Appendicization of the colon after appendectomy

The blind colonic loop following end to side ileo- sigmoid anastomosis resembles a vermiform appendix in anatomy and function. This anatomical alteration is associated with delayed complications and is not advisable.

A complicated case of delayed onset intermediate syndrome post organophosphorus poisoning: A rare case report

Herein, we present a case of 44-year-old male who landed in our emergency department with altered mental status with difficulty in breathing after 14 days of consumption of chlorpyrifos. Organophosphorus (OP) poisoning is one of the most common causes of poisoning encountered in rural India. There are reported cases of its acute and sub-acute atypical presentation but very few of delayed onset intermediate syndrome. By means of this case report, we want to emphasize on the delayed complications post OP poisoning and importance of treating physician’s awareness to recognize and treat such complications.

Nomogram to Predict Delayed Complications in Patients with Uncomplicated Acute Type B Aortic Dissection

Background Delayed complications within the first 2 weeks in initially uncomplicated acute type B aortic dissection (uATBAD) are not scarce, which needs special attention to prevent potentially fatal complications. This study aims to develop a nomogram for estimating the probability of patients with uATBAD developing delayed complications. Methods The nomogram was derived from a retrospectively study of 135 patients with uATBAD from 2011 to 2021 at a single medical center. The performance of the nomogram was evaluated from discrimination, calibration, and clinical usefulness. The results were internally validated by bootstrapping. Results In the multivariate analysis, the independent predictors of delayed complications identified were age ≥65 years (OR, 0.320; 95%CI, 0.108-0.831; P = 0.027), C-reactive protein (OR, 1.017; 95%CI, 1.006-1.029; P = 0.003), and maximum diameter of primary entry tear (OR, 1.089; 95%CI, 1.025-1.162; P = 0.007). The prediction model was internally validated by bootstrapping and revealed good discrimination (optimism-corrected C statistic, 0.706) and good calibration (Hosmer–Lemeshow test, P = 0.6468). Decision curve analysis demonstrated that the prediction nomogram was clinically useful. Conclusions This study presents a nomogram based on independent predictors of clinical and morphological parameters that could help identify patients with uATBAD who might occur delayed complications and thus improve the prognosis of patients.

Delayed Complications following Dermal Filler for Tear Trough Augmentation: A Systematic Review

Tear trough deformity is a popular target for the treatment with filler injections. The side effects are generally mild and transient. However, delayed complications may occur. We aim to perform a thorough systematic review of the published literature related to delayed complications after tear trough filler injections. A search of published literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in June 2021 and included PubMed, ScienceDirect, and Embase databases. The Medical Subject Headings (MeSH) terms used included the following terms: delayed complications, nodules, granulomas, swelling, discoloration, dermal filler, hyaluronic acid (HA), polyacrylamide, calcium hydroxyapatite (CaHA), poly-L-lactic acid (PLLA), eyelid, periorbital, periocular, and tear trough. Twenty-eight articles consisting of 52 individual cases were included in the final analysis. 98% (51/52) of patients were female and had an average age of 48.3 years. HA was the most reported product (71.2%, 37/52), followed by PLLA (4/52, 7.7%), and CaHA (4/52, 7.7%). The most common delayed complication with any dermal filler was swelling (42.3%, 22/52) followed by lumps or nodules (25.0%, 13/52). Xanthelasma-like reaction (17.3%, 9/52), migration (7.7%, 4/52), discoloration (3%, 3/52) also occurred. The average time of onset of any complication was 16.8 months with xanthelasma-like reaction appearing soonest (mean: 10 months) and discoloration appearing latest (mean: 52 months). Most swelling cases were caused by HA. Semi-permanent fillers such as PMMA and synthetic fillers such as PLLA were more likely to be associated with lumps and nodules than other complications. It is important that clinicians who perform tear trough augmentation with dermal fillers have a thorough understanding of the risks of the procedure to diagnose and manage them promptly as well as provide patients with accurate information regarding the potential adverse effects.

274 Use of DHS For Fixation of Unstable Hip Fractures – Are Outcomes Any Different from Nails?

Aim To determine if the outcomes and rate of complications differ based on choice of implant for unstable hip fractures. Method Retrospective analysis of 105 hip fractures operated in 2015 + 2016 with AO classification A2.2. A2.3 or A3. These were divided into 2 groups depending on whether DHS/Plate implant was selected (n = 86) or Nail implant was used (n = 19). Any complications occurring in their subsequent management or performance of any revision procedures were recorded. 6-month mortality rate was also calculated for both groups. Results When A2 and A3 fractures were assessed together the rate of acute complications was similar in both groups. 21% for nails and 19% for plates. The rate of delayed complications was not significantly different either, 16% for nails and 10% for plates. Revision procedures were more common where nails had been used (16%) compared to only 6% of plate fixations. Mortality rates were identical. When looking at A3 fractures in isolation, the rate of delayed complications is significantly higher when plates are used (24%) compared to 12% when nails are selected. Conclusions We did not identify any significant difference in acute complications including bleeding and infection based on choice of implant. This goes against common arguments raised against use of nails. Successful use of DHS fixation in unstable A2 hip fractures is possible, as evidenced by similar rates of delayed complications. Revisions were higher when nail was selected. It is however noted that for reverse oblique fractures nails perform demonstrably better, with half as frequent delayed complications and revisions.

Routine Repeat Imaging of Pediatric Blunt Solid Organ Injuries Is Not Necessary

Introduction Nonoperative management of hemodynamically stable patients with blunt splenic and/or hepatic injury has been widely accepted in the pediatric population. However, variability exists in the utilization and timing of repeat imaging to assess for delayed complications during index hospitalization. Recent level-IV evidence suggests that repeat imaging in children should be performed based on a patient’s clinical status rather than on a routine basis. The aim of this study is to examine the rate of delayed complications and interventions in pediatric trauma patients with blunt splenic and/or hepatic injuries who undergo repeat imaging prompted either by a clinical change (CC) or non-clinical change (NCC). Methods A 9-year (2011-2019), retrospective, dual-institution study was performed of children (0-17 years) with blunt splenic and/or hepatic injuries. Patients were grouped based on reason for repeat imaging: CC or NCC. The rate of organ-specific delayed complications and interventions was examined by reason for scan. Results A total of 307 injuries were included in the study period (174 splenic, 113 hepatic, and 20 both). Of 194 splenic injuries, 30(15.5%) underwent repeat imaging (CC = 19; NCC = 11). Of 133 hepatic injuries, 27(20.3%) underwent repeat imaging (CC = 21; NCC = 6). There was no difference in the incidence of organ-specific delayed complications between the CC and NCC groups. Of the 4 patients with complications necessitating intervention, only one was identified based on NCC. Conclusions Our data suggest routine repeat imaging is unnecessary in children with blunt splenic and/or hepatic injuries; therefore, practitioners may rely on a patient’s clinical change.