Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 10th International Conference on Clinical & Medical Case Reports Amsterdam, Netherlands.

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Scientific Program Day 1

Day 1 :

Keynote Forum

Mohamamad Hamad

Mediclinic Welcare Hospital, UAE

Keynote: New approach to dizziness with clinical method

Time : 10:00-10:40

Conference Series Euro Case Reports 2019 International Conference Keynote Speaker Mohamamad Hamad photo
Biography:

Muhammad Hammad has completed his MBBS degree from the Hamdard University Hospital, Karachi, Pakistan and completed MRCEM (UK) in 2017. He has clinical experience in Emergency Medicine more than eight years and he is currently working in Mediclinic Welcare Hospital, Dubai, UAE since 2015 till to date. and has completed his Internship in Gen. Medicine and Gen Surgery six months in each respectively followed by work at National Institute of Cardiovascular Diseases, Karachi, Pakistan. He has worked in General ICU for about two years, and worked in Adult Emergency Medicine Department and got trained in Aga Khan University Hospital, Karachi, Pakistan, followed by continue working in A&E Department of Al Dhaid Teaching Hospital, UAE and then joined A&E Department of Mediclinic Welcare Hospital, Dubai.

Abstract:

Dizziness is the most common condition or symptom to be present in emergency departments or rooms in most part of the world. It can easily be missing diagnosed as central vs peripheral vertigo if not deal with proper history and examination in EDs by emergency physicians or clinicians. Dizziness can be defi ned as “spinning movement in surroundings’’ or whirlpool like feeling. Dizziness is common among elderly age with many different reasons apart from peripheral or central causes of vertigo which includes risk of fall, trauma, dietary intake, walking aids, organic diseases, vision problems etc. Author presentation will focus on new method of diagnosing dizziness in emergency departments as quick and easy three steps which includes three clinical tests which are: nystagmus; skew test and; head thrust test.

  • Plenary Tracks
Location: Field Meeting Room 2

Session Introduction

Andrew Tan

John Hunter Hospital, Australia

Title: Large cell neuroendocrine carcinoma of the tongue base
Speaker
Biography:

Andrew Tan has completed his Bachelor of Medicine in 2016 at the University of Newcastle, NSW, Australia. He is currently employed as an Otorhinolaryngology SRMO at John Hunter Hospital in Newcastle. Within this role he is working closely with head and neck cancer specialists for this region.

Abstract:

Large cell neuroendocrine carcinoma (LCNEC) is a rare entity usually arising from a pulmonary origin. Unfortunately, due to a lack of clinical trials, there is no defined approach for the treatment of these cancers. To date there have only been two reported cases of LCNEC originating from the base of tongue. In this case report we discuss the presentation, management and disposition of a patient diagnosed with LCNEC originating from the base of tongue, with a review of the current literature

Daniel Phung

John Hunter Hospital, Australia

Title: Recurrent retropharyngeal collection – An unusual and challenging case of second branchial cleft cyst

Time : 11:30-12:00

Speaker
Biography:

Daniel Phung is a Surgical Registrar from Newcastle. He has completed a Bachelor of Medicine from the University of New England, Australia and is completing Surgical training in New South Wales.

Abstract:

Second branchial cleft cysts are congenital anomalies that occur due to failed obliteration of the second branchial cleft during embryogenesis. Whilst location of these anomalies commonly lies between the palatine tonsil and anterior border of sternocleidomastoid, atypical presentations are described in the literature and may prove to be a diagnostic and management challenge. We present a case of a 38-year-old gentleman who underwent multiple drainages and excisions of a recurrent retropharyngeal collection with a histological diagnosis of second branchial cleft cyst. This report documents the difficulty in clearance of a recurrent branchial cleft cyst in the retropharyngeal space and highlights the importance of suitable surgical access to prevent recurrence.

Mohamed Javid R

Rajiv Gandhi Government General Hospital, India

Title: Non Iatrogenic of colorectal barotrauma with extraperitoneal rectal injury

Time : 12:00-12:30

Speaker
Biography:

Mohamed Javid R has completed his MBBS from TN Dr. MGR Medical University and is currently in his final year of General Surgery Residency in the prestigious Madras Medical College, which is the third oldest medical college in India. He is known to actively participate in local surgical society meetings, clinical audits, poster presentations, and other academic presentations. He is known for his special interest in medical research and is currently the Principal Investigator in three studies which are expected to be completed by this year-end.

Abstract:

Barotrauma was once very rare but recent reports of such incidents across the globe suggest that advances in the usage of high pressure compressed air for various purposes in the industrial environment has led to an increase in pneumatic injuries. Colorectal barotraumas are injuries that happen due to an elevated intraluminal pressure mainly by air and these injuries can vary from simple mucosal traumas to perforation of the bowel. We present a case of a 22-year-old boy, who presented to us with abdomen discomfort with subcutaneous emphysema in the abdomen and lower chest, following a prank played by his friend who had inserted a nozzle through his anal orifice and pumped high pressure condensed air through it. Computed tomography (CT) of the abdomen and pelvis showed evidence of air pockets in ischiorectal fossa and pelvis. Intraoperatively, we found rectal tears and large bowel serosal tears with distension of small bowel and large bowel. The tears were primarily sutured and a transverse loop colostomy was fashioned to facilitate healing of rectal wounds and to relieve the distension. The colostomy was closed after eight weeks. Not many of such colorectal barotraumas have been reported and many of these injuries presented with bowel perforations and tension pneumoperitoneum. Most of these patients underwent surgery and very few patients were managed conservatively. Such variations in clinical presentations and the interventions which are done in these scenarios imply the need for further reporting of such injuries and its interventions for formulating better management protocols.

Mohamed Breish

Darent Valley Hospital, United Kingdom

Title: The impact of inadvertent high dosage of Degarelix on the patient’s psychological wellbeing
Speaker
Biography:

Mohamed Breish is a clinical research fellow in Urology at Darent Valley Hospital and currently doing MCh in Surgery (Urology) at Canterbury Christ Church University. Mr Breish obtained bachelor of medicine from the University of Southampton in 2013 and completed core surical training with MRCS exam in 2018.

Abstract:

Renal cell carcinoma (RCC) is a highly vascular tumour which metastasise via lymphatic or haematogenous route. Classically, RCC presents as a triad of flank pain, haematuria and a palpable renal mass. Extra renal manifestations of metastatic RCC includes pulmonary, inferior venacave, bones and liver involvement. Sarcoid- like reaction (SLR) is a phenomenon used to describe non caseating granulomas which does not fulfi l the criteria for systematic sarcoidosis. The aetiology of SLR remains unclear, however they are commonly observed in haematological malignancies such as lymphomas. Only few reports have documented the presence of non-caseating granulomas of SLR in the context of RCC. We present a rare case of 38 old gentleman initially presented to the cardiology team with dyspnoea associated with junctional bradycardia and right bundle branch block on ECG. A CT scan revealed bilateral pulmonary nodules with reticular changes, diff use small lesions in liver and spleen indicative of granulomatous inflammation. However, the CT scan also showed a solid lesion in the left kidney suggestive of RCC. Ten months later, radical nephrectomy was performed and G1 pT1a N0M0 renal cell carcinoma, Conventional/clear cell subtype was confi rmed. The tumour showed extensive epithelioid granulomatous (sarcoid-like) reaction affecting both peritumoral and intratumoral area. Follow up images 28 months
after nephrectomy demonstrated almost complete resolution of granulomatous lesions. The remarkable resolution of granulomas after removing RCC confi rms the interesting association between malignancy and SLR. Our case supports the hypothesis that non-caseating granulomas of SLR could be a manifestation of an immunologically mediated antitumor response.

Andrew Tan

John Hunter Hospital, Australia

Title: Tracheostomy as a cause of late flap failure
Speaker
Biography:

Andrew has completed his Bachelor of Medicine from the University of Newcastle, Australia. He is currently employed in the Otolaryngology department working closely with the Head and Neck Cancer specialists in the region.

Abstract:

Introduction: Late flap failure is a rare occurrence in reconstruction surgery. The most common cause of failure is due to vascular injury. We examine two cases where a communication between the tracheotomy and neck dissection potentially led to late flap failure.
 
Method: Medical records were examined of two patients who experienced late flap failure with tracheostomy.
 
Discussion: A literature review was performed showing the main aetiology of late flap failure. The cases were discussed with learning points from the flap failure including ensuring the two dissections do not communicate.
 
Conclusion: Tracheotomies need to be identified as a potential source of flap
failure. Swift removal as clinically able as well as ensuring dissections are separate is the crux to avoiding late flap failure.

 

Daniel Phung

John Hunter Hospital, Australia

Title: Pneumothorax post TASER activation
Speaker
Biography:

Daniel Phung is a Surgical Registrar from Newcastle. He has completed a Bachelor of Medicine from the University of New England, Australia and is completing Surgical training in New South Wales

Abstract:

Use of conducted electrical weapons (CEWs) is increasingly common in law enforcement worldwide. CEWs have infrequently been associated with significant injury; advocates for CEWs suggest that underlying psychiatric and substance abuse profiles are more likely to be at the root of adverse effects. Previously associated injuries from TASER use include simple superficial injuries (contusions, abrasions) to complications of fall, rhabdomyolysis, spinal fractures, testicular torsion, miscarriage and formation of cataracts. Internal visceral injury is thought less probable given the diminutive size of the taser barbs. We present a
case of pneumothorax post TASER discharge.

Mohamed Javid R

Rajiv Gandhi Government General Hospital, India

Title: Cogenital intestinal malrotation with midgut volvulus in adult
Speaker
Biography:

Mohamed Javid R has completed his MBBS from TN Dr. MGR Medical University and is currently in his final year of General Surgery Residency in the prestigious Madras Medical College, which is the third oldest medical college in India. He is known to actively participate in local surgical society meetings, clinical audits, poster presentations, and other academic presentations. He is known for his special interest in medical research and is currently the Principal Investigator in three studies which are expected to be completed by this year-end.

Abstract:

Congenital intestinal malrotation is a complex gastrointestinal anomaly that occurs when there is an aberration in the normal development and rotation of the gut. Though this is commonly seen in children, it can rarely present in adults. The clinical features may be acute or chronic or sometimes patients may even remain asymptomatic throughout their lives. The majority of the patients present within their fi rst birthday but complications due to malrotation such as volvulus and obstruction can occur at any age implying the need to consider this diagnosis when there is a dilemma in identifying the cause of intestinal obstruction in the adult population. We report a case of a 30-year-old gentleman who came to us with a clinical presentation suggestive of acute intestinal obstruction. X-ray abdomen showed dilated small bowel loops. Contrast-Enhanced CT of the abdomen showed evidence of bowel wall enhancement, fl uid-fi lled dilated small bowel loops and the presence of pneumatosis intestinalis. These suggested the possibility of intestinal ischemia. An emergency laparotomy was done and it was found that the intestinal obstruction was due to midgut volvulus resulting from intestinal malrotation. The patient had viable bowel and so we subsequently performed a Ladd's procedure. The patient recovered well and the postoperative period was uneventful. We intend to present this case to highlight the high degree of clinical suspicion needed to diagnose this condition in adults, where an early intervention plays a crucial role in determining the final outcome.

Mohamed Breish

Darent Valley Hospital, United Kingdom

Title: The association between sarcoid-like reaction and renal cell carcinoma
Speaker
Biography:

Mohamed Breish is a clinical research fellow in Urology at Darent Valley Hospital and currently doing MCh in Surgery (Urology) at Canterbury Christ Church University. Mr Breish obtained bachelor of medicine from the University of Southampton in 2013 and completed core surical training with MRCS exam in 2018.

Abstract:

Renal cell carcinoma (RCC) is a highly vascular tumour which metastasise via lymphatic or haematogenous route. Classically, RCC presents as a triad of flank pain, haematuria and a palpable renal mass. Extra renal manifestations of metastatic RCC includes pulmonary, inferior vena cave, bones and liver involvement. Sarcoid- like reaction (SLR) is a phenomenon used to describe non caseating granulomas which does not fulfi l the criteria for systematic sarcoidosis. The aetiology of SLR remains unclear, however they are commonly observed in haematological malignancies such as lymphomas. Only few reports have documented the presence of non-caseating granulomas of SLR in the context of RCC. We present a rare case of 38 old gentleman initially presented to the cardiology team with dyspnoea associated with junctional bradycardia and right bundle branch  block on ECG. A CT scan revealed bilateral pulmonary nodules with reticular changes, diffuse small lesions in liver and spleen indicative of granulomatous inflammation. However, the CT scan also showed a solid lesion in the left kidney suggestive of RCC.  Ten months later, radical nephrectomy was performed and G1 pT1a N0M0 renal cell carcinoma, Conventional/clear cell subtype was confirmed. The tumour showed extensive epithelioid granulomatous (sarcoid-like) reaction affecting both peritumoral and intratumoral area. Follow up images 28 months after nephrectomy demonstrated almost complete resolution of granulomatous lesions. The remarkable resolution of granulomas aft er removing RCC confirms the interesting association between malignancy and SLR. Our case supports the hypothesis that non-caseating granulomas of SLR could be a manifestation of an immunologically mediated antitumor response.

Andrew Tan

John Hunter Hospital, Australia

Title: Inverted papilloma of the external auditory canal with malignant transformation
Speaker
Biography:

Andrew has completed his Bachelor of Medicine from the University of Newcastle, Australia. He is currently employed in the Otolaryngology department working closely with the Head and Neck Cancer specialists in the region.

Abstract:

Inverted papillomas commonly occur in paranasal sinuses and is the second most common benign tumour of the sinonasal tract. There is an association with squamous cell carcinoma with a reported prevalence of between 3.4-9.7%. Inverted papillomas are suspected to have a viral aetiology with human papillomavirus being demonstrated in polymerase chain reactions (PCR). The serotypes 16 and 18 have been associated with malignant transformation histologically. We present the case of an 80 year old man who had suffered with chronic unilateral otorrhoea for 20 years and presented to an otolaryngology clinic. A biopsy was taken demonstrating an atypical papilloma favouring an inverted papilloma. He proceeded to surgical resection of the lesion confi rming an inverted papilloma with malignant transformation to a squamous cell carcinoma. He proceeded to be discussed at the Head and Neck Multidisciplinary team meeting for treatmnent and elected to undergo radiotherapy. To date, there have been no reports on inverted papilloma of the external auditory canal. We discuss this patients case along with a literature review.

 

Niraj Khatri Sapkota

Chitwan Medical College, Nepal

Title: Stress oriented Pitting edema alike hypothyroid symptoms: A rarest case presentation
Speaker
Biography:

Niraj Khatri Sapkota has completed his PhD in Molecular Physiology applications to pharmacology at the age of 32 years from Zhejiang University, China, one of the Thomson Reuters and Elsevier best ranked university of the world; he is now working as an Associate Professor in the Department of Physiology in Chitwan Medical College affiliated to Tribhuvan University, Nepal. He is an active researcher and academician of his country, Nepal. He has published more than 50 papers both original and review papers as a single author or with collaboration in reputed international journals and is serving as a reviewer, advisory and editorial board member and Editor of more than 30 international reputed journals.

 

Abstract:

Background: Edema is general symptomatic feature of different organ failure or due to malnutrition or in sometimes due to long stand especially during summer with, heavy weight bearing, vasodilatation, or cardio-hepato-renal disease or in rare hypothyroidism, but in atypical case could demonstrates depression with progressive stress also shows indication of mild pitting edema.
 
Case presentation: This is a case of middle age divorced male under depression who is under medication since 10 years complained of weight gain almost 10kg in 30 days duration, less attentive to his work and always feel sleepiness during day (once get to sleep, slept more than 5 hours during day) and also late upto morning if not called to wake-up, also with diminished memory, more specific event was before 60 days of these symptoms he unexpectedly suffered family tragedy.
 
Test and Result: He performed all the test that possibly could lead to diagnosis of foot edema echocardiography, ECG, Creatinine clearance, total protein, albumin and finally thyroid function test but all test were normal except high 24 hours creatinine clearance therefore no any medication were prescribed, on counseling and motivation all his symptoms slowly disappeared in 45 days duration.
 
Conclusion: This case is rarest presentation of depression led progressive stress pitting edema that got managed after appropriate counseling along with changes in his life style.

  • Poster Presentation
Location: Field Meeting Room 2

Session Introduction

Mohamed Javid R

Rajiv Gandhi Government General Hospital, India

Title: An unusual cause of adult ileoileal intussusception
Speaker
Biography:

Mohamed Javid R has completed his MBBS from TN Dr. MGR Medical University and is currently in his final year of General Surgery Residency in the prestigious Madras Medical College, which is the third oldest medical college in India. He is known to actively participate in local surgical society meetings, clinical audits, poster presentations, and other academic presentations. He is known for his special interest in medical research and is currently the Principal Investigator in three studies which are expected to be completed by this year-end.

Abstract:

Intestinal intussusception in adults is not considered to be common. It is usually encountered in children, in whom, it is generally considered idiopathic. In contrast, adults presenting with intussusception generally possess a demonstrable pathological lead point; commonly a polyp, submucosal lipoma or other tumors. Clinical presentations may range from an acute presentation to a chronic one and such wide variations make it challenging to establish the diagnosis on time. But the use of computed tomography (CT) in these scenarios has considerably enhanced the diagnostic capabilities. Th ough a conservative approach might be preferred in some circumstances, these patients usually require surgery, especially when the viability of the involved bowel is compromised. Our patient, a 42-year-old male, presented to us with clinical features suggestive of acute intestinal obstruction. X-ray abdomen showed multiple air-fl uid levels. CT of the abdomen showed diffuse dilatation of the jejunal and ileal loops and the collapse of the large bowel with a transition point probably at the terminal ileum or ileocaecal junction. Following this, he underwent an emergency laparotomy when intussusception of the ileum was noted and the involved bowel segment was resected. Histopathology showed that the lead point was due to tuberculous lesion. Further investigations showed that the patient had pulmonary tuberculosis which was unidentifi ed till then. The patient was started on anti-tuberculous treatment thereafter. We intend to present this case to sensitize the readers to the unusual presentation of intestinal tuberculosis as intussusception which should be considered especially in countries with high tuberculosis endemicity.

Masego Nelly Esendi

Jocham Hospital, Kenya

Title: Resistant HCV Variant after cure treatment with Ledipasvir/Sofosbuvir in a patient with chronic Hepatitis C
Speaker
Biography:

Abstract:

Our patient was a 58-year-old man with HCV diagnosed four years ago. He had no co-morbidities and his brother was also diagnosed HCV. There were no risk factors. His fi brosis stage by Ishak was F5 four years ago and he was treatment- experienced with pegylated interferon- RBV. On initial evaluation, he was asymptomatic and examination was unremarkable. Laboratory testing revealed elevated transaminase levels and HCV genotype 1b with a viral load of 4.2+E6 IU/mL. The patient was treated with 12-week course of SOF (400 mg daily)/ LDV (90 mg daily) and RBV (1000 mg daily). In the first month of the therapy there was rapid normalization transaminase levels and clearance of the virus however, no side effects of therapy have found. The compliance of the treatment was certainly perfect. Three months after completing treatment, virological relapse was occurred with a HCV RNA 4.0+E5 IU/mL and his transaminase levels were slightly elevated.
 
Methods: The patient was categorized as CHC according to the European Association for the Study of the Liver Clinical Practice Guidelines. Blood sample with K2EDTA was immediately separated by centrifugation, liquated, and kept at -80ËšC until required. The presence of anti- HCV was tested for the sample which was anti-HCV positive through ELISA testing, using a commercial kit (Cobas E601 Analyzer Roche Diagnostic- Mannheim, Germany). In addition, for protease inhibitors; asunaprevir, boceprevir, faldaprevir, grazoprevir, pariteprevir, simeprevir, telaprevir, for NS5A inhibitors; daclatasvir, elbasvir, ledipasvir, ombitasvir, velpatasvir, and for NS5B inhibitors; dasabuvir and sofosbuvir were analyzed in the HCV NS3, NS5A and NS5B sequencing, respectively.
 
Discussion: Our patient was one among the rare occurrences of the cases in whom viral relapse occur after achieving end-of-treatment response with LDV/SOF. Inspite of the compliance of the treatment, infected with genotype 1b and addition of RBV, with no reinfection and no comorbidity; the patient had only three poor prognostic factors: cirrhosis, male gender and treatment was experienced. Molecular analysis demonstrated that Y93H as a cross - resistant mutation for NS5A region related resistance mutation was determined. In addition, S282G and C316S were determined as amino acid substitution for NS5B region. NS5A resistance associated mutation (Y93H) could be eff ective in relapse in LDV/SOF therapy. However, in Turkey, this case with Y93H mutation was the fi rst to be reported.

Jie Zhao

John Hunter Hospital, Australia

Title: A rare case of Littre's and Richter's inguinal hernia
Speaker
Biography:

Jie Zhao has completed her MD degree from the University of New South Wales and Master’s degree from the University of Edinburgh. She is currently working as a Research Fellow/ Surgical Registrar with John Hunter University.

Abstract:

Background: A hernia is defined as the protrusion of an organ through a muscle or tissue holding it in place, Littre’s hernia is a rare surgical entity, containing Meckel’ diverticulum. A Richter’s hernia is when bowel wall partially herniated. We present a case of an elderly lady with the rare surgical presentation of having both hernias simultaneously.
 
Case Study: The case study begins with an 84 year-old lady presented with signs and symptoms consistent with a small bowel obstruction. This is on the background of obesity, type 2 diabetes, ischaemic heart disease, and asthma. On examination she was hemodynamically stable, alert and orientated. Her abdomen was soft and non-tender with an easily reducible ventral hernia. She subsequently had a CT abdomen which showed a left side inguinal hernia which was not detected by the emergency or surgical staff due to the patient’s body habitus. She underwent open inguinal hernia exploration, and on opening the sac, a Littre as well as Richter’s hernia was revealed. The neck of the small bowel was deemed viable, so only a diverticulectomy of the Meckel’s diverticulum was performed. The hernia was subsequently repaired with a Lichtenstein technique. There were no significant post-operative complications, and patient was discharged on day seven post operation.
 
Discussion: There is no published literature reported on combined Littre’s and Richter’s inguinal hernia. Given the potential high morbidity and mortality associated with Richter’s hernia, this condition should be included in the list of
differential diagnosis.

Joie Sheen Ayuste Bastian

Davao Doctors Hospital, Philippines

Title: The unexpected twist – A rare case of a 67 year old female with gastrointestinal stromal tumor presenting as gastric volvulus
Speaker
Biography:

Joie Sheen Ayuste Bastian has completed her BS Biology degree at the University of the Philippines – Mindanao specializing in molecular biology and ecology. By the age of 24 years, she has completed her Doctorate degree in Medicine at Davao Medical School Foundation. She is currently in Residency training program at the Department of Surgery in Davao Doctors Hospital. She has published an international scientific journal in Molecular Taxonomy and presented in national interesting case presentation.

Abstract:

Gastric volvulus is a clinical dilemma due to its nonspecific history and physical examination. Early diagnosis is warranted, and if left undetected, may cost the patient’s life. Due to difficulty in diagnosis, most cases are unreported, which is evident by an unknown incidence and prevalence of this condition. With the advent of advanced imaging modality and ancillary procedures, patients affected with gastric volvulus may now be treated at its golden period. Surgical intervention remains the gold standard of treatment in patients with this clinical entity and has a significant effect in prognosis when addressed immediately. This is a case report of a 67 year-old female who presented with an eight-week history of abdominal pain, hematemesis and vomiting. Seen initially by a gastroenterologist, an upper GI endoscopy was performed which showed a gastric mass lesion causing difficulty of the scope to traverse the body of the stomach. CT scan of the whole abdomen revealed an organo-axial gastric volvulus. Th e patient was referred to general surgery service and was scheduled for exploratory laparotomy, detorsion of gastric volvulus, wide excision of gastric mass, gastrorrhaphy and gastropexy. Post-operative course was unremarkable. Further work up on histopathology and immunohistochemical staining, turned out to be positive for CD 117, revealing gastrointestinal stromal tumor as the turning point causing the volvulus.

Mohamed Breish

Darent Valley Hospital, UK

Title: Has our nurse-led clinic helped to improve the efficiency and overall experience of urodynamic tests?
Speaker
Biography:

Mohamed Breish is a Clinical Research Fellow in Urology at Darent Valley Hospital. He obtained Bachelor of Medicine from the University of Southampton in 2013 and has completed Core Surgical Training and passed MRCS exam in 2018.

Abstract:

Aim: To analyse and compare the number of patients who underwent urodynamic tests before and aft er the introduction of nurse-led urodynamic clinic and assess staff ’s adherence to local policy.
 
Background: Urodynamics tests (UDT) are physiological measurements of the voiding and storage function of the lower urinary tract that are commonly performed in clinical practice to investigate bothersome lower urinary tract symptoms. Despite considerable eff orts to improve UDT, standardization of the practice remains challenging. Th e International Continence Society (ICS) continues to urge for “Good Urodynamic Practice”. Hence, we introduced a nurseled urodynamic clinic (NLUC) to improve effi ciency and patient experience.
 
Methods: Urodynamics clinic patient database was used to identify the patients who underwent UDT between October 2017 and June 2019. The first cycle included retrospective data of 82 randomly selected patients between September 2017 and September 2018. The NLUC was introduced in November 2018. The data of 86 patients who underwent UDT after the introduction of NLUC were assessed and analysed retrospectively.
 
Results: The average number of patients undergoing UDT was 25 per month with inconsistent referrals that are lacking important information such as significant comorbidities, predisposing factors, findings of the clinical examinations, and urinalysis results. 23/82 (28%) patients were not commenced on appropriate treatment and only 12/82 (≈15%) had bladder diary charts completed. Findings concluded that up to 25% of referrals were deemed inappropriate for UDT. After the introduction of NLUC the average number of patients decreased to 18.8 and 91.1 of patients had a fi nal diagnosis or appropriate management plan aft er UDT.
 
Conclusion: Not only has the introduction of NLUC reduces same-day cancellations in patients undergoing UDT, but also decreases the burden on our department and off ers patients education, providing better overall experience.

Jie Zhao

John Hunter Hospital, Australia

Title: Wound protector for umbilical hernia repair in a patient needing diagnostic laparoscopy
Speaker
Biography:

Jie Zhao has completed her MD degree from the University of New South Wales and Master’s degree from the University of Edinburgh. She is currently working as a Research Fellow/ Surgical Registrar with John Hunter University.

Abstract:

Background: A wound protector has been recommended for hernia repairs to improve surgical exposure and to reduce the rate of surgical site infections (SSI). However, in patients needing laparoscopy, wound protectors create barriers for achieving complete seal of the abdominal cavity.
 
Case Study: A 53-year-old man presented with a two-year history of right upper quadrant pain and bloating. He was diagnosed with biliary colic and progressed to a laparoscopic cholecystectomy and open suture repair of an incidental umbilical hernia. His symptoms did not resolve and his umbilical hernia reoccurred within 12 months. He was therefore booked for another laparoscopy (diagnostic) and repairs of umbilical hernia with mesh. In order to achieve this, an Alexis was used. Subsequently, a GelPortTM was placed over the Alexis who achieved a good seal for the laparoscopy, facilitating the identifi cation of adhesion. This was successfully divided and his umbilical hernia was fixed with mesh. His pain was subsequently resolved and to date there was no recurrence of his umbilical hernia.
 
Discussion: Umbilical/ventral hernia is common surgical presentations. With increasing prevalence of obesity, fixation of these types of hernias can be technically challenging. A wound protector such as AlexisTM has been previously demonstrated to be beneficial by increasing exposure and decreasing risk of SSI. However, it could be challenging if patients necessitate fixation of umbilical hernia and laparoscopy simultaneously. Utilizing the GelPortTM system could facilitate completing both procedures successfully concurrently, and thus, reducing the cost associated with another surgery or complications such as recurrence and infection.

Mohamed Breish

Darent Valley Hospital, UK

Title: Laparoscopic nephrolithotomy in a horse shoe kidney
Speaker
Biography:

Mohamed Breish is a Clinical Research Fellow in Urology at Darent Valley Hospital and currently doing MCh in Surgery (Urology) at Canterbury Christ Church University. He obtained Bachelor of Medicine from the University of Southampton in the UK in 2013 and has completed Core Surgical Training with MRCS exam in 2018.

 

Abstract:

Horseshoe kidney (HSK) is the most common congenital renal fusion anomaly with incidence of 1/400 the majority of which are incidental findings. HSK is characterized by malrotation of kidney, altered blood supply and tendency to form pelvi-ureteric junction obstruction in 30% of the cases which can be asymptomatic. However, HSK may present with complications such as urinary tract infections (UTI), stone formation and obstruction. Nephrolithiasis which is seen in 20% of cases of HSK is considered one of the most common indications for surgery. Indeed, the anatomical abnormalities challenge the treatment of stones in HSK. For instance, due to caudal and medial location of calyces, and the abnormal anterior position of the kidney, extracorporeal shock wave lithotripsy (ESWL) fails to achieve the same success rate in HSK. Percutaneous nephrolithotomy (PCNL) is also associated with major complications in anomalous kidney. Thanks to recent advancements of laparoscopic instrumentation and techniques, laparoscopic surgery continues to emerge as a promising alternative for stone treatment in HSK. We present a case of a 61-year-old lady who presented initially with recurrent UTI irresponsive to multiple courses of antibiotics. Urine cultures confirmed positive E. coli. Ultrasound sonography showed duplex kidney with multiple stones in the right kidney. CT scan revealed HSK with multiple right renal stones (35 mm in right lower pole with eight stones of 2-4 mm in size) associated with severe hydronephrosis of the right kidney. Th e patient was treated successfully with laparoscopic nephrolithotomy. Our case demonstrates that laparoscopy is an effective and safe approach in treatment of greater than 2 cm renal stones in HSK.

  • E-poster
Location: Field Meeting Room 2

Session Introduction

Manasa Anand

Rajiv Gandhi Government General Hospital, India

Title: Looks are deceptive
Speaker
Biography:

Manasa Anand has completed her MBBS from Rajiv Gandhi University of Health Sciences, Karnataka, India and is currently in her final year of General Surgery residency in the prestigious Madras Medical College, Chennai, India, which is the third oldest medical college in India. She has been awarded the best paper award by the Association of Surgeons of India, Chennai city chapter. She actively participates in local surgical society meets, clinical audits, poster presentations and other academic presentations. She is known for her keen interest in medical research activities.

 

Abstract:

Fistula in ano, one of the common conditions, which usually arise as a complication of incompletely drained perianal abscess. Our first case is a 73 year old male with complaints of purulent discharge in the perianal region for duration of five years. Operated twice for perianal abscess 5 and 3 years ago. On examination, external openings noted at 6, 8 and 10 ‘o’ clock position. Rectal examination revealed a growth arising from anorectal junction, extending for 5 centimetres upwards, confirmed by computed tomography abdomen. Colonoscopy guided biopsy revealed infiltrating adenocarcinoma which was congruent with the wedge biopsy taken from the fistulous tract. Our second case is a 60 year old male patient with complaints of purulent discharge from the perianal region since seven years, with history of surgery for perianal abscess seven years ago. Examination revealed external openings at 1, 2, 3 and 5’o’ clock position with mucous discharge. Rectal and colonoscopic examinations were normal. Wedge biopsy revealed it to be mucinous adenocarcinoma. Following tumour board consensus, both of them were sent for neoadjuvant chemotherapy. Systemic conditions like tuberculosis and Crohn’s disease are commonly associated with chronic multiple fistulae. Colorectal malignancy with implantation in a fistula and a primary malignancy arising in a fistula are extremely rare presentations, with less than 50 cases being reported. They act as a guide for an underlying solid tumour. With a high index of suspicion, mandatory colonoscopies and guided biopsies for patients with chronic fistulae is of utmost importance.

Manasa Anand

Rajiv Gandhi Government General Hospital, India

Title: Anal canal melanoma masquerading as hemorrhoids
Speaker
Biography:

Manasa Anand has completed her MBBS from Rajiv Gandhi University of Health Sciences, Karnataka, India and is currently in her final year of General Surgery residency in the prestigious Madras Medical College, Chennai, India, which is the third oldest medical college in India. She has been awarded the best paper award by the Association of Surgeons of India, Chennai city chapter. She actively participates in local surgical society meets, clinical audits, poster presentations and other academic presentations. She is known for her keen interest in medical research activities.

 

Abstract:

Anal canal melanoma is a rare tumor, constituting 0.5-2% of all the anorectal malignancies and less than 2% of all melanomas. We present a case of a 38 year old male, who presented with mass descending per-rectum for duration of three months, with occasional bleeding Per-rectum while straining for stools. He consulted in various hospitals, which diagnosed him to have hemorrhoids and advised for conservative management. On examination, he had a 4x4 centimeters bluish black mass descending per rectum which became prominent on bearing down, with no active bleeding and no lymphadenopathy. Computed tomography (CT) abdomen revealed anal canal thickening, extending to the distal rectum with peritoneal deposits. Colonoscopy revealed a growth arising from the anal verge, extending 10 centimetres upwards. Guided biopsy confirmed it to be mucosal melanoma, following the application of S-100 and HMB 45 stains. Considering the advance nature of the condition, he received chemotherapy (dacarbazine and cisplatin).Anal canal melanomas are the third most common, following cutaneous and ocular varieties. They frequently present with non-specific symptoms: rectal bleeding, tenesmus, anorectal mass, change in bowel habits and hemorrhoids. It most commonly metastasizes to inguinal lymph nodes, mesenteric lymph nodes, hypogastric lymph nodes, para –aortic lymph nodes, liver, lung, skin and brain. Surgery (WLE/APR) may be an option when presented early without distal organ involvement. Palliative chemo/radiotherapy for advanced diseases. High index of clinical suspicion, especially when the symptoms are incongruent with clinical findings is of utmost importance in diagnosing and managing aggressive conditions like this.