Background Older patients undergoing emergency surgery experience higher mortality and morbidity. ‘Care of Older People in Surgery’ (COPS) is a comprehensive geriatric care model developed for acute surgical units (ASU) to improve clinical outcomes in older general surgical patients. This study aimed to evaluate the impact of COPS on clinical and health service outcomes in an Australian hospital. Methods The before‐and‐after study was conducted in the ASU, at Nepean Hospital. Data from patients ≥75 years admitted for >24 h into the ASU during the intervention period between April 2017 and March 2018 were compared to patients admitted in the previous year (April 2016 to March 2017) prior to the COPS intervention (n = 212). Health service outcomes measured include the average stay length, medical emergency team response, unplanned intensive care unit admission and 28‐day readmission rates. Results The COPS group (n = 214) suffered significantly fewer medical complications, including less acute kidney injuries, arrhythmias and urinary tract infections compared to the pre‐intervention cohort (n = 212). Medical emergency team activation was significantly reduced after COPS model implementation and the average length of stay decreased. However, the incidence of postoperative delirium and acute coronary syndrome were higher in COPS cohort. Conclusion Our study demonstrated that comprehensive geriatric assessment and care delivered through a shared model of care in older general surgical patients improved clinical outcome and patient safety measures.

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Massive pure gastric yolk sac tumour: a unique presentation of a rare pathology An 86-year-old lady presented to our emergency department with a large central abdominal mass growing in size over a 4-month period, associated with a decreasing appetite and weight loss. She reported no pain, was tolerating oral intake and passing bowel motions daily. Her past medical history was significant for colorectal cancer in 2012, for which she had a right hemicolectomy and remained in remission.Observations were stable, and focussed abdominal examination revealed a central, firm and immobile mass, measuring approximately 20 cm in diameter and palpable throughout the entire abdomen. The abdomen was not tender to palpation.Computed tomography (CT) scan of the abdomen and pelvis revealed a 20 × 16.5 × 13 cm irregular central abdominal mass with smooth contours (Fig. 1). It appeared to arise from the gastric antrum, and had peripheral enhancement with a central hypo-dense component suggesting necrotic change. Mass effect was demonstrated on the surrounding bowel, mesenteric vessels and the inferior vena cava in particular. The remaining CT findings were normal with no evidence to suggest recurrence of the patient's previous malignancy. Serum alpha-fetoprotein (AFP) was elevated to 6590 IU/mL.The patient consented to a laparotomy and resection. Intraoperatively, the tumour was found to arise from the gastric antrum, but was adherent to the posterior rectus sheath, first part of the duodenum, proximal Jejunum, pancreas and serosa of the transverse colon (Fig. 2). Given the patient's age and frailty, we elected not to pursue an R0 multivisceral resection, and luckily we were able to mobilize the tumour from these structures. A distal gastrectomy followed by a gastro-jejunostomy (Billroth II procedure) was performed. The patient recovered well and was discharged 1 week post-operatively.

Introduction. With the rising rate of obesity world-wide, there are increasing weight loss options including operative and non-operative techniques. Endoscopic intragastric balloons (IGB) have gained popularity since its inception three decades ago and is viewed as a less invasive alternative to bariatric surgery. However, complications, though rare and probably under-reported, can be associated with significant morbidity and mortality. Case Presentation. We present the case of a 44-year-old woman who presented with a two-day history of upper abdominal pain, nausea, and obstipation, on the background of a Spatz3™ Balloon (Spatz FGIA, Great Neck, NY, USA) endoscopically placed seven months prior. Computed tomography scan confirmed small bowel obstruction due to a migrated IGB, requiring laparotomy and enterotomy for retrieval. Conclusion. With the development of new types of IGB and increasing usage, it is important to monitor for issues and complications.

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