Acute Surgical Emergency Research Articles

An Uncommon Cause of Peritonitis: Perforation of Undiagnosed Gastric Cancer

Gastric cancer, while common, rarely presents as an acute surgical emergency, with perforation occurring in less than 5% of cases. This report details a 53-year-old male who presented with abdominal pain and vomiting, leading to a diagnosis of perforated gastric adenocarcinoma confirmed by imaging and subsequent total gastrectomy. The case underscores the challenges of diagnosing perforated gastric cancer, which often mimics benign conditions. Effective imaging, especially CT scans, is crucial for timely diagnosis and management. Given the high mortality associated with surgical interventions, further research is needed to establish standardized treatment guidelines for this rare complication.

WP7.13 - Recognising Clinical frailty in the Periooperative setting in the Acute Surgical Unit

Abstract Aim Due to an ageing population the number of elderly patients undergoing surgery is increasing. The literature and NELA guidance has highlighted frailty can lead to increased risks related to surgery, quantified by Clinical frailty scoring. With the introduction of the regions first Perioperative care for Older People undergoing Surgery (POPS) service, we aim to determine if formal documentation of clinical frailty score improved awareness of these patients and impacted on clinical outcomes. Methods A 3 week note review was completed of all patients over 65 admitted to the acute surgical emergency unit. Frailty was scored using the Rockall Score. The first cycle was a review of current documentation practice, with a subsequent cycle of documentation of frailty score following interventions included; clinical posters in clinical areas, teaching and medical and nursing staff handover. Results At baseline zero patient had a Rockall Clinical frailty score CFS documented. There has been an increase in the number of patients >65 years old who have a frailty score documented within 24 hours of admission. 15/40 patients over 65 had a CFS documented improved by 37.8%. Conclusion Overall improvement of documentation and awareness has been demonstrated highlighting higher frailty patients and those for POPS review to improve perioperative outcomes.

The effect of the SARS-CoV2 pandemic and lockdown on non-Covid ICU admissions: Experience from a South African tertiary hospital.

Future pandemic planning involves analysing past experiences. We compared intensive care unit (ICU) admissions during the SARS-CoV-2 pandemic (2020) with the preceding year. To assess the SARS-CoV-2 pandemic's effect on ICU admissions in a tertiary hospital, examining differences in patient characteristics, organ support requirements, reason for admission, mortality rates and length of ICU stay. This retrospective cohort study compared ICU patient data at a tertiary hospital during the SARS-CoV-2 pandemic (26 March 2020 to 20 September 2020) with the same period in 2019. Patient admissions (p=0.39) and severity of illness (p=0.27 adults; p=0.92 paediatrics) showed no differences across the study period. Similarly, no differences were observed for underlying chronic conditions between the two years. Adult trauma admissions significantly declined, specifically those related to road traffic accidents (RR 0.63). Admissions for acute infectious conditions, including respiratory infections, sepsis, urosepsis, septic arthritis and gastroenteritis significantly declined in both adults (RR 0.50) and paediatric admissions (RR 0.25). During the lockdown period, the length of stay (LOS) decreased for adults, but mortality rates remained unchanged across the study period. The paediatric mortality rate decreased during the lockdown period (p=0.004). There was no reduction in SARS-CoV-2-negative ICU admissions during the 2020 lockdown period compared with the preceding year, likely due to chronic resource limitations. We found a decrease in acute trauma and acute infectious illness admissions, while acute surgical emergency admissions increased. These findings suggest that lockdown orders may have affected admission patterns, aiding in future pandemic planning. The study highlights the chronic shortage of critical care resources in South Africa and aids with future pandemic preparedness and planning in a resource limited setting.

Healthcare Professional's Knowledge of the Systemic ABCDE Approach: A Cross-Sectional Study.

Background and aim Assessing the knowledge of healthcare professionals regarding the Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is crucial since it prioritizes the initial assessment and treatment of patients who are critically ill, regardless of the underlying cause or their age. Since adherence requires knowledge, this study aimed to evaluate the knowledge level of the ABCDE approach among healthcare professionals. Methods This cross-sectional study among healthcare professionals was performed from April to August 2023 in Taif City, Saudi Arabia. The study included healthcare professionals employed in departments exposed to patients with critical illnesses and excluded those from other specialties and individuals from outside Taif City. Data was collected via Google Forms using a previously validated questionnaire designed to assess the ABCDE approach knowledge among healthcare professionals. Statistical analysis was conducted using IBM SPSS, version 26. Results The study included 242 healthcare professionals with a mean (SD) age of 35.77 (9.93) years. About half of the participants were female (52.5%) nurses (50.8%) and had been working in intensive care units (ICU) and neonate intensive care units (NICU) (41.4%). The mean (SD) of the participants' working experience was 9.28 (8.295) years. The overall mean test score was 52.94 % (SD 16.27). The mean knowledge score among males was significantly higher than females (56.37% vs. 49.85%, respectively) (p-value= 0.001). The mean knowledge score was significantly higher among medical specialists and residents (63.308% and 55.67%) than among nurses (46.34%) (p-value <0.001). Attending an advanced trauma life support course and theoretical lecture significantly impacted the total knowledge score among the participants (p-values= 0.001 and <0.001, respectively). The total knowledge significantly increased with age (r: 0.265, p-value <0.001). Years of experience correlated with total knowledge score; with increasing years of experience, the total knowledge was significantly increased (r: 0.248, p-value <0.001). Conclusion The ABCDE approach is a valuable tool for the initial examination and treatment of patients in acute medical and surgical emergencies. The findings indicate that there is a need for further awareness programs and training on the ABCDE approach, as the total knowledge score among healthcare professionals was found to be suboptimal. Further research is needed to assess the association between knowledge level and clinical performance in different healthcare settings within Saudi Arabia.

How to Reduce the Cardiac Risk, One of the Most Common Perioperative Complications Following Invasive Surgery in Gynecology

The role of preoperative cardiac evaluation is to determine the medical condition of the patient's cardiovascular status .A history and cardiovascular examination are crucial to identify severe cardiac conditions such as unstable coronary syndromes, serious arrhythmias, decompensated HF, and valvular disease. These conditions would place the patient in a high surgical risk category. In some situations, an additional diagnostic cardiac evaluation is necessary on the basis of the results of the initial preoperative test. In an acute surgical emergency, preoperative evaluation might have to be limited to simple tests, such as a rapid assessment of cardiovascular vital signs, ECG, blood pressure, hematocrit, electrolytes, renal function, blood analysis. Only the most essential tests and interventions are appropriate until the acute surgical emergency is resolved. Under other, less urgent circumstances, the preoperative cardiac evaluation may lead to a variety of responses, including delay or cancellation of surgery until the cardiac problem has been clarified and treated appropriately. This ideally would include direct communication with the surgeon, anaesthesiologist, and other physicians, as well as discussion directly with the patient and, if appropriate, the family. Conclusion: Preoperative cardiac evaluation is very important for all the patients undergoing gynaecologic surgery because cardiac related perioperative complications are well-known in general practice.

Emergency intestinal stomas incidence and early complications

Background: An intestinal stoma is a frequently performed procedure with a high percentage of complications. Even though creating an intestinal stoma is a procedure that can save lives while treating various gastrointestinal conditions, its accompanying morbidity and mortality have been the topic of many studies. This study was carried out in order to better understand a variety of complications in various types of intestinal stomas. Methods: A total of 60 patients with intestinal stoma construction in the general surgery emergency department at Kasr Al-Ainy emergency hospital Cairo, Egypt as an emergency procedure from December 2019 to May 2020 were included in this prospective cohort analysis. The inclusion criteria were all emergency cases undergoing intestinal stomas for treatment of either traumatic bowel injuries or acute abdominal surgical emergencies. Results: With a mean age of 45.18 years, 60 patients in all were evaluated. Males were 65% and females were 35%. End ileostomy with mucous fistula (33.3%) and loop transverse colostomy (18.30%) were the two stomas that were constructed most frequently. Intestinal obstruction (41.7%) was the most often reported indication of stoma formation. Complications of the peristomal skin made up the majority of cases (61.90%). Conclusions: This work significantly advances our understanding of stoma problems and their prevention to some extent through pre-operative soma site marking, good surgical technique, an experienced surgeon, a stoma therapy nurse, and patient education to enhance the care and quality of life for those who have stomas.

CLINICAL STUDY ON ACUTE APPENDICITIS INCORPORATING MODIFIED ALVARADO SCORE AND ABDOMINAL ULTRASOUND

Acute appendicitis is one of the most common acute abdominal surgical emergencies the diagnosis of which is often challenging. If there is a delay in the diagnosis and prompt action is not taken, it may lead to perforation and other complication. Many scoring systems have been devised for the diagnosis of appendicitis, among which Modified Alvarado score is being used widely. Ultrasound also has gained importance in recent years. Our study aims in combining the use of Modified Alvarado score and USG in the diagnosis to bring down the rate of negative appendicectomies. Aimof The Study 1. To evaluate the sensitivity of the use of modified Alvarado scoring system and ultrasound in the diagnosis of acute appendicitis 2. To reduce the rate of negative appendicectomy. Materials &amp; Methods: This study was done in 100 patients admitted in Navodaya Medical College Hospital from November 2019 to May 2021. All patients chosen on purposive sampling basis who present with right lower quadrant pain. Preoperatively, modified Alvarado score and abdominal ultrasound are assigned to those included in the study. Intraoperative findings and histo-pathological reports are followed up and the results are compared with modified Alvarado score and abdominal ultrasound. Results 1. In our study, the sensitivity of Modified Alvarado score in diagnosing Acute Appendicitis in the score range of 1-4 is 60%, so 6 out of 10 patients were confirmed with Acute Appendicitis. 2. In the score range of 5-7, out of 26 patients, 24 patients were confirmed with Acute Appendicitis using HPE having 92.3% sensitivity. 3. In the score &gt;7, out of 64 patients , 63 patients had Acute Appendicitis confirmed with HPE and the sensitivity of HPE was the highest among this score range and its found to be 98.43%.The remaining 7 patients had normal appendix. 4. In our study, the sensitivity of USG Abdomen in diagnosing Acute Appendicitis was 95.83% in the score range of 5-7, 71.42% in score range of &gt;7 and 66.6% in score range of 1-4.Out of 100 patients, USG abdomen showed positive result for Acute Appendicitis in only 72 patients when compared to HPE which showed 93 patients with Acute Appendicitis. Interpretation &amp; Conclusion: Modified Alvarado scoring system is the better indicator for confirmation of diagnosis of Acute Appendicitis in the clinical setting rather than relying on USG abdomen imaging modality of investigation for diagnosing and treating the patient with Acute Appendicitis. When we incorporate both Modified Alvarado Scoring system and USG abdomen then we can diagnose Acute Appendicitis with accuracy close to HPE diagnosis of Acute Appendictis.

Gangrenous Bowel Obstruction Managed With Local Tumescent Anesthesia and MAC

Since the mid-1980s, Klein’s tumescent anesthesia has been used routinely in different surgical specialties such as cosmetic surgery, dermatology, vascular surgery, reconstructive plastic surgery, and breast surgery. The tumescent anesthesia technique was developed by Dr Jeffrey Klein, a board-certified dermatologist. The technique was first published in 1987. Tumescent means “swelling.” This technique involves injection of an ultra-dilute lidocaine and epinephrine solution into the surgical planes offering multiple advantages including, but not limited to, postoperative analgesia, reduced blood loss, and avoidance of general anesthesia. The standard liter of Klein’s solution contains lidocaine 1 g, epinephrine 1 mg, and sodium bicarbonate 12.5 mg. Multiple modifications and variations have been implemented and used over the years, an evolution from Klein’s original description. While tumescent anesthesia started in liposuction procedures, its application has now extended into a wider variety of procedures and specialties. In this article, we present a case of tumescent anesthesia in a critically ill general surgery patient who presented with an acute life-threatening surgical emergency. The patient was assessed to be a very high risk for general anesthesia, and after collaborative discussion between the surgical and anesthesia teams and taking informed consent from the patient, the decision was made to proceed with surgery under monitored intravenous sedation with tumescent anesthesia. The patient had an uneventful recovery and survived a very high mortality surgical emergency. He was subsequently discharged back to his nursing home in stable condition. Tumescent anesthesia has become tremendously popular in cosmetic surgery. Tumescent anesthesia allows patients to have surgical procedures in an ambulatory setting, avoid general anesthesia, and allow for better pain control postoperatively. While tumescent anesthesia is used in other specialties, the field of general surgery has not widely adopted tumescent anesthesia. Many general surgeons and anesthesiologists are not familiar with the technique and how to implement it in their practice. It is of utmost importance to understand the pharmacokinetics of tumescent solution and safe implementation. Tumescent anesthesia with monitored anesthesia care is here reported as an alternative to general anesthesia in the care of a moribund patient with multiple comorbidities requiring open abdominal surgery. Close cooperation between the surgeon and the anesthesiologist made the successful conduct of this case possible.

E020 Pneumatosis intestinalis with spontaneous pneumoperitoneum in a patient with systemic sclerosis-myositis overlap syndrome: a case report and review of the literature

Abstract Background/Aims Pneumatosis intestinalis (PI) is a rare complication of systemic sclerosis (SSc), characterised by submucosal and/or subserosal collections of free gas, forming cystic lesions within the gastrointestinal (GI) tract. Methods A 67-year-old man with SSc-myositis overlap syndrome presented acutely unwell with worsening abdominal pain, bloating, bloody diarrhoea and vomiting for three weeks. He was afebrile and haemodynamically stable. His abdomen was distended with generalised tenderness but soft and regular bowel sounds were audible. There were no palpable organomegaly or signs of peritonism. He had raised CRP, serum amylase, serum lactate and pre-renal acute kidney injury. He tested positive for ANA Hep2 (speckled) and anti-Mi-2b. His contrast-enhanced CT abdomen and pelvis displayed extensive pneumatosis changes, moderately dilated small bowel loops and pneumoperitoneum without portal venous gas or acute thrombotic occlusion in the main-stem superior or inferior mesenteric arteries. He was managed conservatively with bowel rest, elemental diet, cycling antibiotics for small intestinal bacterial overgrowth (SIBO) and commenced on end-of-life care as surgical exploration was deemed too risky considering that he has exceedingly poor cardiac reserve. He made a surprisingly excellent recovery and his repeat CT scans at approximately 11 weeks showed a complete resolution of pneumatosis intestinalis and pneumoperitoneum. Results PI in SSc generally runs a benign course and is usually managed conservatively. The development of PI is multifactorial, involving a complex interplay between mechanical, biochemical, bacterial and drug factors. PI is usually asymptomatic but patients can present with GI and constitutional symptoms or peritonism. CT scan is the most preferred diagnostic modality for PI. Conservative management is preferable to surgical intervention after careful exclusion of acute surgical causes. The underlying cause of PI should be appropriately addressed and managed in all cases. The management of PI is based on the severity of symptoms and it includes bowel rest, elemental diet or parenteral nutrition, antibiotics, high concentration oxygen, hyperbaric oxygen therapy and/or octreotide. Our patient was managed conservatively as he did not exhibit clinical signs of peritonism or bowel ischaemia and surgical interventions were deemed too risky. He was treated with and has responded well to cycling oral antibiotics for SIBO which was thought to be contributory to his PI. Conclusion This case illustrates that PI with or without pneumoperitoneum could be a rare complication of SSc, and contrary to common belief, it is usually benign and managed conservatively with favourable outcome. An accurate interpretation of its clinical significance is crucial as acute presentations and ambiguous imaging findings can simulate acute surgical emergency leading to diagnostic dilemma and unnecessary or risky surgical interventions. However, emergency laparotomy should be considered in patients who exhibit signs of peritonism or bowel ischaemia and therefore timely involvement of surgeons and multidisciplinary team is essential. Disclosure K. Lim: None. S. Knights: None. J. Pauling: None. J. Gotto: None.

Outcome of Laparostomy as a Treatment Measure for Abdominal Compartment Syndrome: A Retrospective Study

Introduction Abdominal compartment syndrome is a life-threatening condition that affects critically ill patients. When pressures inside a fixed cavity of the body increases, ischemia, muscle injury, and organ failure can result. Aim To assess the benefits and outcomes of laparostomy for abdominal compartment syndrome. Methods This retrospective study included patients who underwent a laparostomy procedure as a treatment measure for abdominal compartment syndrome, secondary to different etiologies such as sepsis and major abdominal visceral trauma. Results Although there are a few complications such as incisional hernia in the future following a laparostomy, the mortality rate following the procedure is less than &lt; 10%, thus ensuring a good prognosis for patients who present with acute surgical emergencies. It could also be further noted that an early closure by 7 to 14 days had definite beneficial outcomes as compared with delayed closure of more than 14 days. It prevented most long-term complications such as entero-atmospheric fistula formation or granuloma formation, the outcomes of which were further aided by the use of a transparent custom-made polypropylene mesh. Conclusion Laparostomy is the gold standard treatment for abdominal compartment syndrome. The use of a custom-made polypropylene mesh has proven to have the least complications in the follow-up period. Incisional hernias are the most common complications documented, followed by entero-atmospheric fistula.

Management of appendicitis: appendicectomy, antibiotic therapy, or both?

Electronic searches of the MEDLINE (PubMed) database, Cochrane Library, and Science Citation Index were performed to identify original published studies on appendicitis and the pre-COVID-19 (coronavirus disease 2019) and post-COVID-19 management. Relevant articles were searched from relevant chapters in specialized texts, and all have been included. There are indications for operative (surgery), nonoperative (antibiotics), or both in the management of acute appendicitis. Although laparoscopic appendicectomy is becoming the gold standard of treatment, knowledge of the pros and cons of this approach versus the open approach is important. The controversy in the management of the appendix mass/abscess between an expedient appendicectomy or a combination of conservative management (antibiotics) and interval appendicectomy remains. Laparoscopic appendicectomy is becoming the gold standard for the treatment of appendicitis. However, the advantages of the innovations in minimally invasive and endoscopic surgery are unlikely to render formal open appendicectomy obsolete. Nonoperative management with antibiotics may suffice in selected cases with uncomplicated appendicitis. It is imperative that patients are counseled appropriately if primary antibiotic treatment is to be routinely offered as first-line therapy.

A standard experiment with emergency endovascular interventions on the descending thoracic aorta

Background: Using emergency endovascular aortic repair to treat severe acute aortic disorders affecting the descending aorta is an appealing prospect. Aim: This study's objective was to evaluate the efficacy of thoracic endovascular aortic repair (TEVAR) in the management of acute surgical emergencies involving the descending thoracic aorta. Methods: The medical records of every patient who underwent TEVAR in a single centre since 2007 were retrospectively evaluated. Emergency criteria for inclusion were used to treat patients with aortic disease who had complicated spontaneous acute aortic syndrome (csAAS), traumatic aortic acute injuries (TAIs), and other symptoms calling for urgent treatment. The Society for Vascular Surgery reporting guidelines for thoracic endovascular aortic repair were used to evaluate the technical and clinical success with regard to patient mortality, survival, and re-operation rate (TEVAR). Results: In 74 cases (51.0%), emergency procedures were required, including those involving patients with traumatic aortic acute injuries (TAIs) (31.1%) and complicated spontaneous acute aortic syndrome (csAAS) (64.8%; n = 48). Aortic iatrogenic dissection (AID) in one case and two other fistulas following the prior stent graft were also identified as implantation's. While 2 hybrid operations required extra approaches, all procedures were performed through surgically exposed femoral arteries. The main technical success rate was 95.9%; endoleak was recorded in 3 instances. In 94.5% of cases, the main clinical success was achieved. All of the patients made it through the endovascular procedures, however one of them passed away in the hospital as a result of multi-organ failure (early mortality: 1.3%). 11 patients passed away throughout the follow-up period, which lasted 6 to 164 months (median 67). The probability of survival over one year, five years, and 10 years was 86.4 ± 0.04%, 80.0 ± 0.05%, and 76.6 ± 0.06%, respectively. However, following TAI (95.2%) compared to scAAS (63.4%), the rate of 5-year survival was significantly greater (p=0.008). One person experienced temporary para-paresis right after the operation (1.3%). Throughout the post-discharge follow-up period, no more severe stent-graft-related adverse events were reported. Conclusion: The probability of survival over one year, five years, and 10 years was 86.4 ± 0.04%, 80.0 ± 0.05%, and 76.6 ± 0.06%, respectively. However, following TAI (95.2%) compared to scAAS (63.4%), the rate of 5-year survival was significantly greater (p=0.008). One person experienced temporary para-paresis right after the operation (1.3%). Throughout the post-discharge follow-up period, no more severe stent-graft-related adverse events were reported.

Retrospective analysis of outcome of COVID positive patients undergoing emergency surgeries for acute general surgical conditions

Background: There is a significant impact of COVID-19 disease on medical and surgical community. Acute surgical emergencies had to be addressed inspite of several hardships to save the lives of patients. There is a need to understand the impact of COVID-19 disease on outcome of surgical emergencies. This study aimed to analyse the outcomes of COVID-19 patients with general surgical emergencies. Methods: This retrospective study was conducted on 50 patients undergoing emergency surgeries for acute general surgical pathologies in department of general surgery, Government General Hospital, Guntur from January 2021 to October 2021. Patients were divided into two groups, 25 patients who were COVID positive and 25 patients who were COVID negative. The outcomes assessed were mortality, multi organ dysfunction syndrome, surgery related complications and number of days of hospital stay. Results: Mortality was higher in COVID group when compared to non COVID group (32% vs. 8%). Average number of hospital stay was higher in COVID group than non Covid group (11.78 days vs. 8.43 days). COVID-19 patients developed MODS 2.88 times greater than non COVID patients (20% vs. 8%). Surgery related complications were higher in COVID-19 patients (28% vs. 8%). Conclusions: COVID positivity was associated with higher complications rate, higher mortality and increased duration of hospital stay.

Spectrum of abdominal tuberculosis presenting as acute surgical emergency: Relevance in 21st century, a case series

BackgroundAbdominal tuberculosis presenting as acute surgical emergency continues to be a major issue in developing countries including India. Being an indolent disease with varied presentation, there is a need to describe the epidemiology, clinicopathological nature of the disease. Hence, this series was conducted with the aim of describing our institutional experience in the management of abdominal tuberculosis presenting as acute surgical emergency, outlining the epidemiology, management aspects and the analysis of risk factors for poor outcome in our population. MethodsThis was a descriptive series of patients operated for abdominal tuberculosis presenting as acute surgical emergency at a tertiary care hospital in Eastern India from January 2021 to January 2022. All consecutive patients presenting with intestinal obstruction or peritonitis who underwent laparotomy with intra operative and histopathological finding suggestive of tuberculosis were taken for the study. ResultsA total of 30 patients with acute abdominal tuberculosis were included in the study. 56.7% of patients were males; the mean age of presentation was 43 years with majority of patients in the younger to middle age groups. Most (80%) patients were from rural areas with limited access to healthcare. One patient had co-infection with HIV. Five patients had diabetes and six patients had hypertension as co-morbidities. 73.3% of patients had primary intestinal tuberculosis. Majority (76.7%) presented with acute intestinal obstruction. All patients had colicky abdominal pain as a consistent feature. 40% of patients were anaemic and 70% had low serum albumin levels. The most common site of affection was Ileo-cecal region (73.3%) with stricture as the pathology. Segmental resection with end to end anastomosis was the most common procedure performed (46.7%). 26.7% of patients had an adverse post operative complication, and 23.3% had surgical site infection (SSI). The mortality rate in our series was 6.7%. Although coexisting SSI, co-morbidities were associated with increased mortality, it was not found to be statistically significant (p = 0.08). 16 patients were lost to follow up. ConclusionAbdominal tuberculosis presenting as acute abdomen continues to challenge surgeons even in the 21st century. Majority in the developing countries present late with varied complications. A high index of clinical suspicion is required for timely diagnosis to reduce the mortality and morbidity of the disease.

Emergency Endovascular Interventions on Descending Thoracic Aorta: A Single-Center Experience.

Implementation of emergency endovascular aortic repair provides an attractive opportunity in the treatment of complicated acute aortic syndromes involving descending aorta. The aim of this study was to analyze the effectiveness of thoracic endovascular aortic repair (TEVAR) for the treatment of acute surgical emergencies involving the descending thoracic aorta. A retrospective review of the medical records of all patients undergoing TEVAR in a single center since 2007 was undertaken. Patients with the aortic disease treated on emergency inclusion criteria were complicated spontaneous acute aortic syndrome (csAAS), traumatic aortic acute injuries (TAIs), and other indications requiring emergent intervention. Technical and clinical success with patient mortality, survival, and reoperation rate was evaluated according to Society for Vascular Surgery reporting standards for thoracic endovascular aortic repair (TEVAR). The emergency interventions were necessary in 74 cases (51.0%), including patients with the complicated spontaneous acute aortic syndrome (csAAS) (64.8%; n = 48) and traumatic aortic acute injuries (TAIs) (31.1%). In addition, in one case aortic iatrogenic dissection (AID) and in 2 other fistulas after the previous stent graft, implantations were diagnosed. All procedures were done through surgically exposed femoral arteries while 2 hybrid procedures required additional approaches. The primary technical success rate was 95.9%, in 3 cases endoleak was reported. The primary clinical success occurred in 94.5%. All patients survived the endovascular interventions, whereas during in-hospital stay one of them died due to multiorgan failure (early mortality 1.3%). During the follow-up period, lasting 6 through 164 months (median 67), 11 patients died. Annual, five- and ten-year probability of survival was 86.4 ± 0.04%, 80.0 ± 0.05%, and 76.6 ± 0.06%, respectively. However, the rate of 5-year survivors was significantly higher after TAI (95.2%) than scAAS (63.4%) (p=0.008). Early after the procedure, one individual developed transient paraparesis (1.3%). No other serious stent-graft-related adverse events were noted within the postdischarge follow-up period. Descending aortic pathologies requiring emergent interventions can be treated by endovascular techniques with optimal results and low morbidity and mortality in an experienced and dedicated team.

Penile Fracture at the Crus of the Penis - A Rare Case Report.

Penile fracture is an uncommon acute surgical emergency, typically occurring after sexual intercourse, self-manipulation and at times, may be accidental. We report here a 39-year male who attended the department of emergency with swelling and bruising of the scrotum and penis. Physical examination exhibited a diffuse abdominal and perineal ecchymosis. Imaging confirmed a crural penile fracture. Operative fixation was performed appropriately and satisfactory erectile function was reported at the follow-up. We report a very rarely documented case involving the penile crus fracture and its management. Key Words: Crus, Penile fracture, Surgical repair.

IMPACT OF COVID-19 ON EMERGENCY SURGICAL MANAGEMENT AT VICTORIA AND BOWRING HOSPITAL, BMCRI BANGALORE.

Aim: To study the outcomes of emergency surgical management during the COVID-19 pandemic. Methodology- A retrospective study was done on the emergency services provided at BMCRI Bangalore from April 1st to December 31st 2020 when the impact of COVID-19 was highest. COVID-19 positive and COVID-19 negative patients were both included, who underwent surgeries for their acute surgical emergency. Sars CoV RTPCR test was done for all patients. For Haemodynamically unstable patients, surgery was done after Rapid antigen testing without waiting for RTPCR reports. All these patients were observed for postoperative outcomes till they were t for discharge. A total of 196 patients were included in the study who underwent surgeries for acute emergencies. Results reveal that, 5.2% Results- patients were tested to be COVID-19 positive before the procedure. 24% of them were tested positive after the surgery. Post-operative complications were noted in 17.4% of patients, of which 15.3% were COVID-19 positive group. Mortality rate of 7.6% was noted in COVID-19 positive group and 1.6% in COVID-19 negative patients. Signicant increase in wait Conclusion- ing time for surgery and duration of surgery was seen during this pandemic. Morbidity and mortality was noted to be signicantly increased in COVID19 positive patients who also presented with concurrent surgical emergencies. Despite the fact that operating with PPE, increased duration of surgery and is laborious, it is mandatory to wear them regardless of the rapid antigen test negative status of patients presenting with acute surgical emergency requiring lifesaving emergency procedures.

WE3.10 The Impact of Simulation Training on Junior Doctors Managing Surgical Emergencies

Abstract Aim The use of simulation for the training of junior doctors in surgery usually involves either practicing technical skills or exercising communication skills. We have identified a gap in crisis resource management training of junior surgical trainees with scenario-based simulation. We have developed a one-day simulation course on general surgical emergencies and evaluated its impact. Methods The course included a human factors presentation and several scenarios of acute surgical emergencies. It was aimed at core surgical trainees, but other junior doctors were invited. High fidelity human simulator (SimMan®) was used and controlled by faculty. Surgical scenarios were selected in order to provide insight for the appropriate resuscitation for acute surgical patients. The impact of the course was evaluated with a post course questionnaire. Results Ten courses were completed between 2015 and 2021. A total of 58 doctors attended, 45 were core surgical trainees. All 51 participants who responded to the questionnaire rated the course “Good (4/5)” or “Excellent (5/5)”. Following the course, of 51 participants, 50 felt better prepared and 51 were confident in recognising unwell surgical patients; 42 felt better prepared and 50 confident in providing resuscitation; 46 felt better prepared and 51 confident in escalating care. During debriefs and on free text feedback, participants frequently reported the course helped develop their non-technical skills. Conclusion The General Surgical Emergencies simulation courses were rated useful by the learners. The course has positively impacted on the preparedness and confidence of junior surgical trainees in recognising unwell surgical patients, providing initial resuscitation and escalating care.

An analytical study of acute surgical emergencies in groin hernia

Aim and Objectives: This is a analytical study about various presentations, etiopathogenesis, complications and management in acute surgical emergencies in groin hernia presented in Trichy SRM medical college Hospital from May 2019 to October 2021. Observation and Conclusions: Incidence of highest in age group of 60yrs to 70yrs and Complication of inguinal hernia was more common in males than females and it was observed hernia is commoner on the right side than on the left side. The most common symptom was groin swelling with pain followed by vomiting and most common content found in the sac was small bowel followed by omentum with the most common site of obstruction. The most common procedure followed in my study was only herniorraphy. It was followed by omentectomy.

The microbiome in adult acute appendicitis.

Acute appendicitis is a common acute surgical emergency; however, the pathogenesis of adult appendicitis remains poorly understood. The microbiome is increasingly thought to play a key role in inflammatory disease of the bowel and similarly, may play a role in appendicitis. This study aimed to characterise the microbiome of adult acute appendicitis in a prospective cohort. We recruited 60 adults with acute appendicitis and 20 healthy controls. Rectal swabs were taken from each patient. After DNA extraction, 16S rRNA amplicon sequencing was carried out for analysis of diversity and taxonomic abundance. Phylogenetic sequencing of the samples indicated that there is a difference between the microbial composition of those with acute appendicitis and healthy controls, with a statistically significant decrease in alpha diversity in rectal swabs of appendicitis patients compared to healthy controls. At the genus level, we saw an increased abundance of potential pathogens, for example, Parvimonas and Acinetobacter, and a decrease in commensal taxa such as Faecalibacterium, Blautia and Lachnospiraceae in appendicitis patients compared to healthy controls. There was a reduction in diversity and loss of commensals in the microbiome of those with acute appendicitis, which may play a role in the cascade leading to acute appendicitis or the result of this.