ABSTRACT
INTRODUCTION: The COVID-19 pandemic has led to major changes in the provision of surgical services and also affected patients' health-seeking behaviour. This contributes to delayed presentation of many surgical conditions resulting in poorer outcomes. Colorectal cancer (CRC) patients who present with acute surgical emergencies such as complete bowel obstruction, perforation, bleeding or sepsis often require immediate intervention. This study aimed to assess the impact of COVID-19 pandemic on the proportion of emergency surgery in CRC patients. MATERIALS AND METHODS: This is a retrospective cohort study. All CRC patients who underwent elective and emergency surgery from January until December 2019 (pre-COVID era) and September 2020 until August 2021 (COVID era) were included. Patient demographics, presentation, tumour stage, surgery performed and waiting time for surgery were collected. Data were then compared. RESULTS: Seventy-seven and 76 new cases of CRC underwent surgery before and during COVID-19, respectively. The proportions of emergency surgery before and during COVID-19 are 29% vs 33% (p=0.562). Of those who required emergency surgery, the proportions of patients who required stoma formation are 59% vs 72% (p= 0.351). There was no difference in median waiting time for patients requiring elective surgery (p= 0.668). CONCLUSION: The proportion of emergency surgery for CRC patients is not statistically higher during the pandemic.
Subject(s)
COVID-19 , Colorectal Neoplasms , Humans , COVID-19/epidemiology , Pandemics , Retrospective Studies , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/surgery , Elective Surgical ProceduresABSTRACT
Alimentary tract duplication is a rare congenital anomaly which may involve any part of the alimentary tract extending from stomach to rectum. Clinical presentation may mimic an inflamed appendix as described in this case. A 9-year-old boy with a clinical diagnosis of perforated appendix was noted to have a normal appendix intra-operatively. On further search for an underlying pathology, a gangrenous ileal duplication was discovered. En-bloc resection with primary bowel anastomosis was done. Histopathology report revealed a gangrenous small bowel duplication. We discuss the preoperative diagnostic dilemma and management options in approaching this rare entity.
Subject(s)
Gangrene/etiology , Ileum/abnormalities , Appendicitis/diagnosis , Appendicitis/surgery , Child , Diagnostic Errors , Gangrene/diagnosis , Gangrene/surgery , Humans , Ileum/microbiology , Ileum/surgery , MaleABSTRACT
The cost of maintaining autogenous arteriovenous fistula is less expensive than artificial access because of lower surgical morbidity, mortality, incidence of infection and good patency rate. However when autogenous AVF was occluded by thrombosis, the salvaging procedure for re-vascularisation did not show satisfactory results. The National Kidney Foundation Dialysis Outcomes Quality Initiatives suggests that choosing the method of salvage procedure depends on the ability of each institute. Here we present a 38year old man came with failure of left brachio-cephalic fistula thrombosis due to cannulation site infection and thrombosis. Proximal neo vein to vein anastomosis was performed. 3weeks post intervention, wound was well-healed and patient was able to continue hemodialysis without venous hypertension in the forearm.
ABSTRACT
Transposed brachio-basilic fistula could be created for successful use for dialysis especially in patients who has exhausted other option of native fistulas.
ABSTRACT
Femoral vein tunnelled catheter is susceptible to various complication, Advocating early arteriovenous fistula creation in chronic renal impairment patients should be emphasised.
