A patient with right iliac fossa pain underwent CT angiography which demonstrated isolated caecal necrosis with associated superior mesenteric artery (SMA) stenosis. This was supported by colonoscopic findings and histopathological analysis. Isolated caecal necrosis is a rare presentation of ischaemic colitis.. Clinical and imaging findings of ischaemic colitis may mimic other pathologies. To improve diagnostic accuracy both referrers and radiologists should be aware of risk factors associated with ischaemic colitis. Isolated bowel wall thickening and pneumatosis of a colonic segment on CT are suggestive of focal bowel ischaemia, in the right clinical context.
HighlightsGallstone sigmoid ileus is a rare condition caused by a stone obstructing the sigmoid colon.Manual evacuation of an obstructing gallstone has not previously been documented before.No center has reported more than one case; consequently no case series are documented in the literature.Where conservative measures fail, endoscopy/lithotripsy appear valuable next line interventions.Gallstone ileus can progress to gallstone sigmoid ileus.
Background:In 2008, the Royal College of Physicians (RCP) alongside National Health Service Connecting for Health endorsed standards for patient records to improve patient safety by standardizing the information held on patients throughout their stay in hospital. Opinion on accurate recordkeeping, safe handover, and optimal management of acute surgical patients has reached a consensus within general surgical practice since the publication of the Handover Guidance and the Emergency Surgery Standards by the Royal College of Surgeons of England. This audit assesses the improvement in clerking notes following implementation of a proforma for acute surgical admissions. Method: The surgical admission clerking notes of 100 acute patients were audited against standards derived from the Handover Guidance and Emergency Surgery Standards, and RCP Record Keeping Standards. A standardized proforma was constructed and implemented across the unit and 100 patient notes were audited in a second audit cycle. Results: The proforma significantly improved documentation across multiple fields including patient history, patient examination, and investigations (P , 0.05). Completion of venous thromboembolism risk assessment increased by 62% (P , 0.001). There was increased documentation of the time taken until senior review of the patient post-admission, which occurred within an average of 323 minutes, an overall improvement of 173 minutes. Conclusion: The use of a surgical clerking proforma on admission has been shown to improve documentation significantly, and standardize the information recorded for patients admitted in an acute general surgical setting. A proforma can also be used as an audit tool to measure against national standards.
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