scholarly journals P118 The 134-year-old problem meets the 1-year-old problem: lessons learned in managing acute appendicitis during the COVID era

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Sherwin Fernando ◽  
Diwakar Ryali Sarma ◽  
Sherwin Fernando
Keyword(s):  
Pain Treatment ◽  
Iliac Fossa ◽  
Lessons Learned ◽  
Open Approach ◽  
Patient Demographics ◽  
Right Iliac Fossa Pain ◽  
American Society ◽  
The Uk ◽  
The Right

Abstract Introduction The Right Iliac Fossa Pain Treatment (RIFT) study highlighted the rate of negative appendicectomies in the UK as one third of all procedures. However, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID) pandemic has changed surgical practice. New practices in the COVID era have changed the rate of negative appendicectomies. Methods A retrospective analysis was conducted of patients admitted with appendicitis from March 2020 to June 2020. Patient Demographics 58 patients were identified, 43 (74%) were adults and 15 (26%) were children. The median age of the adults was 33 (range 18-80) and the median American Society of Anaesthetists (ASA) grading was 1. The median age of children was 11 (range 4-17) and all were ASA grade 1. Results 73.8% (31) of adult patients had a Computerised Tomography (CT) scan as part of their workup. 40% of paediatric patients underwent an ultrasound scan of the abdomen whilst the remaining 60% were diagnosed clinically. The open approach was favoured in both cohorts (39.5% and 46.7% respectively). No negative appendicectomies were performed. Conclusion COVID19 has changed practice resulting in better outcomes for colorectal units. Further studies (COVID SURG and COVID HAREM) are needed to fully assess the role of imaging in reducing the number of negative appendicectomies.

scholarly journals Giant sigmoid diverticulitis mimicking acute appendicitis

2011 ◽  
Vol 93 (6) ◽  
pp. e89-e90 ◽  
Author(s):  
M Anderton ◽  
B Griffiths ◽  
G Ferguson
Keyword(s):  
Computed Tomography ◽  
Iliac Fossa ◽  
Treatment Options ◽  
Sigmoid Diverticulitis ◽  
Acute Presentation ◽  
Rare Manifestation ◽  
Giant Sigmoid Diverticulum ◽  
Right Iliac Fossa Pain ◽  
Colonic Diverticula

Giant colonic diverticula are a rare manifestation of diverticular disease and there are fewer than 150 cases described in the literature. They may have an acute or chronic presentation or may remain asymptomatic and be found incidentally. As the majority (over 80%) of giant diverticula are located in the sigmoid colon, they usually present with left-sided symptoms but due to the variable location of the sigmoid loop, right-sided symptoms are possible. We describe the acute presentation of an inflamed giant sigmoid diverticulum with right iliac fossa pain. We discuss both the treatment options for this interesting condition and also the important role of computed tomography in the diagnosis and management of abdominal pain in elderly patients.

scholarly journals CLINICAL STUDY OF PAIN IN RIGHT ILIAC FOSSA

2020 ◽  
Vol 4 (8) ◽  
Author(s):  
Saurabh Kothari ◽  
Manjula Kothari ◽  
Shree Mohan Joshi ◽  
Kalp Shandilya
Keyword(s):  
Iliac Fossa ◽  
Signs And Symptoms ◽  
Clinical History ◽  
X Ray ◽  
Pain Abdomen ◽  
Detailed Clinical History ◽  
Right Iliac Fossa Pain ◽  
Chest X Ray ◽  
The Right ◽  
Appendicular Mass

Background: A mass in the right iliac fossa is a common diagnostic problem encountered in clinical practice, requiring skill in diagnosis. Methods: 100 patients with signs and symptoms of right iliac fossa mass admitted in Hospital were identified and were studied by taking detailed clinical history, physical examination and were subjected to various investigations like x ray erect abdomen, chest x-ray, contrast x-ray . Result: In this study of out of 100 cases, 65.00% of cases were related to appendicular pathology either in the form of appendicular mass or appendicular abscess. There were 12.00% cases of ileocaecal tuberculosis. Conclusion: Appendicular lump remains the most common cause for right iliac fossa pain. Ileocaecal tuberculosis is one of the most important differential diagnoses for pain abdomen. Keywords: Appendicular Mass, Ileocaecal Tuberculosis, Carcinoma Caecum, Right Iliac Fossa Mass.

Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain

2021 ◽  
Vol 14 (1) ◽  
pp. e232797
Author(s):  
Clemmie Stebbings ◽  
Ahmed Latif ◽  
Janakan Gnananandan
Keyword(s):  
Abdominal Pain ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Sudden Onset ◽  
Greater Omentum ◽  
Caribbean Woman ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Fat Stranding

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.

scholarly journals Role of C-Reactive Protein, White Blood Cell Counts, Bilirubin Levels, and Imaging in the Diagnosis of Acute Appendicitis as a Cause of Right Iliac Fossa Pain

Cureus ◽  
2018 ◽  
Author(s):  
Shetty Sushruth ◽  
Chellappa Vijayakumar ◽  
Krishnamachari Srinivasan ◽  
Nagarajan Raj Kumar ◽  
Gopal Balasubramaniyan ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Blood Cell ◽  
Iliac Fossa ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Cell Counts ◽  
Blood Cell Counts ◽  
Right Iliac Fossa Pain ◽  
White Blood Cell Counts

scholarly journals Translation, Copyright & Authority

Pólemos ◽  
2018 ◽  
Vol 12 (2) ◽  
pp. 361-391 ◽  
Author(s):  
Alan Cunningham
Keyword(s):  
Institutional Change ◽  
Critical Point ◽  
Copyright Law ◽  
The Uk ◽  
The Right

Abstract The UK copyright law regime presents the right to adapt as the sole, authoritative instrument in matters of legitimising translation; a legal “Big Other” conferring an otherwise unreal objective commodity status on what are instead always only ever individual and subjective acts of translation. Drawing primarily on the work of Theo Hermans, and the experiences of poet Jack Underwood in unsuccessfully attempting to formally translate poems by Mascha Kaléko, this article argues for (a) the development and (at the very least) implicit recognition of deviationist and subversive translative replies within – or at the very least alongside – the traditional UK legal schema and (b) a softening of the UK right to adapt by application of the integrity moral right to translations. In addition, a deeper quasi-Ungerian notion of institutional change that accommodates both principles (e. g. legitimate translations can, of course, be argued to exist, to which copyright accords) and counterprinciples (there are also, however, in the long term only multiple acts of translation, some preferred and commoditized, some existing outside that sphere, less functional and more creative/expressive but no less important and not to be prevented for those reasons) can also be advanced. Finally, a much broader critical point regarding the nature and role (or non-role) of law in the context of creative practices more generally can also be presented.

scholarly journals 956 Retained Appendiceal Tip and Abdominal Wall Appendicolith - A Rare Combination of Post Appendicectomy Complications

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Dey ◽  
N Symons
Keyword(s):  
Abdominal Wall ◽  
Iliac Fossa ◽  
Symptomatic Relief ◽  
Radiological Investigation ◽  
Complete Excision ◽  
Rare Combination ◽  
Abdominal Wall Abscess ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Inflammatory Changes

Abstract Appendicitis involving the appendix stump is a recognised post appendicectomy complication but the same involving the appendiceal tip is rare. Similarly, abdominal wall abscess secondary to retained appendicolith is also infrequently encountered. Our case highlights a rare combination of both complications arising separately. A 29-year-old man presented with 3 days of generalised malaise and progressively worsening right iliac fossa pain some ten months after a laparoscopic appendicectomy. This had been complicated by residual right iliac fossa inflammation that was treated conservatively and serial scans demonstrated gradually resolving inflammation. He also had well controlled ulcerative colitis. On examination, he was noted to be pyrexial with a tender fluctuant mass in the right flank. An ultrasound scan demonstrated inflammatory changes in the abdominal wall with no intra-abdominal collections. A diagnostic laparoscopy found an inflamed appendix tip, attached to the residual mesoappendix and embedded in the abdominal wall behind the mid-ascending colon. A completion appendicectomy was performed. The patient recovered well but returned 4 months later with persistent pain and a fluctuant mass over the right iliac fossa. Radiological investigation revealed an abdominal wall collection containing a calcified appendicolith. The collection was refractory to ultrasound guided drainage and an exploration of the abdominal wall allowed extraction of the appendicolith followed by symptomatic relief. This case emphasizes the importance of complete excision of the appendix and extraction of debris, which can be challenging when the appendix lies in a retro-colic position.

scholarly journals Peran Gereja Masa Kini Menyikapi Teologi Pembebasan Gutiérrez

2019 ◽  
Vol 2 (1) ◽  
pp. 14-26
Author(s):  
Fajar Gumelar ◽  
Hengki Wijaya
Keyword(s):  
Liberation Theology ◽  
Latin American ◽  
Word Of God ◽  
The Past ◽  
American Society ◽  
The Right ◽  
The Church ◽  
Latin American Society ◽  
Real Action

The background of Latin American society in the past who were familiar with the hegemony of power of the bourgeoisie caused concern in the hearts of Christian theologians at the time. This concern finally gave birth to a theological model known as Liberation Theology. Liberation Theology is a praxis-oriented theological model, namely real action for the liberation of marginalized, poor and oppressed people. But the thought of Marxism influenced the concept of Liberation Theology so that the theological model was more like a destructive ideology. Bringing the concept of Liberation Theology to the light of the word of God is the right action for the church today in responding to the Liberation Theology. The aim is to analyze the contents of Liberation Theology, and how should the role of the church address the Liberation Theology, and apply liberation theology in everyday life. The method used is an explanatory qualitative approach to the role of the church in response to Liberation Theology.Abstrak: Latar belakang masyarakat Amerika Latin di masa lampau yang akrab dengan hegemoni kekuasaan kaum borjuis menyebabkan timbulnya keprihatinan dalam hati para teolog Kristen kala itu. Keprihatinan ini akhirnya melahirkan suatu model teologi yang dikenal dengan nama Teologi Pembebasan. Teologi Pembebasan adalah model teologi yang berorientasi pada praksis, yaitu tindakan nyata untuk pembebasan kaum termarginalkan, miskin dan tertindas. Akan tetapi pemikiran Marxisme turut memengaruhi konsep Teologi Pembebasan sehingga model teologi ini lebih mirip ideologi yang destruktif. Membawa konsep Teologi Pembebasan kepada terang firman Tuhan adalah tindakan yang tepat bagi gereja masa kini dalam menyikapi Teologi Pembebasan. Tujuan tulisan ini adalah menganalisis isi Teologi Pembebasan, dan bagaimana seharusnya peran gereja menyikapi Teologi Pembebasan tersebut, dan menerapkan teologi pembebasan dalam kehidupan sehari-hari. Metode yang digunakan adalah pendekatan kualitatif yang bersifat eksplanatori tentang peran gereja menyikapi Teologi Pembebasan.

scholarly journals Diagnostic Role of Ultrasonography in Right Iliac Fossa Pathologies

2019 ◽  
Vol 7 (3) ◽  
pp. 382-386
Author(s):  
Mishal Javaid ◽  
Ayesha Tariq ◽  
Hiba Noreen Javaid
Keyword(s):  
Imaging Modality ◽  
Iliac Fossa ◽  
Sampling Technique ◽  
High Volume ◽  
Symptom Duration ◽  
Cross Sectional ◽  
Use Of Resources ◽  
Diagnostic Role ◽  
Right Iliac Fossa Pain

Ultrasound is often the imaging modality of choice in patients with acute right iliac fossa pain.  Right iliac fossa pain remains the commonest clinical dilemma encountered by general surgeons. The management of acute right iliac fossa pain is audited, examining the relationship between symptom duration, use of pre-operative radiological imaging and patient outcome. Objective: To determine the diagnostic role of ultrasonography in Right Iliac Fossa pathologies. Methods: A cross sectional descriptive study was carried out at the Department of Radiology in Sir Ganga Ram Hospital Lahore, Pakistan. Duration of study was from March 2018 to November 2018. 85 patients with Right Iliac Fossa pain selected through convenient sampling technique. Statistical software for social sciences (SPSS version 22.0) is used for the analysis of data. Conclusion: The results in the study reflect findings from high volume emergency surgical departments and patients of pain in right iliac fossa demonstrating that unfocussed abdominal and pelvic ultrasounds are not an appropriate use of resources in patients with Right iliac fossa pain. Int. J. Appl. Sci. Biotechnol. Vol 7(3): 382-386  

Public Libraries and the Right to the [Smart] City

2018 ◽  
pp. 1720-1735
Author(s):  
John Blewitt
Keyword(s):  
Public Libraries ◽  
Freedom Of Information ◽  
Library Services ◽  
Traditional Role ◽  
Ready Access ◽  
The Uk ◽  
Access To Knowledge ◽  
The Right ◽  
Funding Cuts

The future of public libraries has been threatened by funding cuts and new digital technologies which have led many people to question their traditional role and purpose. However, freedom of information, ready access to knowledge and information literacy in all its digital and analog guises are more important than ever. Thus, public libraries remain significant spaces and places where people can socially interact and learn. In many countries public libraries are reinventing themselves and part of this process has been the redesign of library services and the design and construction of new library building and facilities that articulate the values, purpose and role of what has been termed ‘the next library'. Following discussion of new library developments in London, Birmingham and Worcester in the UK, Aarhus in Denmark and Helsinki in Finland, the article concludes that public libraries are now both social and media spaces as well as being important physical places that can help city dwellers decide what type of urban world they want to see.

Best Value and Performance Management Inspired Change within UK Councils

2014 ◽  
pp. 199-226
Author(s):  
Sandra Moffett ◽  
Tim Walker ◽  
Rodney McAdam
Keyword(s):  
Knowledge Management ◽  
Public Sector ◽  
Performance Management ◽  
Exploratory Study ◽  
Lessons Learned ◽  
Full Potential ◽  
Best Value ◽  
And Performance ◽  
The Uk

This chapter focuses on an exploratory study from an operational perspective, investigating the role of Knowledge Management (KM) in the UK Public Sector, the case setting being within the council’s waste services. Key literary findings outline that while Government seeks to improve council service delivery, significant legacies remain from earlier change programmes that appeared to be restricting the Local Government Modernisation Agenda (LGMA). Given the exploratory nature of the study, a theory building approach is adopted based on results from the exploratory study. The findings show that although knowledge and information flows could inform performance management frameworks to trigger change, a lack of suitable networks or a culture of knowledge sharing, combined with tight implementation timescales and a shifting agenda, meant that councils did not respond as anticipated due to systemic weaknesses. As with many organisations, KM implementation did not reach full potential. However, there are a number of lessons learned and key findings that can act as a learning process for further knowledge management applications within public sector contexts.

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