Staff Publication

intra-Peritoneal Gallstone Leading to Chronic Sinus Formation Following Laparoscopic Cholecystectomy and Common Bile Duct Exploration - Rare Case Report (2025)

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Type of publication:

Conference abstract

Author(s):

*Lakshmipathy G.; *Parampalli U.; *Pattar J.;

Citation:

British Journal of Surgery. Conference: AUGIS Annual Scientific Meeting. Glasgow United Kingdom. 112(Supplement17) (pp xvii23-xvii24), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Background: Dropped gallstones can be a common occurrence during laparoscopic cholecystectomy. However, only 3% patients develop abscess secondary to intra-peritoneal spilled gallstone. We report the case of a 41-year-old woman who suffered with persistent intra-abdominal collections and sinus tract discharge following laparoscopic cholecystectomy. Case Presentation: Our patient originally underwent elective laparoscopic cholecystectomy and common bile duct (CBD) exploration for CBD stones. Two weeks later, she underwent incision and drainage procedure for port site abscess. Three years later, she re-presents with right upper quadrant pain, discharge through the umbilical wound and raised inflammatory markers. Computed Tomography (CT) scan revealed a collection postero-lateral to the right lobe of the liver, which was then drained through interventional radiology. Despite drainage, patient re-attends with recurrence of pain, a repeat CT scan confirmed a persistent peri-hepatic collection likely secondary to retained intra-peritoneal gallstone. Patient underwent diagnostic laparoscopy, in which, the collection was tracked by flushing radiological drain and then the stone was retrieved. Patient recovered well. Discussion(s): Diagnosis of an intra-peritoneal gallstone following cholecystectomy and CBD exploration can be hampered by unusual clinical presentations, radiologically occult nature of stones and the vast area they can settle into. Whilst rare, retained intra-peritoneal gallstones have the potential to cause economic burden to the health service, in addition to, the physical and psychological impact on the patient. Our case demonstrates that it is imperative to be meticulous in clearance of bile and stone spillage all cases of cholecystectomy with CBD exploration.

DOI: 10.1093/bjs/znaf270.088

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Interventions to preserve beta cell function in patients with newly diagnosed type 1 diabetes: An updated descriptive analysis of time trends in randomised controlled trials (RCTs) identified in a systematic review (2025)

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Type of publication:

Conference abstract

Author(s):

Beese S.E.; Gerard C.; Narendran P.; Price M.J.; Quinn L.; Gada R.; *Horgan T.J.; Andrews R.C.; Moore D.J.; Tomlinson C.; Sharma P.; Harris I.M.; Adriano A.; Maggs F.; Burrows M.;

Citation:

Diabetic Medicine. Conference: Diabetes UK Professional Conference 2025. Glasgow . 42(Supplement 1) (no pagination), 2025. Date of Publication: 01 Feb 2025.

Abstract:

Aims: In newly diagnosed type 1 diabetes, residual beta cell function (indicated by c-peptide) is associated with improved glucose control and reduced long-term complications. We assessed time trends in RCTs of categories of interventions for beta cell preservation in newly diagnosed type 1 diabetes. Method(s): RCTs of any intervention for newly diagnosed type 1 diabetes measuring c-peptide were identified in Cochrane CENTRAL, MEDLINE, Embase and trials registries (to July 2024). Trends in trial characteristics were assessed, focusing on types of intervention. Result(s): The 171 completed published trials were distributed across non-antigen-specific (NAS) immunomodulatory therapies (n = 60, 33%), vitamins (n = 23, 13%), antigen-specific immunotherapies (n = 20, 11%), interventions to maintain glucose control (n = 38, 21%) and 'other' interventions (n = 39, 22%). A further 102 ongoing/ unpublished trials were included. Over 40 years, RCT frequency has increased, with 54 trials published between 2011 and 2020 and 39 since 2021. Twenty-four ongoing trials of 'other' interventions and 19 NAS trials have been initiated since 2021. Average sample size per trial has increased from 63 (SD 66) prior to 2014 to 83 (SD 110) in the last 10 years. Taking the NAS group as an example, time from completion of data collection to publication has increased. Trials with significant primary endpoint results are published 6 months quicker than non-significant findings (mean 17.6 vs 23 months). The number of NAS trials with significant results has risen from 40% (13/33) to 61% (16/26). Conclusion(s): RCTs of therapies to preserve beta cells are increasing in frequency with greater focus on NAS interventions and therapies not easily fitting standard categories. Significant findings may be published sooner.

DOI: 10.1111/dme.15498

Pulmonary Embolism and Myocardial Infarction With Non-obstructive Coronary Arteries in Immune Thrombocytopenia: Unmasking Underlying Antiphospholipid Syndrome (2026)

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Type of publication:

Journal article

Author(s):

*Shahzeb, Muhammad; Naeem, Faiqa Jabeen; *Naz, Kiran; *Irfan, Muhammad; *Ahmad, Nawaid; Rafiq, Nawal; Ul Haq, Ijaz.

Citation:

Cureus. 18(1):e100731, 2026 Jan.

Abstract:

This case report presents the clinical scenario of a 35-year-old male patient who experienced chest pain due to a combination of pulmonary embolism (PE) and myocardial infarction with non-obstructive coronary arteries (MINOCA), concurrently while undergoing treatment with avatrombopag for immune thrombocytopenia (ITP). His investigations included a CT pulmonary angiogram that confirmed a PE, a coronary angiography which was normal, a cardiac MRI which showed evidence of subendocardial infarct, and a CT coronary angiogram, which was normal. His unique presentation with these findings prompted further investigations, which revealed an undiagnosed antiphospholipid syndrome (APS) alongside a patent foramen ovale (PFO). Hence, the paradoxical thrombotic incidents were precipitated by this unique diagnosis. After establishing the diagnosis, our patient was commenced on warfarin, and his treatment protocol for ITP was changed to a different drug. He remains under haematology follow-up.

DOI: 10.7759/cureus.100731

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IUGA Opinion Paper on Obstructed Defecation: Management of Clinical and Proctographic Rectoceles (2026)

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Type of publication:

Journal article

Author(s):

*Rachaneni, Suneetha; Dietz, Hans Peter; Latthe, Pallavi; Sirany, Annie; Spivak, Anna; Dua, Anupreet.

Citation:

International Urogynecology Journal. 37(1):75-85, 2026 Jan.

Abstract:

INTRODUCTION AND HYPOTHESIS: Obstructed defecation syndrome (ODS) is a defecatory abnormality with a sensation of incomplete evacuation, the need to strain at stool, the need for digitation in the vagina, the anus, or the perineum. Anterior rectocele and rectal intussusception are the frequent pathologies behind ODS. The review focuses on the assessment and treatment of obstructed defecation in women with rectocele, recto-enterocele and rectal intussusception in the remit of a urogynecologist.

METHODS: A working subcommittee from the International Urogynecology Association (IUGA) Research and Development (R&D) Committee was formed with colorectal surgeons from the American Society of Colon & Rectal Surgeons (ASCRS). An initial document was drafted based on a literature review. The review focused on the treatment options of women with presenting with obstructed defecation and posterior compartment prolapse either on clinical examination or on imaging. After evaluation by the entire IUGA R&D Committee revisions were made. The quality of the evidence was graded and used to form consensus recommendations.

RESULTS: Ultrasound and dynamic MRI are helpful imaging modalities in triaging patients. A defecating proctogram to evaluate the size of rectal intussusception and enterocele is the standard investigation. Conservative therapies are effective first-line management options. The transvaginal native tissue rectocele repair is a safe and effective first-line surgical treatment in women with obstructed defecation.

CONCLUSIONS: When evaluating patients with obstructive defecation, it is important to address anatomy as well as function. In the absence of a clinically significant rectocele or enterocele during vaginal examination, in women with obstructed defecation, referral to a gastroenterologist or colorectal surgeon for further evaluation and management is recommended.

DOI: 10.1007/s00192-025-06288-7

An Electromyographic Study Comparing Muscle Function During Supination and Pronation of the Forearm (2025)

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Type of publication:

Journal article

Author(s):

Kondi, Suresh; *Murugesan, Thivagar; Postans, Neil; Thumri, Paavana; Kantamaneni, Ketan; Ansari, Shahbaz; Pickard, Simon.

Citation:

Cureus. 18(1):e101255, 2026 Jan.

Abstract:

BACKGROUND: Forearm pronation and supination are fundamental movements essential for daily activities and clinical applications. While supinator and biceps brachii contribute to supination, and pronator quadratus and pronator teres facilitate pronation, the precise activation patterns and torque-dependent recruitment strategies of these muscles remain incompletely understood. Conflicting evidence exists regarding muscle contribution at varying load conditions, with implications for rehabilitation protocols, surgical planning, and prosthetic design.

PURPOSE: This study aimed to quantify and compare the electromyographic (EMG) activity of forearm rotator muscles during isometric contraction under progressively increasing torque loads during both supination and pronation movements.

METHODS: Four healthy right-handed subjects (3 males, 1 female; mean age 32.5 years) underwent simultaneous EMG and motion capture recording. Surface electrodes captured activity from biceps brachii, triceps, pronator teres, and pronator quadratus, while fine-wire electrodes measured supinator muscle activity. Participants maintained a neutral forearm position against applied loads of 1 kilogram positioned at increasing distances (10-35 cm) from the supination axis, creating progressively higher torques. EMG signals were filtered, rectified, normalized, and analyzed using root mean square values across three trials per loading condition.

RESULTS: During supination resistance, the supinator demonstrated higher activation at lower torques compared to the biceps brachii. As applied torque increased, the biceps brachii activity increased proportionally more than the supinator, indicating load-dependent recruitment. Triceps showed increased co-activation for joint stability. During pronation resistance, the pronator quadratus exhibited greater activity at lower torques relative to the pronator teres. With increasing torque, the pronator teres demonstrated relatively greater activation increases than the pronator quadratus. Both movement patterns demonstrated progressive recruitment of multi-joint muscles as torque demands increased.

CONCLUSIONS: This pilot EMG study (n=4) provides preliminary descriptive evidence suggesting that supinator and pronator quadratus primarily govern low-torque forearm rotation, while biceps brachii and pronator teres become increasingly dominant during high-torque demands. These observed patterns are consistent with a hierarchical muscle recruitment strategy optimized for mechanical efficiency and joint stability. Understanding these activation patterns may have potential clinical applications for rehabilitation protocol design following nerve injury or tendon rupture, surgical planning for nerve transfer procedures, and development of myoelectric prosthetic control algorithms.

DOI: 10.7759/cureus.101255

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Emergency hospital admissions while on an elective waiting list in England: an observational study using administrative data (2026)

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Type of publication:

Journal article

Author(s):

James, Anthony P; Gray, William K; *Cheetham, Mark J; Eardley, Ian; Lansdown, Mark.

Citation:

British Journal of Surgery. 113(2), 2026 Feb 11.

Abstract:

INTRODUCTION: Patients awaiting elective procedures often have conditions that carry a risk of medical emergencies. This study quantifies the extent and variation of emergency hospital admissions during the waiting period across selected specialties and procedures.

METHODS: Data from the NHS England Waiting List Minimum Dataset linked to the Secondary Uses Service hospital admissions data set from 1 January 2022 to 31 December 2023 was analysed. Emergency admissions occurring while patients awaited treatment were identified and categorized from 'very likely' related to the index condition or its recognized co-morbid risks-and potentially avoidable through definitive treatment-through to 'unrelated'.

RESULTS: In 2023 some 2 093 789 waits (both incomplete and complete) were recorded across 41 selected procedures spanning 11 specialties. Over a combined waiting time of 33 832 790 days, 69 322 emergency admissions occurred, accounting for 535 806 bed days. The highest emergency admission rates per 52 weeks waiting were observed for urinary stent procedures (0.71), endoscopic retrograde cholangiopancreatography (0.63), and urinary catheter care (0.55). Nine procedures had more emergency bed days during the wait than elective bed days post-treatment, with the highest emergency/elective bed day ratios for ureteric stones (4.59), colonoscopy (2.80), and ablation/cardioversion (2.05).

CONCLUSION: A substantial number of patients on elective waiting lists are being admitted as emergencies during their wait, placing a burden on emergency care that would be avoided through more timely treatment. The variation in risk between specialties and pathways requires further prioritization strategies that mitigate patients' risk of associated harm, acting both within and across waiting lists, specialties, and organizations.

DOI: 10.1093/bjs/znaf292

Audit of Laparoscopic Cholecystectomy Operative Notes in a DGH (2025)

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Type of publication:

Conference abstract

Author(s):

*Ramesh S.; *Magalong J.A.; *Parampalli U.

Citation:

British Journal of Surgery. Conference: AUGIS Annual Scientific Meeting. Glasgow United Kingdom. 112(Supplement17) (pp xvii60), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Introduction: Operation notes are essential documents in patient care. The use of standardized guidelines, such as those endorsed by recognized organizations, is crucial to ensure consistent and detailed record-keeping. Documenting parameters specific to laparoscopic cholecystectomy provides valuable information for management in the event of complications and it also provides direction for follow-up care. Aim(s): This audit aims to assess the quality of laparoscopic cholecystectomy operative notes in our trust by comparing them against NHS England's GIRFT (Getting It Right Rirst-Time) recommendations. It also aims to Identify areas for improvement and implement targeted interventions. Method(s): A retrospective audit of 78 laparoscopic cholecystectomy operative notes conducted in 2024 were selected by systematic random sampling. Data were compared against GIRFT recommendations. After intervention, a re-audit of 78 laparoscopic cholecystectomy operative notes from 2025 was done using the same methodology and compared against initial audit. Result(s): Significant improvement was observed in the re-audit compared to the initial audit, after intervention in the form of surgeon education and use of modified operation note proforma specific to laparoscopic cholecystectomy was implemented. Documenting significant steps involved in Laparoscopic cholecystectomy for example, details of calot's triangle dissection, details of bile/gallstone spill and its management and mention of port used to extract gallbladder increased by 13%, 42%, and 48%, respectively. Conclusion(s): This audit demonstrates a significant improvement in operative note quality by implementing interventions from an initial audit, emphasising the importance of use of recommendations issued by GIRFT. Audits should be conducted at regular intervals to sustain improvements.

DOI: 10.1093/bjs/znaf270.230

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Lesser Omental Infarction: A Rare Cause of Intraperitoneal Focal Fat Infarction (IFFI) (2025)

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Type of publication:

Conference abstract

Author(s):

*Ramesh S.; *Jayaramegowda A.K.

Citation:

British Journal of Surgery. Conference: AUGIS Annual Scientific Meeting. Glasgow United Kingdom. 112(Supplement17) (pp xvii18), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Lesser Omental Infarction is a rare type of Intraperitoneal Focal Fat Infarction (IFFI) caused by the cut-off of blood supply to the fat tissue in the lesser omentum. Patients typically present with symptoms and signs mimicking more serious conditions such as perforated gastric ulcer, pancreatitis, or cholecystitis. This report aims to share insights into the clinical presentation, diagnostic challenges, and management strategies for patients with this condition. A 29-year-old gentleman presented with complaints of upper abdominal pain for two days, radiating to the right side. On abdominal examination, there was a soft but tender right hypochondrium. The patient was admitted with a provisional diagnosis of cholecystitis. Blood investigations were unremarkable, except for an elevated C-reactive protein (CRP). Ultrasound abdomen study was normal and ruled out gallbladder pathology. A CT scan of the abdomen suggested lesser omental infarction secondary to torsion. The patient was managed conservatively with analgesics and discharged after resolution of symptoms. Radiological imaging plays a crucial role in diagnosing lesser omental infarction. If missed, the patient may undergo unnecessary investigations and Interventions. When accurately diagnosed, most cases can be managed conservatively with analgesia. Surgical intervention is rarely required and is reserved for cases where devitalized tissue forms an abscess that does not resolve with conservative management.

DOI: 10.1093/bjs/znaf270.065

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Impact of the new UK guidelines on the emergency management of anaphylaxis at two hospitals (2024)

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Type of publication:

Conference abstract

Author(s):

*Elshahawy M.; *Kadambi M.; *Inani M.; Hughes D.; Clarke D.; Cooper A.; Goddard S.; Diwakar L.

Citation:

Allergy: European Journal of Allergy and Clinical Immunology. Conference: European Academy of Allergy and Clinical Immunology Hybrid Congress. Virtual. 79(Supplement 113) (pp 328-329), 2024. Date of Publication: 01 Oct 2024.

Abstract:

Background: In 2021, the UK Resuscitation Council made changes to the guidance on the management of acute anaphylaxis. The most significant of these included a) removal of antihistamine (chlorpheniramine) and steroid (hydrocortisone) from the algorithm b) Advise to administer repeated doses of IM adrenaline every 5 minutes until there has been an improvement in breathing and circulation. We carried out an audit to understand how the change in guideline has impacted patient care. Other aspects audited include measurement of serum tryptase and referral to specialist clinic. Method(s): This was a retrospective study using Ambulance Service and hospital notes to assess management of all patients presenting to the accident and emergency department at the university hospital of North Midlands (UHNM) and Shrewsbury and Telford hospitals (SaTH) with anaphylaxis in the years 2018 and 2022. ICD 10 codes were used to identify patients. Result(s): A total of 103 and 109 patients presented in 2018 and 2022 respectively with anaphylaxis. A&E and ambulance notes were available for 100 patients in 2018 (97%) and 103 (95%) patients in 2022. There were no deaths. Patient groups similar in age (range: 1-90 yrs) and gender (60% female) for both years across both sites. Less than half had tryptase measured. A significant number of patients with only skin symptoms were classified as having anaphylaxis. There was a significant reduction in the use of steroids and antihistamines between 2018 and 2022. Use of adrenaline was lower in 2022. Very few patients were referred to specialist clinics in both years, particularly from SaTH hospital. Conclusion(s): Anaphylaxis maybe over diagnosed in the emergency department. There has been some adherence to the new UK guideline for anaphylaxis management. Most patients still do not have serum tryptase checked. Referral rates are low.

DOI: 10.1111/all.16299

Use of GLP-1 analogues in Prader-Willi syndrome with type 2 diabetes: Tackling the underlying pathogenetic mechanism (2025)

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Type of publication:

Conference abstract

Author(s):

*Basavaraju N.; *Jones A.; *Wilkes V.; *Singh P.; *Moulik P.

Citation:

Diabetic Medicine. Conference: Diabetes UK Professional Conference 2025. Glasgow . 42(Supplement 1) (no pagination), 2025. Date of Publication: 01 Feb 2025.

Abstract:

Background and Aims: Prader-Willi syndrome (PWS) is a rare genetic neurodevelopmental disorder causing hypothalamic-pituitary dysfunction, hyperphagia resulting in weight gain, short stature and mild cognitive impairment. We present two cases of PWS and role of GLP-1 analogues. Material(s) and Method(s): Retrospective review of two cases. Case 1: A 31-year-old female with PWS at the age of 7 years, learning difficulty, type 2 diabetes at 28 years, treated with metformin, linagliptin. She continued to gain weight despite calorie restriction, commenced on Semaglutide. Case 2: A 25-year-old female with PWS at age of 4 years, type 2 diabetes at 18 years, treated with metformin. Due to suboptimal glycaemic control, empagliflozin and liraglutide started. Result(s): Case 1: At initiation of Semaglutide, weight 93 kg, BMI 43.6 kg/m2, glycated haemoglobin (HbA1c) 106 mmol/mol (ref: 20-41). Twenty months on GLP-1 analogue, weight reduced by 21 kg, and HbA1c was 38 mmol/mol with reduction in appetite and positive change in eating habits. Case 2: At initiation of liraglutide, weight 91 kg, BMI 35 kg/ m2, HbA1c 72 mmol/mol. Six months later appetite, food cravings reduced; HbA1c 65 mmol/mol, weight stable. Conclusion(s): PWS is associated with high ghrelin, low insulin levels, visceral adiposity resulting in hyperphagia causing altered glucose metabolism predisposing to cardiovascular complications. Mainstay of treatment is behavioural modifications posing stress to patient and caregiver. There is no approved pharmacological management for this aspect of PWS. Systematic review on use of GLP-1 analogues with PWS showed improved glycaemic control, reduced appetite, without any significant side effects. Our patients showed improvements with metabolic control of type 2 diabetes, reducing food cravings. Further studies are required to explore exact mechanism of ghrelin suppression by GLP-1 analogues in PWS.

DOI: 10.1111/dme.15498