Introduction: Sarcopenia, defined as low skeletal muscle mass and poor muscle function, has been associated with worse postoperative recovery. This study aims to evaluate the significance of low muscle mass in the elderly who require emergency surgeries and the postoperative outcomes. Method: Data from the emergency laparotomy database were retrieved from Khoo Teck Puat Hospital, Singapore, between 2016 and 2019. A retrospective analysis was performed on patients aged 65 years and above. Data collected included skeletal muscle index (SMI) on computed tomography scan, length of stay, complications and mortality. Low muscle mass was determined based on 25th percentile values and correlation with previous population studies. Results: A total of 289 patients were included for analysis. Low muscle mass was defined as L3 SMI of <22.09cm2/m2 for females and <33.4cm2/m2 for males, respectively. Seventeen percent of our patients were considered to have significantly low muscle mass. In this group, the length of stay (20.8 versus 16.2 P=0.041), rate of Clavien-Dindo IV complications (18.4% vs 7.5% P=0.035) and 1-year mortality (28.6% vs 14.6%, P=0.03) were higher. Further multivariate analysis showed that patients with low muscle mass had increased mortality within a year (odds ratio 2.16, 95% confidence interval 1.02–4.55, P=0.04). Kaplan-Meier analysis also shows that the 1-year overall survival was significantly lower in patients with low muscle mass. Conclusion: Patients with low muscle mass have significantly higher post-surgical complication rates and increased mortality. Keywords: Emergency laparotomy, geriatrics, mortality, postoperative outcome, sarcopenia

A 36-year-old male was admitted with 1-day duration of sudden onset abdominal pain, vomiting and fever. Clinically, he was lethargic looking with generalized abdominal tenderness and guarding.Investigations revealed an elevated white cell count of 19 with no pneumoperitoneum seen on erect chest radiograph. However, plain abdominal radiograph revealed multiple metallic foreign bodies in the left hypochondrium. A computed tomography scan of the abdomen subsequently revealed perforation of the proximal jejunum, where the metallic foreign bodies were located.At laparotomy, a cluster of magnetic beads was found eroding through the jejunum, resulting in perforation at 80 cm from the duodenal-jejunal (DJ) junction. Two other areas of jejuno-jejunal fistulous formation were seen at 30 and 60 cm from DJ junction ( Fig. 1). As there was a long segment of healthy small bowel intervening the point of first fistulous track (at 30 cm) and the second (at 60 cm), which was within short distance to the site of perforation (at 80 cm), decision was made to perform two small bowel resections with primary anastomosis. A linear foreign body comprising six small magnetic beads (Fig. 2) was retrieved. The patient had a smooth and uneventful post-operative recovery. The patient's history was revisited for which he admitted to losing magnetic tongue studs during his sleep on several occasions since the start of usage 6 weeks ago.Accidental foreign body ingestion remains a common clinical scenario among patients of all ages. These (inert) objects usually pass through the gut without much clinical consequences. 1 However, magnetic beads ingestion poses special risks of bowel erosion, fistulation and perforation, and is more common in the paediatric population. 2,3 This can occur either because of a result of direct pressure being exerted on the bowel wall, resulting in necrosis and subsequent perforation, or via the strong attractive forces that magnetic beads can generate across bowel wall, when two or more beads are present at different locations of the small bowel. 4 We report the first case in literature the inadvertent ingestion of magnetic tongue studs causing small bowel perforation in an adult.Magnetic tongue stud is a relatively novel and popular fashion item among young adults. This fashion craze is largely fuelled by its affordability and ease of access from online sales. The magnetic Fig. 1. Jejunal perforation at 80 cm from DJ flexure caused by foreign body. Arrows indicate two areas of jejuno-jejunal fistula formation proximal to site of perforation, at 30 and 60 cm from DJ flexure.Fig. 2. A linear chain comprising six small magnetic beads.Fig. 3. Magnetic beads placed superiorly and inferiorly to simulate tongue studs.