Common or external iliac artery injury due to blunt trauma is unusual without an associated pelvic fracture. Here we report on a 62 years old man that sustained left external iliac artery thrombosis due to blunt trauma following fall from motorbike. There was no immediate circulatory compromise. Contrasted CT of abdomen revealed an associated left lower abdominal wall traumatic hernia. The iliac artery was intervened with an endovascular stent to restore luminal flow and the hernia was repaired electively. The entire clinical course and management dilemma are described in this article.

INTRODUCTIONSingapore was one of 29 countries worldwide affected by severe acute respiratory syndrome (SARS) in 2003.

MATERIALS AND METHODSThere were 238 cases identified during the outbreak. We performed a retrospective analysis of the clinical and laboratory data of 234 patients admitted to Tan Tock Seng Hospital and Singapore General Hospital.

RESULTSThe mean age of patients was 21 years, 31.6% of patients were males and 41.8% were healthcare workers. At presentation, the common symptoms were fever, myalgia, cough and headache; rhinorrhoea was uncommon. On admission, 21% had leukopenia, 18% had thrombocytopaenia, 29% had hyponatraemia, 31% had hypokalaemia, 21% had transaminitis. Polymerase chain reaction (PCR) testing of respiratory and stool samples provided the best yield at the end of the first week of illness. Thirty-two patients were initially not recognised as probable SARS and were reclassified when the serology test results were available. The chief reasons for not identifying these patients early were persistently normal chest X-rays (68.8%), very mild presentation (43.8%) and the presence of a concomitant illness (12.5%). Overall, 12% of the patients were probable SARS with atypical presentations. Overall mortality was 11.8%.

CONCLUSIONPatients infected with the SARS coronavirus had a wide clinical presentation with non-specific symptoms.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibodies, Viral ; analysis ; Child ; Child, Preschool ; DNA, Viral ; analysis ; Diagnosis, Differential ; Female ; Humans ; Incidence ; Infant ; Male ; Middle Aged ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction ; SARS Virus ; genetics ; immunology ; Severe Acute Respiratory Syndrome ; diagnosis ; epidemiology ; virology ; Severity of Illness Index ; Singapore ; epidemiology

Background: Ingestion of foreign bodies leading to impaction at the pharynx and oesophagus have been extensively described in English literatures. However, impactions at the gastrointestinal tract distal to the oesophagus are less commonly encountered due to the more capacious luminal diameter as it approaches the stomach. While intentional foreign body ingestions impacted distal to the oesophagus are often more complicated, literatures on the management of these distal oesophageal impactions are scarce. Case presentation: We present five cases of foreign body impaction at varying sites of gastrointestinal tract beyond the oesophagus, contrasting management approach comparing the role of endoscopy, open surgery and conservative management. Cases presented include patients aged 40 to 70 with intentional foreign bodies ingestion. The first case described a cerebral palsy patient with pica who had to undergo difficult evacuation under anaesthesia followed by colonoscopy; the second and third cases presented 2 different schizophrenic patients with 2 differing management approach. The second case was managed with multiple operations due to complications and died eventually, making the only mortality in our case series; whereas the third case was managed conservatively with acceptable outcome after multiple laparotomies prior. Fourth and fifth cases described 2 body packers who swallowed tobacco and 2 phones, respectively; the former was uneventfully managed conservatively, the latter, had to undergo surgical extraction. Individualized approach to these distal impactions of ingested foreign bodies are described with a review of available literatures which are tabulated and discussed in this case series. Conclusion Endoscopy, surgery, conservative management and sometimes a combination of approaches are utilised for the management of foreign bodies impacted distal to the oesophagus, especially in complex and recurrent cases. Decision, timing and approach of extraction must be individualised with consideration of risk weighed against the benefit of each intervention over the other

Purpose: Numerous guidelines have been proposed in managing surgical emergencies during COVID-19 pandemic. Literature on the implications of these adjustments during this pandemic remained limited. This review aims to examine the implications of these critical adjustments with focus on appendicitis management. Method: This is a single-centre retrospective observational study in a Malaysian tertiary state surgical centre and review of recent guidelines and literature. Patients with appendicitis from March to May 2020 were included and medical records were reviewed and analysed. Results: Of the 173 appendicitis patients, 117 (67.6%) were operated and 56 (32.4%) were conservatively treated. Those screened for SARS-CoV-2 pre-operatively showed longer wait for operation (3.0 vs 2.0 days, p=0.001) and a longer hospital stay (4.5 vs 4.0 days, p=0.005). One-third of patients screened (36.6%) were expedited for surgery on clinical suspicion of complicated appendicitis and 42.1% progressed from acute to complicated appendicitis while waiting for screening result. All patients screened were COVID-19 negative. Delay due to SARS-CoV-2 screening did not result in worse outcome for appendicitis patients. Conclusion With the increase in incidence and rise of COVID-19 cases, routine screening by questionnaire, physical examination and naso-oropharyngeal swab may be considered to detect asymptomatic carrier, especially in regions with high infection. Regular reassessment with low threshold to expedite the surgery is necessary, to ensure satisfactory surgical outcome.

Blunt traumatic tracheobronchial injury is rare, but can be potentially life-threatening. It accounts for only 0.5%-2% of all trauma cases. Patients may present with non-specific signs and symptoms, requiring a high index of suspicion with accurate diagnosis and prompt treatment. A 26-year-old female was brought into the emergency department after sustained a blunt trauma to the chest from a high impact motor vehicle accident. She presented with signs of respiratory distress and extensive subcutaneous emphysema from the chest up to the neck. Her airway was secured and chest drain was inserted for right sided pneumothorax. CT of the neck and thorax revealed a collapsed right middle lung lobe with a massive pneumothorax, raising the suspicion of a right middle lobe bronchus injury. Diagnosis was confirmed by bronchoscopy. In view of the difficulty in maintaining her ventilation and persistent pneumothorax with a massive air leak, immediate right thoracotomy via posterolateral approach was performed. The right middle lobar bronchus tear was repaired. There were no intra- or post-operative complications. She made an uneventful recovery. She was asymptomatic at her first month follow-up. A repeated chest X-ray showed expanded lungs. Details of the case including clinical presentation, imaging and management were discussed with an emphasis on the early uses of bronchoscopy in case of suspected blunt traumatic tracheobronchial injury. A review of the current literature of tracheobronchial injury management was presented.
Humans ; Female ; Adult ; Pneumothorax/surgery* ; Bronchi/injuries* ; Wounds, Nonpenetrating/diagnosis* ; Bronchoscopy ; Trachea/injuries*

In this paper, we provide guidance to clinicians who care for infants born to mothers with suspected/confirmed COVID-19 during this current pandemic. We reviewed available literature and international guidelines based on the following themes: delivery room management; infection control and prevention strategies; neonatal severe acute respiratory syndrome coronavirus 2 testing; breastfeeding and breastmilk feeding; rooming-in of mother-infant; respiratory support precautions; visiting procedures; de-isolation and discharge of infant; outpatient clinic attendance; transport of infant; and training of healthcare staff. This guidance for clinical care was proposed and contextualised for the local setting via consensus by members of this workgroup and was based on evidence available as of 31 July 2020, and may change as new evidence emerges.
Infant, Newborn ; Pregnancy ; Female ; Humans ; Mothers ; COVID-19/epidemiology* ; Singapore/epidemiology* ; COVID-19 Testing ; Pandemics/prevention & control* ; Infectious Disease Transmission, Vertical/prevention & control* ; Pregnancy Complications, Infectious/prevention & control*