Background Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major cause of potentially preventable morbidity and mortality amongst trauma patients. Venous thromboembolism prevalence varies from 1 to 58%, and traditionally, compliance with prophylaxis protocols is low in major trauma cohorts. This study aimed to describe VTE prevalence, prophylaxis practices and outcomes amongst VTE cases at an Australian level-one trauma centre. Methods A retrospective review of all VTE cases occurring in acute, major trauma admissions between 1 January 2010 and 30 June 2019 was conducted using prospectively collected registry data. Data regarding demographics, time to diagnosis, VTE prophylaxis, VTE risk assessment tool (RAT) usage and all-cause mortality were collected. Chemoprophylaxis was considered adequate if administered for 48 h prior to diagnosis. VTE cases diagnosed within 48 h of admission were excluded from prophylaxis compliance analysis. A subgroup analysis of patients with intracranial haemorrhage (ICH) was also completed. Results During the study period, 238 VTE events occurred in 237 patients from 7482 major trauma admissions, giving a VTE prevalence of 3.18%. The all-cause mortality rate was 8.0%. VTE chemoprophylaxis was administered for 109 of 211 eligible patients (51.7%). Of the remaining 102 VTE cases, 75 (73.5%) did not receive prophylaxis due to a documented contraindication, while 27 (26.5%) did not receive prophylaxis with no contraindication recorded. The VTE RAT was completed in 49.0% of cases. Conclusion Venous thromboembolism prevalence at our institution was consistent with published figures for comparable institutions. A review of compliance with prophylaxis protocols showed several potential areas for improvement.

The broad uptake of the acute surgical unit (ASU) model of surgical care in Australia has resulted in general surgeons becoming increasingly involved in the management of patients with acute abdominal pain (AAP), some of whom will be labelled as having non‐specific abdominal pain (NSAP) (Kinnear N, Jolly S, Herath M, et al. The acute surgical unit: An updated systematic review and meta‐analysis. review. Int. J. Surg. 2021;94:106109; Lehane CW, Jootun RN, Bennett M, Wong S, Truskett P. Does an acute care surgical model improve the management and outcome of acute cholecystitis? ANZ J. Surg. 2010;80:438‐42). NSAP patients lack a clear diagnosis of surgical pathology based on standard clinical, laboratory and imaging work‐up, although they may require ASU admission for pain control and assessment. This article provides a review of uncommon conditions, presenting as AAP, that could possibly be mis‐labelled as NSAP, with a focus on aspects of the presentation that may aid diagnosis and management including specific demographic features, clinical findings, key investigations and initial treatment priorities for ASU clinicians. Ultimately, most of the conditions discussed will not require surgical intervention, however, they require a diagnosis to be made and initial treatment planning before on‐referral to the appropriate specialty. For the on‐call general surgeon, some knowledge of these conditions and an index of suspicion are invaluable for the prompt diagnosis and efficient management of these patients.

cases of wandering spleens were managed operatively. Sato et al. previously published and reviewed the literature of wandering spleens with gastric varices. 4 To date, there were a total of 16 cases of wandering spleens reported in literature. 4,8 All patients except one 9 had undergone a splenectomy with outstanding results. 4,8 A splenectomy remains the definitive standard of care for a wandering spleen should there be evidence of splenic infarction or splenic vessel thrombosis. 8 However, Tagliabue et al. proposed that in the absence of splenic complications, splenopexy with suture or mesh fixation may be attempted especially in patients who may be at risk of overwhelming post-splenectomy sepsis. 8 Another remarkable trend noted over the years was the increasing use of laparoscopy. Of the 16 cases of wandering spleens with gastric varices, all cases published before 2010 were done open, while three out of five cases published after 2010 were performed successfully laparoscopically. 4,8 Out of the two open cases published after 2010, only one case was performed after 2010. This was reported by Irak et al., who performed an open splenectomy on a 55-year-old lady with supramassive splenomegaly 10 with a wandering spleen, measuring 25 × 15 × 10 cm, complicated by upper gastrointestinal haemorrhage. In conclusion, wandering spleens may result in the formation of gastric varices secondary to chronic intermittent torsion. The conscientious clinician should consider this as a differential diagnosis in young patients who present with recurrent abdominal pain. A laparoscopic splenectomy should be considered in suitable patients.

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