Faculty Bibliography

Objective: Geriatric admissions to trauma centers have increased, and in 2013, our center integrated geriatrician consultation with the management of admitted patients. Our goal is to describe our experience with increasing geriatric fall volume to help inform organized geriatric trauma programs. Method: We retrospectively analyzed admitted trauma patients ≥65 years old, suffering falls from January 1, 2006, to December 31, 2017. We examined descriptive statistics and changes in outcomes after integration. Results: A total of 1,335 geriatric trauma patients were admitted, of which 1,054 (79%) had suffered falls. Falls increased disproportionately (+280%) compared with other mechanisms of injury (+97%). After 2013, patient discharge disposition to skilled nursing facility decreased significantly (-67%, p < .001), with a concomitant increase in safe discharges home with outpatient services. Regression analysis revealed association between integration of geriatrician consultation and outcomes. Discussion: Geriatrician consultation is associated with optimized discharge disposition of trauma patients. We recommend geriatrician consultation for all geriatric trauma activations.

INTRODUCTION/BACKGROUND:Large bowel obstruction (LBO) warrants prompt evaluation and management. Although causes of LBO are most commonly intrinsic to the colon (e.g. malignancy, diverticular stricture, intussusception or volvulus), rare extrinsic etiologies exist. An extremely rare extrinsic etiology of LBO described only once, is compressive splenic hematoma. PRESENTATION OF CASE/METHODS:A 64-year-old female presented to the emergency department complaining of two days of diffuse abdominal pain and distension, watery diarrhea and nausea subsequent to a mechanical fall to her left side. Computed tomography demonstrated a grade 3 splenic hematoma with active extravasation, causing extrinsic compression and obstruction of the colon. Embolization of the splenic artery was performed, and non-operative LBO management resulted in resumption of normal bowel function after six days. DISCUSSION/CONCLUSIONS:To our knowledge, the only other case of colonic compression by splenic hematoma (a case report in the radiology literature from 1994) describes a 62-year-old male whose symptoms similarly spontaneously resolved. Increasing frequency of non-operative management of splenic trauma may result in increased frequency of splenic hematoma complications. Physicians and surgeons who treat LBO should be aware of this rare etiology and its potential for non-operative management. CONCLUSION/CONCLUSIONS:Our case demonstrates the importance of considering splenic hematoma as an etiology of LBO, particularly in the setting of trauma and that management of this entity can be successfully non-operatively.

Chilaiditi syndrome is a very rare disorder characterized by abdominal pain due to the entrapment of the colon between the liver and the diaphragm. However, it is rare to have bowel perforation as a complication of this syndrome with only 2 cases reported to date. In this article, we present the case of a 56-year-old woman with medical history of scleroderma who presents with abdominal pain and was found to have colonic perforation from Chilaiditi syndrome. She was also incidentally found to have cecal adenocarcinoma. Sometimes abdominal pain in patients with Chilaiditi syndrome may be more than benign and calls for increased attention from clinicians regarding this.

Introduction/UNASSIGNED:Breast cancer metastasis to the gastrointestinal tract is rare and mostly limited to case reports which recommend consideration of metastasis when breast cancer patients particularly those with invasive lobular carcinoma present with new gastrointestinal complaints. Presentation of case/UNASSIGNED:We report a 50-year-old female who presented with gastrointestinal symptoms of nausea and vomiting determined to be the result of large bowel obstruction secondary to rectosigmoid metastasis and carcinomatosis of breast invasive lobular carcinoma. She was treated with diverting loop sigmoid colostomy for her large bowel obstruction. Discussion/UNASSIGNED:Our case reflects the importance of gastrointestinal surveillance of patients with a history of breast cancer. Current National Comprehensive Cancer Network (NCCN) guidelines for stage I-II breast cancer suggest posttreatment lab and imaging evaluation for metastasis only if new symptoms present. Conclusion/UNASSIGNED:We observed an unusually rapid disease progression, requiring evaluation of new gastrointestinal symptoms. Assessment for GI tract metastatic involvement should be done as early as progression to symptomatic disease can result in need for further invasive surgery in advanced stages of cancer.

INTRODUCTION/BACKGROUND:Spontaneous common bile duct perforation is an uncommon clinical entity in both adults and children. Few case reports have been published since the first clinical description in 1882. Our work has been reported in line with SCARE criteria. PRESENTATION OF CASE/METHODS:Herein, we describe the case of a 28 year-old female who suffered spontaneous common bile duct perforation while admitted for choledocholithiasis. DISCUSSION/CONCLUSIONS:The perforation occurred while in-hospital, and extensive imaging and laboratory tests characterized the disease in detail. To our knowledge, this is the first report of spontaneous common bile duct perforation witnessed from pre-perforation through definitive management. CONCLUSION/CONCLUSIONS:Physicians and Surgeons should seek out this uncommon diagnosis in the patient with suspected Choledocholithiasis who suddenly become peritoneal on physical exam so that definitive care can be expedited.

INTRODUCTION/BACKGROUND:Primary leiomyosarcomas of the breast are extremely rare. Because of this rarity, only a small number of studies have been published about the disease; diagnosis, treatment, and prognosis are not well-described. Our work has been reported in line with the SCARE criteria. PRESENTATION OF CASE/METHODS:We present a 20-year-old female with primary breast leiomyosarcoma who despite mastectomy, developed lung metastases three years later. DISCUSSION/CONCLUSIONS:We discuss the rarity of breast leiomyosarcoma and risk of metastatic disease even with treatment. We review the literature and provide an outline of available data to shed light on the best strategies to manage this aggressive disease. CONCLUSION/CONCLUSIONS:Physicians and surgeons treating breast leiomyosarcoma must be vigilant of potential lung metastases in order to optimize short- and long-term oncologic outcomes.