Abstract Introduction The term "Biloma," introduced in 1979 by Gould and Patel, denotes an encapsulated extrahepatic bile collection primarily caused by iatrogenic or traumatic injuries1. Spontaneous Biloma, a rare non-traumatic occurrence, involves the spontaneous perforation of extrahepatic or intrahepatic bile ducts. In our case report, the spontaneous Biloma developed because of an abrupt increase in bile duct pressure secondary to biliary obstruction because of choledocholithiasis 2. Case Report We present an 85-year-old male with calculous cholecystitis and concurrent choledocholithiasis, leading to acute severe cholangitis. There was no history of surgery, instrumentation, or trauma. He exhibited hemodynamic instability and acute renal failure. Diagnostic tests revealed raised inflammatory markers and deranged liver and kidney functions. CT scans unveiled a large subcapsular liver collection compressing the parenchyma (Figure a &b), alongside dilated intrahepatic biliary radicles, common bile duct, and choledocholithiasis. Treatment Nowadays, treatment for spontaneous Biloma is nonsurgical. Urgent endoscopic drainage and percutaneous transhepatic cholangiogram (PTC) – (Figure c) were performed, followed by ERCP, sphincterotomy, and stone removal (Figure d) once the patient stabilized3. Subsequent CT scans indicated resolution of the subcapsular collection (Figure e). During recovery, the patient experienced a small pulmonary embolism, managed conservatively. Conclusion This case underscores the rare occurrence of spontaneous hepatic subcapsular Biloma associated with choledocholithiasis in an elderly patient. Timely intervention with endoscopic and radiological procedures proved effective, leading to resolution of the Biloma and successful management of causative pathology.
The objective was to compare perioperative morbidity and mortality of patients with advanced epithelial ovarian cancer (EOC) treated with either of the two treatment approaches; neoadjuvant chemotherapy (NACT) followed by interval debulking versus upfront surgery.Prospective comparative observational study.In total, 51 patients were included in the study. All patients with diagnosed advanced EOC (International Federation of Gynecology and Obstetrics IIIC and IV) presenting for the 1(st) time were included in the study.Patients were either operated upfront (n = 19) if deemed operable or were subjected to NACT followed by interval debulking (n = 32).Intra- and postoperative morbidity and mortality were the primary outcome measures.Patients with interval cytoreduction were noted to have significantly lesser operative time, blood loss, and extent of surgery. Their discharge time was also significantly earlier. However, they did not differ from the other group vis. a vis. postoperative complications or mortality.Neoadjuvant chemotherapy although has a positive impact on various intraoperative adverse events, fails to show any impact on immediate postoperative negative outcomes.
Abstract Aim This retrospective, single-institutional study aimed to comprehensively investigate the demographic features, clinical presentations, and outcomes of emergency procedures in individuals with colorectal cancers presenting as acute emergencies at GEH over the last three years. Methods In this study at GEH, we analysed colorectal cancer cases presenting as emergencies from January 2019 to January 2022 were examined. Out of 310 total colorectal malignancy surgeries during this period ,57 cases (18.38%) were identified as acute emergencies. Demographic details, clinical history, outcomes of emergency procedures, adjuvant therapies, and prognostic variables were retrieved from hospital records and electronic medical records. Cases operated on elective basis & cases without confirmed colorectal cancers were excluded. Results The study revealed demographic insights, with an average age of 72 years and a balanced gender distribution. The majority presented with obstructive symptoms (87.7%), emphasizing the acute nature of cases. Emergency procedures exhibited diversity, with right hemicolectomy and Hartman's procedure being predominant. Gender-specific patterns in emergency procedures, along with details on tumor location, morphology, and complications, were analysed. Right-sided tumours, particularly caecal tumours, were prevalent. Adenocarcinoma was the predominant tumor morphology. Treatment approaches included curative intent in 56.14% and palliative intent in 35.09%. Adjuvant chemotherapy was administered in 50.88%, and adjuvant radiotherapy in 7.02%. Recurrence was noted in 12.28%, while mortality rates varied among different emergency procedures. Conclusion This study provides a comprehensive understanding of colorectal cancers presenting as emergencies, offering valuable insights into demographic characteristics, emergency procedures, tumor characteristics, treatment approaches, and outcomes. Prospective studies are recommended to further validate and extend these findings, contributing to a nuanced comprehension of emergency colorectal cancer scenarios.
Abstract Aim Hospital readmission rates are a general indicator of quality of care, however these rates are currently variable nationally. Lowering these rates will not only alleviate the financial burden of the National Health Service but will improve patient outcomes. Our primary aim was to establish if implementing a senior-led Surgical Assessment Unit would reflect positively on reducing the rates of avoidable emergency readmissions within 30 days of discharge, in our General Surgery department at a district general hospital. Method We compared two 3-month cycles of all General Surgery emergency readmissions in our department within 30 days of discharge from June to August 2022 versus August to October 2021. Data of 361 patients in cycle 2 versus 389 patients in cycle 1 were collected and analysed to determine the readmission rates and to prevent the potential avoidable factors. Results A total of 6.6% of patients were readmitted with various surgical conditions, and the number of extra days of hospital stay totalled to 26 extra days collectively. This is compared to 11%, and 69 days respectively from the previous cycle. The main reasons for readmission were recurrences of the original problem (namely pancreatitis), and post-operative infections. Conclusion Overall, our implemented action plan has reduced the rate of emergency surgical readmissions by 4.4%. However, the main factors for readmissions remained similar. We will continue to provide an efficient use of the Surgical Assessment Unit and senior-led discharge to ensure we minimise the rates of surgical readmissions.
Anastomotic bleeding is well known complication after gastrointestinal resection and anastomosis procedures. The percentage of patients experiencing this complication is between 0.5% to 9.6%. Delayed postoperative anastomotic bleeding is even more rare, herein, we report a case of pseudoaneurysm of right external iliac artery with arterio-colonic fistulae in a patient who underwent open right hemicolectomy and presented as delayed postoperative anastomotic bleeding-a complication never reported before related to this procedure.
Abstract Background:Primary pancreatic lymphoma (PPL) is an extremely rare neoplasm, which may be confused with pancreatic adenocarcinoma. So far only about 150 cases of PPL have been reported.Materials and Methods:We present our experience of 3 cases of PPL over a 4-year period.Results:All the patients presented with vague abdominal pain of duration ranging from 1½ months to 3 months. Two patients had diagnosis confirmed histologically by CT-guided core biopsy or Fine needle aspiration procedure. We were able to avoid unnecessary laparotomy in 2 patients using preoperative guided Fine needle aspiration Cytology, although the third patient did undergo a Whipple′s procedure as the diagnosis of PPL was not considered during the initial workup.Conclusions:There is no significant difference noted with regard to patient′s age or duration of symptoms between patients with either pancreatic adenocarcinoma or PPL. The differential diagnosis of PPL includes pancreatic adenocarcinoma and secondary involvement of pancreas from extra-nodal lymphoma. Combination of two things is suggestive of Pancreatic lymphoma: (1) Bulky localized tumor in pancreatic head (2) Absence of significant dilatation of main pancreatic duct strengthens a diagnosis of pancreatic lymphoma over adenocarcinoma. Majority of patients can be managed with chemotherapy with much better prognosis compared to patients with pancreatic adenocarcinoma. Larger series of patients are needed to evaluate whether chemotherapy, eventually followed by involved-field radiation therapy, is the treatment of choice for PPL.
Abstract Background Gallstone disease is known in 10-15% of adults in Western populations. Cholangiopancreatography is the investigation of choice for choledocholithiasis; however, its use is varied, and guidelines are not well-defined. The NICE guidelines recommend MRCP be done when common bile duct dilatation ≥ 8mm or liver function tests) are abnormal but do not quantify this further. The liberal use of MRCP is gaining popularity as a roadmap prior to cholecystectomy, aiming to assess primarily for the presence of migrated gallstones within the cystic duct or common bile duct, as well as providing information regarding the anatomical features of the extrahepatic biliary tree on an individualized basis. Due to these reasons, MRCP is at times done unnecessarily which creates an economic burden and restricts access to patients in real need of imaging slots. Method It is a hospital-based retrospective observational study. The time frame was July 2021 to July 2022. The sample size was 230 patients. Result Our Study showed that isolated elevated Alanine Aminotransferase levels should not be a reason to evaluate patients for Choledocholithiasis. It concluded that elevated serum bilirubin levels, Alkaline Phosphatase, and Gamma Glutamyl Transferase are the strongest predictors of CBD stones in patients with gallstone disease and hence can be used to triage patients for undergoing MRCP. Conclusions To conclude elevated serum bilirubin levels, ALP and GGT are the strongest predictors of CBD stones in patients with gallstone disease and hence can be used to triage patients for undergoing MRCP. Isolated elevated ALT should not be a reason to evaluate patients for CBD stones.
'%3e%3ccircle r='20' fill='%23008'/%3e%3ccircle r='17.5' fill='%23fff'/%3e%3ccircle r='3.5' fill='%23008'/%3e%3cg id='d'%3e%3cg id='c'%3e%3cg id='b'%3e%3cg id='a' fill='%23008'%3e%3ccircle r='.875' transform='rotate(7.5 -8.75 133.5)'/%3e%3cpath d='M0 17.5.6 7 0 2l-.6 5L0 17.5z'/%3e%3c/g%3e%3cuse xlink:href='%23a' transform='rotate(15)'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(30)'/%3e%3c/g%3e%3cuse xlink:href='%23c' transform='rotate(60)'/%3e%3c/g%3e%3cuse xlink:href='%23d' transform='rotate(120)'/%3e%3cuse xlink:href='%23d' transform='rotate(-120)'/%3e%3c/g%3e%3c/svg%3e)
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
