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Femoral hernias accounting for 2-4% of all hernias rarely involve appendicitis, known as De Garengeout hernia, with only a few reported cases. We present a case of a 66-year-old woman with acute right groin pain but no signs of intestinal obstruction. Physical examination revealed a tender, partially reducible mass in the right groin. Computed tomography scan confirmed a femoral hernia containing incarcerated bowel loops, leading to urgent surgical intervention. The McEvedys approach was used for appendicectomy and hernia repair. The patient recovered without complications. Strangulated femoral hernia with the appendix is a rare condition posing diagnostic challenges. Early recognition is crucial to prevent complications like perforation and abscess formation. Cross-sectional imaging aids in diagnosis. Surgical intervention, either open or laparoscopic, is the preferred treatment, based on surgeon expertise and patient-specific factors. Timely diagnosis and prompt surgery minimise complications.
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Aims COVID-19 can present with abdominal pain and affects the management of emergency surgical patients. The aim of this retrospective study was to assess the incidence of positive findings on CT chest in patients presenting with acute abdomen, who underwent CT thorax as part of the Intercollegiate General Surgical Guidance on COVID-19 during the first wave. To correlate CT chest findings with confirmed cases on reverse transcription polymerase chain reaction (RT-PCR), and to determine its influence on surgical management of abdominal emergencies. Methods A retrospective observational study of adult emergency surgical referrals (excluding trauma) for acute abdomen over a 10-week period was performed. COVID-19 changes on CT chest were categorized as per the British Society of Thoracic Imaging (BSTI) CT reporting criteria. Patient demographics, COVID-19 RT-PCR, management and outcome were recorded. Statistical analysis was performed using Microsoft Excel (Microsoft Corporation, Redmond, USA) with p-value significant at ≤0.05. Results Of the 160 patients included, 111 (69.38%) had COVID-19 RT-PCR. Twenty-four patients had CT chest findings suggestive of COVID-19. Amongst these, 45.83% demonstrated classic/probable CT features of COVID-19, of which 36.36% had positive RT-PCR. Most patients who had acute abdominal findings had a normal CT chest (p=0.03). Twenty-five (15.63%) patients presenting with abdominal pain had normal CT abdomen and seven (28%) of these had CT features of COVID-19. Only 43 (34.4%) patients needed a surgical intervention, of which 18.6% had COVID-19 changes on CT, confirmed by positive RT-PCR in 12.5%. Conclusion CT chest is an important investigation during the COVID-19 pandemic in suspected cases to help assess the severity of lung involvement. CT chest as an additional investigation modality in acute abdomen had clinically helped in triaging of patients to appropriate specialties but did not influence emergency surgical management.
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Background The coronavirus disease 2019 (COVID-19) pandemic has changed the dynamics of healthcare, and the elective surgical consent process has also evolved. The Royal College of Surgeons of England published guidance on consent during COVID-19. Through this study, we aimed to assess our local consent adherence to these guidelines on the resumption of elective activity after the first wave of COVID-19. Methods This prospective review of consecutive elective surgical consent forms was conducted from 20 July 2020 to 16 August 2020 at the Princess Alexandra Hospital NHS Trust, England. The primary outcome was evidence of COVID-19 risk documentation on the consent forms. Results A total of 116 patients' consent forms were reviewed. Most patients were American Society of Anaesthesiologists (ASA) grade 2 (n=70; 60.34%). Only 25 consent forms (21.55%) had COVID -19 and its associated risks documented, with registrars being the most compliant (19/46; 41.3%) followed by consultants (6/51; 11.7%). With regards to the surgical sub-specialities, general surgery, orthopaedics and ENT had the highest compliance with the guidance. Conclusions As the elective activity resumes, peri-operative risks of COVID-19 should be weighted in during the informed consent process, as mentioned in the latest international guidelines on consent to avoid litigation and negligence claims.
