Diffuse Idiopathic Skeletal Hyperostosis Prevalence, Characteristics, and Associated Comorbidities: A Cross-Sectional Study of 1815 Whole Spine CT Scans

STUDY DESIGN

A Retrospective Study.

OBJECTIVE

To determine the prevalence and characteristics of DISH using whole spine CT scans and to evaluate the association of DISH with co-morbidities and other ossified lesions.

METHOD

A retrospective study of whole-spine CT scans of polytrauma patients from 2018-2021 above the age of 20 years. The screening was done using modified Resnick criteria. Overall and age-specific prevalence, characteristics, and associations with obesity, diabetes mellitus (DM), ischemic heart disease (IHD), aortic calcification (AC), ossified posterior longitudinal ligament (OPLL), and ossified ligamentum flavum (OLF) were evaluated.

RESULTS

Out of 1815 patients, 347 had DISH, with a prevalence rate of 19.1% and a mean age of 61.7 years. The highest prevalence of DISH was seen in individuals over 80 years of age (45.5%). The prevalence among males (20.2%) was higher than for females (14.9%). The most commonly involved level was T8-T9 (95.4%), followed by T9-T10 (91.9%), and the most common vertebra involved was T9 (96%). All the cases involving T9 had ossification on the right anterior aspect of the vertebral body. The presence of DM, high BMI, and IHD was found to be significantly higher in patients with DISH (P value < .001). The incidence of aortic calcification was 22.5%, OPLL was 13.3%, and OLF was 4.9% in patients with DISH.

CONCLUSION

This study reports a prevalence rate of 19.1% for DISH, with the highest prevalence among individuals above 80 years of age (45.5%). DISH has a higher propensity to affect the right anterior aspect of the vertebral body in the thoracic spine and is strongly associated with obesity, DM, IHD, and AC.

A prospective randomized control trial comparing outcomes of casting, pinning, and plating for distal end of radius fractures (AO type A2, A3, C1, or C2) in the elderly population

PURPOSE

With this prospective randomized control trial (RCT), we aim to provide the outcome analyses of the three most used treatment modalities for distal end of radius (DER) fracture management in the elderly.

METHODS

A prospective randomized control trial was performed. Fifty-two patients with DER fractures (AO A2, A3, C1, or C2) were randomized to the casting (n = 17), percutaneous pinning (n = 18), and the volar plating group (n = 17). Radiological measurements measured were radial inclination (RI), radial height (RH), volar tilt (VT), and ulnar variance (UV). The outcome was measured based on range-of-motion, grip strength, Patient-Related-Wrist-Evaluation (PRWE) score, and the Quick-Disabilities-of-the-Arm-Shoulder-Hand (QDASH) score.

RESULTS

Immediate post-operative and 1-year-follow-up X-rays showed a significant difference measurement between the groups (p < 0.05). Pairwise comparisons of the casting and pinning groups (p < 0.05) and the casting and plating groups (p < 0.05) revealed significant differences at the 1-year follow-up, but not the pinning and plating groups (p > 0.05). The analysis found significant differences in clinical outcomes after 1 month of follow-up, with the plating group outperforming the other two (p > 0.05). However, after a year of follow-up, all groups had comparable outcomes; however, the plating group showed improved palmar flexion (p < 0.001), radial deviation (p < 0.001), and a lower PRWE score (p < 0.05), indicating better wrist function. Complications were more in casting group.

CONCLUSION

The study found a radiologically significant difference between groups throughout the follow-up, but it did not affect functional results. Clinical outcomes were similar across the groups, with plating showing better palmar flexion and radial deviation. Grip strength was also better in the plating group, but statistically insignificant. The study suggests plating should be chosen over other treatments for high-demand patients.

Robotic-assisted free flap harvesting for diverse soft tissue reconstruction: a PRISMA scoping review of clinical outcomes over the last decade

Introduction

The aim of our study was to assess the advantages and limitations of robotic technology in diverse reconstructive procedures.

METHODS

A scoping review was conducted in Oct'23, on published studies from 2013 to 2023, focussing on robotic-assisted free flap harvesting. Three databases Ovid-MEDLINE, Scopus, and PubMed were searched. Original research studies reporting robotic-assisted free flap harvest were included. Studies on lesion excision, microvascular anastomosis, local flap harvest, roboticassisted flap inset, review articles, abstract-only studies, non-English documents, and animal studies were excluded from this review.

RESULTS

Sixteen studies met the inclusion criteria out of a total of 318, searched initially. These studies included a total of 128 patients, who underwent robotic-assisted free flap harvest for the reconstruction of various defects, with 140 free flaps harvested. The most common flaps harvested by robotic technique were deep inferior epigastric artery perforator (DIEP) flap 120 (85.7%), radial forearm free (RFF) flap 11 (7.9%), latissimus dorsii flap 4 (2.9%), rectus abdominus flap 4 (2.9%), and omental flap 1 (0.7%). Breast reconstruction was the major procedure done i.e. 120 (85.7%) followed by head and neck 11 (7.9%) and limb defects 9 (6.4%) reconstruction procedures. The reported clinical outcomes were acceptable in all the studies with a 99% flap success rate and minimal complications. Variability in operating time was observed depending upon surgical steps undertaken with robotic systems.

CONCLUSIONS

This scoping review highlights the role of robotic-assisted free flap harvesting in plastic surgery and its potential benefits on clinical outcomes, due to its high precision and minimal invasiveness. However, challenges like cost effectiveness, resource distribution and learning curve are there.

Risk factors for severe morbidity and definitive stoma after elective surgery for sigmoid diverticulitis: a multicenter national cohort study

BACKGROUND

In the decision to perform elective surgery, it is of great interest to have data about the outcomes of surgery to individualize patients who could safely undergo sigmoid resection. The aim of this study was to provide information on the outcomes of elective sigmoid resection for sigmoid diverticular disease (SDD) at a national level.

METHODS

All consecutive patients who had elective surgery for SDD (2010-2021) were included in this retrospective, multicenter, cohort study. Patients were identified from institutional review board-approved databases in French member centers of the French Surgical Association. The endpoints of the study were the early and the long-term postoperative outcomes and an evaluation of the risk factors for 90-day severe postoperative morbidity and a definitive stoma after an elective sigmoidectomy for SDD.

RESULTS

In total, 4617 patients were included. The median [IQR] age was 61 [18.0;100] years, the mean ± SD body mass index (BMI) was 26.8 ± 4 kg/m2, and 2310 (50%) were men. The indications for surgery were complicated diverticulitis in 50% and smoldering diverticulitis in 47.4%. The procedures were performed laparoscopically for 88% and with an anastomosis for 83.8%. The severe complication rate on postoperative day 90 was 11.7%, with a risk of anastomotic leakage of 4.7%. The independent risk factors in multivariate analysis were an American Society of Anesthesiologists (ASA) score ≥ 3, an open approach, and perioperative blood transfusion. Age, perioperative blood transfusion, and Hartmann's procedure were the three independent risk factors for a permanent stoma.

CONCLUSIONS

This series provides a real-life picture of elective sigmoidectomy for SDD at a national level.

TRIAL REGISTRATION

Comité National Information et Liberté (CNIL) (n°920361).

Assessing causality in the association between neurocognitive gains and fasting

Fasting is associated with improvements in cognitive function, and triggers weight loss in human and animal models. In recent years, the connection between fasting, brain health, and cognitive function has increasingly proven deserving of attention from researchers. The objective of this review work is to highlight evidence supporting a positive association between fasting and enhanced cognition. We looked at the following database sources "The Cochrane Library, PubMed, EMBASE, Web of Science and Google Scholar" for present review article. All the studies based on the key words "impact of fasting", or "cognitive function" or "brain stimulation". Much of this evidence demonstrates that fasting results in enhanced performance in cognitive tests of memory and visuospatial processing, which rely heavily on hippocampal function. The mechanisms responsible for the cognitive improvements associated with fasting are not fully understood, although current evidence suggests neuroplasticity plays an important role. Maintaining the health and the functionality of neurologically and cognitively impaired individuals can be extremely costly. Higher life expectancy and ageing populations globally is anticipated to increase the prevalence of many non-communicable, chronic, progressive conditions including neurological disorders.

A novel technique for prevention of anterior fistula and facilitation of alveolar cleft repair: Gingivoperiosteoplasty with palatoplasty

Background & Objectives:

The Cleft palate is one of the most commonly encountered congenital deformity in plastic surgery clinics and can be associated with cleft lip and alveolus. Though palate repair can be associated with several complications, the most frequent and troublesome is anterior fistula formation. Various technical modifications are in practice to avoid this dreaded complication. We have started combining gingivoperiosteoplasty with palate repair to avoid postoperative anterior fistula formation and to close alveolar cleft at the same time.

Methods:

A prospective study was performed at the department of plastic and reconstructive surgery, Liaquat National Hospital, Karachi and selected patients were enrolled in the study after informed consent. A total of 15 patients were operated on from January 2017 to December 2020. All patients had cleft palate repair along with primary gingivoperiosteoplasty (GPP) at the age of standard palatal repair. Buccal/oral and nasal layers of the alveolus were dissected as per standard gingivoperiosteoplasty and repaired in continuation with nasal and oral layers of the palate. Postoperatively, the standard cleft palate repair protocol was followed. Follow-up was done at four weeks, 12 weeks, and six months and repair integrity was checked. Future follow-up at 4-5 years of age is planned to see the effect on alveolar collapse, bone growth, and the need for secondary bone grafting.

Results:

All patients were followed up regularly. None had a complication of fistula. The repairs of both palate and alveolus remained intact. Patients were kept on the follow-up to assess the need for alveolar bone grafting in the future.

Conclusion:

Gingivoperiosteoplasty combined with the palatal repair is a novel technique for the prevention of anterior palatal fistula.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Abstract 428: A Localized Giant Coronary Artery Aneurysm

Background: Coronary artery aneurysm (CAA) incidence is thought to be as common as 0.3 to 5 % of the angiographically examined patients. Regardless of underlying pathogenic mechanism, it results in adverse long-term outcomes. The management of the CAA can be challenging because of lack of clearly defined guidelines.

Case Presentation: A 75-year-old male without known history of tobacco abuse, DM, hypertension, OSA, CAD, PCI or connective tissue disorder presented with a chief complaint of 2 months of intermittent angina. He had an unremarkable serum troponin level and an EKG. Echocardiogram revealed moderate mitral regurgitation without any regional wall motion abnormality [1]. Because of equivocal exercise stress EKG test, he underwent a coronary angiogram which showed a proximal LAD stenosis followed by a localized fusiform aneurysm [2]. Given his significant symptoms, large size of the aneurysm, ostial LAD stenosis and proximity of diagonal arterial branch the patient underwent CABG surgery involving LIMA to LAD.

Discussion: CAA patients may present with stable angina, ACS or it may just be an incidental finding on a coronary angiogram. The pathogenesis of CAA is not well known. However, some of the risk factors can be genetic predisposition, underlying atherosclerotic coronary artery disease, autoimmune and connective tissue disorders, trauma such as following PCI, and infections. Coronary CT can be of great utility in evaluating giant CAA as it can help to delineate mechanical complications of these aneurysms. In our patient it was unusual to see localized CAD and an aneurysm limited to one coronary artery territory when atherosclerotic CAAs usually affect more than one artery.

Conclusion: Since pathophysiology of CAA is not well understood and there are no obvious society guidelines regarding their management, therefore, it becomes important to tailor treatment based on the location and size of the CAA, underlying risk factors and the clinical presentation.

Comparison of the Interrupted and Continuous Suture Techniques for the Closure of Oral and Nasal Mucosal Layers in Cleft Palate Surgery

Background

Cleft lip and palate are common congenital craniofacial anomalies, treated conventionally by surgery at the ages of six to 18 months. Mostly, the interrupted suture technique is used to close the nasal and oral layers of the palate. In some studies, the interrupted suture technique was compared with continuous suture techniques for the closure of oral and nasal layers and found that there was less utilization of time and suture materials in the continuous technique. This study was designed to see the outcomes of interrupted versus continuous suture techniques.

Materials & methods

A total of 36 patients were included in the study and were divided into two groups according to the type of suturing technique. The time utilized for the repair of the oral and nasal layers of the cleft palate, the number of suture packs utilized, and the incidence of fistula formation were noted and compared between the two groups. Out of 36 patients, 17 were included in group A (operated by interrupted techniques), and 19 were included in group B (operated by the continuous technique).

Results

The mean time taken to close nasal layer in Group A was 18.12 ± 1.16 minutes and in Group B was 8.37 ± 0.89 minutes (p-value < 0.001), whereas for oral layer closure, it was 14.00 ± 1.17 minutes in group A and 6.00 ± 0.57 minutes in group B (p-value < 0.001). The average usage was 2.26 ± 0.45 suture packs for repair with the continuous technique and 4.00 ± 0.35 suture packs when repaired via interrupted stitches. There was no difference noted in postoperative outcomes in both groups in terms of postoperative fistula and wound dehiscence.

Conclusion

A continuous suture technique for closing the oral and nasal layers in patients with cleft palate is recommended, as it is more beneficial in terms of time, cost-effectiveness, and utilization of suture material.

1611 Significant Epistaxis Secondary To COVID-19 Nasopharyngeal Swab

Aim

This case highlights the need for appropriate training when adopting new techniques, even for relatively simple procedures.

Method

we report a rare complication of the innovative COVID-19 nasopharyngeal swab which is a new skill for many healthcare professionals and frequently performed with little or no training.

Results

We describe a case of iatrogenic epistaxis after a diagnostic nasopharyngeal swab was taken during the COVID-19 pandemic. The epistaxis was significant, causing haemodynamic and respiratory compromise. In a frail patient who is susceptible to epistaxis, the potenial for further harm is significant. After initially presenting with shortness of breath, this patient (who had no previous nasal pathology) underwent routine naso- and oro- pharyngeal swabbing to test for COVID-19. He felt immediate discomfort in his nasopharynx and epistaxis ensued. The bleeding persisted for several hours; bilateral anterior and posterior nasal packing was required to eventually cease the bleed. He was compromised with a falling haemoglobin, and aspiration of blood compounded his shortness of breath.

Conclusions

Epistaxis is a potentially serious side effect of nasopharyngeal swabbing; a procedural skill dramatically increasing in prevalence during the COVID-19 pandemic. We advocate for formal training of this procedure for all healthcare staff required to undertake it. Presenting such a case report can help us in understanding the complications of this procedure, and better thus inform the patient consenting process.

247 Single-Photon Emission Computed Tomography (SPECT) In Predicting Localisation of Parathyroid Adenomas: A Closed-Loop Prospective Study

Aim

to measure the sensitivity of SPECT in localising parathyroid adenomas particularly whilst attempting minimally invasive parathyroidectomy.

Method

2-cycles prospective study correlating SPECT and operative findings was conducted. All patients underwent ultrasound and SPECT, those with concordant findings on both modalities underwent minimally invasive parathyroidectomy, whilst patients with discordant findings on both modalities had central neck exploration. Following operative findings, recommendations of changing the SPECT reporting method such as surgically relevant structures adjacent to the lesion, such as the thyroid, were implemented. Following which, a second prospective study assessed the outcome of change.

Results

In the first cycle, 20 patients underwent partial parathyroidectomy, either by open (n = 13), or minimally invasive (n = 7) approach. SPECT sensitivity was 85% (n = 17) in identifying the adenoma. Out of all histologically confirmed adenomas, SPECT identified all adenomas (n = 17) on the correct side and 41% (n = 7) on the correct level (superior vs. inferior parathyroid). In the second cycle following recommendation, 14 patients had surgery, 9 as minimally invasive and 5 as open approach. SPECT sensitivity was 79% (n = 11) for adenoma identification. Of all confirmed adenomas, SPECT identifying adenomas at the correct side increased to 91% (n = 10) and correct level to 91% (n = 10).

Conclusions

SPECT alone is not yet regarded as gold standard in parathyroid adenoma localisation. The study has demonstrated that feedback to the radiologist of the operative findings may enhance its usefulness, particularly in attempting to proceed with a minimally invasive parathyroidectomy.

1640 Stridor in An Infant with Double Aortic Arch

Conclusions

Although foreign body aspiration is the commonest cause of stridor in infants and young children, external compression of the trachea, particularly with vascular rings, should be considered in children with otherwise unexplained stridor.

The Application of Buccal Fat Pad to Cover Lateral Palatal Defect Causes Early Mucolization

Introduction

Cleft lip and cleft palate are among the most common birth defects. These deformities lead to profound psychosocial and functional effects on cleft palate patients. Several surgical techniques have been described for the repair of the cleft. The defects lateral to mucoperiosteal flaps closure are sometimes covered with sterile gauze soaked with soft paraffin or tincture of benzoin or are left open for mucolization by means of secondary intention. The buccal fat pad (BFP) is used as a pedicled graft to cover the exposed bone of the lateral palatal defect, and it is associated with proposed benefits of early healing and fewer effects on transverse growth of the maxilla.

Materials and methods

This was a prospective study involving 42 cleft palate patients who underwent cleft palate repair; 21 patients received BFP as an additional step to cover lateral palatal defect while the rest of the patients (n=21) underwent conventional surgical cleft palate repair and the defect was covered with Surgicel (Ethicon, Inc., Bridgewater, NJ). Postoperative follow-up was conducted at first, second, and third weeks postoperatively to assess the time required for mucolization.

Results

Our cohort of 42 patients included an equal number of complete and incomplete cleft palate patients. Follow-up at the first postoperative week showed an equal number (n=21, 100%) patients with incomplete mucolization on both groups, while at the second postoperative follow-up, only one (4.8%) of the patients who underwent conventional cleft palate repair had complete mucolization while 20 (95.2%) among the patients who underwent BFP had complete mucolization. At the third-week postoperative follow-up, three (14.3%) patients from the conventional group had complete mucolization, while 18 (85.7%) had incomplete mucolization. Only two patients (4.8%) developed recipient area complications, and they were managed conservatively.

Conclusion

BFP is a good source of vascularized tissue to cover the hard palate bones after primary cleft repair. It is easy to harvest as a local tissue with a low learning curve. The epithelialization rate is faster than conventional methods with minimal complication rates.

Tibialis Posterior Transfer for Foot Drop: The Difference in Outcome for Two Different Attachment Sites

Introduction Common peroneal nerve injury leading to foot drop is of multifactorial etiology. The goal is to restore a normal toe-heel gait. Various static or dynamic surgical options are being performed. Among all, tendon transfer is the most commonly performed procedure with its different dorsal attachment sites on the foot i.e. tendon to bone or tendon to tendon transfer. The objective of our study was to evaluate the outcomes of two methods of transfer in terms of attachments sites on functional outcomes. Materials and methods In a retrospective study conducted at Liaquat National Hospital Karachi, a total of 38 patients were included. All of them were operated upon for foot drop from June 2015 to May 2018. A total of 32 patients showed up for the follow-up, 17 patients underwent tibialis posterior transfer with attachment on the second metatarsal and 15 on the tibialis anterior tendon. Functional outcome was assessed by grading of active foot dorsiflexion at six months and at the time of the study by and categorized as excellent, good, moderate, and poor. Results Most of the patients in both groups were male, and the mechanism of injury was penetrating trauma. At six months post-operatively, the majority of the patients in both groups showed excellent to good category of active dorsiflexion. At the time of the study (mean 34.4 months postoperatively) patients with insertion at second metatarsal were found to have active dorsiflexion as: excellent: 6 (35.3%), good: 8 (47.1%), moderate: 3 (17.6%), and for insertion at Tibialis Anterior tendon: excellent: 1 (6.7%), good: 6 (40.0%), moderate: 6 (40.0%) and poor: 2 (6.2%). These results were compared using the chi-square test and it was found to be statistically significant (p-value: 0.016). Conclusion Insertion at second metatarsal gives more favorable results as compared to insertion at tibialis anterior with balanced dorsiflexion.

P14.76 Bevacizumab (BEV) alone or in combination with chemotherapy in recurrent Glioblastoma Multiforme (GBM): A real world experience

BACKGROUND

Patients with glioblastoma multiforme (GBM) have a median survival of about 14 months. In recurrent GBM no active intervention has shown improvement in survival. Clinical trials has shown that bevacizumab (BEV) alone or in combination with chemotherapy is associated with better progression free survival (PFS). The current study aims to assess efficacy of BEV in real-world setting.

MATERIAL AND METHODS

Population-based retrospective cohort study patients with recurrent GBM diagnosed in the province of Saskatchewan during 2008–2018 and received BEV alone or in combination with chemotherapy were evaluated. Survival was compared with historic control.

RESULTS

43 eligible patients with GBM treated with BEV with or without chemotherapy. 25 patients were treated with Bev alone and 18 patients treated with chemotherapy+ BEV. Median age of the patients were noted to be 53 years. 28 male, and 15 female. 80% of patients treated with single agent BEV had a performance status of either 2 or 3 compared to 33% of patient treated with BEV+ chemotherapy.

Median PFS was 4.6 months with 95% CI 2.9–6.9. Median Overall survival (OS) from the time of diagnosis was 17.5 month. Median OS from the time of start of BEV was 5.4 months with 95% CI 3.4–6.8. Partial response (PR) was noted in 3 patients (7%) with stable disease (SD) in 6 patients (14%). 33 (77%) had progressive disease (PD). We were unable to confirm response status in one patient (2%). No statistically significant difference in response rate for patients treated with BEV and BEV+ Chemotherapy. From the start of Bev to the best response, 11 patients (30.56%) noted decrease in the dose of steroids, 14 patients (38.89%) dose remained unchanged. 7 patients (19.44%) required increase in the dose of steroids. 4 patients (11.11%) were not on steroids. For 7 patients we did not have the information on use of steroids. PFS was better for patients treated with chemotherapy + BEV with median PFS of 6.9 months, 95% CI 3.2- 22.3 verses BEV alone with median PFS 3.53 months 95% CI 1.4–5.3, P-value 0.0449. The Cox regression model for PFS to test comparing Bev with chemotherapy vs. Bev alone with the co-variables of sex, age, and ECOG performance status (PS). The model showed that patient with higher ECOG PS were noted to have inferior PFS with a Hazard ratio of 1.92 95% CI 1.09–3.37. P value of 0.2. Patient treated with BEV+ chemo had better PFS with a HR of 6.44 95% CI 1.86–22.28. P value of 0.003.

CONCLUSION

Retrospective real world study confirms that, patients with recurrent GBM, treatment with BEV is associated with similar PFS as reported in literature. Our study showed similar overall survival from the diagnosis compared to historic control. However the Median OS from Start of BEV was noted to be inferior to what is reported in EORTC EH1.3. Better ECOG performance status is associated with better PFS. Higher number of patients with ECOG 2 and 3 received BEV alone.

229 Uncomplicated Diverticulitis: A Proposed Diagnostic Algorithm

Introduction

Covid-19 has changed surgical practice. Infection risk and hospital pressures means appropriate patient ambulation is paramount. Uncomplicated diverticulitis can be managed as an outpatient. Clinical differentiation of uncomplicated and complicated diverticulitis remains challenging. This study aims to develop a diagnostic algorithm to differentiate complicated from uncomplicated disease prior to imaging.

Method

A single-centre retrospective review of 177 patients referred as diverticulitis between Sept-Dec 2018, was performed. Data collected included clinical presentation, biochemistry and imaging. Complicated diverticulitis was defined as occlusion, perforation, abscess formation, fistula and/or bleeding. Inferential parametric analysis was performed to ensure predictive value.

Results

Of 177 patients referred, 71 received a consultant diagnosis of diverticulitis. 60 were confirmed and differentiated on CT scan. LIF/lower abdominal pain (P < 0.01) and bowel habit change (P < 0.05) was significantly higher in patients with diverticulitis compared to other pathology. In complicated diverticulitis, symptoms occurred < 4days (P < 0.05), fever was present (P < 0.001) and CRP was > 75.

Conclusions

Once diverticulitis diagnosis is made based on pain localisation and change in bowel habit, complicated disease can be predicted by symptom duration (< 4 days), presence of fever and a CRP > 75. Plans to assess these findings prospectively in a Surgical Admissions Unit are currently in development.

Hemorrhagic Posterior Reversible Encephalopathy Syndrome as a Manifestation of COVID-19 Infection

We describe 2 hospitalized patients with confirmed coronavirus 19 (COVID-19) infection in whom brain imaging showed hemorrhagic posterior reversible encephalopathy syndrome, and we discuss the possible reasons for these findings and their relationship to the infection.