Russells Hall Hospital is an NHS general hospital located in Dudley, West Midlands, England, managed by the Dudley Group NHS Foundation Trust. The hospital is south-west of the town centre on the A4101 road, which connects to the Kingswinford area of the borough.
Background Colorectal cancer is the third most common malignancy worldwide with rectal cancer accounting for approximately 30% of all new cases. Surgery is the standard of care in the treatment of localised malignancy and can be performed through open and various minimally invasive approaches. Trans-anal minimally invasive surgery (TAMIS) represents a rectal-sparing hybrid technique between single-port laparoscopy and trans-anal endoscopic microsurgery (TEM) for resection of benign and early-stage rectal cancers. We present our initial experience with TAMIS including short-term outcomes and provide an updated systematic review. Methods A retrospective case series of patients with rectal lesions who underwent TAMIS between February 2022 to June 2024 at a district general hospital in the UK was performed. Basic patient demographics, intra- and postoperative outcomes including complications were collected and analysed.A comprehensive search of various electronic databases for the systematic review was conducted including PubMed, Embase, MEDLINE, and Web of Knowledge. Studies (excluding case reports) including patients diagnosed with rectal malignancy or benign polyps and treated with TAMIS were included. Analysed outcome measures were excision quality and complications. Results Our case series cohort included a total of 25 patients with a mean age of 70.7 years (SD = 14.3). Mean distance of lesion from the anal verge was 5.8 cm (SD = 3.2), with intra-operative blood loss of 6.0 mls (SD = 10.5), and an operative duration of 67.0 min (SD = 38.9). Final histopathological analysis showed adenocarcinoma in 20%, morbidity rate of 12%, R0 resections in 72%, and 30-day re-admission rate of 16%. The mean length of stay was 2.4 days (SD = 1.8).A total of 48 studies, with 1964 patients were included in the systematic review, with a mixture of case series, comparative studies and published abstracts. Average age was 64.4 years (SD = 6.4) and 42.8% were female. Mean distance of lesion from the anal verge was 6.9 cm (SD = 1.3) with an operative duration of 71.2 min (SD = 18.5). Length of stay was 1.5 days (SD = 1.3), R0 resection rates of 91.8%, morbidity rate of 11.6%, and recurrence rate of 4.7%, respectively. Conclusion Although TAMIS is a safe and feasible option in the treatment of benign polyps and early-stage malignancy, outcomes remain similar in the decade since the first published review. TAMIS is still a relatively new technique and it is anticipated that outcomes will likely improve with time.
Abdominal compartment syndrome (ACS) is a rare surgical emergency characterized by end-organ dysfunction resulting from sustained elevation of intra-abdominal pressure. Gynecological malignancies are an uncommon cause of ACS. We report the case of a 61-year-old woman who presented following an unwitnessed fall with hypotension, tachycardia, confusion, and marked abdominal distension. Initial laboratory investigations demonstrated severe acute kidney injury (AKI), hyperkalemia, anemia, and markedly elevated inflammatory markers. Computed tomography (CT) imaging revealed a massive septate cystic pelvic mass causing compression of the inferior vena cava (IVC) and displacement of bowel loops, with associated liver lesions and lymphadenopathy concerning for metastatic gynecological malignancy. Ongoing hemodynamic instability and evidence of end-organ dysfunction raised suspicion for ACS. The patient underwent emergency decompressive laparotomy with drainage of approximately 6 liters of cystic fluid, followed by total abdominal hysterectomy with bilateral salpingo-oophorectomy. Her postoperative course was complicated by persistent AKI, anemia, bilateral femoral vein thromboses, Clostridioides difficile infection, and lower-limb ulcers secondary to chemical burns. Initial histopathological findings were inconclusive; however, subsequent lymph node biopsy confirmed metastatic high-grade adenocarcinoma consistent with an ovarian or Müllerian primary malignancy. Due to advanced metastatic disease and profound frailty, the patient was deemed unsuitable for systemic oncological treatment and was transitioned to palliative care. She later died while receiving end-of-life support.
BACKGROUND:Arterial blood gas (ABG) testing is a common investigation in critical care; however, evidence suggests that 33%-66% of samples may be taken without a clear clinical indication. Unnecessary testing increases costs, contributes to iatrogenic anaemia and wastes staff time. It also carries an environmental burden through resource use, waste generation and associated carbon emissions. AIM:To evaluate the impact of an education- and guideline-based intervention on reducing clinically inappropriate ABG testing in a UK Intensive Care Unit (ICU) and to perform a triple bottom line assessment. STUDY DESIGN:A pre- and post-quality improvement project in a 23-bed level III ICU. Baseline audit data were collected on ABG indications and appropriateness. A locally developed ABG guideline was introduced, supported by targeted bedside teaching and reinforced through visible prompts. Post-intervention audit mirrored baseline methods. This quality improvement project was underpinned by the Sustainability in Quality Improvement (SusQI) framework, which integrates environmental, financial and social sustainability principles into traditional plan, do, study and act (PDSA) methodology. RESULTS:The total number of ABG tests decreased from 7348 to 4819, representing a 34.4% reduction. The mean ABGs per patient decreased from 14.27 to 11.78 (rate ratio, 0.826; 95% CI, 0.796-0.856; p < 0.001). The proportion of inappropriate ABGs declined from 27.0% to 4.1% (absolute risk reduction 22.9%, NNT = 4.4, p < 0.001). Post-intervention savings included £2781.90 in direct costs, 210.8 h of clinician time, 1.396 L of patient blood and 124.0 kg CO2e emissions. No adverse impact on patient care was identified. CONCLUSIONS:A low-cost, nurse-engaged intervention reduced unnecessary ABG testing without compromising safety, delivering quantifiable financial, operational and environmental benefits. Incorporating sustainability metrics strengthens the case for change and aligns with the NHS Net Zero agenda. RELEVANCE TO CLINICAL PRACTICE:Critical care nurses play a central role in ABG stewardship. Equipping them with clear guidelines, education and visible prompts can rapidly change practice, improving patient safety, reducing waste and supporting sustainable healthcare delivery.
We present the case of an 87-year-old man in whom a giant azygos vein aneurysm was incidentally detected on chest radiography (CXR) performed following an acute stroke. The radiograph demonstrated a right paratracheal mediastinal opacity with attenuation similar to the adjacent aortic arch, raising suspicion of a vascular abnormality. Contrast-enhanced CT confirmed a large azygos vein aneurysm draining into the superior vena cava. Retrospective review demonstrated subtle right paratracheal prominence dating back to 2007, with gradual interval enlargement over more than a decade. No acquired cause was identified, and the patient remained asymptomatic throughout follow-up, supporting conservative management in selected patients. The patient also demonstrated concurrent isolated segmental partial anomalous pulmonary venous return (PAPVR) draining into the superior vena cava. This case highlights the importance of recognising azygos vein aneurysms as a differential for mediastinal masses on CXR and considering associated congenital vascular anomalies.
