Emborrhoid technique performed on a patient with portal hypertension and chronic hemorrhoidal bleeding as a salvage therapy

Background Hemorrhoidal disease most commonly manifests itself with chronic rectal bleeding and, in its most severe and refractory forms, may lead to chronic anaemia with the need for recurrent blood transfusions. The main pathogenetic mechanism involved seems to be arterial hyperflux in the terminal branches that supply the hemorrhoidal plexus. It is based on this principle, that embolization of the superior rectal artery (emborrhoid technique) has recently re-emerged, with very promising results that support its feasibility, treatment efficacy, and safety. Case presentation We report a case of a patient with both recurrent hemorrhoidal bleeding and portal hypertension with rectal varices, who underwent SRA embolization as a salvage therapy, with significant clinical improvement and no immediate or short-term complications. Conclusions We believe that the positive results from our case raise the possibility that the emborrhoid technique could be effective and safe even in patients with portal hypertension, and that it would be clinically relevant to investigate this hypothesis on larger samples with a longer follow-up.

Endoscopy Capsule Retention in a Young Female with Small Bowel Strictures Secondary to Non-Steroidal Anti-Inflammatory Drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) can cause small bowel damage, which could present in different ways, including abdominal pain and occult gastrointestinal bleeding. NSAID use can also result in small bowel strictures, which can be challenging to diagnose and manage. Here, we describe a case of a 49-year-old female who presented with chronic anaemia and intermittent abdominal pain, with a history of NSAID use. She underwent capsule endoscopy as part of the workup for anaemia and subsequently had capsule retention due to a small bowel stricture.

Ileal Dieulafoy lesion arose 15 years after partial small bowel resection for meconium obstruction of the neonate: a case report

Background Anastomotic or perianastomotic ulcers present with symptoms such as chronic anaemia and occult bleeding as long-term complications of bowel resection performed in infancy. Case presentation Herein, we describe a 15-year-old girl with a history of surgery for meconium obstruction without mucoviscidosis in infancy who was hospitalized with chief complaints of presyncope and convulsions. Seven hours after admission, she developed melena and went into shock. An emergency laparotomy was performed, and a Dieulafoy lesion was detected near the site of ileal anastomosis from the surgery that had been performed during infancy. Conclusions Although overt massive lower gastrointestinal bleeding necessitating emergency care is rare in the long term after infant bowel resection, Dieulafoy lesions can cause serious bleeding, requiring rapid life-saving haemostatic procedures.

TP9.2.24Is preoperative ABO blood typing required in emergency appendicectomies?

Aims Intra-operative bleeding is very rarely a complication of laparoscopic appendicectomy. Despite this, it is often mandatory for any patient undergoing an emergency appendicectomy to have pre-operative ABO blood type sampling. This could be an unnecessary expense and may lead to patients being delayed for theatre. The aim of this study was to see how many patients who underwent an appendicectomy required a blood transfusion intra-operatively or within 30 days of their operation. Methods Data were collected retrospectively for patients of all ages who underwent an appendicectomy for suspected appendicitis at a single centre from March 2018 to May 2020. The primary outcome measure was intra-operative and post-operative blood transfusion up until 30 days after the operation. Results Over 26 months, 698 appendicectomies were performed. Preoperative ABO blood typing was performed in 95% (n = 663) of patients. Collectively, 1,305 blood samples were obtained at a combined total cost of £13,703 to the hospital. None of the patients required blood transfusion intra- or post-operatively. Pre-operative blood transfusion was performed in only three patients, all due to chronic anaemia. 21 (3%) patients were delayed in going to theatre whilst awaiting two valid ABO blood typing results. Conclusions Emergency appendicectomies very rarely experience complications associated with bleeding or requiring blood transfusion. Clinical guidelines should reflect this by avoiding recommendation of such tests in emergency appendicectomies, reducing delays to surgery and resulting in a more efficient allocation of financial and staff resources.

1320 Evaluation of Routine Group and Save Testing Prior To Appendicectomy

Introduction Group and save (G&S) testing is often performed prior to emergency appendicectomy. However, there are no standard national guidelines regarding the routine use of preoperative G&S. We performed a Trust Audit to review the need for G&S prior to appendicectomy in order to recommend new guidelines. Method Retrospective review of all patients that underwent appendicectomy at Chelsea and Westminster Hospital between October 2019 and March 2020. We evaluated the existing literature on blood transfusion rate and the need for G&S prior to appendicectomy. Results One hundred and seventy-three patients (female 56%, median age 26 years) underwent appendicectomy (94% laparoscopic, 6% open). One hundred and thirty-four (77%) patients had a valid G&S and none of the patients received a blood transfusion perioperatively. The estimated total cost of G&S sampling for laparoscopic appendicectomy over one year in the Trust is £6825 (excluding all other laparoscopic surgery). Conclusions Based on the audit findings and literature review, routine G&S testing is not necessarily required for all patients undergoing laparoscopic appendicectomy. G&S should be requested on a patient case-specific basis (for example, chronic anaemia or haematological conditions) with discussions between the anaesthetist and surgeon. This would reduce delays in emergency lists, have financial implications and there is no evidence to support that the routine use of G&S benefits patient outcomes. These recommended guidelines have been presented at Surgery/Anaesthetics Clinical Governance and have been rolled out in the Trust with the aim to perform a re-audit in 3-6 months.

Gastric Epithelioid Haemangioendothelioma: A Case Report

Objective: To report a case of gastric epithelioid haemangioendothelioma, given its low incidence. Introduction: Epithelioid haemangioendothelioma is a vascular neoplasm composed of epithelioid or histiocytoid cells with endothelial characteristics. They have a very low incidence of approximately one per one million and are usually asymptomatic with a difficult preoperative diagnosis. Case Report: This study reports the case of a 58-year-old woman with a history of chronic anaemia. She underwent an elective upper endoscopy with evidence of an ulcerated submucosal lesion in the gastric antrum. The histological examination performed over the endoscopic biopsies showed the vascular characteristic of the tumor and endosonography confirmed the submucosal origin of the lesion. After resective surgery, the tumor showed the histological and immunohistochemical features of the epithelioid haemangioendothelioma. Conclusion: Surgery in the form of wide excision seems to be the treatment of choice for this rare neoplasm in the absence of histological markers of malignant potential.

Rare hereditary nonspherocytic hemolytic anemia caused by novel homozygous mutation, c.301C>A, (Q101K) in the AK1 gene in an Indian family

BackgroundAdenylate kinase (AK) deficiency is an uncommon form of congenital non-spherocytic haemolytic anaemia. To date, only 13 families have been affected by this disorder exhibiting symptoms like chronic anaemia supported by recurrent blood transfusions, jaundice, hepatosplenomegaly, and mental and psychomotor retardation in exceptional cases. This study aimed to identify a pathogenic mutation in the undiagnosed case of haemolytic anemia and to offer a parental diagnosis in the subsequent pregnancy.MethodNext-generation sequencing (NGS) was performed to identify pathogenic variants in the patient. Prenatal diagnosis during the second pregnancy was performed on genetic testing was performed on chronic villus sample (CVS) collected in 11 weeks of pregnancy from the mother and intravenous blood was drawn from both the parents.ResultsNovel causative mutation (p. Gln101Lys) in the AK gene was identified in a 5-year-old male child with severe transfusion-dependent hemolytic anemia. Bioinformatics tools predicted the deleterious effect of the novel variant on the structure of the protein. Prenatal diagnosis of the fetus was found to be heterozygous for the mutation. Both the parents were heterozygous for the variant c.301C > A, p. Gln101Lys.ConclusionWe have presented a review of the literature and novel mutations in the AK1 gene (p. Gln101Lys) associated with adenylate kinase deficiency. It is first a prenatal diagnosis AK deficiency report from India where heterogeneity is too high in the population and custom of intra-community marriages are prevalent.

A STUDY ON SIGNIFICANCE OF COOMBS TEST AND ANTIBODY SCREENING IN PATIENTS WITH CHRONIC ANAEMIA IN A TERTIARY CARE HOSPITAL

Most of the inpatients admitted in our hospital for the evaluation of anemia needs blood transfusion as part of the treatment. A total of 719 cases from medical ward received blood transfusion from the period of January 2016 to December 2016. Irrespective of the provisional diagnosis of case, we performed Direct Coombs test, Indirect Coombs test, Autocontrol and 3 cell antibody panel from the samples received for cross matching. Of that 532 case were females, 187 cases were male patients. Our transfusion protocol included identication of presence of antibodies including the following antibodies: A, B, C, c, D, E, e, Lea, Leb, K, Fya, Fyb, Jka, Jkb, M, N, S, s, by using 3 cell panel. Screening for antibodies was performed before transfusion, according to standard antiglobulin techniques. If screening was positive, the antibody was identied by means of panels of reagent red cells, identication was conrmed by a regional reference laboratory. We identied most of the female patients between the age group 20 to 30 with chronic anemia were found to have DCTpositive hemolytic anemia. Few patients had only DCTpositive without abnormal antibodies and some had DCTnegative AIHA.