ABSTRACT
Appendicitis is one of the most common diagnoses that general surgeons encounter in practice. An exceedingly rare cause of this disease is neoplasm. We report the case of a 24-year-old female who presented with non-specific right lower quadrant abdominal pain and equivocal findings of appendicitis and pelvic congestion syndrome on CT imaging. After an extensive work-up, the patient underwent a diagnostic laparoscopy with an appendectomy. The appendix appeared grossly normal; however, on a pathologic review of the specimen, a low-grade appendiceal mucinous neoplasm (LAMN) was found. This case is unique in that it demonstrates exclusive management of LAMN laparoscopically. It reinforces the need to approach non-specific abdominal pain from a multidisciplinary perspective and to utilize laparoscopy as a diagnostic/therapeutic modality when other, less invasive, modalities fail to diagnose a patient's pain.
ABSTRACT
Small Bowel Obstruction (SBO) is one of the most common diagnoses that general surgeons encounter. Adhesive disease, hernia, and neoplasm are the most common causes. A more rare cause is bezoar. A 66-year-old female with a history of prior abdominal surgery presented with clinical concern for SBO. CT scan of the abdomen and pelvis demonstrated SBO with a transition point in the left lower abdomen. The patient failed nonoperative management and was taken to the operating room for exploration. On exploration, a segment of hemorrhagic jejunum was found with an intraluminal bezoar. SBO secondary to bezoar can be managed endoscopically or operatively depending on location and size of the stone. Operative intervention can vary between laparoscopic milking of the bezoar distally, enterotomy with stone extraction, or bowel resection and anastomosis. This case illustrates the importance of maintaining a broad differential for common surgical disease processes.
ABSTRACT
BACKGROUND: Reuse of personal protective equipment (PPE), masks more specifically, during the COVID-19 pandemic was common. The primary objective of this study was to compare pre-pandemic surgical site infection (SSI) rates prior to reuse of PPE, to pandemic SSI rates after reuse of PPE in trauma surgical patients. METHODS: A retrospective cohort analysis collected from the Michigan Trauma Quality Improvement Program database was performed. The pre-COVID cohort was from March 1, 2019 to December 31, 2019 and post-COVID cohort was March 1, 2020 to December 31,2020. Descriptive statistics were used to assess differences between variables in each cohort. RESULTS: Nearly half (49.8%) of our cohort (n = 48,987) was in the post-COVID group. There was no significant difference in frequency of operative intervention between groups (p > .05). There was no significant increase (p > .05) between pre- and post-COVID cohorts for superficial, deep, or organ space SSI when reuse of masks was common. CONCLUSION: Reuse of PPE did not lead to an increase in SSI in surgical patients. These findings are consistent with previous studies, but the first to be described in the trauma surgical patient population. Studies such as this may help inform further discussion regarding PPE usage as we continue to emerge from the current pandemic with the continuous threat of future pandemics.
