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Background: Acute appendicitis is the most common aetiology of acute abdomen in children. Our aim is to describe the accuracy of diagnosis, and complications in a limited resources setting in children between 5 and 14 years old at the only tertiary referral hospital in the West region of Afghanistan. Methods: A retrospective study for a period of 1 year (21 March 2015–20 March 2016). Data was collected from patients' files. Data were analysed by epi info 7. Results: We identified 774 children who had appendectomies at Herat Regional Hospital during the study period with complete records available for analysis. The median age was 11 years [5–14]. The rate of positive appendectomy was 87%. 72% of appendectomies were done within 24 h of the onset of symptoms. Of 675 positive appendectomies, the most common clinical features were migratory abdominal pain (90%), nausea/vomiting (80%), RLQ tenderness (90%), and rebound tenderness (81%). Among the 99 negative appendectomies, the most common signs and symptoms were anorexia 68%, nausea/vomiting 59%, RLQ tenderness 79%, and rebound tenderness 43%. 98% of positive and 71% of negative appendectomies had elevated WBC count. Post appendectomy complications occurred in 9% of our patients mostly commonly intra‐abdominal abscesses (5%). Conclusion: Although the diagnosis of acute appendicitis is challenging in children and may involve sophisticated imaging techniques, in many settings these are unavailable. Classical manifestations such as migratory abdominal pain, abdominal tenderness, nausea, and simple lab tests play a crucial role in the diagnosis of acute appendicitis in low resource environments. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is the commonest paediatric surgical emergency. Adult studies suggest non‐operative management (NOM) may have a place in care. There have been no adequately powered randomized controlled trials in children. Objective: to determine the safety and efficacy of NOM for paediatric simple appendicitis. Methods: A non‐inferiority randomized controlled trial was conducted comparing operative (OM) to NOM of SA in children aged five‐15 years. Primary outcome was treatment success (no unplanned or unnecessary operation, or complication) at 30 days and 12 months, with a non‐inferiority margin of 15%. (anzctr.org.au: ACTRN12616000788471). Results: From 11 June 2016 to 30 November 2020, 222 children were randomized: 94 (42.34%) to OM and 128 (57.66%) to NOM. Non‐inferiority of NOM was not demonstrated at either time point, with 45.67% of NOM patients subsequently undergoing operation. There was no significant difference in complications. Conclusions: While noninferiority was not shown, NOM was safe, with no difference in adverse outcomes between the two groups. Further research to refine the place of NOM of simple appendicitis in children is required, including nuanced patient selection, longer term evaluation, the place of choice, and the acceptability of the treatment for children and their carers. [ABSTRACT FROM AUTHOR]

Introduction: The accessory appendicular artery (AAA) is an accessory source of blood supply to the appendix. Its existence and potential point of origin are seldom addressed in the literature. Methods: To fill this knowledge gap, we performed a systematic review of all available studies involving both cadaveric and surgical specimens and documented the presence and the origin of the AAA, following the guidelines outlined in the preferred reporting items for systematic reviews and meta‐analysis (PRISMA) statement. Results: Eleven studies, with an overall of 604 specimens were included. Our research revealed that the AAA is notably absent in most cases (83.6%). When present, it most commonly originates from the posterior cecal artery (12.4%), followed by the descending branch of the ileocolic artery (2%), and the ileal branch of the ileocolic artery (0.7%). Instances of origin from the anterior cecal, common cecal, or the ileocolic trunk were even more infrequent. Based on our observations, we introduced a new simplified classification system. Discussion: The effect of an accessory artery on the process of appendicitis remains to be clarified. We firmly recommend that surgeons should consider the possible presence and various origins of the AAA during appendectomy procedures to avoid serious complications. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is a common surgical condition that requires urgent medical attention. Recent advancements in artificial intelligence and large language processing, such as ChatGPT, have demonstrated potential in supporting healthcare management and scientific research. This study aims to evaluate the accuracy and comprehensiveness of ChatGPT's knowledge on appendicitis management. Methods: Six questions related to appendicitis management were created by experienced RACS qualified general surgeons to assess ChatGPT's ability to provide accurate information. The criteria of ChatGPT answers' accuracy were compared with current healthcare guidelines for appendicitis and subjective evaluation by two RACS qualified General Surgeons. Additionally, ChatGPT was then asked to provide five high level evidence references to support its responses. Results: ChatGPT provided clinically relevant information on appendicitis management, however, was inconsistent in doing so and often provided superficial information. Further to this, ChatGPT encountered difficulties in generating relevant references, with some being either non‐existent or incorrect. Conclusion: ChatGPT has the potential to provide timely and comprehensible medical information on appendicitis management to laypersons. However, its issue of inaccuracy in information and production of non‐existent or erroneous references presents a challenge for researchers and clinicians who may inadvertently employ such information in their research or healthcare. Therefore, clinicians should exercise caution when using ChatGPT for these purposes. [ABSTRACT FROM AUTHOR]

Introduction: Correct diagnosis of acute appendicitis may sometimes be challenging. The Negative appendectomy rate (NAR) has declined in the recent years in Europe and USA, in part due to better diagnostic imaging tools. The aim of this study was to examine the rates of negative appendectomy in our institution, investigate trends in its incidence, and identify possible predicting factors. Methods: A retrospective cohort study, including all patients younger than 18 years of age who underwent an appendectomy between 2007 and 2021 in a single tertiary medical center. Data regarding patient's demographics, laboratory and imaging results, pathological results and clinical outcome were collected. Results: Between 2007 and 2021, a total of 3937 pediatric patients underwent appendectomy due to a working diagnosis of acute appendicitis. Overall, 143 patients (3.6%) had normal appendix on pathological examination. However, in the last 5 years, the rate of normal appendix was 1.9%, together with an increased rate of pre‐operative imaging (from 40% to nearly 100%). Conclusion: Low NAR under 2% is an achievable benchmark in the era of accessible pre‐operative imaging. In unequivocal cases, a secondary survey that includes repeated physical examination, blood work and imaging is recommended and may result in near‐zero rates of NAR. [ABSTRACT FROM AUTHOR]

Background: Paediatric appendicitis may be challenging to diagnose, and outcomes difficult to predict. While diagnostic and prognostic scores exist, artificial intelligence (AI) may be able to assist with these tasks. Method: A systematic review was conducted aiming to evaluate the currently available evidence regarding the use of AI in the diagnosis and prognostication of paediatric appendicitis. In accordance with the PRISMA guidelines, the databases PubMed, EMBASE, and Cochrane Library were searched. This review was prospectively registered on PROSPERO. Results: Ten studies met inclusion criteria. All studies described the derivation and validation of AI models, and none described evaluation of the implementation of these models. Commonly used input parameters included varying combinations of demographic, clinical, laboratory, and imaging characteristics. While multiple studies used histopathological examination as the ground truth for a diagnosis of appendicitis, less robust techniques, such as the use of ICD10 codes, were also employed. Commonly used algorithms have included random forest models and artificial neural networks. High levels of model performance have been described for diagnosis of appendicitis and, to a lesser extent, subtypes of appendicitis (such as complicated versus uncomplicated appendicitis). Most studies did not provide all measures of model performance required to assess clinical usability. Conclusions: The available evidence suggests the creation of prediction models for diagnosis and classification of appendicitis using AI techniques, is being increasingly explored. However, further implementation studies are required to demonstrate benefit in system or patient‐centred outcomes with model deployment and to progress these models to the stage of clinical usability. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is the most common reason children undergo acute general surgery but international, population‐level disparities exist. This is hypothesised to be caused by preoperative delay and differential access to surgical care. The impact of prehospital factors on paediatric appendicitis severity in New Zealand is unknown. Methods: A prospective, multicentre cohort study with nested parental questionnaire was conducted by a national trainee‐led collaborative group. Across 14 participating hospitals, 264 patients aged ≤16 years admitted between January and June 2020 with suspected appendicitis were screened. The primary outcome was the effect of prehospital factors on the American Association for the Surgery of Trauma (AAST) anatomical severity grade. Results: Overall, 182 children had confirmed appendicitis with a median age of 11.6. The rate of complicated appendicitis rate was 38.5% but was significantly higher in rural (44.1%) and Māori children (54.8%). Complicated appendicitis was associated with increased prehospital delay (47.8 h versus 20.1 h; P < 0.001), but not in‐hospital delay (11.3 h versus 13.3 h; P = 0.96). Multivariate analysis revealed increased anatomical severity in rural (OR 4.33, 95% CI 1.78–7.25; P < 0.001), and Māori children (OR 2.39, 95% CI 1.24–5.75; P = 0.019), as well as in families relying on external travel sources or reporting unfamiliarity with appendicitis symptomology. Conclusion: Prehospital delay and differential access to prehospital determinants of health are associated with increased severity of paediatric appendicitis. This manifested as increased severity of appendicitis in rural and Māori children. Understanding the pre‐hospital factors that influence the timing of presentation can better inform health‐system improvements. [ABSTRACT FROM AUTHOR]

Background: In acute appendicitis, decision‐making around operative intervention for paediatric patients differs from adults due to a higher weight placed on clinical assessment and reduced rates of cross‐sectional imaging. In regional settings, non‐paediatric emergency doctors, general surgeons, and radiologists usually assess and manage this patient group. Differences have been observed in paediatric negative appendicectomy rates between general and paediatric centres. Methods: A retrospective cohort study was performed, identifying paediatric patients undergoing emergency appendicectomy at the Southwest Health Campus (Bunbury, Western Australia) from 2017 to 2021. The primary outcome measure was histopathology confirming the absence of transmural inflammation of the appendix. In addition, clinical, biochemical and radiological data were collected to identify predictors of negative appendicectomy (NA). Secondary outcome measures were hospital length‐of‐stay and post‐operative complication rates. Results: Four hundred and twenty‐one patients were identified, of which 44.9% had a negative appendicectomy. Statistically significant associations between female gender, white cell count less than 10 × 109, neutrophil ratio less than 75%, low CRP and NA were observed. NA was not associated with a lower risk of re‐admission or complications compared with appendicectomy for appendicitis. Conclusions: Our centre's NA rate is higher than that observed in the literature at both non‐paediatric and paediatric surgical centres. NA has similar morbidity risk to appendicectomy for uncomplicated appendicitis and offers a timely reminder that diagnostic laparoscopy in children is not benign. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic led to a global shortage of iodinated contrast media (ICM) in early 2022. ICM is used in more than half of the computed tomography of the abdomen and pelvis (CTAP) performed to diagnose an acute abdomen (AA). In response to the shortage, the RANZCR published contrast‐conserving recommendations. This study aimed to compare AA diagnostic outcomes of non‐contrast CTs performed before and during the shortage. Methods: A single‐centre retrospective observational cohort study of all adult patients presenting with an AA who underwent a CTAP was conducted during the contrast shortage period from May to July 2022. The pre‐shortage control comparison group was from January to March 2022; key demographics, imaging modality indication and diagnostic outcomes were collected and analysed using SPSS v27. Results: Nine hundred and sixty‐two cases met the inclusion criteria, of which n = 502, 52.2% were in the shortage period group. There was a significant increase of 464% in the number of non‐contrast CTAPs performed during the shortage period (P < 0.001). For the six AA pathologies, only n = 3, 1.8% of non‐contrast CTAPs had equivocal findings requiring further imaging with a contrast CTAP. Of the total CTs performed, n = 464, 48.2% were negative. Conclusion: This study showed that when non‐contrast CTs are selected appropriately, they appear to be non‐inferior to contrast‐enhanced CTAPs in diagnosing acute appendicitis, colitis, diverticulitis, hernia, collection, and obstruction. This study highlights the need for further research into utilizing non‐contrast scans for assessing the AA to minimize contrast‐associated complications. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic status and distance from hospital have been shown to be associated with poor surgical outcomes related to acute appendicitis. Indigenous populations experience greater socioeconomic disadvantages and poorer healthcare access than their non‐Indigenous counterparts. This study aims to determine whether socioeconomic status and road distance from hospital are predictors of perforated appendicitis. It will also compare surgical outcomes of appendicitis between Indigenous and non‐Indigenous populations. Methods: We performed a 5‐year retrospective study of all patients who underwent appendicectomy for acute appendicitis at a large rural referral centre. Patients were identified using the hospital database for theatre events coded as appendicectomy. Regression modelling was used to determine if socioeconomic status and road distance from hospital were associated with perforated appendicitis. The outcomes of appendicitis between Indigenous and non‐Indigenous populations were compared. Results: Seven hundred and twenty‐two patients were included in this study. The rate of perforated appendicitis was not significantly impacted by socioeconomic status (OR 0.993, 95% CI 0.98–1.006, P = 0.316) or road distance from hospital (OR = 0.911, 95% CI 0.999–1.001, P = 0.911). Indigenous patients did not have a significantly higher rate of perforation compared to non‐Indigenous patients (P = 0.849) despite having overall lower socioeconomic status (P = 0.005) and longer road distance from hospital (P = 0.025). Conclusion: Lower socioeconomic status and longer road distance from hospital were not associated with an increased risk of perforated appendicitis. Indigenous populations have poorer socioeconomic status and longer road distance to hospital but did not have higher rates of perforated appendicitis. [ABSTRACT FROM AUTHOR]

Major operations such as laparoscopic liver resection, laparoscopic distal pancreatectomy, laparoscopic repair of large hiatus hernias and bile duct exploration can now be offered to patients of Far North Queensland without the added logistical complexities and cost of transporting patients and their families to distant hospitals. OUTCOMES OF COLORECTAL RESECTION IN RURAL SURGICAL CENTRES: A QUEENSLAND AUDIT OF SURGICAL MO... Derek Mao, Therese Rey-Conde, John North, Raymond Lancashire, Sanjeev Naidu and Terence Chua The Queen Elizabeth II Jubilee Hospital, Queensland B Purpose: b With over 30% of the Australian population living outside capital cities, rural hospitals manage a significant proportion of surgical patients. RS017P EMERGENCY UROLOGY SURGERY PERFORMED BY GENERAL SURGEONS: A SYSTEMATIC REVIEW Jessica Paynter, Patrick Miao and Janelle Brennan Bendigo Health, Victoria B Purpose: b General surgeons may be required to perform emergency operations within other surgical specialities, including urology in rural and under-resourced settings. In 2022 Cairns Hospital employed surgeons with fellowships in Upper Gastrointestinal surgery and Hepatobiliary surgery. [Extracted from the article]

B Result b : There were 100 patients (out of 1394) identified who met the study criteria, Management of anastomotic leak was significantly dependent ( I P i < 0.001) upon the degree of the leak, with the majority of patients with an uncontained perforation being managed by operative abdominal drainage (90%); patients with contained perforation were mainly managed with intravenous antibiotics only (60%), When examining the degree of anastomotic leak (contained, not contained or anastomotic stricture) with overall FISI score and EQ-VAS score, there was no difference seen ( I P i = 0.78 and 0.94 respectively). This study investigated the effect of a providing patients with a list of suggested questions they may like to ask their surgeon, a question prompt list (QPL) on patient recall, anxiety, consultation duration, and patient-surgeon communication. Early deaths (<72 h) after an EL may reflect futile surgery and will be reduced by EL eligible patients who die without an operation (No-Laps) Australia's unique national surgical mortality audit has had a long term focus on the avoidance of futile surgery. B Conclusion: b Robotic surgery is a safe approach to colorectal surgery and hernia repairs with some potential benefits in terms of patient outcomes as surgeon experience increases. GS006 IMPROVING COMMUNICATION AND PATIENT INFORMATION RECALL VIA A QUESTION PROMPT LIST: A RANDOMIZ... Jesse Ey, Matheesha Herath, Jessica Reid, Ying Yang Ting, Emma Bradshaw and Guy Maddern The Basil Hetzel Institute Surgical Science Research Group, South Australia B Purpose: b Inadequate clinical communication leads to poor patient understanding, resulting in unrealistic expectations, and non-satisfactory patient outcomes. [Extracted from the article]

Background: There is some evidence of the association between acute appendicitis and colorectal neoplasm in patients over the age of 40 years. Despite this, few centres routinely evaluate the colon endoscopically following an episode of appendicitis in these patients. Our aim was to investigate the incidence of colorectal neoplasm in patients aged 40 years and over who underwent screening colonoscopy following acute appendicitis. Methods: Retrospective cohort study of patients aged 40 years and over who were diagnosed with acute appendicitis via imaging or histology between January 2015 and May 2022. Findings on subsequent screening colonoscopy were evaluated and classified according to adenomatous and non‐adenomatous lesions. Results: A total of 176 patients met inclusion criteria, with a median age of 54 years (range 40–92) and female to male ratio of 1:1.3. One hundred patients (56%) had a colonoscopy following their admission, at a mean duration of 3.5 months post discharge. 15% of patients had an adenomatous polyp detected (10 adenomas, 4 advanced adenomas, and 1 sessile serrated adenoma), and 9% had a non‐adenomatous lesion detected (8 hyperplastic polyps and 1 lipoma). Conclusion: Adenoma detection rate in patients aged 40 years and over undergoing colonoscopy after acute appendicitis was 15% in our cohort. This high adenoma detection rate supports the view of appendicitis as an indication for screening faecal immunochemical testing or colonoscopy in patients above 40 years. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate whether there is a delay in treatment for patients having pre-operative CT imaging with both intravenous and oral contrast (CTIVO) compared to intravenous contrast alone (CTIV). Methods: A retrospective review of patients who underwent emergency appendicectomy at a single hospital during a two-year period (1/1/2019–31/12/2020) was performed. Demographic details, imaging timing/modality; biochemical markers; American Society of Anaesthesiologists (ASA) physical status classification, anaesthetic induction time; operative report findings; histopathology, peri-operative complications, admission/discharge times were recorded. The Sunshine Appendicitis Grading System (SAGS) score was used for severity of appendicitis. Results: Pre-operative CT was performed in 294 patients; CTIVO: 159 (54%), CTIV: 135 (46%). Both groups were comparable for age, sex, ASA status and inflammatory markers. The median time from CT request to scanning was longer with CTIVO (CTIVO: 170 min, CTIV: 65 min, P < 0.0001). The median time from CT request to induction of anaesthesia was also longer with CTIVO (CTIVO: 780 minutes, CTIV: 406 min, P < 0.0001). A delay to theatre was not significantly associated with severity of appendicitis (SAGS score). The diagnostic accuracy was not reduced in the CTIV group compared to the CTIVO group. Conclusion: CTIVO scans significantly delay CT diagnosis and surgical treatment of appendicitis compared to CTIV. Omitting oral contrast does not result in a reduction in diagnostic accuracy for appendicitis. [ABSTRACT FROM AUTHOR]

Background: This study investigated whether there was a change in acute appendicitis, appendicectomy admissions or disease severity during the 2020 lockdown period in NSW. Methods: A retrospective before‐and‐after study was undertaken of patients admitted to two Sydney hospitals (St. Vincent's and Liverpool Hospitals) who had appendicectomy for presumed acute appendicitis and patients who had confirmed appendicitis but did not undergo surgery. Study periods were the 2020 lockdown period (15 March–15 May 2020), the corresponding period in the previous year, and the 1‐month after these periods. Patients were classified as having no, mild or severe appendicitis using operation and histopathological reports. Results: (Thirty‐six percent) fewer patients were admitted with acute appendicitis during the lockdown period compared with the previous year with a substantial reduction in normal/mild appendicitis presentations (OR 0.56, 95% CI 0.34–0.93, P = 0.03). There were 46% fewer patients with mild appendicitis during lockdown (56) compared with the previous year (103); numbers of patients with severe appendicitis were very similar (46 vs. 51). There was no increase in number of admissions with severe appendicitis, or in the time from onset of symptoms to admission, in the month following lockdown. Conclusion: Compared with the previous year, there were markedly fewer admissions with appendicitis during lockdown, with no evidence of a shift to more cases of severe appendicitis nor delayed presentation in the post‐lockdown period. It is plausible that some patients with mild appendicitis may have recovered without hospitalization, supporting the importance of implementing trials on non‐surgical management of appendicitis. During COVID‐19 lockdown in Sydney we noted a reduction in hospital presentations with acute appendicitis but not severe acute appendicitis. Mild appendicitis may be able to be successfully managed in the outpatient setting. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis remains an uncommon cause of non‐obstetric abdominal pain during pregnancy, with surgery being the preferred management option. We examined our experience with the surgical management of appendicitis during pregnancy, particularly the risk of foetal loss during the 1st and 2nd trimester and performed a meta‐analysis of the available literature. Methods: We performed a retrospective analysis of all patients who had an appendicectomy during pregnancy (January 2010 to December 2019) and a meta‐analysis comparing foetal death in open appendicectomy versus laparoscopic appendicectomy during the 1st and 2nd trimester. Results: Seventy pregnant patients were included in our study (57 laparoscopic, 13 open). There were 4 foetal deaths during the study period (7%), all of which occurred after the laparoscopic approach (P‐value = 0.578). Open appendicectomies were associated with an increased risk of pre‐term delivery (P‐value = 0.038). The meta‐analysis of 9 studies, which included 311 patients, showed that there was no significant difference between OA and LA in foetal deaths during the 1st and 2nd trimesters (1st trimester foetal deaths: 9/143 laparoscopic versus 4/57 open, M‐H risk difference—0.02, 95% CI, −0.14 to 0.10): 2nd trimester foetal deaths: 7/159 laparoscopic versus 2/154 Open, M‐H risk difference 0.03, 95% CI, −0.02 to 0.09). Conclusion: Our findings suggest there is no increased risk of foetal loss in pregnant patients undergoing a laparoscopic appendicectomy. [ABSTRACT FROM AUTHOR]

Backgrounds: The COVID‐19 pandemic presents ongoing challenges for healthcare. Stay at Home orders ('lockdowns') and community fears have been suggested to create reluctance to seek healthcare. We aimed to determine whether the rates of perforated appendicitis and negative appendicectomy have been affected by the pandemic, and to analyse the effect of lockdowns on the management of acute appendicitis in Victoria. Methods: We conducted a retrospective audit of emergency appendicectomies performed under adult General Surgery units at Monash Health in Victoria from January 2019 to September 2021, including 242 days of lockdown. Results: 2459 patients were included. Fewer patients had perforated appendicitis during the second lockdown (6.3% versus 10.7% baseline; p = 0.027). The rate of negative appendicectomy was reduced during the first lockdown (4.1% versus 14.9% baseline; p = 0.002) and during intervals between lockdown in 2021 (9.8%; p = 0.010). There was no difference in the rate of perforated appendicitis or negative appendicectomy at other times. Time to surgery and number of appendicectomies performed were also not significantly different. Fewer appendicectomies were performed after hours during lockdowns and in 2021 more generally compared to baseline (p < 0.05). Conclusion: The lower negative appendicectomy rate during the first lockdown may reflect increased pre‐operative imaging or clinical observation for undifferentiated presentations. There was a reduction in perforated appendicitis during the second lockdown, and no significant difference at other times. Contrary to other studies, lockdowns associated with the COVID‐19 pandemic may not create a reluctance to seek healthcare in all regions. [ABSTRACT FROM AUTHOR]

Background: In contrast to many countries, the prevalence of COVID‐19 in Australia and New Zealand has been low. We hypothesised, however, that a potential secondary effect of the COVID‐19 pandemic would be delayed presentation of paediatric appendicitis, with resultant higher rates of complicated appendicitis. This study was an initiative of the Australian and New Zealand Surgery in Children Registrars' Association for Trials collaborative, a trainee‐led research group based in Australia and New Zealand. Methods: A binational multicentre, retrospective review was undertaken of paediatric patients with appendicitis early in the COVID‐19 pandemic (20 March–30 April 2020), compared with previous years (2018, 2019). Primary outcomes were the duration of symptoms prior to presentation and the severity of disease. Results: A total of 400 patients from six centres were included. Duration of symptoms prior to presentation, sepsis at presentation, complicated disease and presence of complications did not differ significantly between time periods. Duration of intravenous antibiotic treatment and overall antibiotic treatment were both significantly shorter during 2020 (2.4 days versus 3.5 in 2018 and 3.0 in 2019 [P = 0.0038] and 3.7 days versus 5.2 in 2018 and 4.6 in 2019 [P = 0.04], respectively). Management approach did not differ, with the majority of patients managed operatively. Conclusions: We did not demonstrate any difference in duration of symptoms prior to presentation or other markers of disease severity early in the pandemic. Duration of antibiotic treatment was shorter during this period compared with previous years. Management of children with appendicitis, both simple and complicated, did not appear to change as a result of COVID‐19. [ABSTRACT FROM AUTHOR]

Background: Timely preoperative recognition of children with complicated appendicitis allows for planning and effective management. The aim of this study was to evaluate hyponatremia, an objective biochemical marker, as a predictor of complicated appendicitis. Methods: A retrospective review of 1283 paediatric patients (≤15 years) who underwent acute appendicectomy from January 2016 to December 2020 (5‐year period) was performed. Complicated appendicitis was defined by intraoperative findings of; macroscopic perforation, free pus, gangrene, faecal contamination or intraabdominal abscess. Comparison groups consisted of patients with complicated appendicitis, patients with uncomplicated appendicitis and patients with presumed appendicitis who went on to have no appendicitis on histology (no appendicitis group). Preoperative hyponatremia was defined as serum sodium <135 mmol/L. Results: Of the 1283 children; 35% (443/1283) had complicated appendicitis, 54% (690/1283) had uncomplicated appendicitis and 12% (150/1283) had no appendicitis. Rates of hyponatremia were much greater in the complicated group (31.4%; 139/443) than in the uncomplicated group (3.8%; 26/690) (p < 0.0001) or the no appendicitis group 10.7% (16/150) (p < 0.0001). The no appendicitis group had higher rates of hyponatremia than the uncomplicated group (p = 0.001), an unexpected finding. The receiver operating characteristic curve for diagnosis of complicated appendicitis versus uncomplicated appendicitis, using a cut‐off serum sodium of <135 mmol/L will identify complicated appendicitis with sensitivity 31.4% and specificity of 95.7% (area under the curve of 0.76). Conclusion: Hyponatremia is a discriminating predictor of complicated appendicitis in a paediatric population. [ABSTRACT FROM AUTHOR]

Background: Appendiceal neurendocrine tumours (NETs) are rare neoplasms and diagnosis is commonly incidental following appendectomy. We aimed to review our experience with appendiceal NETs. Methods: Records of children with appendiceal NETs were reviewed and data concerning demographic characteristics, clinical findings, surgical procedures, histopathological findings, management and outcomes were recorded. Results: Between 1985 and 2021, 33 cases with appendiceal NETs (median age 11.8 years, range 7.8–16; male/female = 10/23) were identified. All but one patients presented with abdominal pain, six had vomiting, four had fever and they underwent appendectomies with presumed diagnosis of acute appendicitis. Abscess drainage and appendectomy was performed in a 16‐year‐old girl for suspected right ovarian mass, and tumour was positive in the omentum. Histopathological diagnosis was classical carcinoid tumour (NET) in all cases. Median tumour size was 0.9 cm (n = 26, range, 0.1–3.5 cm); tumours were ≤1 cm in 19 cases, 2 cm in one, 3.5 cm in another case. Tumours were located in the tip (n = 11), body (n = 6) and base of appendix (n = 1) (in others data unavailable). In 28 patients with data, tumour extended to submucosa in five, to tunica muscularis in seven, to subserosa in six, to serosa in six, to mesoappendix in three, to periappendiceal fat in one. Three cases were lost to follow‐up, 31 cases were alive (median follow‐up 53 months). Conclusions: Paediatric appendiceal NETs do not behave aggressively and appendectomy alone is sufficient for tumours ≤2 cm regardless of local invasion. The need for further extensive surgery in tumours >2 cm also remains controversial. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis (AA) is the most frequently seen surgical emergency in pregnant women and the most frequently encountered cause of non‐obstetric acute abdomen. Due to the physiological and anatomical changes that occur during pregnancy and the limited use of radiological methods, it is difficult to diagnose AA during pregnancy. These conditions increase the risk of morbidity and mortality; therefore, it is crucial to identify ideal laboratory markers that can be utilized to diagnose disease. Methods: One hundred and ten pregnancies that fulfilled the inclusion criteria for AA diagnosis were retrospectively analysed between 2010 and 2021. Markers with high diagnostic values were discussed. Results: The patients were divided into three groups as follows; Group I: negative appendectomy (n = 19); Group IIa: uncomplicated appendicitis (n = 59); Group IIb: complicated appendicitis (n = 32). There was no statistically significant difference in mean age or gestational week (P > 0.05). Group IIb had a higher rate of complications and a longer length of hospital stay (P < 0.05). There were significant differences between the groups in terms of white blood cell (WBC), neutrophil, neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), C‐reactive protein, lymphocyte‐to‐ C‐reactive protein ratio, total, direct, and indirect bilirubin values (P < 0.05). While platelet and lactate dehydrogenase (LDH) values did not differ substantially between groups, both were found to have a high diagnostic value. Conclusion: It was concluded that WBC, neutrophil, NLR, PLR, total, direct and indirect bilirubin levels could be utilized to diagnose AA. Moreover, levels of WBC, neutrophil, NLR, platelet, PLR, LDH, total, direct and indirect bilirubin can be utilized to diagnose complicated appendicitis. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is a leading cause of surgical hospital admission. To date, there have been no published epidemiological studies describing appendicitis in tropical and remote Australia and none specifically documenting appendicitis in Indigenous Australians. This descriptive study used available state data to investigate appendicitis across Far North Queensland (FNQ). Methods: Queensland Health hospital admission data for FNQ was analysed to explore appendicitis epidemiology and outcomes in FNQ, 2012–2018. Population data for the same time period provided rates. Results: Over the study period, 3458 hospital presentations for appendicitis were available for analysis. Mean incidence was 178 per 100 000/yr. Median age was 27 years with 50.1% female patients. The annual rate of appendicitis was higher in the Indigenous population. Most patients had a laparoscopic procedure with a low rate of conversion to open surgery (2.6%). More than 80% of patients were discharged from hospital in less than 3 days. Intensive care (ICU) admission rate was low overall (1.1%) although higher for Indigenous people (2.4%). Following discharge, the hospital re‐admission rate was 3.8% and all‐cause mortality was 0.03%. Conclusion: The incidence of appendicitis in FNQ is higher than that reported in the rest of Australia in both Indigenous and non‐Indigenous populations. Despite logistical challenges of health care, clinical outcomes are in line with best practice across the country. Clinicians in FNQ should maintain a high index of suspicion for diagnosing appendicitis in rural and remote settings. [ABSTRACT FROM AUTHOR]

RETROSPECTIVE STUDY OF DELIRIUM IN PATIENTS WITH MAJOR BURN INJURIES AT THE VICTORIAN ADULT B... Dr. Nupur Shukla, Dr. Ignatius Rudd, Mr. Eldho Paul, Dr. Hannah Dobson, Mr. Cheng Lo, Miss H... Victorian Adult Burns Service, Alfred Health B Introduction: b Delirium affects acutely unwell patients and is associated with poor patient outcomes. Dr. Daniel Cox, Dr. Nicholas Low, Dr. Su Kah Goh, Dr. Eunice Lee, Ms. Angela Vago, Dr. Louis... The University of Melbourne, Department of Surgery, Austin Hospital B Purpose of Study: b Graft-derived cell-free DNA (gdcfDNA) quantification is a promising, minimally- invasive tool for detecting acute cellular rejection (ACR) post-liver transplantation. OUTCOMES OF DAMAGE CONTROL SURGERY WITH LAPAROSTOMY IN NON-TRAUMA PATIENTS Dr. Jia Ying Isaac Tay, Dr. Calvin Peng, Mr. Ian Hayes Royal Melbourne Hospital B Purpose: b Damage control surgery (DCS) and laparostomy is used in unstable trauma patients but there is paucity of literature for its application in non-trauma abdominal emergencies. CHOICE OF IMAGING MODALITY AND INJURY SCORE BASED ON MECHANISM OF INJURY IN TRAUMA PATIENTS P... Dr. Emily Doole, Dr. Kirk Underwood, Mr. Daniel Breen, Mr. Sonal Nagra University Hospital Geelong, Barwon Health B Hypothesis: b Selective CT (SCT) is not inferior to whole-body CT (WBCT) in identifying injuries in motor vehicle accidents less than 60 km/h. [Extracted from the article]

Computed tomography (CT) of the abdomen and pelvis with intravenous contrast demonstrated acute uncomplicated appendicitis with hyperdense faecal material in the appendiceal tip. Benign multi-cystic peritoneal mesothelioma discovered at the time of acute appendicitis: a rare pathology in association with a common disease A 36-year-old Caucasian male presented to the emergency department with acute onset right lower quadrant pain associated with loose bowel motions and vomiting. [Extracted from the article]

Background: Globally, patients presenting with acute surgical disease in rural areas have poorer outcomes when compared to urban areas; little data are available regarding outcomes for New Zealand (NZ) rural patients. This study aimed to compare the surgical management of appendicitis in a large metropolitan centre with its regional referral centres. Methods: In this retrospective cohort study, patient data were collated from the studied centres between November 2014 and October 2019. In addition to patient demographics, patterns of referral and presentation, the primary outcome was time to the theatre; secondary outcomes were perforation rates, length of stay and complications. Data are presented as medians (interquartile range). Results: A total of 3533 patients underwent appendicectomy over the period studied. For those presenting directly to the metropolitan centre, the median wait‐time to the theatre was 16 h (9.2–23.2); if patients were transferred, they waited for 20.8 h (13.6–27). Patients presenting to regional centres waited for 7.6 h (4.5–15.4, P < 0.001). Perforation rates for transferred patients were 31% which was greater than for those presenting to the metropolitan (20%) or regional centres (17%, P = 0.014). Complications were also highest in transferred patients (20%) when compared to the metropolitan (17%) or regional centres (10%, P < 0.001). Conclusion: Patients who were transferred to Christchurch Hospital from rural centres without surgical services had a longer wait‐time than those who presented to Christchurch Hospital directly or were treated in regional centres. This was associated with higher rates of perforated appendicitis. [ABSTRACT FROM AUTHOR]

Backgrounds: In cancer patients, the optimal appendicitis treatment has not been established. Therefore, we aimed to determine the ideal treatment option for appendicitis in cancer patients. Methods: This retrospective study included 185 cancer patients with acute appendicitis who were divided into the early surgical group (n = 152) involving surgery performed within 48 h following the appendicitis diagnosis or the conservative group (n = 33) involving intravenous antibiotics. We compared the appendicitis treatment efficacy between the groups. Results: In the early surgical group, the antibiotic duration [5.5 days (4.0–8.0) vs. 17.0 days (12.5–25.0), p < 0.001] and hospital stay length [7.0 days (5.0–11.75) vs. 10.0 days (8.0–32.0), p < 0.001] were significantly shorter. Regarding pathology, 16/171 (9.4%) patients who underwent surgery exhibited appendiceal tumours. During the 1‐year follow‐up period, one recurrence occurred in each group [1/152 (0.7%) vs. 1/33 (3.0%), p = 0.326]. The 1‐year treatment success rate was higher in the early surgical group [99.3% (151/152) vs. 42.4% (14/33), p < 0.001]. Conclusion: Early surgical treatment yielded a significantly higher success rate than conservative treatment for appendicitis in cancer patients. Surgery for appendicitis in cancer patients should be considered not only for treatment but also for pathologic confirmation. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is the most common reason children undergo emergency general surgery. Worse appendicitis outcomes have been demonstrated in rural, lower socioeconomic, and indigenous populations. These findings are hypothesised to be a result of differential access and delay in presentation to hospital. However, no qualitative study has investigated why prehospital delay may exist. Methods: We conducted individual, semi‐structured interviews with the parents of 11 rural children who presented with acute appendicitis between June 2019–January 2020. Utilising grounded theory methodology, we created an exploratory framework. Results: Participating families travelled a mean distance of 50.4 km to access hospital, and the median prehospital symptom duration was 42 h. Families with reduced financial or social resources were more likely to 'watch and wait' due to the increased relative burden of access. Key considerations were travel, organising childcare and parental income loss in a rural environment. Structural healthcare barriers further dissuaded prompt access and subsequent engagement. These included poor cultural safety, maldistribution of rural health services, and contradictory public health messages. Several families sought informal community‐based health advice to mitigate these barriers, leading to earlier hospital presentation. Conclusion: Prehospital delay in rural families occurred most frequently due to an extended decision‐making phase where families evaluated the costs and benefits of accessing hospital‐level care. The utilisation of informal community expertise and whānau advocacy helped circumvent reduced access to health facilities. Cultural safety remains problematic and hinders engagement with Māori families. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is a common surgical emergency that can be a challenging entity to manage. In the elderly, it is associated with significant morbidity and mortality. Risk prediction is not routinely performed prior to surgery. Methods: All patients aged >65 years undergoing appendicectomy over 5 years from one NHS Trust were included. Age, American Society of Anesthesiologists physical status classification system (ASA grade), Rockwood score, type of surgery, length of stay, morbidity and 90‐day mortality were recorded. ACS NSQIP was retrospectively calculated. Spearman's Rank correlation coefficient and linear regression analysis were conducted, assessing correlation between ASA, Age, Rockwood Score and ACS NSQIP with length of stay and post‐operative complications. Results: A total of 225 patient cases were reviewed. A complication rate of 29.3% was recorded, with a 6.7% serious complication rate. Two mortalities occurred. ASA, Age, Rockwood and NSQIP scoring systems all showed low degree positive correlation with length of stay (+0.16–+0.34). As predictors of length of stay, ASA was superior. Rockwood and age showed low degree positive correlation (+0.25–+0.33) with post‐operative complications. NSQIP and ASA demonstrated a greater degree of correlation (+0.38–+0.40). Conclusion: Both ASA and ACS NSQIP appear superior indicators for outcomes compared to age and Rockwood score. However, caution is warranted when interpreting the superiority of ASA over validated risk stratification tools. Therefore, we advocate the use of pre‐operative risk stratification for elderly patients undergoing low‐risk surgery such as appendicectomy. Validated tools are not routinely applied in many centres currently. Utilisation of scores such as ACS NSQIP may help improve consent, patient selection, outcomes and expectations. [ABSTRACT FROM AUTHOR]

Background: Complicated appendicitis encompasses a spectrum of severity with heterogeneity in definition and substantial variation in care. Enhanced recovery after surgery or 'fast‐track' protocols aim to reduce practice variation by standardizing care. These initiatives may improve quality and efficiency of care, preserve resources and expedite discharge. This study aims to evaluate the impact of a standardized Enhanced Recovery Pathway (ERP) on the post‐operative recovery of children with a subset of complicated appendicitis termed 'advanced' appendicitis. Methods: We defined advanced appendicitis as gangrenous or suppurative appendicitis without perforation, contained iatrogenic perforation, or localized purulent fluid. Children with operative findings reflecting these criteria were enrolled in the ERP protocol. Key protocol components include early upgrade of diet, avoidance of intravenous analgesia, abridged intravenous antibiotics, early ambulation and standardized discharge criteria. The study period was May 2018 to June 2019. A historical cohort was used as the comparator group. Results: Outcomes for 44 children treated under the ERP were compared to 44 historical controls. There was a 20% reduction in median post‐operative length of stay (1.80 vs. 2.24 days, p = 0.02). Intravenous analgesia was received by fewer patients (6.8% vs. 36.4%, p = 0.01) with significant reduction in antiemetic requirement (p = 0.03). No significant difference in 30‐day complication rates was observed. Conclusion: Reduced post‐operative length of stay and reduction in practice variation were achieved after implementation of a 'fast‐track' protocol for children with advanced appendicitis. Additional benefits of this protocol include reduced provision of intravenous morphine analgesia, decreased resource use and cost savings. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is the most frequent aetiology of acute abdominal pain requiring surgical treatment, with an estimated lifetime risk between 7% and 8%. Antibiotics play a substantial role in treatment, and there is considerable debate regarding the duration of antibiotics in treating appendicitis. Methods: We searched multiple databases from inception until June 2019 for peer‐reviewed studies that compared different durations of antibiotic treatment after appendicectomy for acute complicated appendicitis in adults. We dichotomized reported data into short‐ and extended‐term antibiotic use and controlled for different definitional thresholds in the meta‐analysis. We generated risk ratios using restricted maximum likelihood methods and mixed effects modelling for each outcome of interest. Results: Four observational studies involving 847 participants were included in the meta‐analysis. For the primary outcomes of intra‐abdominal infection, we did not find a statistically significant difference between extended‐ and short‐term antibiotic strategies for intra‐abdominal infection (Risk ratio 0.92, 95% confidence interval (CI) 0.49–1.74). Three randomized controlled trials involving 291 participants were included in a separate meta‐analysis. We found that extended antibiotic usage was not associated with a statistically significant reduced risk for intra‐abdominal infection (RR 0.52, 95% CI 0.21–1.29) or surgical site skin infection (RR 1.44, 95% CI 0.43–4.81). Conclusion: This systematic review and meta‐analysis found that extended post‐operative antibiotic treatment may not be associated with a reduced risk of intra‐abdominal infection; however, meta‐analysis was significantly limited by heterogeneity between studies and underpowered trials. Further large randomized controlled trials are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

This article, titled "Laparoscopic appendicectomy with right sided ports at 28 weeks of pregnancy," discusses a case study of a 42-year-old pregnant woman diagnosed with acute appendicitis at 28 weeks gestation. The article highlights the challenges of diagnosing appendicitis during pregnancy and the higher complication rates associated with delays in diagnosis and reluctance to operate. The safety of laparoscopic surgery during pregnancy is also discussed, with a focus on the challenge of inserting ports in the third trimester. The authors describe their approach of using non-standard port sites to ensure the safety of the procedure, which was completed successfully in 30 minutes with the patient experiencing an uneventful recovery. [Extracted from the article]

(c) A coronal view showing a peri-diverticular collection (white arrow) with an intestinal non-rotation: The entire small intestine is arranged on the right side of the abdomen and the whole large bowel is located at the left hemi-abdomen. Abdominal CT scan showed a perforated small bowel diverticulum (Fig. The CT-scan also revealed intestinal non-rotation as the entire large bowel was abnormally located in the left hemi-abdomen whereas the entire small intestine occupied the right side of the abdomen (Fig. [Extracted from the article]

ART AND SURGERY IN TIMES OF DISRUPTION: FEMALE SURGEONS AT JUDY CHICAGO'S DINNER PARTY David Watters Deakin University, VIC The dinner party is a artwork housed in the "Elizabeth A Sacker centre for feminist art" (Brooklyn Museum), created between 1974 and 1979 by female artist, Judy Chicago. The impact of the professionalization of surgery on the relationship between surgeons and patients was investigated by analysing the perspectives of the patients and the views of the surgeons on their encounters during consultations, diagnosis, and treatment. SH038P CELEBRATING THE PAST 50 YEARS OF LAPAROSCOPIC SURGERY Lachlan Allan Westmead Hospital, NSW Laparoscopic surgery is integral to the modern surgeon's skill set, with laparoscopy providing more accurate diagnosis, less debilitating operations and far superior cosmetic outcomes. B Conclusion: b Dr James Rutherford Morison was a pioneer Surgeon whose dedication to surgery is recognized through the eponymously named Rutherford Morison incision, which is common practice in KT. SH041P HENRI DE MONDEVILLE (1260-1320): ASEPTIC SURGEON Rory Middleton and James Briffa Royal Melbourne Hospital, VIC Little is known about the early life of Henri de Mondeville, though it is likely he was born in Normandy, France, in 1260. SH049P SURGEON, HEAL THYSELF: STORIES OF SELF-SURGERY THROUGHOUT HISTORY Francesca Paterson and Joshua Tesar Royal Brisbane & Women's Hospital, QLD The history of surgery is dotted with examples of extreme acts of desperation or curiosity, in which surgeons have elected to perform operations on themselves. [Extracted from the article]

B Results: b Out of the 118 patients who had abdominal pain, 32 patients obtained complete imaging with a radiology report whilst 86 patients either did not have any imaging performed or was referred to a general surgical unit prior to obtaining a formal report. B Results: b Of 3068 patients who underwent a general surgical procedure, 129 patients (4.2%) had an UROT within 30 days. SURGICAL EXPERIENCE FOR PATIENTS WITH SERIOUS MENTAL ILLNESS: A QUALITATIVE STUDY Kate Mcbride, Michael Solomon, Tim Lambert, Sarah O'Shannassy, Catherine Yates and Nick Gloz... RPA Institute of Academic Surgery, NSW B Background: b People with serious mental illness (SMI) have significantly worse surgical outcomes compared to the general population. QA039P PATIENT REPORTED EXPERIENCE ON CONSENTING FOR SURGERY - ELECTIVE VERSUS EMERGENCY PATIENTS Dominic Maher, Jonathan Serpell, Darshini Ayton and James Lee Alfred Hospital, VIC B Purpose: b Informed consent for surgery is a medical and legal requirement, but completing these does not necessarily translate to high patient satisfaction. B Results: b Of the total of 652 patients who underwent an appendicectomy, 203 patients were private, 444 patients were public, and 5 were overseas patients. [Extracted from the article]

All trauma patients from January 2015 to August 2020 at a major Australian paediatric trauma centre were reviewed. We recorded patient demographics; whether the patient had a follow-up endoscopy with us, and what the findings were. B Results: b A total of 255 patients were identified: 63 LR were performed in 41 patients and 253 OR were performed in 214 patients. A REVIEW OF PAEDIATRIC SPLENIC INJURIES AT A MAJOR TRAUMA CENTRE IN SOUTH AFRICA Bernike Conradie, Victor Kong, Cynthia Cheung, Chris Varghese, Damian Clarke, Abdalla Elsaba... University of Auckland, Auckland, New Zealand B Backgrounds: b This study reviews our experience with paediatric splenic trauma in order benchmark our experience against the international experience and to identify discrepancies in access to care and in surgical outcomes. [Extracted from the article]

Nine patients received RBC with Hb between 60-69 g/L, 13 patients received RBC with Hb between 70-79 g/L, four patients received RBC with Hb between 80-89 g/L and five patients received RBC with Hb between 90-100 g/L. 22 patients transfused with a Hb less than 80 g/L were according to recommended guidelines; seven patients received RBC inappropriately. B Result: b Among 42 patients, 28 patients did not have symptomatic recurrence and 14 patients experienced symptomatic recurrence. B Results: b Fewer patients were admitted with acute appendicitis during the COVID study period compared to the control period (107 patients versus 168 patients, I p i < 0.05 assuming stable population). Patients with no TP were more likely to have a successful challenge: 65/81 patients with a TP were successful, compared to 26/26 patients with no TP ( I p i = 0.01). SENTINEL LYMPH NODE BIOPSY FOR HIGH RISK THIN (T1B) MELANOMA: THE QUEENSLAND EXPERIENCE OVER... Harrison Theile, Julie Moore, Nathan Dunn, Pip Youl and Mark Smithers Queensland Cancer Control Analysis Team, QLD B Purpose: b Current Australian guidelines recommend sentinel lymph node biopsy (SLNB) be considered for patients with melanoma >0.75 mm Breslow thickness with other "high risk pathological features.". [Extracted from the article]

Background: The diagnosis of acute appendicitis (AA) remains a clinical one, with selective use of adjunct imaging. Patients with equivocal clinical presentation often undergo a diagnostic laparoscopy. To help reduce negative appendicectomy rates in women, we aimed to develop a simple scoring system based on the Alvarado score (AS) and ultrasound scan (US), as a diagnostic aid for AA in females. Methods: All patients who underwent appendicectomy for AA at The Alfred Hospital Melbourne between 1 July 2012 and 30 June 2017 were included for this case–control study. Logistic regression was used to identify pre‐operative parameters predictive of AA. Histopathological identification of AA was interpreted as the gold standard. Statistical analysis was performed using IBM SPSS Statistics V26. Results: A total of 1194 patients were included, with 26% negative appendicectomy rate in women. Of the 8 parameters in the AS, logistic regression identified migratory pain, leukocytosis and leukocyte left shift as most significant predictors for AA. These three parameters were used in a 3‐point test which carried a sensitivity of 92.1% and specificity of 28.7%. In women, a negative or non‐diagnostic US improved the negative predictive value of the 3‐point test from 57% to 82%. Conclusion: The 3‐point abbreviated AS in combination with US may be clinically useful in women to exclude appendicitis without diagnostic laparoscopy. Further large‐scale prospective studies are required to validate the utility across different subgroups. [ABSTRACT FROM AUTHOR]

Background: In Australia, there has been a shift from the traditional 'on‐call' surgical model to the 'acute surgical unit' (ASU) model to improve outcomes in acute general surgery. Using emergency appendicectomy as a standardized procedure, we aimed to identify the different patterns of care between these on‐call structures by comparing two metropolitan district hospitals; one that employs a traditional on‐call model and the other, which employ the ASU model. Methods: Data on consecutive patients undergoing emergency appendectomies at the two hospitals (traditional and ASU model) between July 2018 and December 2018 were retrieved for retrospective review. Patient factors, preoperative factors, operative factors and post‐operative outcomes were collected and tabulated for comparative analysis between the traditional versus ASU model of care. Results: Univariate analysis demonstrated that there were a greater proportion of consultant‐led cases (P < 0.001), a shorter time to theatre (P = 0.047) and a greater number of out‐of‐hours operations (P < 0.001) in the ASU model compared to the traditional model. A larger proportion of patients from the traditional model underwent a computed tomography scan as part of their diagnostic workup compared to the ASU model (P < 0.001). There was no difference in negative appendicectomy rates, intraoperative conversion rates, post‐operative complication rates or mean lengths of hospital stay between the two on‐call models. Conclusion: The ASU and traditional on‐call model appears to achieve equivalent care outcomes for patients with acute appendicitis. [ABSTRACT FROM AUTHOR]

Subsequently, the recurrent caecal tumour was classified as a mixed neuroendocrine - non-neuroendocrine neoplasm with components of large cell neuroendocrine carcinoma and mucinous adenocarcinoma. Pathologist opinion is that the relationship between the appendiceal and caecal tumour is unclear; however, it likely represents evolution of mucinous adenocarcinoma to neuroendocrine carcinoma. An open right hemicolectomy was performed with histopathology from this procedure showing a T3N0M0 mixed neuroendocrine neoplasm of caecum, with components of mucinous adenocarcinoma and neuroendocrine carcinoma. [Extracted from the article]

Differential diagnosis includes a wide range of tumors, which comprises epithelial tumors (adenocarcinoma) or non-epithelial tumors (lymphoma and carcinoid tumors). Shaib et al. report that in tumors involving peri-appendiceal area, tumors that are 2 cm or larger, and histologically proven tumors with high-grade histology or invades the muscularis propria a formal right hemicolectomy should be the treatment of choice. Mucinous appendiceal neoplasms (MAN) are rare entities which have a prevalence of less than 0.5% from all gastrointestinal neoplasms. [Extracted from the article]

A 52-year-old man was first referred to the clinic for a review of an incidentally detected 9 × 5 cm simple right-sided retroperitoneal cystic lesion (Fig. 1a,b) from computed tomography (CT) of the spine for investigation of lower back pain in 2014. A follow-up CT of the abdomen/pelvis 12 months later showed no change in the size and characteristics of the lesion (Fig. [Extracted from the article]

A discussion of this disease is undertaken, with special regard to aetiology, pathology, treatment and prognosis. Again, a patient suffering from chronic Crohn's disease may have another portion of bowel affected by acute Crohn's disease. While the surgeon may feel compelled to remove the lesion, if he/she is wise, he/she will seek elsewhere for a source of symptoms (in particular, the acid secretory status of the stomach should be tested), and will hesitate before assuring his/her patient that the symptoms will be relieved by operation. [Extracted from the article]

GLO:HWR/01dec21:ans16840-fig-0001.jpg PHOTO (COLOR): 1 Computed tomography (CT) of the abdomen and pelvis revealed multiple mesenteric and serosal nodules suspicious for carcinomatosis peritonei (a), and right hepatic lobe subcapsular deposits suspicious for metastasis (b). An interval CT scan at the 6-month treatment interval showed interval near resolution of the pulmonary nodules and decreased background peritoneal nodules. [Extracted from the article]

Background: Acute Appendicitis is the most common surgical presentation within Australia. Despite the increasing use of radiological investigations to aid clinical diagnosis, many appendectomies result in a histologically normal appendix. This study examines the histological negative appendicectomy rate (NAR) in a metropolitan hospital and determine factors associated with a negative appendicectomy (NA). Methods: Patients who underwent emergency appendicectomy for suspected acute appendicitis at Logan Hospital, Australia, between February 2016 and March 2019 inclusive were included. Clinicopathologic and imaging variables were analysed for associations with NA. Results: A total of 1241 patients underwent emergency appendicectomy of which 121 patients (9.8%) had a NA. The NAR for clinical diagnosis alone (no imaging) was 9.9%, 14.5% for ultrasonography alone and computed tomography scan alone was 4.9%. Univariate analysis revealed age <27 years (P < 0.001), absence of hypertension (P = 0.008), symptoms >48 hours (P < 0.001), absence of leucocytosis (P < 0.001), undergoing ultrasonography only (P < 0.001), undergoing computed tomography scan only (P < 0.001), macroscopically normal appendix (P < 0.001) and time to operation >24 hours (P < 0.001) were associated with NA. Multivariate analysis identified symptoms >48 h at presentation (odds ratio (OR) 1.98, 95% confidence interval (CI) 1.20–3.24; P = 0.007), absence of leucocytosis (OR 2.41, 95% CI 1.52–3.81; P < 0.001) and macroscopically normal appendix (OR 5.70, 95% CI 3.49–9.33; P < 0.001) to be associated with a NA. Conclusion: The NAR reported is lowest in an Australian institution. The identified predictors of NA will be useful in identifying patients who would truly benefit from an appendicectomy versus those would have a higher rate of NA who may be suitable to be treated non‐operatively to be spared the unnecessary morbidity of surgery. A low negative appendicectomy rate may be achieved by careful clinical assessment by elucidating a patients signs and symptom duration with blood test results assessing for leucocytosis. [ABSTRACT FROM AUTHOR]