ObjectiveThere is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.DesignA prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.Results1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection.ConclusionPatients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.

Purpose: To detect the presence of viral RNA of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in conjunctival swab specimens of coronavirus disease-19 (COVID-19) patients. Methods: Forty-five COVID-19 patients positive for real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 in nasopharyngeal swab with or without ocular manifestations were included in the study. The conjunctival swab of each patient was collected by an ophthalmologist posted for COVID duty. Results: Out of 45 patients, 35 (77.77%) were males and the rest were females. The mean age was 31.26 ± 12.81 years. None of the patients had any ocular manifestations. One (2.23%) out of 45 patients was positive for RT-PCR SARS-CoV-2 in the conjunctival swab. Conclusion: This study shows that SARS-CoV-2 can be detected in conjunctival swabs of confirmed cases of COVID-19 patients. Though the positivity rate of detecting SARS-CoV-2 in conjunctival swabs is very less, care should be exercised during the ocular examination of patients of COVID-19.

The incidence of IPA is probably under-reported. The vague presentation leads to delays in diagnosis and increases morbidity and a high index of suspicion is the key to early diagnosis. Percutaneous drainage with antibiotics is the first line of treatment although recurrence rate is high. Open drainage allows simultaneous treatment of underlying pathology in secondary abscesses.

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PCs are straightforward with few complications. Most patients improve clinically and the procedure can therefore be used as a definitive treatment in unfit patients or as a bridge to surgery in those who might subsequently prove fit for a definitive operation.

INTRODUCTION Patient-directed informationa vailable on the internet is not always regulated; it may be confusing and sometimes just overwhelming. We aimed to establish the proportion of patients undergoing two common surgical procedures, who searched the internet for information about their operations and to assess the usefulness of the information they received.PATIENTS AND METHODS At otal of 105 consecutive patients undergoing elective abdominal wall hernia repair (n =5 4) or laparoscopic cholecystectomy (n =5 1) in as ingle surgical firm were included in the study.P atients were counselled about their operation in pre-operative assessment clinics and standard trust information leaflets were provided without any mention of this study.P atients were then asked to complete aq uestionnaire on the morning of their operation.RESULTS All patients completed the questionnaire. Of the patients, 59% stated that they had access to the internet and 77% of these accessed the internet over 2haw eek. Of the patients with internet access, 31% used it to acquire additional information about their operations and 58% used internet search engines. Of the patients who searched the internet regarding their operations, 26% were confused and/or worried by the information they received. CONCLUSIONS As ignificant proportion of patients undergoing common surgical procedures used the internet and about onethird of them specifically sought information about their operation on the internet. Such information can cause worry and confusion in patients. Our study highlights the need for regulated, comprehensible, patient information on hospital websites to which patients should be directed. TAMHANKAR MAZARI EVERITTR AVI USE OF THE INTERNET BY PATIENTS UNDERGOING ELECTIVE HERNIA REPAIR OR CHOLECYSTECTOMYAnn RC oll Surg Engl 2009; 91:4 60-463

Ann R Coll Surg Engl 2009; 91: 39-42 39One-fifth of Western adults will develop gallstones, with women three times more commonly affected than men; approximately 20% will become symptomatic.1 The treatment of choice for symptomatic cholelithiasis remains cholecystectomy. The traditional open approach has now largely been replaced by laparoscopic cholecystectomy which was first introduced into the UK in 1990. Whilst waiting for elective cholecystectomy, approximately 70% of patients will suffer on-going biliary symptoms 2 and up to 50% will require admission.3 Repeated hospital admissions increase costs and utilise beds unnecessarily. Traditionally, patients admitted with biliary symptoms have been treated conservatively with intravenous fluids, analgesia and antibiotics in cholecystitis to allow the inflammation to settle followed by delayed cholecystectomy. 4 In the early years of laparoscopic cholecystectomy, surgery for acute cholecystitis was eschewed because of increased rates of bile duct injury; 5 however, as it has entered routine practice, it has become clear that there is no increase in complications associated with surgery in the acute setting.6 Acute laparoscopic cholecystectomy during the index hospital admission is associated with decreased overall hospital stay. 7,8 Seven of the nine general surgeons in our hospital performed elective laparoscopic cholecystectomy during the study period, but none performed acute laparoscopic cholecystectomy. Patients admitted with acute biliary symptoms were managed conservatively and cholecystectomy scheduled for a second admission. This study was designed to identify the number of patients admitted with acute biliary symptoms once the decision to perform cholecystectomy had been made; the cost of additional or repeated investigations during these admissions and the cost implications for the trust in terms of tariff income were estimated. Immediate cholecystectomy during the first admission is safe and effective, even when performed laparoscopically, but acute laparoscopic cholecystectomy has only recently become increasingly commonplace in the UK. This study was designed to quantify this problem in our hospital and its cost implications. PATIENTS AND METHODS The case notes of all patients undergoing laparoscopic cholecystectomy in our hospital between January 2004 and June 2005 were examined for details of hospital admissions with biliary symptoms or complications whilst waiting for elective cholecystectomy. Additional bed occupancy and radiological investigations were recorded and these costs to the trust calculated. We compared the potential tariff income to the hospital trust for the actual management of these patients and if a policy of acute laparoscopic cholecystectomy on first admission were in place. RESULTS In the 18-month study period, 259 patients (202 females) underwent laparoscopic cholecystectomy. Of these, 147 presented as out-patients and only 11% required hospital admission because of biliary symptoms whilst waiting for elective surgery. There ...

Visceral artery aneurysms are rare, with a reported incidence of less than 2% in the general population.1,2 Aneurysms of the left gastric artery are particularly uncommon, accounting for 4% of all visceral aneurysms. 3,4 Although the majority are discovered incidentally and can be managed conservatively, prompt treatment of those ruptured or at risk of rupture is crucial to reduce the associated morbidity. Increasing awareness of visceral artery aneurysms as a cause of spontaneous intraperitoneal haemorrhage will improve early recognition and impact on survival. We present a rare case of spontaneous rupture of a left gastric artery aneurysm. KEYWORDSRuptured aneurysm -Haemoperitoneum -Visceral artery aneurysm -Gastric artery aneurysm Case historyA 60-year-old woman presented to our local hospital with acute onset chest and upper abdominal pain, with vomiting and hypotension. Examination demonstrated a soft but tender and distended abdomen, with a systolic blood pressure of 78mmHg and haemoglobin of 116g/l. She had a past medical history of hypertension treated with amlodipine, bendroflumethiazide and ramipril.Despite aggressive fluid resuscitation, she remained hypotensive. Her haemoglobin dropped to 67g/l and 2 units of red blood cells were transfused. This prompted urgent contrast-enhanced computed tomography (CT) of the chest and abdomen, which demonstrated an acute intraperitoneal bleed with a large haematoma in the lesser sac. A diagnosis of spontaneous haemorrhage from a left gastric artery aneurysm was made, owing to a demonstrable focus of active contrast extravasation close to the left gastric artery (Fig 1). The images were reviewed at the regional vascular centre and the patient was transferred for coil embolisation of the left gastric artery (Fig 2). Post intervention, the patient made a gradual but full recovery.Following successful embolisation, further investigations were performed to identify contributory factors for the aneurysm development and to assess for further aneurysms. Echocardiography showed mild mitral regurgitation. Magnetic resonance angiography of the brain demonstrated normal anatomy of the circle of Willis and no evidence of intracranial aneurysms. CT angiography confirmed two further visceral artery aneurysms both on the splenic artery, one measuring 6mm in diameter and the other 11mm. On review of the initial CT imaging, these splenic artery aneurysms could be seen but they were not reported at the time; they were visualised at angiography during embolisation. The patient has remained under long-term surveillance of these aneurysms, with regular imaging and outpatient follow-up. She has also been referred to a specialist rheumatology clinic to exclude underlying connective tissue disorders. DiscussionVisceral artery aneurysms (VAAs) affect branches of the abdominal aorta supplying the abdominal organs, with 80% found on the splenic and hepatic arteries. 1 They are rare and have a reported incidence of less than 2% in the general population, a figure that is rising with ...