We outline the narrative of a 28-year-old woman who initially presented to the emergency department with vomiting, diarrhoea, abdominal pain and fever. Blood tests revealed significantly raised inflammatory markers and acute renal failure. Initially, this was attributed to gastroenteritis due to a recent foreign travel, but further investigations and radiological imaging revealed a large right ovarian dermoid cyst with a significant amount of free intra-abdominal fluid and small bowel dilation. She underwent laparotomy, which revealed a spontaneously perforated right ovarian dermoid cyst resulting in generalised purulent peritonitis and small bowel obstruction due to bowel adherence at the perforation site. Meticulous adhesiolysis, right salpingo-oophorectomy and extensive peritoneal lavage were performed, with a good postoperative recovery. Spontaneous perforation of an ovarian dermoid cyst, without an associated torsion, is extremely rare, but it should be considered in cases of peritonitis and bowel obstruction of unclear cause with a concomitant finding of a dermoid cyst.
Introduction Length of stay (LOS) following colorectal surgery has reduced due to enhanced recovery after surgery (ERAS) programs. Telemedicine has shown potential for patients to remotely access support, communicate progress with their medical team and enhance patient empowerment. We conducted a systematic review of smartphone applications for ERAS following colorectal surgery measuring patient outcomes and experience. Method The review was performed adhering to PRISMA guidelines, using search terms pertaining to ERAS, colorectal surgery, and mobile applications via electronic databases. All peer-reviewed English articles were assessed for inclusion and quality by two reviewers. A qualitative analysis was conducted to evaluate methodologies, patient experience, and outcomes. Results 206 abstracts were identified from which 5 articles (2 RCTs and 3 cohorts) were included in the analysis. Studies surveyed patient adherence to ERAS, LOS, readmission, intra and postoperative complications. Four studies recorded patient satisfaction, whilst one assessed quality of life and application validation. Conclusions The review highlights paucity in the use of smartphone applications after ERAS in colorectal surgery but demonstrates high patient satisfaction levels. Service delivery in the NHS has increasingly moved to a virtual platform during the coronavirus pandemic. More research and engagement in the development and use of smartphone applications would enhance care for patients.
Aim Patients undergoing abdominopelvic surgery at high risk of developing VTE and NICE guidelines mandate a 28-day course of post-operative pharmacological prophylaxis for these patients. We completed a closed loop re-audit to examine the local trust adherence to national guidelines. Method A closed loop re-audit was performed to check for appropriate VTE prescription. 62 patients undergoing elective surgery for colorectal cancer were identified from May 2017 to April 2018. An ERAS nurse was appointed following the initial audit and subsequent data was collected on a cohort of 80 eligible patients from April 2021 to October 2021. Results Previous compliance against national guidance set by NICE was 32% for patients screened from May 2017 to April 2018. There was a significant improvement to a 74% compliance rate following the introduction of an ERAS nurse. The appointment of the ERAS nurses also resulted in a reduction in postoperative hospital stay of 1.2 days. Conclusions A significant improvement in appropriate VTE prophylaxis was provided to patients following the introduction of a dedicated ERAS nurse. In addition, patients had a mean reduction in hospital stay length. Several points for future investigation based on findings: identification of cause behind missed prescriptions, patient education on self-administration of LMWH on discharge when applicable, and whether any VTE related complications occurred in either cohort.
Introduction 12% of cancers in the UK are colorectal in origin1 with 1-3% secondary to genetic mismatch repair due to Lynch syndrome2, for which the 2017 NICE guidance recommended that patients with colorectal cancer (CRC) be tested3. It increases the risk of developing other cancers such as endometrial, ovarian and small bowel1, changes the oncological treatment offered to CRC patients4,5, and prompts investigation of their relatives for the condition. In this audit we assessed our rates of trust wide Lynch testing. Method Patients with a diagnosis of CRC from 2017-2019 were identified from records held by our cancer services department. Histology results were obtained from an online results portal. Results 345 were included in the analysis, 79% of which were tested for Lynch, with time taken from biopsy to results ranging from 2 to 276 days (average 45). 54% had results within 30 days, 34% between 30 and 90 days and 12% exceeded 90 days. There was no significant difference of Lynch testing rates between each year. The proportion of results returned within 30 days increased by year, with rates of 30% (2017), 55% (2018) and 71% (2019). The median days from biopsy to results also improved, from 39 to 28 and 16 days, respectively. Conclusions Rates and efficiency of our screening for lynch syndrome need improvement to meet the target suggested by NICE. The impact of the recent centralisation our regions pathology department on Lynch testing service provision requires further investigation.
Background Abdominal X-rays (AXRs) were a key part of investigating acute abdominal pain prior to the advent of CT imaging. With increasing reliance on CT scanning, the utilisation and therefore reliance on the interpretation of AXRs has reduced. We investigate the concordance rates of interpretations of AXRs with the formal radiological report, along with the time taken for formal reporting. Aim To ascertain the concordance rates of interpretation of emergency AXRs with formal radiological reporting. Method All AXRs performed within the trust in a 15-day period were obtained retrospectively from our electronic imaging database. These were compared with the initial interpretations of the AXR, which was obtained from our electronic record system. Results 248 AXRs were performed, 136 (55%) were not interpreted in the notes. Of the remaining 112, 88 (79%) of AXR interpretations were in concordance with radiological reporting. There was no difference in concordance rates between interpretation by the Emergency Department (ED) or ward-based doctors. The average time for AXRs to be reported was 1.5 days for ED, and 3 for inpatients. Conclusions One fifth of AXRs were incorrectly interpreted and more than half of AXRs were not interpreted at all. This brings into question not only their usefulness in general, but also the utilisation of resources to perform them. As all AXRs are reviewed by a consultant radiologist with little impact on decision making, does this still remain an effective utilisation of resources?
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