Legal & ethical dilemmas in incidental findings during surgery: Review article

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%.

Incidental Finding of Acute Appendicitis During Laparoscopic Cholecystectomy for an Acute Calculous Cholecystitis

Acute cholecystitis and appendicitis are among the most common conditions encountered by general surgeons; however, they are rarely described simultaneously. We are reporting a rare incidental finding of early acute appendicitis during laparoscopic cholecystectomy for a 36-year-old lady who presented to our emergency department with signs and symptoms of acute calculous cholecystitis. Laparoscopy has proved to be a highly useful and ideal tool in the diagnosis and treatment of such surgical situations.

Examining hospital staff members' preferences for allocating a ventilator to a COVID-19 patient with and without Alzheimer's disease

The COVID 19 pandemic has led to an increase in the number of patients in need of ventilation. Limitations in the number of respirators may cause an ethical problem for the medical and nursing staff in deciding who should be connected to the available respirators.  We conducted a cross-sectional survey among a convenience sample of 278 healthcare professionals at one medical center. They were asked to rank their preference in respirator allocation to three COVID-19 patients, one 80 years old with no cognitive illness, one 50 years old with Alzheimer's disease (AD), and one 80 years old with AD. Most respondents (75%) chose the 80-year-old AD patient as last preference, but were evenly divided on how to rank the other two patients. Medical staff have difficulty deciding whether age or cognitive status should be the deciding factor ventilator allocation. Determination of a set policy would help professionals with these decisions.