Necrotising Fasciitis is a life threatening soft tissue infection which requires aggressive, early surgical management.
Case presentation
We present a rare case of a retroperitoneal perforation of a carcinoma of the caecum presenting as a necrotising fasciitis of the anterior abdominal wall.
Conclusion
This case highlights the importance of early aggressive debridement to healthy tissue limits, the consideration of a rare underlying cause, and the scope for plastic surgical reconstruction in order that aggressive initial surgery can be adequately performed.
It is well known that 40 - 80% of information provided by clinicians is forgotten immediately by patients. Furthermore, 50% of the information remembered is incorrect. Research has shown that receiving written communication meets with high satisfaction from patients. According to the NHS plan to improve healthcare delivery, it has been recommended that patients should receive copies of letters written by doctors and that the policy would be implemented in full by April 2004. A total of 100 consecutive patients undergoing day-case gynaecological surgery under a single consultant were sent a postal questionnaire. Questions included were whether the letter was helpful, informative, reassuring, confusing or alarming. Patients were further asked whether they would prefer a similar communication in the future. A total of 78 patients replied. Of these, 67 patients found the letter helpful and preferred to have similar communication in future. Only two patients found the letter confusing and one of these was alarmed as well. Overall, 62 patients found the letter reassuring. The majority of the patients found the copy of GP discharge letter helpful, informative, non-alarming and reassuring and wanted a similar communication in the future. The extra workload involved was minimal and the extra expense involved only an extra page, envelope and postage.
Introduction
The rapid spread of the coronavirus pandemic and the associated high morbidity and mortality led to sudden lock down, forcing the elderly and others in the high risk group into isolation. Elective health care services including diagnostics, therapeutics and elective surgical services were put on hold, leading to delays seriously affecting cancer and non-cancer related services. In spite of lessons learnt during the first wave, similar issues have persisted during the second wave, increasing the pressure on an already fragile infrastructure.
Methods
Information related to surgical patients admitted since lock down (March to August 2020) as an emergency was collected on a structured proforma and analysed. Data was gathered from prospectively kept patient admission lists and Electronic Discharge summaries. All the patients who were directly or indirectly affected with poor outcomes including delayed diagnosis and treatment were identified and included in the analysis.
Results
A total of 185 patients were admitted as an emergency during this period. Of these Eight patients admitted under surgical care were included in the study. Four out of eight patients were diagnosed with advanced cancer and the remainder presented with complications of benign pathologies. Of the four patients with advanced cancer, three patients had advanced colorectal and the fourth had advanced ovarian cancer. All four patients either presented late or had delayed access to investigations. Three out four patients with benign disease presented with complications due to cancellation of elective and semi urgent services. One patient who was COVID positive and presented with bowel perforation died after a prolonged hospital stay.
Conclusion
There is definite evidence of unfavourable patient outcomes in non COVID patients as a result of the COVID pandemic. As COVID is unlikely to whither down in the very near future and highs and lows are expected, rapid and safe reintroduction of elective health care services affected by COVID is the call of the hour. In addition, more efforts should be directed towards increasing awareness amongst patients regarding the importance of reporting red flag symptoms and encouraging them to access health care services.
This, the first case-based survey the authors could find, highlights an issue requiring significant improvement. The implications are likely to be relevant to clinicians in all UK hospitals.
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