Diagnostic Laparotomy Research Articles

Long-term survival outcome of multi-institutional prospective phase II trial of conversion surgery: CCOG1403.

380 Background: From the result of CONVO-GC-1, safety and efficacy of conversion surgery are shown. But there are few prospective studies about conversion surgery. We conducted multi-institutional prospective study of conversion surgery (CCOG1403). Methods: The patients (pts) with gastric cancer, who were initially regarded as non-curable and curably resectable after at least one course of chemotherapy, were enrolled. After diagnostic laparoscopy or laparotomy, pts were performed gastrectomy in case of curably resectable. The primary endpoint was 3-year survival from the start of first line chemotherapy. The planned sample size was 30, with one-sided alpha of 5%, power of 90%, expected 3-year survival rate of 27%, and threshold of 7%. Secondary endpoints were 5-year survival from the start of first line chemotherapy, the proportion of R0 resection, 3-year survival from the conversion surgery, pathological response, and adverse events. This study was registered at the University Hospital Medical Information Network Clinical Trials Registry as UMIN000014251. Results: From April 2014 to March 2019, 30 pts were enrolled from 7 institutions. The mean age was 66.7. Non-curable factors were PER(11), LYM(9), HEP(6), T(4), CY(1), PUL(1), BRA(1), and other(1), respectively. Four pts had more than one non-curable factors. The categories of Yoshida’s classification were Cat.1(3), Cat.2(16), Cat.3(8), and Cat.4(2). Regimen of chemotherapy were SOX (11), SP (8), XP+HER (8), PTX ip containing regimen (6), and others (12). Clinical responses of preoperative chemotherapy were PR in 24 and SD in 6. Operative procedures were TG (18), DG (7), and PG (1). Median operative time was 278.5min. and median blood loss was 417.5ml. Twenty-four (80%) pts achieved R0 resection. Five pts suffered >= C-D Grade III postoperative complication but all pts recovered. The pathological finding revealed major response, defined as disappearance more than two third of the primary tumor, in 26.7% (8/30) pts. Twenty-seven (90%) pts received postoperative chemotherapy. Among 24 pts with R0 resection, 16 pts experienced recurrence in PER(5), LYM(4), HEP(4), PUL(3), BRA(1), and others(4). In 30 pts accrued, 19 (66.3% 43.9-80.1), 16 (55.3% 34.3-71.7) survived more than 3 years from the start of first line chemotherapy and the conversion surgery, respectively. Conclusions: Conversion surgery is effective and worth for testing in the following randomized trial. Clinical trial information: UMIN000014251 .

Variables affecting mortality rates in patients undergoing emergency abdominal surgery: A retrospective cross-sectional study.

Patients operated under emergency conditions have a higher risk of death and complications than those per-formed under elective conditions. Especially the patient group with high comorbidity needs to be evaluated more specifically. Accord-ing to the surgical risk and American Society of Anesthesiologists (ASA) scoring, the perioperative risk should be determined quickly, and the relatives of the patients should be informed. This study aimed to evaluate the factors affecting mortality and morbidity in patients undergoing emergency abdominal surgery. A total of 1065 patients aged 18 years and older who underwent emergency abdominal surgery in 1 year were included in the study. The primary aim of this study was to determine the mortality rates in the first 30 days and 1 year and the variables af-fecting these rates. Of 1065 patients, 385 (36.2%) were female and 680 (63.8%) were male. The most common procedure was appendectomy (70.8%), followed by diagnostic laparotomy (10.2%), peptic ulcus perforation (6.7%), herniography (5.5%), colon resection (3.6%), and small bowel resection (3.2%). There was a significant difference between the age of the patients and mortality (p<0.05). There is no statistically significant relationship between gender and mortality. A statistically significant correlation was found between ASA scores, perioperative complication, perioperative blood product use, reoperation, intensive care unit admission, hospitalization time, periop-erative complication, and 30-day mortality and 1-year mortality. There is a significant relationship between trauma and only 30-day mortality (p=0.030). The morbidity and mortality of patients operated on under emergency conditions increased compared to elective surgical operations, especially those over age 70. The 30-day mortality rate of patients who underwent emergency abdominal surgery is 3%, while the 1-year mortality rate is 5.5%. Mortality rates are higher in patients with a high ASA risk score. However, mortality rates in our study were found to be higher than the mortality rates in ASA risk scoring.

The probability of developing a tumor in the small intestine neocyst

In clinical practice and scientific literature, there is very little data on the occurrence of tumors in the urinary intestinal reservoirs in patients after radical cystectomy with cystoplasty. A characteristic feature of such tumors is a long latent period before the formation of a relapse from 4 to 32 years.The article describes a clinical case of a 1951 patient with a tumor of a small intestinal neocyst. From the patient’s history, there is a long-term hematuria (for 2 years) after radical cystectomy with ileocystoplasty. The intensity of hematuria increased to the formation of profuse with the development of severe anemia. During the examination according to magnetic resonance imaging, computed tomography, ultrasound and invasive diagnostic examinations, no tumor was detected. The patient underwent a diagnostic laparotomy, a tumor was found in the area of ureteral-reservoir anastomosis of the small intestine neocyst. Resection of the small intestine reservoir and ureteral transplantation was performed. The morphological picture of the removed tumor is urothelial cancer of moderate differentiation.Secondary tumors of the small intestinal urinary reservoirs are rare and have the structure of adenocarcinoma. The mechanisms of their occurrence have not been fully studied at the moment. Dynamic monitoring of patients after radical cystectomy and ileocystoplasty should be carried out in a specialized center.

P076: Pneumococcal infection in splenectomised Hodgkin lymphoma patients: Do they pose a problem today and what is the best long-term strategy?

Purpose: Diagnostic laparotomy and splenectomy (DLS) were introduced for Hodgkin lymphoma (HL) patients in Sweden in the late 1960s/early-70s. It was soon established that splenectomised and functional hyposplenic (following irradiation) HL patients carried an increased risk of overwhelming infections, Streptococcus pneumoniae being the major causative agent. Despite this, DLS remained as a staging procedure for more than two decades. The purpose of this study was to compare incidence and outcome of pneumococcal infections between splenectomised (spl+) and non-splenectomised (spl-) HL patients. Material and Methods: HL patients diagnosed 1973–1995 were identified in the Swedish Cancer Register. Information on splenectomies and severe pneumococcal infections was retrieved from the National Inpatient Register. Follow-up started a diagnosis and ended on date of infection, emigration, death, or December 31, 2010, whichever came first. Splenectomy was analysed as a time-varying covariate, i.e., patients were considered unexposed before the date of splenectomy and exposed after the date of splenectomy. Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) comparing infection rates between spl+/spl- patients. Results: A total of 4,237 HL patients were included, among whom 735 (17%) underwent a splenectomy, with a median time from splenectomy to infection of 6.8 years (range 0.1–30.8 years). The number of patients experiencing a severe pneumococcal infection was 39 (3.2 per 1,000 person-years) among spl+ and 60 (1.7 per 1,000 person-years) among spl- patients. The relative rate of severe pneumococcal infection comparing spl+/spl- HL patients was 2.43 (95% CI: 1.55–3.81), adjusted for diagnosis year, diagnosis age, and sex. The 30-day post-infection mortality proportion was 9/39 (23%) among the spl+ and 18% (11/60) among the spl- patients. Broken down by calendar period of infection, the 30-day post-infection mortality proportion among splenectomised patients was 44% (1973–1985), 23% (1986–1998), and 0% (1999–2010). Conclusion: Severe pneumococcal disease is a serious event that is more likely to appear in splenectomised HL patients compared to non-splenectomised, possibly many years after diagnosis. However, the low proportion of deaths in later decades is reassuring, and likely a result of adequate pneumococcal vaccination together with patient and doctor education about the infection risk.

S2167 Chronic, Massive Pneumoperitoneum in a Patient Without Signs of Peritonitis: A Case Report

Introduction: Pneumoperitoneum is the presence of free air in the abdominal cavity. This alarming symptom can be due to a wide variety of etiologies, including infection, trauma, perforation, and others. However, pneumatosis intestinalis, which is the presence of free air in the extraluminal space, can be due to other pathology unrelated to the GI tract. It can be seen in pulmonary disease, such as COPD and asthma, autoimmune conditions, and drug-induced causes as well. It can present with more benign symptoms. We present a case of chronic pneumatosis intestinalis that was present in the patient for over 2 years and presented with relatively minor, nonspecific symptoms. Case Description/Methods: This patient was a 62-year-old male who presented with concerns of bloating and cramping, ongoing for 2 years. Previous work-ups had not revealed a clear cause for his ongoing symptoms. He had undergone CT of the abdomen, which was significant for massive pneumoperitoneum, as well as fluid-filled prominent loops of small bowel concerning for ileus or obstruction. There was no site of bowel perforation that could be visualized. Upper endoscopy and colonoscopy had been performed, which showed normal mucosa and colonic diverticulosis. After further workup at an additional institution, diagnostic laparotomy was recommended to further evaluate his small bowel. At the lower anterior diaphragm, the peritoneal surface had subperitoneal emphysema, suggesting a potential thoracic source for the pneumoperitoneum. Thoracic surgery were consulted for exploratory right-sided thoracoscopy since he was noted to have peritoneal blebs along the diaphragm most notably, with one also being identified on the liver. It was concluded that the etiology was most likely due to an alveolar-peritoneal fistula through the right hemidiaphragm (Figure). Discussion: Pneumatosis Intestinalis can be a benign presenting symptom. Pneumoperitoneum can be due to primary (idiopathic) or secondary causes. Secondary causes are numerous, and these can be seen in the setting of COPD, immunodeficiency, or acute GI pathology. Increased pressure in the abdomen or the mediastinum can result in gas diffusing across tissues and into the bowel wall. Treatment and management varies depending on the patient's presentation. More serious abdominal pathology requires surgical management, while benign causes in the setting of chronic lung pathology can be asymptomatic, or present with mild symptoms that require only conservative medical management.Figure 1.: Pneumatosis Intestinalis on CT Scan.

S2993 Extensive Hepatic Fibrosis Mimicking Primary Liver Malignancy

Introduction: Liver cirrhosis is a pathophysiological outcome of sustained liver inflammation. Sustained hepatic insults generate a process of fibrogenesis, in which an excessive extracellular matrix deposition replaces normal liver parenchyma. We present a patient with newly diagnosed liver cirrhosis who was found to have a liver mass suggestive of primary liver malignancy on imaging; however, multiple biopsies confirmed the mass to be fibrosis with mild hepatitis. Case Description/Methods: A 40-year-old male presented for the evaluation of new bilateral lower extremity edema. He reported a long history of alcohol use but otherwise denied prior medical history and no medication use. Laboratory work on admission was pertinent for a total bilirubin of 3.5, AST 162, ALT 57, alkaline phosphatase 176, albumin 3.0, and a non-reactive viral hepatitis panel. CT abdomen/pelvis revealed a heterogeneous liver suggestive of cirrhosis along with a 6.8 cm x 8.7 cm mass with irregular margins situated between the right and left lobes of the liver. On 3-phase MR imaging, the lesion demonstrated progressive enhancement in the portal venous phase and hepatic venous phase, with retention of contrast on 5-minute delayed images [Image 1a, b, c]. Overall, these findings suggested infiltrative cholangiocarcinoma. Additional imaging ruled out multifocal disease, and tumor markers CEA and AFP were unremarkable. Subsequently, a diagnostic laparotomy with liver biopsy was performed. The biopsy demonstrated fibrosis with atypical ductular proliferation, but the presence of low-grade infiltrative cholangiocarcinoma could not be ruled out. To rule out biopsy sampling error, two additional biopsies later that month concurred cirrhotic liver segments with areas of mild hepatitis. Tumor markers CK20 and CDX2 were negative, and no atypical cells were present. It was concluded that this liver lesion represented extensive hepatic fibrosis and mild hepatitis due to ongoing alcohol use, but no malignancy. Discussion: Liver cirrhosis is a major risk factor for the development of primary liver cancers such as hepatocellular carcinoma and cholangiocarcinoma. Triple-phase CT or MR imaging plays a key role in diagnosing these cancers; however, as demonstrated in our case, certain benign lesions such as liver fibrosis can mimic primary liver malignancy. Improved recognition of these benign lesions is necessary to avoid unnecessary and potentially harmful interventions.Figure 1.: 1a) Pre-contrast MR T2 weighted image showing a large central hepatic mass and lobular contour of liver consistent with cirrhosis. 1b) Post-gadolinium T1 fat-saturated MR image demonstrating enhancement of the liver lesion in the hepatic venous phase. The lesion showed high retention index of contrast on 5-minute delayed images (not included). 1c) Diffusion-weighted MR image showing the liver lesion with significantly restricted diffusion suggestive of infiltrative type of cholangiocarcinoma.

Desmoidní fibromatóza jako vzácný nádor mezenteria

In the following report, we present the case of a 31-year-old patient examined for a suspected small bowel tumour. Small bowel tumours are relatively rare and definitive diagnosis is often preceded by surgical resection. The same was true for our patient examined for a soft tissue lesion found with imaging techniques in close proximity to the small intestine. After ruling out hormonal activity, diagnostic laparotomy was performed. Desmoid fibromatosis, a rare tumour of the mesentery, was confirmed histopathologically. Although without metastatic potential, desmoid fibromatosis is a tumour with moderately malignant potential for aggressive growth into surrounding structures and organs and a large percentage of local recurrences.

Diagnosis and surgical management of idiopathic bile duct cysts in a bearded dragon (Pogona vitticeps)

The case presented shows the clinical signs, diagnosis and surgical management of idiopathic bile duct cysts in a bearded dragon (Pogona vitticeps). A 12-year-old female bearded dragon presented with constipation resulting from the consumption of sand. A soft mass about 4 cm wide could be palpated in the mid-coelom after the substrate passed. The animal started eating, but soon started showing signs of kyphosis. Ultrasound, radiography and computed tomography examinations revealed that the mass was a cyst 4 cm in diameter. Diagnostic laparotomy was performed and the large cyst and affected liver tissue were removed with a partial hepatectomy. Cytology of the cyst was unremarkable, but histopathological examination showed the lesions to be bile duct cysts. No sign of malignancy or inflammation could be seen.

A Case Report of Neglected Gossypiboma Causing Abdominal Pain for 20 Years Post-Cesarean Section.

Gossypiboma refers to a mass usually made of cotton (e.g., surgical gauze or sponge) that is accidentally left in a patient's body during surgery. We report the case of a 54-year-old multigravida menopausal woman who previously underwent cesarean section to deliver her second child. She was referred to our medical center after a 7 cm right ovarian mass with malignant potential was discovered. A diagnostic laparotomy was performed then confirmed the presence of a 10 cm gossypiboma attached to a metallic ring. This case is an alarming example highlighting the importance of adequate intraoperative counting of gauze and radiologic evaluation of chronic pelvic pain.

A Cohort Study to Decode the Application of Peritoneal Carcinomatosis Index in Predicting the Prognosis of Advanced Ovarian Malignancies

Introduction: Peritoneal Carcinomatosis Index (PCI) is used to assess the extent of peritoneal cancer by dividing the peritoneal cavity into 13 well-defined regions and assessing the size of the largest tumour nodule in each region. Aim: To evaluate the imaging features of peritoneal carcinomatosis using Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) and correlate it with diagnostic laparotomy. Also to To determine the prognostic significance of peritoneal carcinomatosis index calculated radiologically in predicting the outcome of advanced ovarian malignancies. Materials and Methods: This was a prospective cohort study conducted in Kilpauk Medical College, Chennai, Tamil Nadu, India, from July 2019 to December 2020. Total of 50 females between 18-80 years of age with advanced ovarian malignancies with peritoneal deposits underwent CT and MRI to calculate initial PCI. Then these patients underwent cytoreductive debulking after which final response was assessed. Followedup for a period of 1 year to assess the treatment response and to look for any complications. IBM Statistical Package for the Social Sciences (SPSS) version 22.0 software was used for statistical analysis. Descriptive analysis was carried out using mean and standard deviation for quantitative variables. Results: Fifty women were included with a mean age of 53.4 years. PCI calculated using CT and MRI showed strong correlation with laparoscopic PCI with correlation coefficient (r) of 0.984 and 0.988 respectively with a statistically significant p-value &lt;0.001. Initial radiological PCI and cytoreduction showed strong correlation when analysed using ROC curve (Receiver Operating Characteristic curve) with an AUC (Area under the ROC Curve) of 0.933. With Youden index a cut-off value of 11 was derived under which patients had optimal cytoreduction and a better outcome. Radiological PCI showed good sensitivity (82.35%) and specificity (88.78) for predicting complications and it was found that patients with PCI &gt;15 were at a higher risk for developing various complications. Conclusion: Radiological PCI strongly correlate with laparoscopic PCI and is a very strong predictor of disease outcome in advanced ovarian malignancies. It was found that patients with high PCI values had poor response to cytoreductive surgery and chemotherapy. So, high initial PCI values above 11 was indicative of poor patient prognosis.

Mesenteric Injury in Blunt Abdominal Trauma in Children: Is Early Surgical Intervention Need of the Hour?

Objective:There is an increasing trend of observational, nonsurgical management of abdominal injuries in children. We analyzed the feasibility and outcome of our management protocol in managing cases of the mesenteric injuries in blunt trauma abdomen in pediatric age group.Methods:Single-center retrospective analysis of pediatric trauma case records from July 2018 to March 2020 was performed.Results:Thirty-four cases of blunt abdominal trauma of whom 13 had mesenteric injuries were reviewed. The male-to-female ratio was 2.2:1, and the mean age was 9.11 ± 4.90 years. Mesentery of the small bowel was the most commonly injured segment and treatment consisted of repair of mesenteric tear, resection, and anastomosis with or without stoma formation.Conclusions:Isolated mesenteric injury of all grades should be managed either with diagnostic laparoscopy or laparotomy irrespective of hemodynamic status.

Case Report on Ectopic Pregnancy with Septicmia

Introduction: Ectopic pregnancy is a complication of pregnancy in which the embryo implants outside the uterus. Abdominal discomfort and vaginal bleeding are common signs and symptoms, but only around half of the women who are affected experience both. The discomfort can be severe, dull, or crampy. If there is bleeding into the abdomen, pain may radiate to the shoulder. A rapid heart rate, fainting, or shock may occur as a result of severe bleeding. The foetus, with a few exceptions, is unable to live. Obstetricians and gynaecologists face a number of obstacles when dealing with emergencies in Jehovah's Witnesses.&#x0D; Main symptoms and/or important clinical findings: She is a 20-year-old woman who had an emergency diagnostic laparotomy for a ruptured ectopic pregnancy with pyosalpinx and septicemia on February 14, 2021. Her diagnostic Ultrasonography has been completed. A complete blood investigation has been completed. She was moderately symptomatic before 8 days, when she was primigravida with 2 months of pregnancy, and then she got abdomen cramps that worsened with time.&#x0D; The main diagnoses, therapeutic interventions and outcomes: She is a 20-year-old woman who had a post-surgical case of Explore Laparotomy For Ruptured Ectopic Pregnancy with pyosalpinx and septicemia, as well as acute abdominal pain. Her treatment began on the day of admission with IV fluids, antibiotics and injectables. Started, advised for Zonac suppository PR, and finished all necessary research. &#x0D; Nursing Perspectives: Laboratory techniques are urgently required. In order to limit the development of treatments to enhance the outcome.&#x0D; Conclusion: Although it is rare for an ectopic pregnancy to go past the first trimester, it does happen. Thus, it is necessary to rule out ruptured ectopic pregnancy in all cases of surgical abdominal urgency during pregnancy, as it is life-threatening to the mother if proper diagnosis and care are delayed. Despite the fact that early intervention saves lives and minimizes morbidity, ectopic pregnancy still accounts for 4 to 10% of all pregnancy-related deaths and is associated with a high rate of ectopic site gestations in subsequent pregnancies.

Хроническая фистула для изучения микробиома слепой кишки кролика

Abstract. The purpose of this work is to approve a device for studying the microbiome of the gastrointestinal tract of mammals. The study of the quantitative and qualitative composition of the digestive tract microbiota is one of the promising directions in metagenomics. Knowledge obtained about the organization of microbiocenosis genome, the determination of species composition and study of metabolic relationships between its representatives not only expand the understanding of its role in the process of evolution, speciation and breeding but also provide a scientifically substantiated basis for targeting changes in the microbiome to form a phenotype (optimization of feed bioconversion, increasing overall resistance, etc.). Scientific novelty. For the first time, the main characteristics of cellulolytic bacteria isolated from the chyme of the rabbit cecum were isolated, cultured and described through a chronic fistula. Methods. In order to carry out research aimed to study mammalian microbiome and its correction, the need arises to develop methods of obtaining microbiome samples from experimental animals. To obtain access to the chyme of the cecum in 7 rabbits for up to 3 months the chronic fistulas developed in Scientific Research Institute of Fur-Bearing Animal Breeding and Rabbit Breeding n. a. V. A. Afanas’ev were installed. No negative manifestations were observed in the animals after installation of the fistulas, no changes in appetite were detected, and complete healing of the skin wound was determined on the 9th day. Diagnostic laparotomies performed 3 months after fistula placement revealed no pathological processes in any of the studied animals. Results. Characteristics of cellulolytic bacteria of the rabbit cecum Butirivibrio fibrisolvens and Ruminococcus flavefaciens were studied. Data on their enzymatic effects on dietary components, fermentation products, digestion and formation of organic substances and chemical compounds are presented.

Vaginal Atresia with Cervical Agenesis, a Rare Congenital Malformation

Congenital vaginal atresia and cervical agenesis is a rare congenital abnormality of the female genital tract. Here we report a case of 15-year old girl with primary amenorrhea with hematometra, presented with lower abdominal mass. She was symptomatic since 5 months and visited local hospital after 4 months of onset of her symptoms when it became severe, where diagnostic laparotomy was performed for suspected Adnexal mass. Intraoperatively adnexal mass was adhered with and extended up to the uterus with 16 weeks size of uterus. Abdomen was closed without any further intervention and was referred to higher center for needful. When she presented to Kathmandu Model Hospital, she was asymptomatic on her 5th post-operative day of laparotomy. We planned for surgical intervention after examination and investigation. Drainage with vaginoplasty with amnion graft with placement of mould was done.

Clinical improvement of encapsulating peritoneal sclerosis after challenging course and 6\xa0months of total parenteral nutrition in child with nephronophthisis: a case report

BackgroundEncapsulating peritoneal sclerosis is a rare but potentially lethal complication of long-term peritoneal dialysis that is associated with significant morbidity and mortality. The occurrence of encapsulating peritoneal sclerosis varies worldwide, but is increased in patients maintained on peritoneal dialysis for 5–8 years. The etiology of encapsulating peritoneal sclerosis remains unidentified, and a high index of clinical suspicion is required for diagnosis.Case presentationWe report a 5-year-old Saudi female with end-stage renal disease secondary to nephronophthisis type 2. She underwent peritoneal dialysis for 30 months, with four episodes of peritonitis. She presented with clinical signs of peritonitis. Three days later, she developed septic shock, which required pediatric intensive care unit admission. The peritoneal dialysis catheter was removed because of refractory peritonitis. Her course was complicated by small bowel perforation, and severe adhesions were revealed on abdominal ultrasound and computed tomography, consistent with a diagnosis of EPS. This finding was later confirmed by diagnostic laparotomy performed twice and complicated by recurrent abdominal wall fistula. She received total parenteral nutrition for 6 months and several courses of antibiotics. The patient received supportive treatment including nutritional optimization and treatment for infection. No other treatments, such as immunosuppression, were administered to avoid risk of infection. Following a complicated hospital course, the patient restarted oral intake after 6 months of total parenteral nutrition dependency. Her abdominal fistula resolved completely, and she was maintained on hemodialysis for few years before she received a kidney transplant.ConclusionWhen treating patients using peritoneal dialysis, it is important to consider encapsulating peritoneal sclerosis with refractory peritonitis, which is not always easy to identify, particularly if the patient has been maintained on peritoneal dialysis for less than 3 years. Early identification of encapsulating peritoneal sclerosis and appropriate conservative treatment, including nutritional optimization and treatment of infections, are essential to achieve a better prognosis.

Congenital gallbladder agenesis in a 9-month-old Bull Terrier

Congenital gallbladder agenesis is an extremely rare disorder, which has, to the best of our knowledge, only been reported in seventeen dogs (mainly in Japan). In almost all of these cases, gallbladder agenesis or hypoplasia was detected in small dogs. In this report, we present a case of gallbladder agenesis in a 9-month-old intact female Bull Terrier. The clinical signs included diarrhoea, sporadic vomiting, apathy and decreased appetite. The serum biochemistry revealed an increased liver enzyme activity, an increased concentration of serum bile acids and mild hyperbilirubinaemia. A diagnostic laparotomy demonstrated the lack of a gallbladder and dilation of the common bile duct, which was misinterpreted as the gallbladder in the ultrasonographic examination. The histological examination of the liver revealed degenerative changes in the hepatocytes with glycogen accumulation and some necrotic hepatocytes. The therapy included a low protein diet, fluids, silymarin and ursodeoxycholic acid. After nine weeks of therapy, the dog was in good condition, the diarrhoea and vomiting ceased, and the liver function parameters, such as the AST and GLDH activities, and the concentration of bile acids had decreased to reference intervals.

Features of the development of traumatic pancreatitis with gunshot wounds to the abdomen

The features of the development of traumatic pancreatitis in gunshot wounds of the abdomen, which present difficulties in timely diagnosis, are considered, hypotheses are formulated for studying the problem. Two clinical cases of developing traumatic pancreatitis against the background of a gunshot wound to the abdomen with indirect damage to the pancreas are presented. Without taking into account the peculiarities of the formation of the wound canal relative to the organs of the abdomen, in conditions of limited diagnostic potential, there is a high probability of late diagnosis of traumatic pancreatitis, especially in indirect damage. Injuries to the organs of the upper half of the abdomen can be risk factors for indirect damage to the pancreas due to the effect of lateral impact energy and the formation of a temporary pulsating cavity. In general, the management of such wounded in a surgical hospital with limited diagnostic capabilities or with stage treatment in a local military conflict requires the surgeon to know the peculiarities of the course of traumatic pancreatitis, which make it possible to prevent the development of complications in a timely manner. The development of traumatic pancreatitis in penetrating gunshot wounds to the abdomen is not always a consequence of direct pancreatic injury. This circumstance must always be taken into account during a diagnostic laparotomy.

O83: COMPASS – MANAGEMENT OF COMPLICATED INTRA-ABDOMINAL COLLECTIONS AFTER COLORECTAL SURGERY, A EUROSURG COLLABORATIVE INTERNATIONAL STUDY

Abstract Presenting Author Email: ruthblancocolino@gmail.com Research question To explore current practices on the use of prophylactic postoperative drains in colorectal surgery and whether it influences 30-day postoperative outcomes. Background and aim Traditionally, postoperative drains have been used in colorectal surgery for the prevention or early detection of intraabdominal collections. However, current evidence suggests there is no clear clinical benefit to prophylactic drain placement following colorectal surgery, and Enhanced Recovery After Surgery (ERAS) guidelines recommend against their routine use. Nevertheless, a previous international audit by Eurosurg (Ileus Management International) found more than a third of participating centres routinely placed a drain in more than half of their patients. Therefore, this study aims to audit compliance to ERAS guidelines regarding the use of postoperative drains in colorectal surgery. Design Patients Adult patients undergoing elective and emergency colorectal surgery will be included. Procedures under any surgical approach including any formation of colostomy or ileostomy, resection of large bowel, or reversal of stoma will be eligible. Patients undergoing appendicectomy, transanal surgery, primarily urological, gynaecological or vascular procedure, surgery involving multivisceral resection, diagnostic laparotomy or laparoscopy or hernia surgery without colorectal resection, will be excluded. Comparator Group of patients receiving a prophylactic drain after surgery. Main explanatory variable will be intrabdominal collections rate including anastomotic leak. Outcomes The primary outcome measure will be the adherence to selected ERAS guidelines regarding rate of routine prophylactic drain insertion in colorectal surgery. As Secondary outcome measures we will assess: • Rate of intra-abdominal postoperative collections, defined as collections which alter the normal postoperative course (e.g. requiring either medical, radiological, endoscopic or surgical intervention). • Time-to-diagnosis (days) of intra-abdominal postoperative collections defined as collections which alter the normal postoperative course. • Rate of drain-related complications defined as: surgical site infection by Centers for Disease Control and Prevention definition; cutaneous irritation at the drain insertion site; small bowel evisceration and herniation of omentum, bowel injury (defined as intraoperative identification of or CT-proven drain-related iatrogenic bowel perforation); time (measured in whole days) until drain removal and drain output (quantity and contents) on day of removal; and overall 30-day adverse event rate as defined by the Clavien-Dindo scale of postoperative complications and length of stay (days). Study design This is a prospective, multicentre, audit that will be conducted through the student- and trainee-led EuroSurg collaborative network across Europe, South Africa and Australasia. Data will be collected on consecutive 14-day periods, from 3rd February to 26th April 2020, with 30-day follow-up on included patients. Data will be collected online on REDCap database based on Birmingham University. Team and infrastructure The study will be run by the European Student Research Collaborative. EuroSurg is a pan-European student- and trainee-led surgical which also counts with international collaboration from Australia, New Zealand and South Africa. The study will be coordinated by the International Study Management Group and at each participating country, there will be a core of national leads or national collaborative in charge of organising the study locally. Each hospital will count with a Local Lead who will coordinate the mini-teams based at their centre and will be in contact with its corresponding National Leads. A mini-team will be composed by three collaborators collecting data and a supervising consultant per centre. As infrastructure for leading the project, we will use social media for study diffusion including Twitter, Facebook, Instagram and LinkedIn, and emails through Gmail official account and Mailchimp. Management group communications will be held through WhatsApp, Slack and Skype.

INTESTINAL MALROTATION - A COMMON YET DEADLY CAUSE OF NEONATAL SMALL BOWEL OBSTRUCTION

Background: This study was done at SMS Medical College, Jaipur with an aim of emphasizing the need of having a high index of suspicion in newborn presenting with bilious vomiting for the diagnosis of malrotation. Methods: Cases of neonatal small intestinal obstruction due to malrotation presenting to the Department of Paediatric Surgery, SMS Medical College, Jaipur over a period of two years were evaluated. Results: A total of 48 newborns presented to our department with intestinal obstruction due to malrotation. Majority (82%) of the patients presented in the 2nd and 3rd week of life. 6 out of 48 patients presented with extensive gangrene of midgut. 9/48 patients died during the course of treatment and during follow-up. Conclusion: Malrotation is a relatively common cause of neonatal small bowel obstruction. A high index of suspicion is required in neonates presenting with bilious vomiting. Prompt diagnostic tools and early laparotomy prevents fatal complication of extensive midgut gangrene due to volvulus.

Asymptomatic Superior Mesenteric Arterial Stenosis: Primum non nocere

In this era of modern imaging the issue of how to handle asymptomatic lesions is a common discussion at hospital rounds worldwide. When I was a young surgical trainee in the 1970s, the most common abdominal surgical procedure was diagnostic laparotomy, imagine! Fortunately, that was a long time ago, but the present situation, in which we are exposed to multiple asymptomatic lesions, creates a new challenge.