EP.TU.373What We Do In The Shadows: Night Surgical Registrars and Abdominal Pain

Abstract Aim Surgical cover at night differ according to hospitals and are often performed by junior registrars. This can be challenging as a certain amount of independence is required in decision making. Abdominal pain remains one of the most common surgical presentations in the Emergency Department. This study analyses the type of abdominal pain presentations that were reviewed overnight in a regional Australian hospital. Method All patient presentations requiring surgical review from 9.00pm to 7.00am over a period of 4 months are prospectively collected and analysed. Patient details collected comprised of gender, date of review, blood tests, imaging results, histopathology, and intra-operative findings. Results Of the 114 patients who presented with abdominal pain, the majority of them were undifferentiated abdominal pain (n = 20, 17.1%). This is then followed by appendicitis (n = 17, 14.5%), diverticulitis (n = 13, 11.1%), pancreatitis (n = 8, 6.8%) and cholecystitis (n = 6, 5.1%). Among the others, a total of 8 presentations required urgent surgical review which resulted in three emergency surgeries being performed overnight, a laparotomy for closed loop small bowel obstruction, a Hartmann's procedure and a laparoscopic appendicectomy on a septic patient. Conclusion Common presentations for abdominal pain overnight include undifferentiated abdominal pain, appendicitis, diverticulitis, cholecystitis and pancreatitis. Hence education for night surgical registrars should be focused on management of these common conditions and also on surgical emergencies such as closed loop bowel obstructions, septic patients and perforated viscus to ensure optimal patient outcome without the need for close supervision.

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Ovarian Torsion in a 5-Year Old: A Case Report and Review

Case Reports in Emergency Medicine ◽

10.1155/2012/679121 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Matthew F. Ryan ◽

Bobby K. Desai

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Case Report ◽

Urinary Tract ◽

Clinical Suspicion ◽

Ovarian Torsion ◽

Surgical Emergencies ◽

High Clinical Suspicion ◽

Tract Infections ◽

Prompt Diagnosis

Ovarian torsion represents a true surgical emergency. Prompt diagnosis is essential to ovarian salvage, and high clinical suspicion is important in this regard. Confounding the diagnosis in general are more commonly encountered abdominal complaints in the Emergency Department (ED) such as constipation, diarrhea, and urinary tract infections and more common surgical emergencies such as appendicitis. Prompt diagnosis can be further complicated in low-risk populations such as young children. Herein, we describe the case of a 5-year-old girl with a seemingly benign presentation of abdominal pain who was diagnosed in the ED and treated for acute ovarian torsion after two prior clinic visits. A brief discussion of evaluation, treatment, and management of ovarian torsion follows.

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Clinico-pathological and etiological evaluation of acute appendicitis and assessment of significance of laboratory and ultrasonography examination as an ancillary aid to clinical diagnosis

International Surgery Journal ◽

10.18203/2349-2902.isj20192078 ◽

2019 ◽

Vol 6 (6) ◽

pp. 1954

Author(s):

Sailendra Nath Paul ◽

Dilip Kumar Das

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Scoring System ◽

Clinical Symptoms ◽

Lower Abdominal Pain ◽

Complication Rates ◽

Alvarado Score ◽

Negative Appendicectomy ◽

Operative Findings

Background: Timely diagnosis and intervention of acute appendicitis reduces morbidity and mortality associated with the disease condition. The study aimed to evaluate the etiology of acute appendicitis, to analyze the sensitivity of modified Alvarado scoring system and radiology in the diagnosis of acute appendicitis and to correlate the observations of laboratory tests, operative findings with the histopathological report of specimen of appendix.Methods: This was a prospective study done on 100 patients with clinical symptoms of acute right lower abdominal pain suggestive of appendicular origin during the period from February 2015 to January 2016 in the department of surgery thorough clinical assessment, laboratory investigations, ultrasound findings as were done for all patients. After confirming the diagnosis of AA the patients had operative intervention and specimens were sent for histopathological study.Results: Male preponderance was seen in the study. Majority of them belongs to 21 to 30 years age group (50%). Faecolith was the most common etiological factor observed (58%). Abdominal pain (100%) was the most common clinical symptom. Alvarado score had sensitivity of 95.74% and specificity of 66.67% in diagnosing AA. In correlation to histopathological findings, ultrasonography findings showed 100% positive visualization rate in all 71 cases. Elevated ESR (94%) had high diagnostic accuracy as confirmed by HPE finding (96.81%) which is statistically significant (p<0.000).Conclusions: Alvarado scoring system, elevated ESR levels and USG findings of the appendix can be considered as adjuncts to clinically diagnose the AA, to improve the diagnostic accuracy thereby consequently the rate of negative appendicectomy can be reduced and thus decreases the complication rates.

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Bouveret syndrome: a rare cause of gastric outlet obstruction

BMJ Case Reports ◽

10.1136/bcr-2020-240236 ◽

2021 ◽

Vol 14 (4) ◽

pp. e240236

Author(s):

Christopher Smith ◽

Shailendra Singh ◽

Paul Vulliamy ◽

Samrat Mukherjee

Keyword(s):

Abdominal Pain ◽

Gastric Outlet Obstruction ◽

Gallstone Disease ◽

Outlet Obstruction ◽

Chronic Cholecystitis ◽

Fistula Formation ◽

Bladder Drainage ◽

Blood Tests ◽

History Of ◽

Bouveret Syndrome

Bouveret syndrome is a rare cause of gastric outlet obstruction. It is characterised by the presence of an obstructing gallstone in the pylorus or proximal duodenum, which has travelled to its obstructing position via an acquired fistula. Our case involves a 73-year-old man presenting to the acute surgical take with a 2-day history of right-sided abdominal pain and vomiting. His medical history included perforated cholecystitis treated with antibiotics and percutaneous gall bladder drainage, 1 year earlier. Examination and blood tests were suggestive of gastric outlet obstruction. CT abdomen and pelvis demonstrated a large gallstone obstructing the duodenum, confirming a diagnosis of Bouveret syndrome. The patient improved following gastrolithotomy, and was discharged 2 weeks postoperatively. Fistula formation is a complication of chronic cholecystitis and therefore Bouveret syndrome should be considered in patients with a background of gallstone disease presenting with gastric outlet obstruction.

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SP3.2.1 Consultant-led Urgent Ambulatory Management of Righted-sided Lower Abdominal Pain: Prospective data collection

British Journal of Surgery ◽

10.1093/bjs/znab361.068 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Mubashar Hussain

Keyword(s):

Abdominal Pain ◽

Iliac Fossa ◽

Lower Abdominal Pain ◽

Clinical History ◽

P Value ◽

Prospective Data ◽

Female Ratio ◽

Blood Tests ◽

Complications Rate ◽

Male To Female

Abstract Aims To study if right lower abdominal pain could be managed safely on ambulatory basis when referred from emergency department or primary healthcare as suspected acute appendicitis to surgical ambulatory unit (SAU). Methods Data collated prospectively involving 586 patients, who presented with right iliac fossa/right-sided pelvic pain from january 2019 to January 2021. Results 0ut of 586 patients, 234 (40%) were admitted and 352 (60%) managed in ambulatory settings after being reviewed by Consulant-lead surgical oncall team. Age ranged from 3 to 92 years. Male to female ratio was 3:2. Their management included clinical history/and examination, urinalysis and blood tests. 157 (44%) patients had scans, 43 (12%) had CT scans and 114 (32%) had pelvic USS the same day or the following morning/day and were reviewed by oncall-surgeons and 107 (30%) patients had repeat blood tests. 39 (11%) out of 352 paitents were admitted the following day review, of which 18 (5%) patients underwent laproscopic appendicectomy (LA) and 8 (2.2%) patients treated conservatively. 9 (1.98%) patients represented with persistent/or worsening symptoms and 5 (1.4%) patients of these had LA and 2 (0.56%) patients had pelvic collection, drained radiologically and 2 (0.56%) had wound infections treated with antibiotics. Complications rate in ambulatory patients compared to in-patients was insignificant, P-value set at 0.05% using Mann-Whitney U test. Conclusions

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Abdominal Pain in the Female Patient: A Case of Concurrent Acute Appendicitis and Ruptured Endometrioma

Case Reports in Surgery ◽

10.1155/2016/2156148 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Martine A. Louis ◽

Amanda R. Doubleday ◽

Elizabeth Lin ◽

Ji Yoon Baek ◽

Alda Andoni ◽

...

Keyword(s):

Differential Diagnosis ◽

Abdominal Pain ◽

Acute Appendicitis ◽

Acute Abdominal Pain ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Common Cause ◽

Surgical Emergencies ◽

Ovarian Endometrioma ◽

General Surgeons

General surgeons are often asked to evaluate acute abdominal pain which has an expanded differential diagnosis in women of childbearing age. Acute appendicitis accounts for many surgical emergencies as a common cause of nongynecologic pelvic pain. In some rare instances, acute appendicitis has been shown to occur simultaneously with a variety of gynecologic diseases. We report a case of concurrent acute appendicitis and ruptured ovarian endometrioma.

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Unusual Presentation of Meckel’s Diverticulum: Gangrene due to Axial Torsion

Case Reports in Emergency Medicine ◽

10.1155/2015/571847 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Ahmet Rencuzogullari ◽

Kubilay Dalci ◽

Orcun Yalav

Keyword(s):

Congenital Anomaly ◽

Abdominal Pain ◽

Small Bowel ◽

Preoperative Diagnosis ◽

Iliac Fossa ◽

Meckel’S Diverticulum ◽

Meckel's Diverticulum ◽

Life Threatening ◽

Operative Findings ◽

The Right

Meckel’s diverticulum is the most common congenital anomaly of the small bowel. The majority of cases are asymptomatic; however, life-threatening complications can also take place. We present a case of a 37-year-old male who was admitted with symptoms of acute, severe abdominal pain in the right iliac fossa. The patient was operated on with the preoperative diagnosis of acute appendicitis but the operative findings were consistent with torted Meckel’s diverticulum due to presence of mesodiverticular band and he was treated successfully with surgical resection.

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Isolated intestinal Ganglioneuromatosis: case report and literature review

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01024-5 ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Angela Mauro ◽

Letizia Zenzeri ◽

Francesco Esposito ◽

Giovanni Gaglione ◽

Caterina Strisciuglio ◽

...

Keyword(s):

Abdominal Pain ◽

Polypoid Lesion ◽

Occult Blood ◽

Fecal Occult Blood ◽

Ileal Loop ◽

Lower Quadrant ◽

Blood Tests ◽

Fecal Occult ◽

The Right ◽

Right Lower Quadrant

Abstract Background Intestinal Ganglioneuromatosis (IG) is a rare disorder of the enteric nervous system. In pediatric age it is often associated with genetic syndromes such as Neurofibromatosis 1 (NF1), multiple endocrine neoplasia type 2B (MEN2B) and Cowden syndrome (PTEN mutation), and ganglioneuromas (GNs) may be sometimes the first sign of the disease. Isolated GNs are rare and sporadic. Clinical symptom vary and depend on the size and on the location of the GNs. This disorder affects intestinal motility and it, consequently, causes changes in bowel habits, abdominal pain, occlusive symptoms and rarely lower gastrointestinal bleeding secondary to ulceration of the intestinal mucosa. On the other hand, patients can remain asymptomatic for many years. Case presentation We describe a 9-year-old boy referred to our emergency department for right lower quadrant abdominal pain. No familial history for gastrointestinal disorders. No history of fever or weight loss. At physical examination, he had diffused abdominal pain. Abdominal ultrasonography showed a hypoechoic formation measuring 41.8 mm by 35 mm in the right lower quadrant of the abdomen. Routine blood tests were normal, but fecal occult blood test was positive. Abdominal TC confirmed the hypodense formation, of about 5 cm in transverse diameter, in the right hypochondrium that apparently invaginated in the caecum-last ileal loop. Colonoscopy showed in the cecum an invaginated polypoid lesion of the terminal ileal loop. Laparoscopic resection of the polypoid lesion was performed. Histological diagnosis of the large neoplasm observed in the terminal ileum was diffuse ganglioneuromatosis. NF1, RET and PTEN gene tests resulted negative for specific mutations. At the 1 year follow-up, the patient presented good general condition and blood tests, fecal occult blood test, esophagogastroduodenoscopy, colonoscopy and MR-enterography were negative. Conclusions Only few cases are reported in literature of IG in pediatric age. Although rare, the present case suggests that this disorder must be taken in consideration in every patient with GI symptoms such as abdominal pain, constipation, lower intestinal bleeding, in order to avoid a delayed diagnosis.

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Diagnostic anticipation to reduce emergency department length of stay: a cohort study in Ferrara University Hospital, Italy

10.21203/rs.3.rs-20219/v1 ◽

2020 ◽

Author(s):

Andrea Strada ◽

Niccolò Bolognesi ◽

Lamberto Manzoli ◽

Giorgia Valpiani ◽

Chiara Morotti ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Abdominal Pain ◽

Chest Pain ◽

Length Of Stay ◽

Diagnostic Algorithm ◽

University Hospital ◽

Blood Tests ◽

Traumatic Bleeding ◽

Ed Crowding

Abstract Background : Emergency Department (ED) crowding reduces staff satisfaction and healthcare quality and safety, which in turn increase costs. Despite a number of proposed solutions, ED length of stay (LOS) - a main cause of overcrowding - remains a major issue worldwide. This cohort study was aimed at evaluating the effectiveness on ED LOS of a procedure called “diagnostic anticipation”, which consisted in anticipating the ordering of blood tests by nurses, at triage, following a diagnostic algorithm approved by physicians. Methods : In the second half of 2019, the ED of the University Hospital of Ferrara, Italy, adopted the diagnostic anticipation protocol on alternate weeks for all patients with chest pain, abdominal pain, and non-traumatic bleeding. Using ED electronic data, LOS independent predictors were evaluated through multiple regression. Results : During the weeks when diagnostic anticipation was adopted, as compared to control weeks, the mean LOS was shorter by 18.2 minutes for chest pain, but longer by 15.7 minutes for abdominal pain, and 33.3 for non-traumatic bleeding. At multivariate analysis, adjusting for age, gender, triage priority and ED crowding, the difference in visit time was significant for chest pain only (p<0.001). Conclusions : The effectiveness of the anticipation of blood testing by nurses varied by patients' condition, being significant for chest pain only. Further research is needed before the implementation, estimating the potential proportion of inappropriate blood tests and ED crowding status

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Serum iron, prealbumin, D-dimer and prothrombin time are indicators of the diagnosis, severity and outcome of Salmonella enterica serovar Enteritidis infection

10.21203/rs.3.rs-60917/v1 ◽

2020 ◽

Author(s):

Xiaowei Li ◽

Shaoxin Wang ◽

Lan Yu ◽

Xiaohui Wang ◽

Zhihui Yan ◽

...

Keyword(s):

Abdominal Pain ◽

Antimicrobial Susceptibility ◽

Salmonella Enterica ◽

Serum Iron ◽

Clinical Laboratory ◽

Fecal Occult Blood ◽

Bacterial Colony ◽

Watery Stool ◽

Blood Tests ◽

D Dimer

Abstract Aims Salmonella enterica serovar Enteritidis (S. Enteritidis) infection is one of the main causes of foodborne illness among individuals in the military. In this study, we aimed to investigate indicators associated with the diagnosis, severity and outcome of S. Enteritidis infection, and to analyze the antimicrobial susceptibility of the isolated S. Enteritidis strains.Methods Routine stool test, fecal occult blood tests (FOBTs), routine blood tests and blood biochemical analyses were completed in our clinical laboratory. The stool samples were inoculated on Salmonella Shigella (SS) agar plates, the single bacterial colony was identified with mass spectrometry (MS). The serum agglutination test was performed to identify the Salmonella serotype. Antimicrobial susceptibility testing was performed using the minimal inhibitory concentration (MIC) method with the VITEK 2 COMPACT analyzer.Results Recently, 6 patients from one company visited our department complaining of fever, watery stool, abdominal pain and so on. The patients’ white blood cell (WBC) counts (66.7%), neutrophil percentages (100%), C-reactive protein (CRP) levels (100%), prothrombin times (PTs, 100%) and serum D-dimer concentrations (83.3%) were higher or longer than normal, while serum iron (100%) and prealbumin (83.3%) were lower than normal when they were admitted. Stool cultures and serovar identification results indicated S. Enteritidis infection. The antimicrobial susceptibility results showed that the 6 isolated bacterial strains were sensitive to trimethoprim-sulfamethoxazole and levofloxacin, and resistant to ampicillin. All patients were administered levofloxacin accompanied by rifaximin and probiotics, and their symptoms and the abovementioned parameters were recovered. During the disease course, the prolonged PT, elevated D-dimer and decreased serum iron were positively correlated with severe symptoms and serum inflammatory indexes.Conclusion Prolonged PT, elevated D-dimer and hypoferremia were associated with the diagnosis, severity and outcome of S. Enteritidis infection, and a decreased prealbumin level was associated with the diagnosis of S. Enteritidis infection. In patients complaining of acute fever, watery stool and abdominal pain, PT, D-dimer，prealbumin and serum iron should be monitored to attain an early diagnosis and initiate appropriate treatment for S. Enteritidis infection.

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Acute Small Gut Obstruction as an Atypical Presentation of Acute Appendicitis without Rupture or Perforation of the Appendix

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v39i4.55947 ◽

2021 ◽

Vol 39 (4) ◽

pp. 261-265

Author(s):

ABM Moniruddin ◽

Salma Chowdhury ◽

Tanvirul Hasan ◽

Kazi Muhammad Mahmudul Hasan ◽

- RounakJahan ◽

...

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Young Male ◽

Recurrent Abdominal Pain ◽

Acute Intestinal Obstruction ◽

Atypical Presentation ◽

Radiological Evaluation ◽

Post Operative Period ◽

History Of ◽

Operative Findings

Acute appendicitis is a very common surgical emergency. It has got diverse presentations and various complications. Here, we report case history of a young male patient with a 2- year history of recurrent abdominal pain, who presented to our center with a 4-day history of increasing abdominal pain, constipation and vomiting. Clinical and radiological evaluation revealed it as a case of acute intestinal obstruction preoperatively. Per-operative findings suggested acute appendicitis without perforation, small gut obstruction by adhesions, appendicular lump or internal herniation. Appendicectomy was done along with other necessary procedures. His post-operative period was uneventful. This case is reported here to highlight that acute appendicitis may present with atypical features like acute small gut obstruction. J Bangladesh Coll Phys Surg 2021; 39: 261-265

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