Seasonal Variation of Presentation of Perforated Peptic Ulcer Disease: An Overview of Patient Demographics, Management and Outcomes.

Background Perforated peptic ulcer disease (PUD) is one of the most common causes of acute peritonitis. It carries significant mortality and morbidity. Several previous studies have reported a seasonal variation in the presentation of patients with perforated ulcers. Here we present this study from our experience in a Northern Irish acute district hospital. Methods A retrospective cohort study was conducted on perforated peptic ulcer patients who presented to Altnagelvin Area Hospital emergency department between 2015 to 2020. Data on patient demographics, clinical presentation, investigations, management and outcomes were collected. Primary outcome was to investigate if seasonality was associated with the incidence of perforated peptic ulcers. Follow-up data were also collected. Seasons were defined as per UK Met Office. Results A total of 50 patients presented with perforated PUD. Male to female ratio was approximately 3:2. Peaks were noted in spring and winter. April was the most common month for presentation followed by December. Smoking was the most common risk factor followed by alcohol abuse. Fourteen patients (28%) were either very frail or had contained perforations and were conservatively managed. Three deaths were noted (6%). Thirteen patients (26%) required ICU admission at some stage in their management. Conclusion Slight seasonal variation was noted in the presentation of perforated peptic ulcers in our study with a higher incidence in the winter and spring months. The month of April was noted to have the peak incidence of the disease in our study.

Acute Pancreatitis During COVID-19 Pandemic: An Overview of Patient Demographics, Disease Severity, Management and Outcomes in an Acute District Hospital in Northern Ireland.

Background Acute pancreatitis (AP) is a common disease requiring admissions under surgical and critical care units. The two most common causes are alcohol and gallstones. Coronavirus disease 2019 (COVID-19) pandemic had a significant impact on service delivery and patient management throughout all surgical specialties. In this study, the primary aim was to ascertain the incidence of COVID-19 in acute pancreatitis patients. Secondary objectives were to study aetiology, demographics, severity, 30-day mortality, outcomes and management of acute pancreatitis patients from 1st March, 2020 till 31st August, 2020. Methods A retrospective observational review of all patients admitted under the General Surgical team was performed. Information regarding demographics, severity of AP (using Glasgow score, Atlanta classification and CT severity index score), ICU admission and organ support, treatment modalities and follow-up data for outcomes was collected based on data collection tool used by COVID-PAN study and results were compared to outcomes results of COVID-PAN study. Results Forty-three (43) patients were admitted with AP. Only one patient (2.3%) was diagnosed with COVID-19 at the time of pancreatitis. Gallstones were noted to be the most common cause of AP in our population. Mortality was 7% (3 patients). Five patients (11%) needed ITU admission due to organ dysfunction. Three patients (7%) developed ARDS. Conclusion The overall incidence of COVID-19 in pancreatitis in our population of the study was low. The incidence of COVID-19 during the first wave in Derry/Londonderry area was low and this may explain why the incidence was low in our study as well. Patients with AP in our target population were mostly elderly, one in five had moderate to severe or severe pancreatitis and in 16.3% the aetiology could not be identified. As observed in other centres globally, urgent cholecystectomy for gallstone pancreatitis faced significant delays with no patients being offered index cholecystectomy and only 4 out of 19 patients having undergone interval cholecystectomy within six months of index admission for gallstone pancreatitis in our centre.

Does evidence based medicine support the effectiveness of surgical facemasks in preventing postoperative wound infections in elective surgery?

BACKGROUND: The incidence of postoperative wound infection is usually not the cause of death but it increases the length of hospital stay and cost of care and morbidity. Since their introduction a century ago there is still controversy about primary purpose of the facemasks as whether they provide protection for the patient from surgical team or weather they protect surgical team from the patient? The Objectives of this study were to critically analyze and systematically review the randomized trials regarding effectiveness of surgical facemasks in preventing post operative wound infection in elective surgery. METHOD: Systematic literature review and analysis of all available trials (randomized controlled trials) regarding use of surgical face masks in elective surgeries. Medline (1966-2007), Embase (1996-2007), Cochrane database, Pubmed, Google Scholar, were searched for the selection of literature for the review. RESULTS: No significance difference in the incidence of postoperative wound infection was observed between masks group and groups operated with no masks (1.34, 95% CI, 0.58-3.07). There was no increase in infection rate in 1980 when masks were discarded. In fact there was significant decrease in infection rate (p < 0.05). CONCLUSION: From the limited randomized trials it is still not clear that whether wearing surgical face masks harms or benefit the patients undergoing elective surgery.

Post hysterectomy spontaneous rupture of spleen.

Spontaneous rupture of spleen is a rare entity in the world of obstetrics and gynaecology. The obstetricians-gynaecologist has to confront with ruptured spleen sometimes in their practice. Ruptured spleen is not uncommon in trauma and some surgical procedures in upper abdomen. Splenic rupture after hysterectomy is exceedingly rare occurrence. However it should be considered as part of diagnostic workup in any unstable post hysterectomy subject with high degree of suspicion along with other differential diagnosis. Early reorganisation of this potentially life-threatening complication is very important for the wellbeing of patient and carries medico legal significance as well. We are reporting fourth case of spontaneous rupture spleen after abdominal hysterectomy found in the literature along with literature review and update on the topic regarding its diagnostic criteria.

Solitary jejunal metastasis from renal cell carcinoma.

A metastatic deposit from renal cell carcinoma into the jejunal wall is a rare phenomenon. Among the frequent modes of presentation, bleeding, obstruction and unexplained anaemia are commonly seen. In addition to the conventional contrast studies and computerized tomography (CT), Capsule endoscopy is a useful diagnostic tool. Factors responsible for resistant behaviour of jejunal wall are still not clear, however when it happens it is really a diagnostic challenge. We are reporting this rare case of solitary jejunal metastasis from renal cell carcinoma.