Jack Cullen

Ureteric colic constitutes a large proportion of acute hospital attendances, across the UK, putting pressure on urological services. The British Association of Urological Surgeons (BAUS) guidelines indicate that for patients managed expectantly, a clinic review should be undertaken within 4 weeks of presentation. This quality improvement project reports the benefit of a dedicated virtual colic clinic to facilitate an efficient care pathway and reduce patient waiting times. A retrospective cycle analysed patients referred from the emergency department (ED) with uncomplicated acute ureteric colic (excluding those admitted for immediate intervention) over 2 months in 2019. A further cycle was carried out 12 months later following the introduction of a new dedicated virtual colic clinic with updated ED referral guidance. The mean time from ED referral to urology clinic review fell from 7.5 to 3.5 weeks. The percentage of patients reviewed in clinic within 4 weeks increased from 25% to 82%. The mean time from referral to intervention including shockwave lithotripsy and primary ureteroscopy fell from 15 to 5 weeks. The introduction of a virtual colic clinic improved the time to definitive management of ureteric stones for patients managed expectantly as per BAUS guidelines. This has reduced waiting times for both clinic review and stone treatment which has enhanced patient experience within our service.

Pelvic vein embolisation (PVE) with metallic coils is an effective treatment for pelvic venous congestion. The migration of coils following the procedure has been well-reported; however, the most effective approach to management is still unclear. In the present case, the authors describe the delayed identification of a migrated coil to the right ventricle following an ovarian vein embolisation. The patient presented to the emergency department with chest pain and subsequent radiology identified a coil in the right ventricle. This was found to be present on previous radiology, but had not been reported on. The position of the coil had remained stable and therefore was deemed an unlikely cause for the chest pain. The coil was managed conservatively. This demonstrates how asymptomatic coil migration may go undetected and thus the migration rates in the literature may be underreported. Post-PVE screening to assess for migration could improve the accuracy of complication rates and prevent delayed complications associated with migrated coils.

Introduction and importance: Heterotopic pancreas (HP) is defined as the presence of pancreatic tissue without anatomical and vascular continuity with the main body of the pancreas. HP typically remains asymptomatic, however complications such as acute pancreatitis can arise. Gastrointestinal involvement with coronavirus disease 2019 (COVID-19) is not uncommon and there are reported cases of associated pancreatitis. Case presentation: A 31-year-old male presented to the Emergency department (ED) with a 3-day history of right iliac fossa pain. The patient was found to have COVID-19 and a planned laparoscopic appendectomy was later converted to a midline laparotomy when a mass close to the duodeno-jejunal (DJ) flexure was identified. Following a hand-sewn anastomosis the patient made a good post-operative recovery. Histology illustrated the presence of heterotopic pancreatic tissue within the small bowel with underlying fat necrosis typical of acute pancreatitis. Follow-up radiology supported the intraoperative finding of intestinal malrotation. Clinical discussion: Rarely the combined presence of intestinal malrotation and HP in patients has been noted. Heterotopic pancreatitis can present in a multitude of ways and it is a difficult diagnosis to make pre-operatively. Emerging literature documents the potential presentation of COVID-19 with acute pancreatitis. The expression of angiotensin-converting enzyme 2 (ACE2) receptors on the pancreas is believed to play a role. Conclusion: This is the first documented case of heterotopic pancreatitis with intestinal malrotation in a COVID-19 positive patient. We hypothesise that the COVID-19 infection contributed to the heterotopic pancreatitis. Highlights: