bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP-277 Emphysematous cholecystitis: A diagnostic dilemma and treatment challenge
Authors: Matias Mariana Rita Afonso , Elnabil-Mortada Ahmed , Ackroyd Roger 
Published: November 2022

Abstract

Background
Emphysematous cholecystitis (EC) is a rare life-threatening variant of acute cholecystitis. It is commonly seen in elderly men who are immunocompromised, known diabetes mellitus or peripheral vascular disease. EC is caused by gas-forming organisms such as Escherichia coli, Clostridium perfringens and Bacteroides fragilis and has a reported mortality of up to 25%. Computed Tomography is the most sensitive diagnostic imaging study for the detection of intraluminal or intramural gallbladder gas.

Methods
We report a diagnostic dilemma and multidisciplinary management of a case of emphysematous cholecystitis with unusual presentation in a young, healthy patient with no risk factors.

Results
A 47-year-old male chef, otherwise fit and well, presented with a clinical picture of sepsis and abdominal pain. Initial investigations were normal apart from bilateral basal atelectasis, hence he was treated for pneumonia, although without clinical improvement. Due to persistent fever, patient underwent further investigations that established the diagnosis of emphysematous cholecystitis. His clinical condition improved dramatically after urgent laparoscopic cholecystectomy with patient being safely discharged home 6 days post-op, with an uneventful postoperative recovery.

Conclusion
A high index of clinical suspicion and multidisciplinary team management including surgery, radiology, and microbiology is crucial for early diagnosis of the rare life-threatening condition of EC. Our clinical case highlights that EC is not limited to elderly morbid patients and urgent laparoscopic cholecystectomy is the best treatment when feasible.
EP-279 Impact of a Subspecialty Emergency Service on Emergency Laparotomy Workload
Authors: Farrow EZ , Cook TA 
Published: November 2022

Abstract

Aims
Subspecialist emergency surgical care, shared between Upper GI (UGI) and Colorectal (CR), can bring clinical benefits. Currently subspecialist emergency care is provided in around 20% of units but is likely to become more common in larger units with a view to driving improvement in outcomes. A subspecialty emergency service was introduced in our Trust in April 2020. The purpose of this study was to assess the impact of the subspecialty emergency service on emergency laparotomy workload for each team.

Methods
Data recorded on the NELA Database over an 18-month period (April 2020 - September 2021) were reviewed. Consultant involvement and subspecialty team were recorded

Results
There were 14 surgeons (7 UGI, 7CR) participating equally in the emergency service (two consultants available 24/7). There were 589 emergency laparotomies (mean 33/month) performed in the 18-month period, 6 were excluded from analysis due to incomplete data. A consultant surgeon was present for 94% of all cases. 357 cases (51 per surgeon) were performed under a CR consultant compared with 226 (32.3 per surgeon) under an UGI consultant. CR consultants performed more laparotomies out of hours then their UGI colleagues.

Conclusions
There was good consultant involvement for all emergency laparotomies. CR surgeons performed 61.2% of emergency laparotomies reflecting the presenting pathology of emergency patients. This had an impact on the amount of out of hours operating for individuals within the service as a whole. These differences should be taken into consideration in units looking to establish a subspecialty emergency service.
EP-283 A rare cause of headache – cerebral sinus venous thrombosis after COVID-19 vaccination
Authors: Kam Cheuk Tung , Rait Jaideep 
Published: November 2022

Abstract

Introduction
Cerebral sinus venous thrombosis (CSVT) is a rare complication of COVID-19 vaccination. There is an incidence of 0.55 per 100,000 person-months. We describe a case of CSVT post COVID-19 vaccine.

Case description
A 58-year-old male presented to a district general hospital after being involved in an RTC with a 3 month history of left sided headache which had followed his first COVID-19 vaccine (AstraZeneca). No focal neurological deficits were elicited. Blood results were unremarkable. Radiological workup suggested left transverse and sigmoid sinus thrombosis with no other intracranial complications. The patient was admitted and managed with low molecular weight heparin with an uneventful recovery.

Discussion
CSVT is a rare and sometimes fatal disease. An increased risk of CSVT after COVID-19 vaccination has been suggested. An underlying immunological mechanism is suspected with the involvement of platelet factor-4 (PF4) antibody. Headache is the most common presenting symptom with onset within one week of vaccination. Positive D-dimer, PF4 IgG assay and thrombocytopenia may also support the diagnosis. CSVT may progress to major complications including intracranial haemorrhage and even death. Prompt diagnosis and appropriate treatment prevents neurosurgical intervention such as decompressive craniotomy and may improve neurological outcome.

Conclusion
This case describes an important and rare finding of complications following COVID-19 vaccine. Consideration should be made in management for patients with a recent history of COVID 19 vaccination presenting with features of headache. A high level of clinical suspicion is needed to investigate and manage these patients appropriately with potential CSVT.
EP-295 Mentoring Scheme for Medical Students Interested in a Career in Surgery
Authors: Bowerman Kathryn , Agarwal Reena 
Published: November 2022

Abstract

Aim
A career in surgery requires dedication and commitment from medical school onwards. Having a mentor is proven to help facilitate career progression and improve self-confidence as well as providing supportive, non-biased, non-judgemental career advice. Mentors report increased job satisfaction and self-esteem when mentoring junior colleagues.

Method
The senior author, along with the local medical school's surgical society, launched a pilot scheme for medical students and volunteering consultant surgeons in April 2021. 46 students were recruited, and 28 consultant surgeon mentors. Mentees were then paired with mentors, with some mentors taking on multiple mentees.

Results
Feedback forms were sent out 6 months later to establish perceptions on progress and any suggestions for improvement. We had a low return rate of the feedback forms with 19 returns from mentees, 13 of which had met their mentors. 8 forms were returned by mentors, 5 of whom had met their mentees. 82.35% of mentees who returned the form said the pilot scheme had either ‘met or exceeded their expectations’.

Conclusion
This pilot scheme was launched just as Covid-19 pandemic recovery work started, with surgical specialities trying to clear the back log, which may be the reason of the meetings not taking place or the feedback forms not being completed. In the future, we hope to recruit surgical trainees to help with the mentorship programme and by time constraining the programme, trying to ensure that all mentees get the benefit of limited number of mentors.
EP-296 Introduction of an Information Leaflet for Patients Presenting with Hand Injuries
Authors: Bowerman Kathryn , Frost Stephen , Agarwal Reena 
Published: November 2022

Abstract

Aim
Patient Information Leaflets (PILs) are an effective way to educate patients, involve them in their care, and improve communication between patient and clinician. Our department did not have a PIL covering all hand injuries in single leaflet, therefore we decided to make one.

Method
We created a PIL to give to all patients with hand injuries that were seen in the Emergency Department by Plastic Surgery. The PIL explains what will happen if they need surgical intervention, or if the injury can be managed conservatively. In our hospital, Plastic Surgery covers hand injuries on Fridays, Saturdays, and Sundays and then patients are either planned for dedicated trauma lists during the week or for follow up in the Hand Trauma Review Clinic.

Results
The leaflet detailed the follow up patients could expect, as well as red flag symptoms to look out for, and who to contact should any problems arise. The PIL enabled us to emphasise the importance of adherence to advice given by healthcare professionals, particularly on any dressings and splints provided to the patients.

Conclusion
While the leaflet is generic in nature to cover all injuries, specific advice is given in addition to the leaflet to ensure that patients have the best possible care. In the future, we would like to make the leaflet electronic in order to reduce waste and risk of infection. Ideally, patients could scan a QR code taking them directly to the relevant part of the leaflet.
EP-313 Timeliness of ultrasound investigation in patients presenting with acute abdominal pain – single-centre audit
Authors: Mateescu Daniela Ioana , Hakeem Abdul , Chedid Youssef , Chattopadhyay Dipankar 
Published: November 2022

Abstract

Aim
To identify patients delays in ultrasound investigation in patients who present with acute abdominal pain; patients who require ultrasound investigation to decide if they require admission or can be safely discharged home.

Methods
Patients who presented to our hospital's Accident and Emergency department with acute abdominal pain and an ultrasound was requested were included in the analysis. The indication was divided into 3 main categories (Upper abdominal pain, post-cholecystectomy and other pathology). Data were analysed in relation to admission and discharge. Patients who had outpatient ultrasounds were excluded from the study. Mean and standard deviations were used for the delays.

Results
A total of 322 patients were included in the study, 160 (49.7%) patients were due to cholelithiasis or upper abdominal pain, 158 (49.1%) were due to other pathologies, 4 (1%) were post-cholecystectomy ultrasounds. The mean admission to ultrasound request was 1.77 (±5.48) with 290 (90.1%) being requested within 2 days of admission. Mean days from request to ultrasound being performed was 1.37 (±4.04) with 299 (93.1%) performed within 2 days.

Conclusions
The study concluded that the average time from ultrasound being requested to being performed in patients with acute abdominal pain was 0–2 days, this shows that the ultrasound is performed appropriately and there are minimal delays.
EP-334 The Impact of Combined DNA Repair and Oncogene Mutations in Colorectal Cancer Survival
Authors: Barnable Keeley , Lloyd Vett , Singh-Ranger Gurpreet 
Published: November 2022

Abstract

Aims
To examine the coexistent effect of either KRAS or BRAF gene status with MMR gene status on patient outcomes in a rural population of colorectal cancer patients.

Methods
Using a colorectal cancer database, results for patient mutation status for mismatch repair genes and other oncogenes, obtained by DNA sequencing and immunohistochemical analysis, were assessed to see if there were significant differences in survival probability in patients with and without single and combined risk factors. Kaplan-Meier survival analyses were performed to examine overall survival probability in the different groups of patients.

Results
Comparison of survival outcomes in patients with and without KRAS and MLH1 mutations showed a significant difference (p=0.018). Pairwise analysis reveals that this difference is mostly between the group with wild-type status for both genes and a patient with mutant KRAS and EGFR status with wildtype MLH1 status (p=0.062 with bonferroni correction). Combined KRAS and PMS2 status results in a borderline insignificant (p=0.056) survival difference as well. The effects of mutations in other combinations of oncogenes, as well as sex or tumour sidedness and mutation statuses, were not significant on survival probability.

Conclusions
These preliminary results should be interpreted with caution owing to the relatively small sample size. This study supports previous findings that mutant oncogenes, combined with altered MMR genes can be predictive of colorectal cancer survival outcome.
EP-336 Compliance of Fluid Balance Charts in Surgical Patients According to NICE Guidelines
Authors: Morsy Hesham , Li Michael , Davidson Chris , Gu Kat , Patel Dharti , Hollingshead James , Ali Maryam 
Published: November 2022

Abstract

Aim
Assess compliance of presence & completion of fluid balance charts for fluid replacement in accordance with NICE Guidelines in the acute surgical admissions population

Method
Total of 158 patients were included. We collected data prospectively for surgical patients admitted between 25/02/21–18/03/21 (first cycle) & 12/09/2021–4/10/2021 (2nd cycle). Maximum of 5 patients daily randomly selected via Google random number generator. Data collected in Wards after clerking Data analysed on Day 1 of admission. Surgical Proforma was used to identify if fluid balance chart was requested. Fluid Balance charts used to assess presence & completion of charts Admissions by audit authors were excluded to prevent selection bias.

Intervention
Posters in Emergency Assessment Unit and Wards, Teaching to junior doctors, Regular reminder messages to on-call teams.

Results
Presence and completion of fluid balance chart in acute surgical admissions in compliance with NICE guidelines for IV Fluid replacement rose from 48% to 64% between cycle 1 and 2, respectively. However, presence and completion of the chart rises significantly from 64% to 100% when it is requested, compared to 58% to 87% in cycle 1.

Conclusions
Most patients had a fluid balance chart made available by the nurses still, regardless of having it requested in their surgical proforma. However, we need to request fluid balance charts for all surgical admissions in order to have all of them present and completed properly as most of them will require replacement. This needs to be clearly documented in the surgical proforma on clerking.
EP-346 Laparoscopic extraction of a migrated gastric balloon from the terminal ileum causing small bowel obstruction
Authors: ELzaafarany Ahmed , Al-Shurafa Haider 
Published: November 2022

Abstract

Aim
Laparoscopic management of small bowel obstruction secondary to a migrated gastric balloon.

Method
A 57 years old female patient with BMI of 45 presented to ED by central colicky abdominal pain and recurrent attacks of vomiting with absolute constipation since 2 days. The patient had history of insertion of a gastric balloon since a year. On examination: abdomen: lax soft, mild abdominal distension, central abdominal tenderness, no signs of peritonitis. observations: Pulse:122bpm, BP 90/60, RR 25. blood tests: WCC 22.0×10 /L and CRP 129 mg/L. Venous lactate of 4.
PMH:DM type 2, Missed appointments for gastric balloon extraction about 6months ago.
Admitted under the surgical team resuscitated with IV fluid, IV antibiotics, sepsis 6 protocol activated. AXR: dilated small bowel loops.
CT abdomen with I.V and oral contrast revealed impaction of the gastric balloon at the terminal ileum causing high grade small bowel obstruction.
Patient had underwent laparoscopic extraction of the migrated gastric balloon from the terminal ileum and primary closure of the ileum by endo-stitch.
Patient has smooth recovery postoperatively and discharged home two days after the surgery.
This case highlights one of the complication of the gastric balloon which is migration of a gastric balloon into a terminal ileum as a result of missed appointments for its extraction after 6 months time.

Conclusion
laparoscopic management of SB obstruction in morbid obese patient should be the first choice provided that the surgeon has the required skills and experience.
EP-368 Intraoperative identification of colorectal cancer lesions using indocyanine green labelled antibodies in preclinical murine models
Authors: Lyons Nicholas , Hooper John , Clark David , Riddell Andrew , Kryza Thomas 
Published: November 2022

Abstract

Aims
The ability to identify cancerous tissue intraoperatively has the potential to allow for real time identification of involved margins, lymph node involvement and extra-colonic deposits. Here we investigate whether antibodies targeting a novel receptor, anonymously referred to as LN1, a frequently over expressed protein in colorectal cancer (CRC), labelled with indocyanine green (ICG) can be used for the intraoperative detection of malignant tissue in preclinical models.

Methods
Representative metastatic CRC models were generated in 20 NSG mice using HCT116 human CRC cells. Mice were treated with either intravenous ICG labelled LN1 antibodies (LN1-ICG) or control treatments (untreated, free ICG or cotreatment unlabelled LN1 blocking antibody + LN1-ICG). Signal intensity of normal and malignant tissue was quantified from near infrared (NIR) endoscopy and IVIS® in-vivo imaging system.

Results
LN1-ICG labelled antibodies was highly effective in identifying cancerous lesions down to 500nm diameter. Quantification of NIR and IVIS images demonstrate significantly greater tumour signal in the LN1-ICG group versus controls (p=0.004 and p=0.001 respectively). Examination of normal organ tissues demonstrated signal in the liver and digestive tract in keeping with hepatobiliary clearance of ICG but nil further off-site accumulation of LN1-ICG. No difference in signal from the liver, small bowel or colon was noted between groups (p&gt;0.05).

Conclusion
LN1-ICG labelled antibodies were highly effective at identifying even small cancerous deposits in murine models. It is highly likely that these effects could be replicated in human procedures which may allow for perioperative identification of extra-colonic deposits, involved tumour margins or lymph node involvement.
EP-373 Appropriate requesting of tumor marker, CEA, at a district hospital in Ireland: An audit cycle to improve practice
Authors: Fatima Iayla , Murphy Gearoid , Mhaonaigh Niamh Ni , Sadoon Adham 
Published: November 2022

Abstract

Aims
Tumor markers play an important role in oncology and the appropriate requesting of tumor marker tests are facilitated by national and international guidelines, inappropriate use increases both the laboratory workload and overall cost of management. Our aim was to assess our practice against the ACBI (Association of Clinical Biochemists in Ireland) guidelines for carcinoembryonic antigen (CEA) and conduct teaching sessions to improve practice.

Methods
1st cycle: All carcinoembryonic antigen (CEA) tests ordered in the hospital between the 1st to 31st of October 2020 were obtained through the HSE Online Lab Web Inquiry System, files were then reviewed for indications. Results from the initial audit were presented to the department and two separate teaching sessions were conducted to educate on the guidelines. 2nd cycle: All CEA test ordered from 1st January to 28th February 2021 were obtained, re-audited and results were compared.

Results
76% of the tests ordered by General Surgery in the second cycle were appropriately ordered and incorrectly ordered tests decreased from 35.7% to 23.8%.

Conclusions
Through the process of this audit an improvement was seen in practice of the department. More tests ordered adhered to indications in guidelines.
EP-379 Day-case laparoscopic Nissen fundoplication. Experience from a tertiary center
Authors: Peristeri Dimitra , Jaunoo Shameen 
Published: November 2022

Abstract

Aim
For day-case laparoscopic surgery to be successful, patient selection is of the utmost importance. This study aimed to assess the acceptability, feasibility, and results of day-case laparoscopic fundoplication for gastro-esophageal reflux disease (GERD) in a university tertiary care center.

Methods
A Day-case surgery for GERD was proposed routinely to all patients with proven asymptomatic, uncomplicated GERD. All of them were fulfilling predetermined inclusion criteria from January 2020 and December 2021. All patients underwent standard anesthetic, surgical, analgesic, and antiemetic protocols. Patient age, social circumstances, and other demographics were also recorded as well as any comorbidities and ASA score. The primary endpoint measured was the rate of readmission and complication rates.

Results
Of 23 patients undergoing laparoscopic fundoplication for GERD during the study period, 16 (69.56%) had day-case procedures. Most of them (81.6%) were discharged 6 to 8h after operation. Five patients were converted to in-patient hospitalization because of nausea (n=1), inadequate pain control (n=3), or anxiety (n=1). There were no complications and no re-admissions recorded.

Conclusion
Day-case laparoscopic Nissen fundoplication is a feasible, effective, and safe option for treating selected patients with gastroesophageal reflux disease (GERD) subject to careful patient selection and surgeon expertise.
EP-384 Surgical site infections: A prospective study of incidence and risk factors at a District General Hospital
Authors: Patel Maitreyi , Anad Adam , Warrag Ibrahim , Abidia Ahmed 
Published: November 2022

Abstract

Aims
To determine the incidence of surgical site infection (SSI)amongst patients undergoing general surgery between 1/10/2020 to 30/11/2020 and identify factors associated with SSI.

Methods
Data of adult patients operated between October 10, 2020, and November, 2020 was prospectively collected. Southampton wound scoring was used for categorizing the wound complication. Patient data was collected using electronic patient records. Data were analyzed using Excel Microsoft 2016. Chi square and t-test were used for analysis as appropriate. P-value &lt; 0.05 was considered statistically significant.

Results
The overall incidence of SSI was 13.84% (22 out of 159 patients). The associated risk factors (p&lt;.05) were found to be an increased age, pre operative haemoglobin &lt;100, type of surgery, longer duration of surgery (&gt; 2 h), post operative critical care admission and prolonged duration of hospital stay. Most patients (36%) had Southampton grade of III. They were all managed conservatively with antibiotics and dressing. Emergency surgery did not significantly increase risk of SSI.

Conclusion
Our data suggests that these risk factors could be considered as indicators of SSI. Relevant strategies for targeting the at-risk patients to optimize the modifiable factors where feasible, would enable to decrease the incidence of surgical site infections.
Emergency surgery did not significantly increase risk of SSI.
EP-393 Antegrade Colonic Enema (ACE) Stoma beyond Childhood: A Literature Review
Authors: Nadeem Tehmina , Umair Muhammad , Mockford Katherine 
Published: November 2022

Abstract

Background
Refractory constipation and faecal incontinence among adults is a common presentation to surgical clinics. ACE stoma has been tried and proven as a successful treatment modality in children. Although it is an acceptable treatment modality in adults, there is little prospective evidence available regarding its use and hence it has not yet come in vogue.

Methods
A literature review was carried out using PubMed, Cochrane Library, Embase, Cinahl and Scopus for studies involving ACE stoma in adults with refractory constipation or faecal incontinence; with a view to determine ACE Stoma as a safe treatment modality among adult population.

Results
A total of 27 studies were identified through database searches. 6 full text articles were included in the literature review describing a total of 209 adult patients; with male to female ratio of 1:3.4, mean age of 35 years and a mean follow up of 42.9 months. Complications discussed include perioperative and long-term stenosis (29%) and leak rates (60%); affecting the quality of life. No statistical difference was noted among the different types of ACE Conduit used. There was significant heterogeneity amongst the studies.

Conclusions
ACE stoma is not without complications; however studies reveal that this can be offered as a safe treatment modality among carefully selected adult patients for the treatment of refractory constipation or fecal incontinence.

Keywords
Adults, Refractory Constipation, Faecal Incontinence, Antegrade Colonic Enema (ACE) Stoma