Incidental findings in surgery

The dilemma of incidental findings in abdominal surgery: A cross-sectional study

Introduction

Despite the recent development in diagnostic techniques, many surgeons experience unexpected findings during the course of surgery. We aim to examine the incidence of all IFs in abdominal surgery -laparoscopy or laparotomy- and identify possible associations.

Methods

This study is a cross-sectional study conducted in Aleppo University Hospital - Department of Surgery. We collected patients' data who underwent abdominal surgery during the period of the two-consecutive years 2018–2019.

Results

The data revealed detection of incidental findings during abdominal surgery -which included proper inspection of peritoneal cavity-in 6 out 543 cases (1.1%), whereas only one case included a misdiagnosis event (0.2%).

Conclusion

Epidemiological information about IFs in abdominal surgery can be extremely useful for the surgeons on various aspects, and can assist them with being more prepared for the surgery and the possible unexpected lesions that might be encountered. We strongly recommend that further studies with larger numbers of participants are conducted as they can provide more generalizable data.

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There is a lack in epidemiologic data regarding incidental findings in abdominal surgery.

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Epidemiological data might be of great benefit for the surgeons when obtained prior to surgery.

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The incidence of incidental findings in abdominal surgery is estimated to be 1.1%.

OUP accepted manuscript

Intraoperative incidental findings are a persistent concern for surgeons. Even when such findings are not overtly life-threatening, surgeons must quickly decide whether to intervene. Esophageal diverticula are rare and underdescribed incidental findings associated with increased morbidity. A 40-year-old man was brought in by EMS after sustaining a penetrating Zone II left anterolateral neck wound. Emergent surgical exploration revealed a full-thickness distal oropharyngeal injury. The endotracheal tube was exposed and a Zenker’s diverticulum was identified on the superior edge of the laceration. The diverticulum was excised and oversewn along with the oropharyngeal laceration repair. Intraoperative esophagogastroduodenoscopy leak test and 7-day post-op computed tomography esophagram were negative. Our case describes the first successful management of an incidental Zenker’s diverticulum in the literature. The decision to resect the diverticulum allowed for proper repair of the oropharyngeal laceration and improved outcomes by reducing the need for future surgical intervention.