Background The clinical assessment of appendicitis remains challenging, especially between genders and across age groups. Negative appendicectomy rates (NARs) can be as high as 43% and are significantly higher in the female population. Evidence suggests blood markers such as white blood cell count (WBC) and C‐reactive protein have poor predictive value. There is a lack of regional data assessing workup and outcomes following laparoscopic appendicectomy. Method A multi‐centre, retrospective study was performed. A database of adult patients undergoing laparoscopic appendicectomy at Manly and Mona Vale Hospitals (Sydney, Australia) was analysed with regard to clinical assessment and outcomes. The primary endpoint was histological confirmation of acute appendicitis (AA). Secondary endpoints were length of hospital stay, NAR, correlation between preoperative WBC and AA, and sensitivity of preoperative imaging. Results A total of 501 patients were included in the study. AA was confirmed in 91.2% of patients. The NAR was 8.8% across all subgroups. The NAR was 12.1% in women. 95.6% of patients had preoperative imaging. There was a statistically significant relationship between WBC and length of stay (P < 0.005), with elevated WBC correlating with increasing length of stay. Conclusion We concluded that preoperative WBC when elevated can be used as a marker for AA and also as a predictor for length of stay in hospital. We would also advocate the use of preoperative imaging in young women and children.
AimMultidisciplinary teams (MDT) are commonly involved in the care of patients with cancer. How frequently dissent occurs within MDT has not been studied. This study aimed to determine how frequently dissent was documented in cancer MDT meetings at our institution, the reasons for this, and the opinions of MDT members on how dissent should be documented and communicated.MethodsA retrospective review of records from cancer MDT meetings at our institution from 2016 to 2020 was performed to identify cases where dissent was documented and the reasons for this. MDT members were invited to complete an online survey assessing their perceptions of how frequently dissent occurred, how comfortable they felt voicing dissenting opinions, and their opinions on how dissent should be documented and communicated.ResultsDissent was recorded in 30 of 7737 MDT case discussions (0.39%). The incidence of dissent varied from 0 to 1.2% between cancer streams. The most common reason for dissent involved the role of surgery. 27% of survey respondents felt either very or somewhat uncomfortable voicing dissenting opinions. Only 3% felt that dissent should not be documented, and none that it should not be communicated in some way, although there were wide ranging of views on how this should occur.ConclusionDissent was rarely documented within cancer MDT meetings at our institution, likely due to underreporting. Measuring the incidence of dissent within an MDT may be a useful performance metric. MDT should develop policies for how dissent should be managed, documented, and communicated.
Gallbaldder volvulus is an extremely rare cause of abdominal pain. It requires high clinical suspicion to diagnose and prompt surgical management. The main risk factors for this condition are age (over 60 years old) and being female. Presentation can often mimic acute cholecystitis or biliary colic as patients with a volvulus will present with right upper quadrant pain, nausea, vomiting with or without fevers and raised inflammatory markers. Imaging can help aid diagnosis with computed tomography of the abdomen or ultrasound often being the most available and time efficient modality. Delay in diagnosis and surgery can lead to significant patient morbidity. We report a case of gallbladder volvulus in a 78-year-old female that was managed successfully with laparoscopic cholecystectomy.
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