Use of a standardized reporting template: can we improve report quality in pancreatic and peri-ampullary malignancy?

BACKGROUND: Accurate pancreatic and periampullary cancer staging with resectability assessment is vital to optimize surgical management and improve patient outcomes. The aim of this study is to assess the usefulness of a standardized reporting template. METHODS: Retrospective review of all surgically managed patients with pancreatic or periampullary malignancy between January 2018 and June 2019. Pre-operative CT imaging report was anonymised and audited against a modified NCCN reporting template. The same imaging studies were re-reported by two experienced GI radiologists using the same template. RESULTS: Fifty-nine patients (37 male) with median age of 68 years (36-83) underwent surgery for suspected pancreatic/peri-ampullary malignancy. The median time between pre-operative CT scan and surgery was 56.5 days (14-225). The use of reporting template resulted in significant increase in number of reported key features (p < 0.005), interobserver agreed features (p < 0.005) and overall k-value assessed interobserver agreement (p < 0.005). Template reports correlated closely with key intraoperative findings whilst primary free text reports did not (k-value 0.85-0.96 versus 0.20-0.46, p < 0.05). CONCLUSION: The use of a reporting template resulted in a more complete and accurate pancreatic/peri-ampullary tumour evaluation, improved inter-observer relatability and correlation with intraoperative findings.

The combined uro-radiological "Rendezvous" procedure, and an unusual CT and cystoscopic finding.

The ureteric "rendezvous" procedure is an interventional procedure involving both uro-radiological and cystoscopic techniques to manage complex ureteric stenoses or fistulae. We present a case in which this procedure was utilised, with an unusual intra-procedural finding. Macroscopic visualisation of lipids within the urinary tract is an unusual finding at CT, and rarely seen at cystoscopy. The aetiology of lipiduria is varied; it may indicate the presence of unrecognised pathology, occur as a sequelae of trauma, or arise secondary to intervention. Understanding the patient's history is vital to determining the likely aetiology and significance of such a finding.

Neutropenic enterocolitis affecting the transverse colon: an unusual complication of chemotherapy.

A 66-year-old woman presented with a 1-day history of sudden onset of generalised abdominal pain associated with fever and vomiting. She was previously diagnosed with left breast cancer 2 months ago and completed a course of chemotherapy 1 week prior to presentation. She was clinically unwell with generalised tenderness in her abdomen. Blood investigations showed severe neutropenia. A CT scan was requested which reported a marked oedematous swelling of the transverse colon with features suggestive of a contained perforation. The decision was made to operate. Intraoperatively, the transverse colon was found to be thickened with omentum adherent focally around the distal third. A right hemicolectomy was performed with an end ileostomy and mucus fistula. The patient made a successful recovery and was discharged within 7 days of presenting. Pathology reported typical features of neutropenic enterocolitis affecting the transverse colon with a normal terminal ileum, caecum and ascending colon.

De Garengeot's hernia: diagnosis and surgical management of a rare type of femoral hernia.

De Garengeot's hernia is quite rare and is a femoral hernia that contains a vermiform appendix and can present as a painful, tender swelling or an asymptomatic lump. We present the case of a 70-year-old patient who presented to our surgical unit after being referred for diagnostic imaging of an asymptomatic groin lump which was found to be a De Garengeot's hernia. She had an open repair of her femoral hernia and laparoscopic appendicectomy. Her post-operative stay was uneventful. De Garengeot's hernia is rare; however, imaging is usually required to make a diagnosis preoperatively. Management is usually surgical with simultaneous repair of the femoral hernia and appendicectomy.

Bascule caecal volvulus: a rare cause of intestinal obstruction.

Caecal volvulus is a rare cause of intestinal obstruction, with the bascule subtype accounting for <10% of all cases of caecal volvulus. It is associated with significant morbidity and mortality if left undiagnosed. We present the case of a 58-year-old female who presented to our surgical department with symptoms of intestinal obstruction. She had various radiological investigations, which supported the diagnosis of a caecal volvulus of the bascule subtype. She was subsequently managed surgically and had a right hemicolectomy and ileocolic anastomosis. Her recovery was uneventful and she was discharged within 1 week of having her operation. Fortunately, caecal volvulus of the bascule subtype is rarely encountered; however, clinicians need to be aware of its presentation and subsequent management options so that clinical outcomes are improved.