BackgroundAccording to the Nationwide Inpatient Sample in 2011, nearly 1,500,000 admissions with over 300,000 laparotomies were performed for adhesion-related small bowel obstructions (SBOs). Small bowel follow through (SBFT) consists of serial X-rays with oral Gastrografin contrast that can diagnose obstructions requiring operative intervention. Furthermore, the contrast has a therapeutic osmotic effect which may promote transit and resolve an SBO. The aim of the study was to determine if early SBFT administration to patients with SBO decreases length of stay (LOS), hospital costs, and can identify patients who will fail nonoperative management (NOM). MethodologyThis is a single institution retrospective study conducted from 2010 to 2019 with a total of 476 patients. We divided patients into three groups: SBFT within <24 hours of admission (n = 40), SBFT >24 hours after admission (n = 198), and did not receive SBFT (n = 238). We compared the overall LOS, hospital costs, and time from SBFT to the operating room using an analysis of variance. ResultsLOS significantly differed between groups with SBFT within ≤24 hours having an average LOS of 6.95 days compared to 10.65 days in the SBFT after >24 hours and 11.75 days in the no SBFT group (p = 0.005). Median time to the operating room in patients receiving SBFT was one day, which was significantly shorter than a median time of four days for no SBFT group (p = <0.05). Decreased LOS by 4.8 days equated to saving $8,657 per patient. ConclusionsSBFT administered within 24 hours decreases LOS, overall costs, and time to operating room in patients who fail NOM.

Background and Objectives:Many risk factors have been identified in minimally invasive cholecystectomies that lead to higher complications and conversion rates. No study that we encountered looked at nonvisualization of the gallbladder (GB) during surgery as a risk factor. We hypothesized that nonvisualization was associated with an increased risk of complications and could be an early intraoperative identifier of a higher risk procedure. Recognizing this could allow surgeons to be aware of potential risks and to be more likely to convert to open for the safety of the patient.Methods:We looked at minimally invasive cholecystectomies performed at our institution from January 2015 through April 2016 and had the performing resident fill out a survey after the surgery. Outcomes were conversion rates, intraoperative complications, and blood loss and were analyzed via Pearson χ2 test or Mann-Whitney U test.Results:The primary outcome showed a conversion rate of 37% in nonvisualized GBs versus 0% in visualized (P = .001). Secondary outcomes showed significant differences in GB perforations (74% vs 13%, P = .001), omental vessel bleeding (16% vs. 0%, P = .005), and EBL (46 mL vs 29 mL, P = .001).Conclusions:Intraoperative nonvisualization of the GB after adequate positioning caused significantly increased risk of intraoperative complications and conversion. This knowledge could be useful during intraoperative assessment, to decide whether a case should be continued as a minimally invasive procedure or converted early to help reduce risk to the patient. Further randomized controlled studies should be performed to further demonstrate the value of this assessment.

Hemorrhagic cystitis is a life-threatening condition in which the transitional epithelium and blood vessels of the bladder necrose leading to severe hematuria, abdominal pain, and voiding lower urinary tract symptoms. Etiology includes chemotherapy (cyclophosphamide, ifosfamide, busulfan), radiotherapy, or infectious agents. We present a pediatric case of a 15-year-old boy with medulloblastoma who developed hemorrhagic cystitis following cisplatin chemotherapy. All other causes were ruled out and it is therefore likely that the agent, in this case, was cisplatin, which has never had hemorrhagic cystitis reported as a side effect. We also suggest a mechanism for urothelial injury centered around OCT-2 receptors.

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Introduction Trauma activation requires mobilization of significant resources to be available at short notice. In 2014, the American College of Surgeons Committee on Trauma issued its latest recommendations for care of the injured patient. Amongst trauma activation criteria, elderly patients that fell from any height on anticoagulation were included. We hypothesized that a reduced trauma team could preserve patient safety while reducing time and cost spent. Method A ‘Head Injury Alert’ was created to denote anti-coagulated patients with a GCS > 14 who fell from a height of <20 feet. An ED attending, surgical resident and one nurse evaluate the patient with the goal of obtaining a head CT within 30 min of presentation. Data were prospectively acquired from June 2017 to August 2018, which included age, anticoagulation, injury severity score (ISS), time-to-CT, outcomes, missed injuries, disposition and activations requiring escalation of care. Results Two hundred and seventy-seven head injury activations occurred; 55% of patients were female, while 45% were male. Average age was 78 years old. The most common anticoagulant was Warfarin (31%). 50% of patients were discharged, 47% were admitted, 2% died before disposition and 1% were transferred to a tertiary care center; 7% required admission to the ICU. The average time-to-CT was 25 min and ISS ranged from 0 to 26. Twenty-two patients (7%) presented with positive head CT. Of the five deaths, three patients had intracranial hemorrhage, one pneumonia present on admission and one cardiac arrest. Conclusion This level III evidence, prospective study suggests head injury alert can be safely applied as a new level of trauma activation at community hospitals. It helps identify a specific patient population and injury mechanism that can be safely triaged using limited resources. With this, community hospitals can maximize their resources and minimize cost, while maintaining patient safety.