
The aim of our study was to identify risk factors predisposing patients to GI complications following cardiac surgery and describe the outcomes of patients suffering a GI complication.

Methods
This was a retrospective cohort study of 6,693 consecutive patients undergoing cardiac surgeries (at least one of CABG, aortic valve replacement, mitral valve replacement, or surgery on thoracic aorta) at a single Scottish centre between 01/01/2015 and 27/09/2023.
Cohort demographics, intra-operative details and postoperative outcomes were compared between patients who did and who did not experience a GI complication.

Results
Patients who experienced a GI complication had greater rates of thirty-day mortality (14.4% vs 2.4%, p&lt;0.001) and in-hospital mortality (6.8% vs 1.1%, p&lt;0.001).
We identified previous PCI (OR 2.27 [1.24-4.17], p=0.007) and combined cardiac surgery (OR 1.67 [1.02-2.74], p=0.043) as two risk factors for developing a GI complication, in addition to several previously identified risk factors (post-operative atrial fibrillation, post-operative vascular complication, use of pre-operative inotropes and increased age).

Conclusions
GI complications frequently occur in elderly, co-morbid patients and in conjunction with other complications. Particularly lethal complications are mesenteric ischaemia, GI bleeding, and small bowel obstruction.
Extra caution should be observed in the patient group undergoing more than one cardiac procedure or those with a prior history of coronary artery disease.
Outcomes after emergency laparotomy are poor, and patients in this cohort are at high risk of futile laparotomy.
eP17 Evaluating the Impact of the Children's Appendicitis Score on the Management of Suspected Paediatric Appendicitis at a District General Hospital
Authors: Kafagi Abdul-Hadi , Peaple Luke , Frerichs Carley 
Published: January 2025

Abstract

Introduction
Appendicitis is a common cause of abdominal pain in children and presents diagnostic challenges due to varied clinical presentations. This audit evaluates the management of suspected paediatric appendicitis at a District General Hospital, comparing it with the GIRFT Paediatric Acute Abdominal Pain Pathway. Our goal was to assess the impact of the Children's Appendicitis Score (CAS) on clinical decision-making and refine practices among emergency clinicians, paediatricians, general surgeons and radiologists.

Methods
A retrospective review of patient data from November 2023 to May 2024 for children under 16 was conducted. CAS scores were assigned based on clinical notes and key patient journey times were analysed. Data on baseline characteristics, initial assessments, imaging and surgical outcomes were recorded.

Results
Of 103 patients, 30 underwent appendectomy, with a negative appendectomy rate of 13.3% (4/30). The remaining 73 were discharged with non-surgical abdominal pain or other diagnoses. CAS demonstrated 100% sensitivity and negative predictive value in low-risk patients (n=36), effectively ruling out appendicitis. Among intermediate-risk patients (n=44), 32% were diagnosed with appendicitis, while 78% of high-risk patients (n=18) had the condition. CAS identified 2 negative appendectomies and highlighted an intermediate-risk patient who was discharged and later returned with a perforated appendix. Of 82 abdominal ultrasounds performed, 26 (31.7%) were deemed inappropriate for low-risk patients, with 86.36% sensitivity and 92.73% specificity.

Conclusion
Integrating CAS into the management of suspected paediatric appendicitis improves risk stratification, reduces unnecessary interventions and enhances diagnostic precision. CAS allows confident discharge of low-risk patients, optimising resource use and patient outcomes.
eP43 Analysis of the Adherence to Guidelines for Consent Forms for Laparoscopic Cholecystectomy at a Hot-Lap-Chole-Center
Authors: Almoshantaf Mohammad Badr , Lopes Sousa Erica Ramos , Hunt Hannah , Jokar Jasmine , Wong WenKyle , Abdalla Sala , Hussein Abdelaal Ibrahim Ahmed 
Published: January 2025

Abstract

Aim
The primary aim of this study is to assess how well LC consent-forms at Ealing Hospital adhere to NHS guidelines. A secondary aim is to evaluate whether the introduction of procedure-specific consent forms would improve compliance and patient care.

Methods
The study reviewed 150 patient records from those who underwent laparoscopic cholecystectomy (LC) over three years at Ealing Hospital, including both elective and emergency cases. Consent forms were analyzed to check if they listed key complications as per NHS guidelines: infection, bleeding, bile duct injury, injury to surrounding structures, deep vein thrombosis (DVT), and post-cholecystectomy syndrome (PCS). Post-operative complications were also recorded, and statistical analysis was conducted to compare differences between elective and emergency procedures.

Results
Only 16 consent forms (10.6%) included all NHS-recommended complications. Infection and bleeding were the most frequently mentioned risks, with infection cited in 98.43% of forms and bleeding in 96.83%. Bile duct injury was mentioned in 93.7% of cases, while over 25% of the forms failed to mention bile leakage, and half of them omitted the risk of PCS entirely. Postoperative complications were observed in 25 patients (16.7%), all of which were listed on their respective consent forms. No statistically significant difference was found between elective and emergency procedures in terms of complication listing in the consent form.

Conclusion
Introducing a standardized, procedure-specific consent-form would ensure comprehensive risk disclosure, improve patient care, and provide better legal protection. Increased education and awareness among healthcare professionals about the importance of thorough consent documentation are also necessary.
eP50 Water-Soluble Contrast Agent Use in Adhesional Small Bowel Obstruction: A Survey of Surgical Practices and Clinical Trial Considerations
Authors: Aimar Kelsey , Walshaw Josephine , Peckham-Cooper Adam , Smart Neil , Magill Laura , Lee Matthew J 
Published: January 2025

Abstract

Background
The role of water-soluble contrast agent (WSCA) as a therapeutic tool in the non-operative management of adhesional small bowel obstruction (ASBO) remains indeterminate. This survey aimed to understand current surgical practices in WSCA utilisation in the conservative approach to ASBO, and to evaluate key design and feasibility factors to inform a future controlled trial of WSCA in ASBO.

Methods
This study is reported in line with CROSS guidance. The survey consisted of 16 questions organised into three sections: respondent characteristics, current decision-making and WSCA use, and opinions on future trial. Pilot testing was conducted prior to online distribution to surgeons in the UK delivering Emergency General Surgery. Descriptive analysis was performed.

Results
Of 73 total respondents, 52 (71.2%) were consultants. When treating ASBO conservatively, 80.8% (59/73) reported using WSCA in more than half of cases, but there was wide variation in timings, utilisation, and repeat challenges. Between 71.2% and 89.0% of respondents affirmed their willingness to adhere to specific trial protocols. Regarding feasibility, 76.7% (56/73) of respondents agreed or strongly agreed that they would be willing to recruit to a trial and 75.3% (55/73) agreed or strongly agreed that their unit would be able to deliver a trial.

Conclusions
The survey revealed widespread acceptance of WSCA as a therapeutic tool in ASBO among emergency general surgeons. While practices around its administration varied, there was a clear readiness to adopt standardised protocols. The majority of respondents expressed support for a controlled trial comparing WSCA against a placebo.
eP56 Gall Stone Pancreatitis: Timing of Surgery is Critical
Authors: Unadike Chinedu , Namme Etomby 
Published: January 2025

Abstract

Aim
Gallstone pancreatitis is a significant contributor to acute pancreatitis, leading to substantial morbidity and healthcare burden. It has been emphasized that early laparoscopic cholecystectomy following an initial episode of gallstone pancreatitis remains more beneficial in outcome compared to delayed cholecystectomy. This retrospective cohort study examines the outcomes associated with index admission versus delayed laparoscopic cholecystectomy, including the impact of delayed surgery performed within and beyond six weeks on readmission rates, length of hospital stays, and complications.

Methods
Data from 99 patients diagnosed with gallstone pancreatitis at a tertiary hospital in the UK between April 2022 and March 2023 were analysed. Patients were categorized based on the timing of their cholecystectomy: index admission, within six weeks, after six weeks, or awaiting surgery. Outcomes assessed included readmission rates, length of stay, intensive care unit (ICU) admissions.

Results
72 patients had surgery: 15% of them had index cholecystectomy, while 85% had delayed surgery (&lt; 6 weeks: 33, &gt;6 weeks: 28). Readmission rates were higher in the delayed group. Between the delayed groups, there was no statistical significance with reference to readmissions (&lt; 6 weeks 7, &gt; 6 weeks: 8). Those who had index cholecystectomy had longer hospital stay (p = 0.0006). ICU admissions were seen in patients who had surgery delayed beyond six weeks.

Conclusions
Early laparoscopic cholecystectomy during index admission, while associated with a longer hospital stay, appears to reduce readmission rates and complications, confirming it is a more effective approach in managing gallstone pancreatitis. Surgeries beyond 6 weeks are associated with severe complications.
eP65 Is routine collection of pus swabs necessary during emergency incision and drainage of abscesses?
Authors: Sonoo Prithvirao , Gull Sadaf 
Published: January 2025

Abstract

Aim
Pus swabs for microbiological analysis are routinely sent during abscess incision and drainage (I&D) procedures. However, this remains a debated issue, particularly regarding its cost-effectiveness, which is often overlooked. This study evaluated whether avoiding routine swabs during I&D could maintain patient outcome while improving cost-effectiveness in ever under pressure NHS trusts.

Methods
Between August and October 2023, all abscess I&D procedures performed at the Surgical Triage Unit in a tertiary centre were retrospectively reviewed. Data collected included patient demographics, pyrexia on admission, co-morbidities, microbiological swab results, documentation of reviewed swab results, perioperative antibiotic use, and 30-day re-attendance.

Results
A total of 72 patients underwent I&D (44 males, 28 females; age range 17–83; median 45). Two patients presented with fever (T ≥ 37.5°C). Antibiotics had already been prescribed in primary care for 42% of patients. The most frequent abscess locations were pilonidal (22%) and back (21%). Microbiological swabs were sent for 32 patients (78%), with 57% showing no bacterial growth. The remaining swabs revealed MRSA (N=1), mixed growth, staphylococcus, and gram-positive cocci. Only one case had a documented review of swab results. Two patients re-attended within 30 days: one for inadequate drainage and another for recurrence despite appropriate antibiotic therapy.

Conclusion
Pus swabs may be avoided in most I&D cases unless specific circumstances such as immunocompromised status or extensive tissue necrosis exist. Most patients are discharged prior to results being available and no link between microbiology results and abscess recurrence or re-attendance was found.
eP66 Do emergency general surgery patients know their consultant? An audit based on the Francis Report
Authors: Thorne Thomas , McCabe Joanne , Littler Sophie , Nandra Saroop , Akbari Khalid 
Published: January 2025

Abstract

Introduction
The Francis Report recommended introducing a responsible consultant, with a headboard showing this by the patient. It is frequently reported that patients are unaware of their responsible consultant. We set out to audit awareness of a responsible consultant at a tertiary referral centre.

Methods
Inpatients from March–August ’24 across 3 general surgical subspecialties (UGI, HPB and colorectal surgery) were included, with eligibility generated from ward round lists. Being unable to answer questions was an exclusion criterion. This audit was registered locally. After cycle 1, data presentation occurred, a change was initiated, then cycle 2 was conducted. Standard: 100% patients are aware of their responsible consultant.

Results
Overall, 107 patients were included. 68.6% (n=72) of patients with data were emergency admissions. There were insignificant demographic differences between cycles. Between cycles 1 and 2, patient awareness of responsible consultant significantly improved for UGI patients (p&lt;0.001), and for all patients improved from 56.5% to 71.1%, though this difference was insignificant (p=0.089). Headboards showing named consultant improved from 43.5% to 53.3%, though this difference was insignificant (p=0.234).

Conclusion
During cycle 1, poor adherence existed. Results were presented to FY1 doctors and surgical departments, with juniors given whiteboard pens, aiding writing headboards. Cycle 2 results improved from cycle 1. It should be noted, electronic noting was introduced between cycles. Further cycles should aim to further improve headboards and improve awareness.
eP75 The effect of time of intra-abdominal drain insertion on surgical outcomes in patients undergoing emergency laparotomy
Authors: Maheshwari Parth , Basu Somprakas 
Published: January 2025

Abstract

Background & Aim
Management of perforation peritonitis involves source control, decontamination of peritoneal cavity, and antibiotics for systemic sepsis. Preoperative abdominal drain placement helps in early decontamination and reduces intra-abdominal pressure. However, it is not fully known how the treatment outcomes are influenced. This study explores any relationship between timing of preoperative drain placement and surgical outcome in emergency exploratory laparotomy.

Method
Consecutive patients (&gt;18 years) with perforation peritonitis planned for emergency exploratory laparotomy were recruited after obtaining informed consent. All underwent preoperative intra-abdominal drain insertion as per protocol. Time to drain insertion from patient’s presentation was recorded, and its effect on APACHE II scores and intra-abdominal pressure (IAP) before and after drain placement, 30-day postoperative mortality and morbidity, and duration of hospital and ICU stays were assessed. Spearman correlation test was used to compare time to pre-operative drain placement with APACHE II scores, IAP, ICU and hospital stay. Effects on Clavien-Dindo scores and 30-day mortality were evaluated using one-way ANOVA test.

Result
In total of 92 cases, a significant correlation (p &lt; 0.01) was observed between time to drain placement (mean 9.15 hours) and change in APACHE II scores (mean 3.85), and with length of ICU stay (p = 0.017), and not with mean hospital stay, Clavien-Dindo score, and 30-day postoperative mortality. Changes in IAP before and after drain placement were not significantly correlated with changes in APACHE II scores (p = 0.08).

Conclusion
Delayed drain placement may impact patient outcomes, particularly APACHE II scores and ICU stay duration significantly.
eP78 Emergency laparoscopic repair of groin hernia in a district hospital: a case series
Authors: Mohamed Mohamed S , Assiri Adel , Myers Alistair , Koronfel Ashraf , Mallappa Sreelakshmi , Aly Mohamed 
Published: January 2025

Abstract

Background
Groin hernia (GH) represents a common surgical presentation, predominantly affecting one third of men worldwide, and adversely impacting their quality of life and work capacity. On emergency sitting they represent a life-threatening condition with mortality rate of 4.9%. Outcomes are significantly worse for emergency hernia repair than the elective one, with increased risk of adverse events up to 18.5 %. Minimally invasive techniques showed a safe and effective therapeutic option for GH requiring emergency surgery. We present a case series of emergency GH repaired laparoscopically at a district general hospital over the past year.

Methods
A retrospective review of prospectively well-maintained data of patients presented with emergency GH, including patient characteristics, Complications, Length of stay (LOS) and recurrence were collected and analyzed to identify the primary outcomes of laparoscopically repaired GH between December 2023 and August 2024.

Results
Eight patients underwent Emergency Transabdominal pre peritoneal repair (TAPP) repair with mesh was used in all included GH cases. One patient had a right femoral hernia, one had both left inguinal and femoral hernia and the remaining 6 patients had inguinal hernias. Average LOS is 1.5 days. One patient developed seroma, one developed an ileus, and one had unexplained hematuria. No recurrence reported.

Conclusions
Several operative techniques were described to repair GH. We opted for the laparoscopic TAPP as a safe option, aids in confirming diagnosis, bowel assessment, and has all laparoscopic surgery benefits. Randomized trials needed to establish the proper guidance and patient selection for such approach.
eP90 Interventions to improve prescribing accuracy in the management of intra-abdominal sepsis in emergency general surgical patients; experiences from an acute teaching hospital
Authors: Reyhani Hadis , Kaur Mandeep 
Published: January 2025

Abstract

Background
Antibiotic stewardship reduces microbial resistance and spread of multidrug-resistant organisms, reducing patient morbidity, mortality, and length of stay.
Sepsis is a significant contributor to poor patient outcomes.
Fishbone conceptualisation suggests possible causes of poor prescribing compliance for intra-abdominal sepsis (IAS) may include lack of experience, awareness, accessibility, and training of prescribing guidelines.
‘Enabling’ interventions, such as audit and feedback, have been proven as most effective in improving pan-specialty antibiotic prescribing practices.

Question
Can enabling, behaviour change techniques successfully improve antibiotic prescribing accuracy for intra-abdominal sepsis in a large, tertiary general surgical unit?

Methods
Data on antibiotic choice was collected for all consecutive patients with a new diagnosis of IAS, over two 2-week periods, one pre- and one post-enabling interventions.
Interventions were: Presentation of audit and group feedback data at consecutive governance meetings attended by key multidisciplinary team members; regular group educational emails; streamlined access to prescribing guidelines with concurrent graphic reminder of sepsis parameters, placed in strategic prescribing locations.

Results
N= 33 across both cycles. Predominant causes of IAS were cholecystitis (N=10) and appendicitis (N=9).
Correct antibiotic choice, initially 18%, significantly increased to 74% after 1 month of sustained interventions.

Discussion/Conclusions
Established interventions to improve antibiotic prescribing practices can be successfully applied in the context of emergency general surgery.
Educational outreach of recommended change, shared directly with target prescribing groups may substantially improve surgical departments’ prescribing practices and antibiotic stewardship, thus improving patient outcomes.
Sustainability of these interventions over time and with rotational staff requires further investigation.
eP94 Addressing antibiotic prescription in acute appendicitis
Authors: Taneja Surina , Gopalan Vignesh , Wijeyaratne Manuk , Sheerin Fatima , Pullyblank Anne 
Published: January 2025

Abstract

Aims/Background
Poor antibiotic stewardship in emergency general surgical patients can increase morbidity and contribute to antibiotic resistance. National guidelines state that all patients with suspected appendicitis should be given pre-operative antibiotics, and only patients with complicated appendicitis (perforation, abscess, phlegmon) should have a post-operative antibiotics. Local microbiology guidelines recommend a course length of 4 days from source control in complicated appendicitis.
Our study aimed to ascertain local compliance with these guidelines.

Methods
In this retrospective audit, data collection included patient demographics, intra-/post-operative findings and pre-/post-operative antibiotic prescription for all patients who underwent an appendicectomy for acute appendicitis between 30th July and 30th August 2024 at a single NHS tertiary surgical unit

Results
Across the study period, 35 patients (20 female) underwent appendicectomy. Median age was 29 years (range 18 – 79). 34 patients (97.1%) received pre-operative prophylaxis.
Documented operative appearance of the appendix was: uncomplicated appendicitis (n=19, 54.3%), complicated appendicitis (n=12, 34.4%), suspected malignancy (n=1, 2.9%) and normal (n=3, 8.6%). 11/12 (91.7%) patients with complicated appendicitis received post-operative antibiotics. 11/23 (47.8%) patients without complicated appendicitis were prescribed post-operative antibiotics. Antibiotic duration was a median of 7 days (range 2 – 12).

Conclusions
This audit showed poor compliance with acute appendicitis antibiotic guidelines. Interventions include delivering educational sessions to the surgical team, liaising with the microbiology team to update trust guidelines, and automated electronic reminders on patients’ records. Results of a second audit cycle to evaluate these will be available for presentation.