Emergency Surgical Intervention Research Articles

Laparoscopic Cholecystectomy in Acute Calculous Cholecystitis (Study of 75 cases)

Background: Acute calculous cholecystitis is one of the commonest biliary tract emergencies. The advent of laparoscopic cholecystectomy has brought about a change in the treatment approach from conservative to emergency surgical intervention. Emergency laparoscopic cholecystectomy is emerging as the standard of care. Therefore the need to evaluate the various factors which determine the safety of the procedure. Aims: The aim of the study is to evaluate the efficacy and safety of laparoscopic cholecystectomy in acute calculous cholecystitis. Materials and methods: Consecutive patients who underwent laparoscopic cholecystectomy for acute calculous cholecystitis over a 2-year-old period were studied prospectively. Results: 75 patients were evaluated. The mean age was 49.48 years. Majority presented with right hypochondriac pain. 22 patients had hypertension. 26 had diabetes and 6 patients had both hypertension and diabetes. In 61 patients the mean duration of surgery was less than 60 minutes. 5 patients needed conversion to an open procedure. 10 patients developed complications. The mean hospital stay was 4.34 days. Conclusion: Early emergency laparoscopic cholecystectomy is a safe and viable option for treating acute calculous cholecystitis.

Ventrikularna tahikardija I hipertenzivna kriza izazvane rutinskom reverzijom neuromuskularne blokade - prikaz slučaja I pregled literature

Introduction: Neuromuscular blockade reversal may provoke cardiovascular events. We present the case of a middle-aged, vascular patient in whom ventricular tachycardia and hypertensive crisis occurred immediately after the initiation of neuromuscular blockade reversal. Patient Review: A 56-year-old man was admitted to our institution for emergency surgical treatment of left extremity ischemia. Besides hypertension, the patient's medical history was negative for any other significant acute or chronic diseases. Routine preoperative analyzes, ECG, and echocardiography showed normal findings. The patient underwent urgent trans popliteal thrombectomy under general endotracheal anesthesia. Immediately following the initiation of neuromuscular blockade reversal, with a diluted mixture of atropine and neostigmine (1 mg/2.5 mg, respectively), ventricular tachycardia and hypertensive crisis developed. Arterial blood gas analyses and electrolyte values were within the reference limits at the moment. Adequate therapeutic measures were undertaken immediately, and sinus rhythm was restored shortly. Later, serial ECG records showed negative T waves in the precordial leads, with an increasing trend of troponin I values (ranging from 0.59 to 5.45 mg/L). Coronary angiography was later performed and revealed a normal coronary angiogram. During the next three days, ischemic ECG alterations showed resolution and the patient was hemodynamically stable. On the fifth postoperative day, the patient was discharged, in good general medical condition. Conclusion: A careful administration of the atropine/neostigmine mixture is advised. Malignant arrhythmias must be recognized and treated promptly by an anesthesiologist, in order to achieve positive treatment outcomes.

Emergency surgical treatment for active bleeding and anemia in patients with hemorrhoidal disease.

The purpose of the study is to describe the clinical and surgical characteristics of patients with hemorrhoidal disease (HD), anemia, and active bleeding in need of urgent surgery. It is a descriptive, retrospective study of 510 patients between 2015 and 2019. Male and female patients diagnosed with HD. The records of these patients were reviewed, and we identified those who underwent emergency surgery due to active bleeding, anemia, shock, and other clinical problems. Statistical analysis was carried out with the SPSS version 24 software. Fifty-three (10.3%) patients met the criteria for presenting active hemorrhoidal bleeding at the time of review and clinical and biochemical data of anemia. Patients presented a mean hemoglobin of 7.5 g/dl. The most frequent degree of HD was Grade II. The treatment received in 92.5% of the cases was hemorrhoidectomy with the Ferguson technique; in 5.7% (3), a hemorrhoidectomy was performed with an advanced energy device, and 1.9% (1) underwent the Milligan-Morgan technique. Emergency hemorrhoidectomy is the treatment of choice for patients with severe active bleeding from HD.

Fetal Ovarian Cysts: Prenatal Diagnosis Using Ultrasound and MRI, Management and Postnatal Outcome-Our Centers Experience.

The present study provides our clinical experience regarding the imaging diagnosis, management and postnatal outcome of neonates prenatally suspected of having developed ovarian cysts. This multicenter observational study included patients diagnosed prenatally with fetal ovarian cysts and follow-up in the postnatal period. Descriptive statistics were used to render the information regarding the prenatal imaging aspect of the fetal pelvic masses using ultrasound and/or MRI, prenatal surveillance and postnatal neonate’s immediate outcome, indications leading to surgery and pathologic aspect. The inclusion criteria were fulfilled by 21 patients. The mean gestational age at the time of initial diagnosis was 31.28 weeks of gestation (WG). Only five out of 21 cysts regressed completely during pregnancy without postnatal complications. In addition, 11 out of 21 infant’s required surgical treatment in the first two weeks after birth, mainly for ovarian torsion. Five out of 21 neonates were referred to postnatal follow-up clinically and by ultrasound, but three out of five cases required emergency surgical treatment for acute complications. Ultrasound plays a major role in the diagnostic of fetal ovarian cyst. From our experience, MRI does not bring supplementary data or change the management. Spontaneous resolution of fetal ovarian cysts is to be expected but the ovarian mass could lead to serious complications, if resolution does not occur in due time.

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

Spontaneous spinal epidural hematomas are rare and potentially disabling neurological emergencies. Its lead to devastating neurologic outcomes and most patient does not recover completely. The clinical presentation is diverse and includes a severe acute attack, radiating pain at the back, interscapular, or neurological deficits. We report a case of a young woman, 24-year-old, that was admitted to our department for sudden non-traumatic cervical spinal cord compression syndrome (Type A of the American Spinal Cord Injury Association “ASIA A”) including intense cervical back pain, sensory loss, and tetraplegia. Her past medical history was unremarkable. The MRI confirmed a cervical mass responsible for the spinal cord compression and the emergent surgical intervention allow us to evacuate acute C3-C7 hematoma. The patient never recovers from the neurologic deficit despite the emergent management of her case followed by functional musculoskeletal rehabilitation for two years.

Torsion of the uterine appendages in an 11-year old girl with ovarian endometriosis

Introduction. It is known that hormonal and immune disorders are the background for endometriosis development. In children, ovarian endometriosis is extremely rare. Enucleation of an endometrioid cyst with preservation of healthy ovarian tissue is an enough surgical volume. However, torsion of adnexa in adolescence is quite an often pathology, and even in case of true ovarian tumor absence, it requires adnexectomy which, as a rule, finishes with uterine appendages removal.A clinical observation. An 11-year-old girl with a history of early menarche was admitted to the surgical department with a clinical picture of twisted adnexa: acute abdominal pain combined with repeated vomiting. After gynecologist’s examination, a torsion of the left appendage was suspected; the patient was transferred to the gynecological department where ultrasound examination revealed a volumetric formation in the left ovary. Indications for emergency surgical treatment were outlined. Laparoscopy and left adnexectomy were performed. Histological examination revealed no necrotic changes in the uterine appendages, but an endometrioid cyst was found. On day 7, the patient was discharged from the hospital. The article presents a clinical observation of 11-year-old girl with twisted adnexa and an endometrioid cyst. To treat this pathology, the girl had laparoscopy and adnexectomy.Conclusion. Immediate and correct diagnosis was put due to a typical clinical picture of twisted adnexa in a teenage girl. The volume of surgical intervention is unreasonably large. Early menarche should be considered as a marker of endometriosis in preclinical diagnostics of the disease so as to prevent urgent conditions and to preserve the reproductive potential. Unjustified ovariectomy during the formation of hypothalamic-pituitary-ovarian axis in a teenager, with the initially unfavorable premorbid background, brings even greater aggravation of hormonal and immune disorders with the stress to homeostasis-regulating systems.

Oral Candidiasis with Subcutaneaous Emphyema Associated With Sari Following Post COVID 19: A Case Report

Background: Over the last few decades, the covid 19 has increased all over the world. More issues are likely to be observed as covid 19 rate increases. The major cause of morbidity and mortality is infection. Oral Candidiasis With Subcutaneaous Emphyema and SARI are very rare complications in Covid 19 patient. The final cause is infection, but sometimes it causes due to allergic or inflammatory reaction of the drugs. If it occurs after post covid 19 then creates very serious issues with the peoples health.
 Case Presentation: Here we are mentioning a very rare case of Oral Candidiasis With Subcutaneaous Emphyema and SARI after Covid 19 positive patient. In this case, on physical examination and investigation, it was found that, after covid 19 patient has developed Oral Candidiasis, Subcutaneous Emphysema , severe breathlessness, cough, fever, nausea, vomiting, throat infection and loss of appetide. To overcome this sudden issue, emergency exploratory medical and surgical treatment was done. During Covid 19 treament her HRCT Score was 21/25 and the infection was severe. There was no any sign of oral candidiasis, subcutaneous emphysema, or tissue or organ damage or no any other abnormality was detected during Covid 19 tratment. No bacterial growth or fungal growth observed on investigation. After some days and treatment of covid 19 the patient was developed a Oral Candidiasis and Subcutaneous Emphysema and SARI. The working diagnosis was finalized by doctors i.e. Oral Candidiasis With Subcutaneaous Emphyema and SARI. After expert medical management and excellent nursing care patient was discharged with full recovery.
 Conclusion: In this study, we mainly focus on expert medical management and excellent nursing care helped in managing the complicated case very nicely. All the patient response was positive for conservative and nursing management and after treatment the patient was discharged without any complications and satisfaction with full recovery.

P-BN29 Laparoscopic cholecystectomy during the era of a Covid-19 pandemic; a cohort study

BackgroundThe Covid-19 era has created a lot of uncertainty for management of common emergency and elective surgical conditions such as acute cholecystitis and other gallstone disease related emergency admissions. At our centre we continued to provide early operative intervention for patients presenting with biliary disease and acute cholecystitis throughout the Covid-19 era during both the 1st and the 2nd waves, despite a significant local surge in Covid-19 hospital admissions impacting on the available resources. Here we present the outcomes of our experience of managing such patients during the Covid-19 pandemic of 2020 of both 1st and 2nd waves.MethodsA retrospective observational study was performed on all patients presenting with acute cholecystitis and biliary disease who underwent elective and emergency surgical intervention at UHNM (University Hospital of North Midlands) during the second wave of the Covid pandemic (2nd CW) between 14/10/2020 and 14/01/2021). These were then compared with patients who presented in the first Covid wave (1st CW) of 1/03/020 – 30/06/2020,) and a control group pre-covid (CG) 1/03/2019 – 30/06/2019, Patients were identified using ICD-10 codes K80 (Cholelithiasis) and K81 (Cholecystitis) and OPCS codes.J18.1 – J18.5. Primary endpoints were length of stay, 30 day readmission rates, mortality and morbidity.ResultsA total of 146 patients were identified who underwent laparoscopic cholecystectomy during the study time period (2ndCW). In comparison to 104 patients during the first covid wave cohort (1st CW) and the control group (CG) of 217 patients in the preceding non covid year. Length of stay (LOS) was significantly lower in the 2ndCW cohort in comparison to both the previous 1st CW cohort and the CG cohort (p < 0.0001), with readmissions also being statistically lower (5% vs 15% and 12% respectively p = 0.027). There was no statistical difference in outcomes for post-operative complications as per Clavien-Dindo classification.ConclusionsOverall our study demonstrates that the recommended good practice of early surgical intervention in both emergency and elective gallstone disease can continue during the pandemic periods without any significant impact on patient care & outcomes. Also during this period length of stay was significantly shorted and lower 30 day readmission rates which are likely to be multifactorial but where lessons could be potentially learnt.

TRAUMATIC RUPTURE OF ISOLATED SPLENIC HYDATID CYST

A traumatic rupture of isolated spleenic hydatid cyst (SHC) has been reported very rarely in the literature. In this article a case of traumatic isolated splenic hydatid cyst rupture treated with emergent surgical intervention is presented. The patient was brought to emergency department after an automobile accident. After 4 hours, his hemodynamic parameters deteriorated with impending frank peritonitis. Immediate laparotomy was performed due to failed non-operative treatment. The recovery was uneventful and the patient was discharged at 6th postoperative day. Spleen is one of the most commonly injured solid organs in the abdomen as a result of trauma. SHC is usually solitary, though it is not common even in endemic regions, and multiple organ involvement is common if spleen is involved. In the present case, no other organ was involved besides spleen. Emergency surgery is the main treatment for ruptured SHC. For relapses, patient should be followed up in post-op period with 4-6 month intervals by abdomen ultrasonography, computerized tomography and indirect haemagglutination.

An uncommon presentation of primary gastro-intestinal non- Hodgkin’s lymphoma (PGINHL) with multiple jejunal strictures in a young patient

Introduction:Primary gasrointesinal non-Hodgkin’s lymphoma (PGINHL) is a heterogeneous complex disease (1).Variations in patients’ characterisics, clinical sages, hisologic sub-types, and treatment options dependlargely on the site of origin (1, 2). In fact, gasrointesinal tract is the mos commonly involved site forprimary NHL occurrence, accounting for nearly 20–40% of all extra-nodal disease (2). It arises from thelymphoid tissues within the wall of small intesine which are more abundant in the ileum (3), being eitherlocalized to a single segment of the small intesine, or multi-centric in 15–20% (3). Clinical presentation isextremely variable with a wide range of presenting symptoms like: non-specifc abdominal pain; anorexiaand weight loss; diarrhea; subacute obsruction; and a palpable abdominal mass (2, 4-6), with an emergencysurgical treatment being required in 11–64 % of cases (4). Herein, authors describe an unusual presentationof a PGI NHL in a young Sudanese patient who suffered from recurrent episodes of subacute small bowelobsruction due to multiple jejunal srictures (simulating Crohn’s disease clinically and radiologically) andfound to have a diffuse large B-cell lymphoma on hisopathological examination of the surgical specimen.

Atraumatic Bilateral Acute Compartment Syndrome of the Lower Legs: A Review of the Literature.

Bilateral acute compartment syndrome of the legs is a very rare presentation that requires emergency surgical intervention. Atraumatic bilateral cases are almost unheard of in medicine. There is currently no link between compartment syndrome and cognitive impairment or mental health.A systematic literature search was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines using the following keywords in multiple databases: compartment syndrome, atraumatic, spontaneous, bilateral, both, lower leg, acute, compartmental pressure, and fasciotomy. Atraumatic, bilateral, acute, and confirmed compartment syndrome cases were included.In total, 33 cases of atraumatic bilateral acute compartment syndrome (ABACS) were identified, of those 72.7% of cases were males. A form of cognitive impairment was found in 66% of cases. The medical history of the cases included substance abuse (nine patients), mental health illness (seven patients), and hypothyroidism (four patients). Within the reports, there was evidence of a misdiagnosis or delayed management in 19 cases (57.6%). Creatinine kinase (CK) was measured in 28 cases with a mean CK of 110,893 IU/L. Compartment pressure measurements were used in only 12 cases. A total of 29 cases were managed with bilateral four-compartment fasciotomy.This review highlights that ABACS is a condition with high rates of misdiagnosis or delay in treatment. Associations found included patients with cognitive impairment on presentation, mental health conditions, substance misuse, and elevated levels of CK. In addition, this review demonstrates that this condition is less rare than previously thought with serious morbidity and mortality.

Laparoscopic Port-Site Hernia: An Underrecognized Iatrogenic Complication of Laparoscopic Surgery.

Port-site hernia is an iatrogenic complication with a documented incidence between 0.65% and 2.8%. However, the true incidence could be higher because of delayed onset, asymptomatic nature, and loss to follow-up. Port-site hernia could be further complicated by incarceration or strangulation leading to small bowel obstruction requiring emergent surgical intervention, thus imposing significant financial and emotional burden to patients. This article aims to provide a summary of the available literature concerning port-site hernia and explore preventive strategies for future clinical practice. This review was formulated through electronic literature searches in Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. The reference lists of the included studies were hand searched to identify other relevant articles to capture all available literature in this narrative review. Following screening for eligibility based on relevance to the topic under consideration, 28 studies were identified. This included 5 original articles, 1 case series, and 22 review articles, including 4 systematic reviews. Included studies were critically appraised in formulating this review. Port-site hernia is an underrecognized yet preventable complication with careful consideration of predisposing technical and host factors, thorough attention to surgical technique, or use of a fascial closure device. With the widespread and increasing use of laparoscopic methods to treat surgical pathologies, knowledge of this complication is imperative to encourage prevention strategies and facilitate early recognition and management should it occur.

Characteristics of Patients with Nonvariceal Upper Gastrointestinal Bleeding - Are We Underestimating Gastroprotection during NSAIDs Therapy?

The aim of our study was to determine the etiological factors, treatment and outcome of patients with non-variceal bleeding from upper gastrointestinal tract. This study enrolled 200 patients admitted to Sarajevo University Clinical Center with signs and symptoms of upper gastrointestinal bleeding, from January 2019 to July 2020. All patients had undergone gastroscopy, confirming the cause of gastrointestinal bleeding. Clinical and laboratory data were collected retrospectively, including previous non-steroid antiinflammatory drugs (NSAIDs) and anticoagulant therapy, comorbidities, risk factors, as well as endoscopic findings, laboratory findings, treatment and clinical follow-up. The majority of patients were men (59%) with an average age of 53±6 years. Duodenal and gastric ulcers were the most common cause, followed by other etiologies. In our study, previous NSAIDs therapy had been registered in 29.5% of patients, anticoagulants in 8%, and proton pump inhibitors (PPI) in 2.9% of patients. Endoscopic intervention was required in 34% of patients. The need for transfusion occurred in 44.5% of cases. Rebleeding during hospitalization was observed in 7.5% of patients, mortality in 1.5% and surgery in 3% of patients. The patients admitted to our hospital with symptoms of acute nonvariceal upper gastrointestinal bleeding were elderly, predominantly males, with significant comorbidities and a higher incidence of NSAID use. Gastroprotection is underutilized during NSAID treatment in patients with other coexisting risk factors, with a low rate of concomitant use of PPI during NSAIDs therapy. Endoscopic therapy, together with PPI, significantly reduces rebleeding rates, mortality and the number of emergency surgical interventions.

Abstract 17228: Not Just Another Knick In The Wall: An Unusual Case Of Multiple Arterial Aneurysms

Case Presentation: 47-year-old Liberian woman with a history of latent TB and no prior cardiac history presented with dyspnea, palpitations, and weight loss. She had fevers, tachycardia, and cervical lymphadenopathy. Cardiac exam showed widened pulse pressure, systolic and diastolic murmur, and features of heart failure. TTE showed dilated left ventricle with preserved ejection fraction, aortic root aneurysm compressing left atrium, severe aortic and mitral regurgitation, and moderate pericardial effusion with no tamponade. CT angiogram of neck, chest and abdomen showed right subclavian artery mycotic aneurysm, large left supraclavicular lymphadenopathy, multiple aortic arch, and descending thoracic aorta mycotic aneurysms. She underwent emergent surgical intervention. Intraoperative TEE revealed rupture of aortic root aneurysm into left ventricular outflow tract causing a fistula, perforated anterior mitral leaflet, and distortion of the left atrial wall. She underwent mitral and aortic tissue valve replacement, aortic root replacement, and a pericardial patch repair of the left atrial wall. Subsequently, she underwent right subclavian artery aneurysm resection, right carotid axillary bypass, and vertebral artery reimplantation. Aortic valve pathology was suggestive of endocarditis with negative cultures. Lymph node biopsy revealed non-necrotizing granulomatous inflammation with no evidence of acid-fast bacilli, fungi, and malignancy. Autoimmune workup was negative. A PET CT showed post-surgical inflammatory changes with no evidence of malignancy. Discussion: We describe an unusual case of multiple large arterial aneurysms causing severe valvular insufficiency requiring emergent surgical intervention. The patient underwent extensive workup which was unrevealing. She was treated for subacute bacterial endocarditis and suspected Bechet’s disease. Thus, the quest for a definitive diagnosis continues to elude us.

Frequency distribution and coordination of emergency operations in German hospitals (FACE) : Analysis in 26hospitals depending on the level of care

Timely emergency surgery is vital as this often has adirect impact on morbidity and mortality. The joint recommendations of the German Associations of Anesthesiologists (BDA), Surgeons (BDC), and Operating Room Management (VOp.M) for coordinative implementation have been available since 2016: N0 (surgery immediately), N1 (surgery start in the next free operating room), N2 (surgery start ≤ 6 h), N3 (surgery at the end of the elective schedule), N4/Urgent (surgery within 12-24 h). The aim of this study was to describe the situation of care in German hospitals of different sizes for the first time using routine data. The data were collected in 26hospitals with different levels of care over aperiod of 10days. The frequency distribution of the individual emergency categories and the duration from the notification of the operation to the start of anesthesia or surgery were examined for the hospital as awhole and for the four operating departments with atypically high ratio of emergencies: general surgery, trauma surgery, gynecology/obstetrics and urology. Atotal of 1603 emergency surgical interventions were analyzed. The number of N0cases was very low due to the specific entity of these emergencies, N1 made up approximately 13-15% of emergencies and categories N2-N4/Urgent comprised approximately 25-32% of emergencies each. The average duration between the notification of the operation and the start of anesthesia or surgery was (min): N0 20.7 ± 14.3 and 43.6 ± 31.8, N1 61.5 ± 48.7 and 90.1 ± 56.1, N2 187.9 ± 152.0 and 220.5 ± 153.4, N3 394.5 ± 392.3 and 428.3 ± 397.9 and N4/Urgent 494.8 ± 484.4 and 519.6 ± 486.6, respectively. The distribution of the emergency categories did not differ significantly between community hospitals compared to tertiary care hospitals, including university hospitals (p = 0.731) and also the duration between notification and start of anesthesia and operation was similar. Significant differences depending on the service level were only found for N1 until the start of anesthesia and for N3 until the start of anesthesia and of surgery. General surgery classified as N3 has asignificantly shorter implementation time in community hospitals compared to tertiary care hospitals, including university hospitals, both at the start of anesthesia (mean 287.8 min versus 417.1 min; p = 0.045) and at the start of surgery (mean 316.3 min versus 459.0 min; p = 0.032). The implementation of trauma surgery emergencies classified as N1 took place, based on the start of surgery in community hospitals with an average duration of 91.2 min, statistically significantly faster than in hospitals with amaximum care of 133.0 min (p = 0.036). In urology, there were notable variations between smaller and larger hospitals in emergency interventions with the classification N4/Urgent for both periods of time, both up to the start of anesthesia (p = 0.012) and up to the start of surgery (p = 0.007). At an average of 291.8 min (start of anesthesia) or 294.4 min (start of surgery), the implementation time in hospitals with maximum care, including university hospitals, was shorter than in urological clinics of community providers (626.5 min and 645.6 min, respectively). In gynecology/obstetrics, there was no statistically significant difference between the two groups. Cases with high urgency were surgically treated within ashort time period. Overall, differences in time management of emergencies were only small between hospital types. The gradations in the temporal implementation of the individual emergency categories were due particularly to distinctions in the resources available, such as the number of operating theaters, including the run times.

Methamphetamine Intoxication and Perioperative Complications Following Orthopaedic Surgical Procedures.

BackgroundMethamphetamine use is increasing in prevalence. There is a theoretical increased risk of complication postoperative due to catecholamine depletion. When presented with an urgent surgical problem, there are little data to help counsel the patient on the risks of undergoing surgery in the setting of a positive methamphetamine test result.Aims and objectivesThe aim of this study was to examine the perioperative complication rate for patients who underwent emergent orthopaedic procedures in the setting of a positive methamphetamine drug screen. Additional data were collected in an attempt to further stratify risk factors for perioperative complications in this patient population.Design and methodsA retrospective case series of 110 patients. Patients were identified by querying the medical record for patients with a positive methamphetamine result within 24 hours of the surgery start time. Data were collected on each patient, including the nature of the surgery, the type of injury sustained, disposition from the operating room, among other data points. The primary outcome was the presence of a perioperative cardiopulmonary complication, as determined by a new diagnosis made in the chart. The secondary outcome was whether the patient needed an increased level of care postoperatively.ResultsOf the 110 charts reviewed, three patients sustained complications during their hospitalization; an overall complication rate of 2.7%. One patient developed acute respiratory distress syndrome (ARDS), while two others developed surgical site infections. Of the 19 patients who went to the intensive care unit (ICU) postoperatively, none were because the patient required a higher level of care than the preoperative level.ConclusionsPatients who underwent emergent surgical intervention in the setting of a positive methamphetamine drug test had a low complication rate. While the dogma is to delay surgery in the setting of methamphetamine use, the true risk of undergoing surgery in this setting is not fully understood. We advocate for continued research in this poorly studied group of patients. Larger studies will need to be done in order to fully understand the risks associated with operating in the setting of a positive methamphetamine drug screen.

EP.FRI.753 Investigating the use of a novel pre-hospital triage tool for acute abdominal surgical emergencies – a two-phase single centre cohort study

Abstract Aims Despite recent improvements, delay to theatre in emergency laparotomy(EL) continues to be associated with increased mortality in the UK. This study aimed to assess if patients requiring urgent surgical intervention for acute abdominal surgical pathology could be identified in the pre-hospital setting. Methods A two-phase, single-centre, cohort study was performed. Phase 1 retrospectively investigated patients who underwent emergency laparotomy between 01/01/2019-31/12/2019 at Leeds Teaching Hospital Trust (LTHT) through the NELA database. Phase 2 prospectively assessed NEWS2 for all patients presenting to LTHT Surgical Admissions Unit with abdominal pain between 01/01/2020-31/01/2020. Results Phase 1: 45 patients were coded through NELA and confirmed through operation note as undergoing EL for gastrointestinal perforation. 66%(n = 30) were assessed by the ambulance service and 80%(n = 24) had a NEWS2 of 3 or greater. Phase 2: 319 patients were assessed in SAU/ED resus of which 69 were initially treated by the ambulance service. 30%(n = 21) of these patients had an initial NEWS2 of 3 or above. The sensitivity of a NEWS2 score of &amp;gt;/3 in predicting the need for immediate surgical intervention including EL was 95%(95%CI, 74-99) and specificity was 95%(95%CI, 83-99) with a PPV of 86%(95%CI 67-95) and NPV of 98%(95%CI, 87-99). Conclusion A NEWS2 score of &amp;gt;/3 predicts the need for emergency surgical intervention including laparotomy for gastroinestinal perforation with reasonable sensitivity in this cohort. A pre-hospital triage tool for patients presenting with abdominal pain could utilise NEWS2 as an adjunct to decision-making in an acute abdominal pathway.

Three-Dimensional Printing Assisted Preoperative Surgical Planning for Cerebral Arteriovenous Malformation.

ObjectiveThe aim of this study to investigate the benefits of patient-based 3-dimensional (3D) cerebral arteriovenous malformation (AVM) models for preoperative surgical planning and education. MethodsFifteen patients were operated on for AVMs between 2015 and 2019 with patient-based 3D models. Ten patients’ preoperative cranial angiogram screenings were evaluated preoperatively or perioperatively via patient-based 3D models. Two patients needed emergent surgical intervention; their models were solely designed based on their AVMs and used during the operation. However, the other patients who underwent elective surgery had the modeling starting from the skull base. These models were used both preoperatively and perioperatively. The benefits of patients arising from treatment with these models were evaluated via patient files and radiological data. ResultsFifteen patients (10 males and five females) between 16 and 66 years underwent surgery. The mean age of the patients was 40.0±14.72. The most frequent symptom patients observed were headaches. Four patients had intracranial bleeding; the symptom of admission was a loss of consciousness. Two patients (13.3%) belonged to Spetzler-Martin (SM) grade I, four (26.7%) belonged to SM grade II, eight (53.3%) belonged to SM grade III, and one (6.7%) belonged to SM grade IV. The mean operation duration was 3.44±0.47 hours. Three patients (20%) developed transient neurologic deficits postoperatively, whereas three other patients died (20%). ConclusionSeveral technological innovations have emerged in recent years to reduce undesired outcomes and support the surgical team. For example, 3D models have been employed in various surgical procedures in the last decade. The routine usage of patient-based 3D models will not only support better surgical planning and practice, but it will also be useful in educating assistants and explaining the situation to the patient as well.

Emergency surgical treatment of total anomalous pulmonary venous connection.

This study explored the strategy and effect of emergency surgical treatment for total anomalous pulmonary venous connection (TAPVC). From March 2009 to February 2020, 78 patients with TAPVC underwent emergency surgical correction. There were 51 males and 27 females. The median age was 39.5 days, and the median weight was 4.0 kg. Preoperative percutaneous oxygen saturation was 80.8% ± 4.5%. Of the cases investigated, seven died during the perioperative period; 16 had a delayed chest closure; 19 had early pulmonary vein obstruction; two had secondary tracheal intubation; one had a brain complication; and one had a third-degree atrioventricular block. Low weight, younger age, cardiopulmonary bypass time, and aortic cross-clamp time were identified as risk factors for early mortality. During the follow-up from 4 to 137 months, 12 cases did not respond to follow-up requests. Ten patients died within 1-6 months after discharge. One patient underwent reoperation due to pulmonary vein obstruction. The longer hospital stay after the operation and intensive care unit time were identified as risk factors for late mortality. Emergency surgery for severe TAPVC patients after admission achieved good short-term results. Prenatal diagnosis should be strengthened to save more patients. The higher late mortality rate of such patients indicates that post-dischargemanagement should be strengthened to reduce the occurrence of post-discharge deaths.

Laparoscopic Approach to Tubal Torsion in the Pregnant Patient

<h3>Study Objective</h3> To highlight the diagnosis and management of fallopian tube torsion and address laparoscopic modifications in pregnancy for patient safety. <h3>Design</h3> Case report. <h3>Setting</h3> Academic based community hospital. <h3>Patients or Participants</h3> 23-year-old multigravida at 18 weeks 5 days gestation presented to the emergency department for intermittent right flank and groin pain. Ultrasound, which confirmed dating, showed possible 5-centimeter hemorrhagic cyst with blood flow, although ovarian torsion could not be excluded. Pelvic magnetic resonance imaging, while unable to visualize the appendix, did reveal a right-sided pelvic mass with surrounding cystic fluid. She was admitted for observation and pain control, but her symptoms continued to worsen. <h3>Interventions</h3> Emergent operative laparoscopy was performed with pregnancy modifications of left lateral tilt, supra-umbilical abdominal entry, and secondary port placement in right upper quadrant. During the procedure, a gravid uterus with normal appearing bilateral ovaries and left fallopian tube was noted. There was a 4-centimeter isolated right fallopian tube torsion. Right salpingectomy was performed without complications for the patient and fetus. Post-operative fetal cardiac activity was confirmed. Surgical pathology noted benign right fallopian tube with hemorrhage. <h3>Measurements and Main Results</h3> Pregnancy is a known risk factor for tubal torsion, with an annual prevalence of 1 in 1.5 million. Presenting symptoms are nonspecific, making diagnosis difficult. Imaging is generally unreliable; however, an ultrasound may reveal a dilated fallopian tube with absent blood flow. Definitive treatment is surgical detorsion, fixation, or salpingectomy. With pregnancy, surgical considerations such as trocar placement, positioning, equipment selection, and fetal monitoring based on gestational age are important. Medically necessary urgent or emergent surgical treatment should not be delayed. <h3>Conclusion</h3> Fallopian tubal torsion is a rare condition. Surgical treatment with laparoscopy can be safely performed in pregnancy with modifications to overcome the challenges of the unique anatomy and physiology of pregnancy.