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INTRODUCTION/BACKGROUND:Direct acting antiviral (DAA) therapeutics have ushered in an era in which transplanting organs from donors infected with hepatitis C virus (HCV+) into recipients without (HCV-) is an increasingly common practice. Rare but potentially life-threatening events have been reported in recipients of HCV+ organs. METHODS:Since 2018 at our institution, 182 HCV- patients have received HCV+ donor organs. Here, we retrospectively reviewed cases in which recipients' family member caregivers reported sustaining needlestick exposures at home following discharge of the transplant recipient from the hospital. RESULTS:Caregiver needlestick exposures were passively reported in three cases of HCV+ into HCV- transplants (1.64% of such cases at our center). In all instances, the exposed individuals were aiding in diabetic management and the exposure occurred via lancets or insulin needles. In one case, the recipient viral load was undetectable at the time of the exposure but in the other two, recipients were viremic, putting their family members at risk to contract HCV infection. Surveillance for the exposed individuals was undertaken and no transmissions occurred. DISCUSSION/CONCLUSIONS:For centers performing HCV+ into HCV- transplants, it is important that informed consent includes discussion of potential secondary risks to family members and caregivers. Further, protocols for post-exposure surveillance and for the acquisition of DAA treatment in the event of a secondary transmission should be in place. This article is protected by copyright. All rights reserved.

Background. The SARS-CoV-2 novel coronavirus disease 2019 (COVID-19) pandemic has posed significant challenges to urban health centers across the United States. Many hospitals are reallocating resources to best handle the influx of critical patients. Methods. At our New York City hospital, we developed the ancillary central catheter emergency support service (ACCESS), a team for dedicated central access staffed by surgical residents to assist in the care of critical COVID-19 patients. We conducted a retrospective review of all patients for whom the team was activated. Furthermore, we distributed a survey to the critical care department to assess their perceived time saved per patient. Results. The ACCESS team placed 104 invasive catheters over 10 days with a low complication rate of .96%. All critical care providers surveyed found the service useful and felt it saved at least 30 minutes of procedural time per patient, as patient to critical care provider ratios were increased from 12 patients to one provider to 44 patients to one provider. Conclusions. The ACCESS team has helped to effectively redistribute surgical staff, provide a learning experience for residents, and improve efficiency for the critical care team during this pandemic.

A 76-year-old woman with surgical history of Roux-en-Y gastric bypass presented with recurrent choledocholithiasis. Double balloon enteroscopy was unsuccessful in cannulating the biliary tree, thus, requiring surgically assisted endoscopic retrograde cholangiopancreaticogram (ERCP) access. Due to her stable clinical status, the non-urgent indication and multiple anticipated ERCPs for definitive biliary clearance, a more durable port of access to the ampulla was desired. A modified laparoscopic Janeway gastrostomy of the gastric remnant was performed and served as access for multiple subsequent endoscopic procedures with successful clearance of the biliary tree.

Background: Acute abdominal pain caused by small bowel obstruction is amongst the most common entities facing acute care surgeons. The vast majority to these obstructions ([90%) are secondary to adhesions, hernias, and malignancy. Miscellaneous causes, such as Meckel's diverticulum (MD), make up a small (2-3%) but important sub-group of this disease process. The presence of a MD predisposes to obstruction in a number of ways. The diverticulum can serve as a lead point for intussusception, it could twist around it's associated fibrous cords (volvulus), it can undergo torsion, or it could become acutely inflamed and narrow the diameter of surrounding bowel. In younger, previously healthy patients with no surgical history or hernias on physical exam it is important to keep in mind the other rarer causes of small bowel obstruction as they are rarely diagnosed pre-operatively. Case Presentation: The patient is a 46-year-old Caucasian male with no significant past medical history presenting with chief complaint of excruciating abdominal pain associated with nausea and vomiting. Patient was diaphoretic with low grade tachycardia. Physical exam showed distention, diffuse tenderness, and voluntary guarding. A CT was obtained and notable for a large ([15 cm) inflamed tubular, fluid and air containing structure ending blindly in the right upper quadrant. Suspicion was raised for acute infection/inflammation of this tubular structure vs. ischemia. He was taken to the operating room for a diagnostic laparoscopy which an additional bowel segment running in parallel with normal jejunum. Procedure was converted to open exploratory laparotomy with segmental small bowel resection of the blind-ended bowel with primary anastomosis. Surgical pathology later revealed a Meckel's Diverticulum (with ectopic tissue) and necrosis/ulceration consistent with torsion/obstruction. Discussion: MD is the most common congenital anomaly of the gastrointestinal tract (prevalence 1.2%). It results from incomplete obliteration of the omphalomesenteric duct during week 5-6 of gestation. It is a true diverticulum off the antimesenteric boarder of normal small bowel often containing metabolically active tissue. In adults, the most common presentation tends to be that of intestinal obstruction/inflammation (vs. GI bleed in children). The mechanism of obstruction includes intussusception, volvulus, torsion, incorporation into a hernia, or diverticular inflammation. The pathogenesis of MD is similar to that of appendicitis. Diverticular obstruction leads to bacterial overgrowth, venous congestion, and ischemia. The associated inflammation leads to decreased luminal diameter of adjacent small bowel which can cause obstructive pathology