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Background: Delayed presentation of cryptorchidism, or undescended testis (UDT), is still a common problem worldwide, despite the clear recommendations of most international guidelines for early referral and correction at 6–12 months of life. Identifying the underlying causes of this delayed presentation is an important step in overcoming this problem.Objectives: To identify the causes and risk factors associated with delayed UDT presentation.Materials and Methods: A cross-sectional study was conducted over 17 months, and included patients with UDT up to 14 years old age. Patients were divided into two groups according to their age at the time of presentation, early (≤ 1 year) and late (> 1-14 years) groups. The causes of delayed UDT presentation were identified in the late group. Both groups were compared regarding possible risk factors of delayed UDT presentation.Results: Of 204 cases with UDT, there were 121 (59.3%) patients presented beyond the recommended age of orchiopexy. The main causes of delayed presentation were parental ignorance and unawareness in 43 (35.5%) patients, false advice from medical and nonmedical personnel in 17 (14.1%) and 28 (23.1%) patients, respectively, the presence of another medical disease in 18 (14.9%) patients, and poverty in 15 (12.4%) patients. Patients in the late group had a significantly less urbanized level of residency (P-value = 0.036), a lower maternal education level (P-value = 0.012), less parent information about UDT (P-value = 0.013), more likely to be first-born boys in their families (P-value = 0.036), and to have another medical disease(s) (P-value = 0.049). We found insignificant differences between the two groups regarding family history of UDT (P-value = 0.300), paternal education level (P-value = 0.288), side (P-value = 0.759), and site (P-value = 0.073) of UDT.Conclusion: Delayed presentation of UDT was attributed mainly to the limited knowledge of the community and medical care providers about its management. Increasing public awareness about UDT and establishing effective measures for earlier detection and referral of patients with UDT are important initial steps to solving this problem in our society.

Abstract Background Ingested dental prosthesis are susceptible to impaction in the gastrointestinal tract due to their sharp edges, size and contour. Delays in presentation arise from the lack of clear history of ingestion and misdiagnosis occurs due to the radiolucency of denture material on plain radiography. An acquired, non-malignant tracheo-oesophageal fistula (TOF) may develop from a chronically impacted denture. Surgical management of a TOF secondary to denture is a challenging clinical problem that is rarely reported in the literature and no previous case reports have described the two-staged reconstruction approach that we present here. Case presentation We report a case of a male in his early 60s who presented to an acute general hospital with symptoms ongoing for over one year of dysphagia, recurrent chest infections and weight loss. Barium swallow and computed tomography identified an ingested dental prosthesis (denture) that had caused a TOF. He was transferred to our specialist thoracic surgery unit where an attempt to remove the foreign body endoscopically was abandoned due to firm impaction and risk of further injury. The subsequent multi-disciplinary management of this complex case required a two-staged reconstruction approach. The first procedure involved extracting the foreign body, repairing the underlying defects with tracheal resection and anastomosis, and creating an oesophageal diversion with cervical oesophagostomy. The second procedure achieved continuity of the gastrointestinal tract with gastric pull-up and pharyngo-gastric anastomosis. Following rehabilitation, the patient was discharged on oral intake alongside percutaneous jejunostomy feeding. Conclusions Early recognition and removal of impacted dental prosthesis is essential to prevent morbidity and mortality. Delayed diagnosis can lead to acquired TOF with associated consequences such as recurrent pulmonary infection, mediastinitis and nutritional deficit. Challenges we encountered, such as failed attempts at endoscopic retrieval and the difficult dissection of fibrotic tissue, were directly due to the delayed identification of the denture. We highlight the importance of holding a high index of clinical suspicion of foreign body ingestion in dental prosthesis wearers who present with recurrent chest infections and ongoing dysphagia. We also promote the need for a collaborative multi-disciplinary approach in the surgical management of complex cases.

Objective: Breast cancer constituted 13.5% of all reported new cancer in India, with a notable mortality rate due to late presentation. The current research aims to address the extent of delay in presentation to the hospital and the factors that contribute to delayed presentation among breast cancer patients. Materials and methods: A descriptive cross-sectional study was conducted among 138 primary breast cancer patients aged 18 to 60 years, with a time lag of more than 2 weeks between the initial recognition of symptoms and the first medical interaction. These patients were attending the oncology Outpatient Department (OPD) of tertiary care center in Central India, where female breast cancer patients receive treatment and follow-up care. The analysis employed binary logistic regression to assess the factors significantly affecting the delayed presentation to the hospital. Results: Most of the participants were aged between 40 and 50 years and did not have a family history of breast cancer. The median delay in presentation to the hospital was 2 months. Women having breast lump as initial breast symptom tend to present late (> 3 months) to the hospital (p=0.037) and if the breast lump was smaller, they are more likely to delay seeking medical attention compared to those with larger breast lump (p=0.012). Conclusion: The study indicates that many patients delayed seeking help due to small breast lumps. Improved screening services are needed for early detection. Future awareness campaigns should emphasize the link between breast lumps and cancer to reduce delays and improve patient quality of life. [ABSTRACT FROM AUTHOR]

Background: Delayed presentation of cryptorchidism, or undescended testis (UDT), is still a common problem worldwide, despite the clear recommendations of most international guidelines for early referral and correction at 6–12 months of life. Identifying the underlying causes of this delayed presentation is an important step in overcoming this problem. . Objectives: To identify the causes and risk factors associated with delayed UDT presentation. Materials and methods: A cross-sectional study was conducted over 17 months, and included patients with UDT up to 14 years old age. Patients were divided into two groups according to their age at the time of presentation, early (≤ 1 year) and late (> 1-14 years) groups. The causes of delayed UDT presentation were identified in the late group. Both groups were compared regarding possible risk factors of delayed UDT presentation. Results: Of 204 cases with UDT, there were 121 (59.3%) patients presented beyond the recommended age of orchiopexy.. The main causes of delayed presentation were parental ignorance and unawareness in 43 (35.5%) patients, false advice from medical and nonmedical personnel in 17 (14.1%) and 28 (23.1%) patients, respectively, the presence of another medical disease in 18 (14.9%) patients, and poverty in 15 (12.4%) patients. Patients in the late group had a significantly less urbanized level of residency (P-value = 0.036), a lower maternal education level (P-value = 0.012), less parent information about UDT (P-value = 0.013), more likely to be first-born boys in their families (P-value = 0.036), and to have another medical disease(s) (P-value = 0.049). We found insignificant differences between the two groups regarding family history of UDT (P-value = 0.300), paternal education level (P-value = 0.288), side (P-value = 0.759), and site (P-value = 0.073) of UDT. Conclusion: Delayed presentation of UDT was attributed mainly to the limited knowledge of the community and medical care providers about its management. Increasing public awareness about UDT and establishing effective measures for earlier detection and referral of patients with UDT are important initial steps to solving this problem in our society. [ABSTRACT FROM AUTHOR]

Background: Ingested dental prosthesis are susceptible to impaction in the gastrointestinal tract due to their sharp edges, size and contour. Delays in presentation arise from the lack of clear history of ingestion and misdiagnosis occurs due to the radiolucency of denture material on plain radiography. An acquired, non-malignant tracheo-oesophageal fistula (TOF) may develop from a chronically impacted denture. Surgical management of a TOF secondary to denture is a challenging clinical problem that is rarely reported in the literature and no previous case reports have described the two-staged reconstruction approach that we present here. Case presentation: We report a case of a male in his early 60s who presented to an acute general hospital with symptoms ongoing for over one year of dysphagia, recurrent chest infections and weight loss. Barium swallow and computed tomography identified an ingested dental prosthesis (denture) that had caused a TOF. He was transferred to our specialist thoracic surgery unit where an attempt to remove the foreign body endoscopically was abandoned due to firm impaction and risk of further injury. The subsequent multi-disciplinary management of this complex case required a two-staged reconstruction approach. The first procedure involved extracting the foreign body, repairing the underlying defects with tracheal resection and anastomosis, and creating an oesophageal diversion with cervical oesophagostomy. The second procedure achieved continuity of the gastrointestinal tract with gastric pull-up and pharyngo-gastric anastomosis. Following rehabilitation, the patient was discharged on oral intake alongside percutaneous jejunostomy feeding. Conclusions: Early recognition and removal of impacted dental prosthesis is essential to prevent morbidity and mortality. Delayed diagnosis can lead to acquired TOF with associated consequences such as recurrent pulmonary infection, mediastinitis and nutritional deficit. Challenges we encountered, such as failed attempts at endoscopic retrieval and the difficult dissection of fibrotic tissue, were directly due to the delayed identification of the denture. We highlight the importance of holding a high index of clinical suspicion of foreign body ingestion in dental prosthesis wearers who present with recurrent chest infections and ongoing dysphagia. We also promote the need for a collaborative multi-disciplinary approach in the surgical management of complex cases. [ABSTRACT FROM AUTHOR]

Background: Cerebral hydatid disease, although rare, presents a significant health risk, particularly in low-income countries where delayed diagnosis and treatment are common. This parasitic infection is more prevalent among children and young adults, with symptoms often manifesting only when the cysts grow large due to the disease’s indolent nature.Case Description: We report the case of an 18-year-old male presenting with an 8-year history of abnormal body movements (epilepsy) and left-sided weakness. Neurological examination revealed a muscle power of 2/5 in the left upper extremity and 3/5 in the left lower extremity (MRC scale). Imaging identified a large right fronto-parietal cerebral hydatid cyst, confirmed by histopathological analysis. The patient received preoperative oral albendazole (400 mg daily) for 14 days. The cyst was successfully removed intact using Dowling’s technique without rupture. Conclusion: This case highlights the urgent need for increased awareness and timely intervention for cerebral hydatid disease in low-income countries. Delayed presentations with severe neurological symptoms show there are barriers to early diagnosis and treatment. Effective use of Dowling’s technique and preoperative albendazole shows that successful outcomes are possible, even in resource-limited settings. Enhancing healthcare access and education on parasitic infections can improve early diagnosis and patient outcomes.

We studied the outcome of dorsal spanning plate for complex carpometacarpal fracture-dislocation management as a feasible option in nine patients, even on delayed presentation with substantial metacarpal shortening. However, patients must be informed about the need for plate removal. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the impact of the COVID-19 pandemic on the examination and treatment of colorectal cancer (CRC) and on the behaviors of patients and practitioners. Methods: This is a retrospective analysis of the CRC patients who presented to our department between April 2019 and March 2021 and underwent surgery. Clinical presentation of CRC and time from symptom onset to medical presentation were compared between the control (April 2019 to March 2020, n=124) and COVID-19 pandemic periods (April 2020 to March 2021, n=111). Results: Two hundred and thirty-five patients were reviewed. The rate of positive fecal occult blood tests was significantly lower during the COVID-19 pandemic period (13.5 vs. 25.0%, P = 0.027). Among the symptomatic patients who had melena and abdominal symptoms, the time from symptom onset to medical presentation was significantly longer during the COVID-19 period (115 vs. 31 days, P < 0.001). In addition, the interval between presenting to a practitioner and being referred to our department was similar between the two periods (19 vs. 13 days, P = 0.092). There were no significant differences in the stage of cancer between the two periods. The rate of preoperative sub-obstruction was significantly higher during the COVID-19 period (41.4 vs 23.4%, P = 0.003). There was no significant difference in overall survival and recurrence-free survival between two periods. Conclusions: Hesitation to seek examination and treatment for CRC was observed in patients but not in practitioners during the COVID-19 pandemic period. The prognosis did not change.

Objective: Breast cancer constituted 13.5% of all reported new cancer in India, with a notable mortality rate due to late presentation. The current research aims to address the extent of delay in presentation to the hospital and the factors that contribute to delayed presentation among breast cancer patients. Materials and methods: A descriptive cross-sectional study was conducted among 138 primary breast cancer patients aged 18 to 60 years, with a time lag of more than 2 weeks between the initial recognition of symptoms and the first medical interaction. These patients were attending the oncology Outpatient Department (OPD) of tertiary care center in Central India, where female breast cancer patients receive treatment and follow-up care. The analysis employed binary logistic regression to assess the factors significantly affecting the delayed presentation to the hospital. Results: Most of the participants were aged between 40 and 50 years and did not have a family history of breast cancer. The median delay in presentation to the hospital was 2 months. Women having breast lump as initial breast symptom tend to present late (> 3 months) to the hospital (p=0.037) and if the breast lump was smaller, they are more likely to delay seeking medical attention compared to those with larger breast lump (p=0.012). Conclusion: The study indicates that many patients delayed seeking help due to small breast lumps. Improved screening services are needed for early detection. Future awareness campaigns should emphasize the link between breast lumps and cancer to reduce delays and improve patient quality of life.

Introduction: ST-elevation myocardial infarction (STEMI) is a significant cause of mortality and morbidity among patients with ischemic heart disease. Early intervention, such as primary percutaneous coronary intervention (PPCI) or thrombolysis has been shown to improve patient outcomes. However, delayed presentation in STEMI results in larger infarct size and increased complications. Objectives: This retrospective descriptive study aimed to identify factors contributing to delayed presentation in STEMI and in-patient outcomes. Methodology: A retrospective descriptive study was conducted. All the STEMI patients who underwent primary percutaneous coronary intervention at National Hospital Kandy from February 2019 to December 2019 were studied. Results: A total of 243 STEMI patients who underwent PPCI at the National Hospital Kandy from February 2019 to December 2019 were studied. Among the study population, 31.27% were delayed presenters and 68.72% were non–delayed presenters. Atypical chest pain was identified as the main reason for a delayed presentation. Female gender was not associated with delayed presentation, contrary to the findings in other studies. Diabetes mellitus and the location of the culprit lesion did not significantly contribute to delayed presentation in this study group. Complications during hospital stay and average duration of hospital stay were not significantly different between delayed and non-delayed presenters. However, delayed presenters exhibited lower left ventricular ejection fraction on discharge, which is a critical predictor of short and long-term outcomes. Conclusions: Community awareness programs are essential to minimize pre-hospital delays in STEMI presentation. Early recognition of atypical symptoms, irrespective of gender, and timely intervention are vital for improving outcomes in STEMI patients. Further research is warranted to explore the impact of other risk factors and co-morbidities on the duration of presentation in STEMI patients.

Introduction: Febrile young infants are at risk of serious bacterial infections (SBIs), which are potentially life-threatening. This study aims to investigate the association between delayed presentation and the risk of SBIs among febrile infants. Method: We performed a prospective cohort study on febrile infants ≤90 days old presenting to a Singapore paediatric emergency department (ED) between November 2017 and July 2022. We defined delayed presentation as presentation to the ED >24 hours from fever onset. We compared the proportion of SBIs in infants who had delayed presentation compared to those without, and their clinical outcomes. We also performed a multivariable logistic regression to study if delayed presentation was independently associated with the presence of SBIs. Results: Among 1911 febrile infants analysed, 198 infants (10%) had delayed presentation. Febrile infants with delayed presentation were more likely to have SBIs (28.8% versus [vs] 16.3%, P<0.001). A higher proportion of infants with delayed presentation required intravenous antibiotics (64.1% vs 51.9%, P=0.001). After adjusting for age, sex and severity index score, delayed presentation was independently associated with the presence of SBI (adjusted odds ratio [AOR] 1.78, 95% confidence interval 1.26–2.52, P<0.001). Conclusion: Febrile infants with delayed presentation are at higher risk of SBI. Frontline clinicians should take this into account when assessing febrile infants. [ABSTRACT FROM AUTHOR]

Cervical facet dislocation is a disastrous injury. Delayed presentation is not uncommon owing to various reasons in developing countries. Autofusion and a halt in progression are seen in spondylolysis and spondylolisthesis. Conservative treatment with close observation can be offered to the carefully selected patients with neglected cervical facet dislocations with intact neurology, as the injury is stable after autofusion. We registered eight male patients with cervical facet dislocation with delayed presentation for various reasons. Dynamic radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI) were done to rule out any instability, cord compression, or bony fusion. Patients were followed up for 6 months clinically and radiologically. A total of eight patients presented with cervical facet dislocation, with a mean delay in presentation of 33 weeks (range: 14–54 weeks). Postinjury, all the patients were neurologically intact, with the only complaint of cervical pain at presentation. Dynamic radiographs did not show any instability. No cord compression or changes were noted on the MRI. Conservative management was advised for all eight patients. A subsequent follow-up CT scan demonstrated bony fusion at the dislocated facets in three of these patients. All the patients remained neurologically intact, with no further progression of the deformity. Surgical management is the mainstay of treatment for neglected facet dislocations. A combined approach has been advocated in most of the studies for proper reduction and alignment in these cases, which is quite extensive and has its own morbidity. A trial of conservative treatment can be offered to selected patients with intact neurology. [ABSTRACT FROM AUTHOR]

Acute stroke care pathways are complex and influenced by various factors at different stages. This systematic review aims to provide a comprehensive analysis of existing literature, exploring factors influencing acute stroke pathways and elucidating their interrelations. A systematic search of PubMed, Embase, and Cochrane Library was conducted, identifying 29 reviews published in English. Inclusion criteria focused on studies related to acute stroke pathways, considering factors at pre-hospital and in-hospital stages. Quality assessment and data extraction were performed, categorizing factors into patient, space, organizational/logistical, and training. Associations between factors were analyzed, both between and within categories. The review identified diverse factors influencing acute stroke pathways. Patient factors, such as stroke knowledge and bystander presence, were consistently cited. Space-related factors included the impact of distance on delays. Organizational/logistical aspects, including pre-notification and CT scan availability, played crucial roles. Training factors, especially stroke recognition, significantly influenced pre-hospital stages. Associations were observed both between and within categories, revealing intricate dynamics. The study concludes that acute stroke delays are multifactorial, involving patient, space, organizational/logistical, and training aspects. The findings emphasize the need for a systemic approach, considering the dynamic interplay of these factors. Multi-factorial interventions, as demonstrated in some studies, show promise in addressing barriers across the stroke pathway. Understanding contextual influences is crucial for effective acute stroke care planning. Further research should explore less-studied factors, contributing to a more nuanced understanding of acute stroke care complexities. [ABSTRACT FROM AUTHOR]

Abstract Objectives To Investigate the value of 3D printed guide-assisted percutaneous management of minimally displaced scaphoid waist fractures(Herbert’s B2) with delayed diagnosis or presentation. Methods From October 2018 to February 2022, 10 patients with established delayed diagnoses and presentation of minimally displaced scaphoid waist fractures were treated with 3D printed guides assisted with percutaneous internal fixation without bone grafting. This technique was based on the patient’s preoperative CT and imported into the software. Based on Boolean subtraction, the most centralized screw placement position was identified and a customized guide was produced. Intraoperative percutaneous insertion of the guide wire was assisted by the custom guide. Results All 10 patients were successful in one attempt. The fractures healed at a mean of 7.7 weeks postoperatively (range 6–10 weeks). At a mean follow-up of 7.7 months (6–13 months), patients had excellent recovery of wrist function with minimal pain reduction. There were no major postoperative complications and the patients all returned to their previous activities before the injury. Conclusions Percutaneous internal fixation based on 3D printed guides is a safe and effective technique for delayed diagnosis or presentation of patients with minimally displaced fractures of the scaphoid waist. This method allows for easy insertion of screws and avoids multiple attempts.

A delayed presentation of traumatic spinal epidural hematoma (SEH) is a rare disease in which most patients are asymptomatic for days to weeks after the injury, followed by pain and then a neurological deficit. A 66-year-old woman who suffered a fractured right clavicle due to a bicycle accident 42 days previously, presented with left shoulder pain and left hemiplegia. The manual muscle test (MMT) scores of the left upper and lower limbs were all 1. Computed tomography and magnetic resonance imaging showed no cervical fracture but showed cervical epidural hematoma. She underwent surgery for the removal of the SEH. Her MMT score improved to 4 at 10 days after surgery. Even in cases with a delayed presentation, suspecting SEH can help clinicians make an early diagnosis. Additionally, the prompt surgical evacuation of the SEH can lead to favorable neurological outcomes in symptomatic cases. [ABSTRACT FROM AUTHOR]

Abstract Background The most common cause of benign biliary stricture is bile duct injury after cholecystectomy. Benign biliary strictures are associated with a broad spectrum of signs and symptoms, ranging from subclinical disease with mild elevation of liver enzymes to complete obstruction with jaundice, pruritis, and cholangitis ultimately leading to biliary cirrhosis. The average duration for stricture development after cholecystectomy is around 7 months. This is a case report of a benign biliary stricture presenting 14 years after laparoscopic conversion to open cholecystectomy without the development of recurrent cholangitis and secondary biliary cirrhosis.

Objectives: To Investigate the value of 3D printed guide-assisted percutaneous management of minimally displaced scaphoid waist fractures(Herbert's B2) with delayed diagnosis or presentation. Methods: From October 2018 to February 2022, 10 patients with established delayed diagnoses and presentation of minimally displaced scaphoid waist fractures were treated with 3D printed guides assisted with percutaneous internal fixation without bone grafting. This technique was based on the patient's preoperative CT and imported into the software. Based on Boolean subtraction, the most centralized screw placement position was identified and a customized guide was produced. Intraoperative percutaneous insertion of the guide wire was assisted by the custom guide. Results: All 10 patients were successful in one attempt. The fractures healed at a mean of 7.7 weeks postoperatively (range 6–10 weeks). At a mean follow-up of 7.7 months (6–13 months), patients had excellent recovery of wrist function with minimal pain reduction. There were no major postoperative complications and the patients all returned to their previous activities before the injury. Conclusions: Percutaneous internal fixation based on 3D printed guides is a safe and effective technique for delayed diagnosis or presentation of patients with minimally displaced fractures of the scaphoid waist. This method allows for easy insertion of screws and avoids multiple attempts. [ABSTRACT FROM AUTHOR]

Background The most common cause of benign biliary stricture is bile duct injury after cholecystectomy. Benign biliary strictures are associated with a broad spectrum of signs and symptoms, ranging from subclinical disease with mild elevation of liver enzymes to complete obstruction with jaundice, pruritis, and cholangitis ultimately leading to biliary cirrhosis. The average duration for stricture development after cholecystectomy is around 7 months. This is a case report of a benign biliary stricture presenting 14 years after laparoscopic conversion to open cholecystectomy without the development of recurrent cholangitis and secondary biliary cirrhosis. [ABSTRACT FROM AUTHOR]

Majority of C2-C3 vertebral dislocations occur as in combination with bilateral pars fractures, also known as Hangman's fractures. Isolated C2-C3 facet dislocation without any associated C2 fracture is a very rare injury. One such case has been presented in this report. A 29-year male was involved in a road traffic accident (RTA) after which he developed midline neck pain. Following a minor neck manipulation at a hair salon 15 days after the RTA, his neck pain worsened and he developed quadriparesis. Imaging at the time of admission showed bilateral high-grade C2-C3 facet dislocations without any associated fracture of C2 vertebra. Due to non-reduction of the dislocation with skeletal traction, surgery was contemplated. Intraoperatively, the C2-C3 joint spaces were opened but only partial reduction could be achieved. Complete reduction was achieved only after opening of the C1-C2 joints was performed. Later, C2-C4 screw-rod constructs were placed. Patient achieved good outcome with resolution of symptoms. This report concludes that, in cases of delayed presentation of irreducible C2-C3 bilateral facet dislocations and non-reducibility by skeletal traction, opening of the C1-2 joints may need to be performed in addition to the C2-C3 joint spaces, in order to achieve complete reduction. [ABSTRACT FROM AUTHOR]

Abstract Background Congenital malformations are the third cause of mortality in children under five. We aimed to report sociodemographic and diagnostic aspects of gastrointestinal ones and their outcomes. Methods We conducted a descriptive cross-sectional study of patients admitted from January 2018 to January 2021 to our department at Albert Royer National Children’s Hospital Center in Dakar, Senegal. A total of 230 were included. Results The frequency of these malformations was 6.18%. The mean age was 1.9 years, with neonates representing 43.48% and males 59.56%. 64.35% of patients came from the Dakar area. Parental consanguinity was reported in 11.73%, prenatal diagnosis in 5.56% of 36 cases, and prematurity in 28.84% of 52 patients. The most typical reasons for referral or symptoms were constipation (23.91%), imperforated anus (23.91%), and vomiting (23.48%). In 93.91%, the malformation was isolated, of which Hirschsprung’s disease accounted for 30.56% and anorectal malformation for 30.09%. Esophageal atresia and anorectal malformations had more associated anomalies with 28.57% each. The VACTER-L association represented 21.42% of associated anomalies. Mortality was 27.83%, and lethality was 100% for intestinal atresia, 87.5% for esophageal atresia, and 85.71% for polymalformation. Causes of mortality were reported in 21%, with septic shock and respiratory distress in all esophageal atresia patients (Manama, Contribution à l’étude des malformations congénitales : à propos de 188 cas du service de néonatologie de l’Hôpital Aristide Le Dantec de Dakar, 1983) and hypovolemic shock in all patients with duodenal atresia (Wright et al., Lancet 398:325–39, 2021). Conclusion Congenital malformations of the gastrointestinal tract are still lately diagnosed in our environment, resulting in higher mortality. Further studies should analyze delayed presentation and mortality, and their risk factors in our settings.

Objectives: This study aims to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the situation of acute appendicitis (AA) with respect to patients' and general practitioners' behaviors in a general community hospital in Japan. Methods: The surgical outcomes and periods from symptom onset to medical presentation besides practitioners' referral time for consecutive AA patients were compared between the control (January 2016 to March 2020) and COVID-19 periods (April 2020 to April 2021). Results: Eighty-three patients who underwent emergency surgery for AA were reviewed. Complicated appendicitis significantly increased in the COVID-19 period (63.6% vs. 31.2%, P = 0.023). In the COVID-19 period, the time from symptom onset to the medical presentation (2.2 vs. 0.9 days, P < 0.001) was significantly longer than in the control period. Among the patients who first presented to a general practitioner, the referral time from the practitioner to our hospital was significantly longer in the COVID-19 period (1.6 vs. 0.7 days, P = 0.017). Furthermore, among patients with a fever of higher than 38°C at medical presentation, the time from symptom onset to medical presentation was significantly longer in the COVID-19 period (3.0 vs. 0.7 days, P = 0.015). There was no difference in severe postoperative complications. Conclusions: Hesitation to seek surgical treatment for AA was seen in both the patients and practitioners in the COVID-19 period. The delay in surgical treatment presumably led to the increase in severe AA. In a pandemic era, timely care for emergent conditions is a crucial challenge.

Background: The most common type of duodenal atresia (DA) (Type I), also known as duodenal web or membrane can present later in infancy or early childhood if the membrane or web is fenestrated. We describe six patients with delayed presentation of DA. Materials and Methods: Retrospective review of hospital records of six patients with delayed presentation of DA due to fenestrated web managed in Paediatric Surgery Department at a tertiary care institute over a period of 2 years (January 2019 to December 2020) was done. The data of these patients were analysed on the basis of age at presentation, clinical presentation, associated anomalies, radiological findings, intra-operative findings, management and postoperative course. Results: The median age at presentation was 6.5 months (range: 1 month to 10 years). There were four males and two females. The most common presentation was emesis seen in all six patients. Two patients had Down syndrome. Associated congenital anomalies were cardiac in one patient, anterior ectopic anus in one patient and malrotation of midgut in one patient. Upper gastrointestinal contrast suggested incomplete duodenal obstruction in all patients. At laparotomy, fenestrated duodenal membrane was observed in all patients – preampullary in three patients and postampullary in three patients. Lateral duodenotomy, web excision and transverse closure was done in all six patients. The postoperative period was uneventful in all patients and mean duration of hospital stay was 9 days. Conclusion: Fenestrated duodenal webs present a diagnostic challenge to the paediatric surgeons because of delayed and variable clinical presentation. A modification of the present classification of DA has been proposed in this study which would help in better reporting of epidemiology and aid in early diagnosis of this congenital anomaly.

Background: Childhood intussusception is a common surgical emergency. The current practice for non-operative management in Sri Lanka is ultrasound-guided hydrostatic reduction (USGHR). This retrospective study aims to demonstrate the efficacy and safety of this procedure even in a setting of delayed presentation. Method: We explore outcomes of USGHR in the management of intussusception in children presenting to a single tertiary care center in Sri Lanka, between November 2019 and March 2021. Hydrostatic reduction was performed in patients with radiologically confirmed intussusception in the absence of contraindications. In failed attempts or early recurrences, USGHR was repeated for a maximum of 2 more attempts. Results: Our study included 135 participants. Of the patients for which data on symptom duration was available 31.5% (n = 41) presented delayed (t>48 hrs). Hydrostatic reduction showed an overall success rate of 86.4%. No association was seen between time since onset of symptoms and success of USGHR (p

Background: Femoral neck fractures are challenging injuries that can lead to non-union and avascular necrosis (AVN), particularly in cases of delayed presentation. Muscle pedicle bone grafting has been suggested as a potential approach to supplement blood supply to the fracture site. The objective of this study was to evaluate the efficacy of Meyer's procedure in the treatment of ununited femoral neck fractures with grade I and II AVN, which involves internal fixation and quadratus femoris-based muscle pedicle bone grafting. Methods: Five patients with delayed presentation of femoral neck fractures with grade I and II AVN were included in this retrospective study. The surgical approach for all patients was Meyer's procedure, consisting of open reduction and internal fixation followed by a muscle pedicle graft and cancellous bone graft. Fixation was done with parallel cannulated screws or non-cannulated cancellous screws. In all cases, the quadratus femoris muscle pedicle graft was utilized. The average follow-up duration was three years. Results: All five patients achieved radiological union and reported excellent functional outcomes, including the ability to perform activities such as squatting and sitting cross-legged. According to the Salvatti and Wilson hip rating system, three cases had excellent results, one had good results, and one had fair results. Two cases had coxa vara, and one case had temporary loss of scrotal sensation as complications. Avascular necrosis and transient foot drop were not observed in any cases. Using the modified Harris hip score, all cases achieved good or excellent outcomes, with an average follow-up period of 130 weeks and radiological union occurring at an average of 6.5 months. Conclusion: Meyer's procedure provides stable internal fixation and enhanced blood supply to promote union in ununited femoral neck fractures with grade I and II AVN. This technique can achieve good or excellent functional outcomes and may represent a viable treatment option for patients with these types of fractures. However, further research is needed to confirm these findings and optimize treatment strategies.

Duodenal web is complete or incomplete obstruction of the duodenum due to a membranous web or intraluminal diverticulum. This abnormality is one of the main causes of intestinal obstruction in children. The symptoms of this disease may rarely appear in older age and cause gastric outlet obstruction in adults. In the present paper, we report a 69-year-old male patient with heartburn, abdominal discomfort, frequent non-bilious, non-bloody vomiting for the past 6 months. Furthermore, the patient had experienced a weight loss of 12 kg during this period. He had been taking aspirin daily for years due to his ischemic heart disease. After performing contrast-enhanced CT imaging, esophagogastroduodenoscopy and barium meal examination, the patient was diagnosed to suffer from duodenal web. Since surgery is currently the mainstay of treatment in the management of this disease, the patient finally underwent a gastrojejunostomy. [ABSTRACT FROM AUTHOR]

Morel-Lavallée lesions are post-traumatic, internal degloving injuries associated with substantial patient mortality that are frequently undetected due to often presenting days to weeks after initial injury. Delay of diagnosis can perpetuate complications such as expansion and infection (Mutluoglu et al., 2021 [1]). A 46 year old male presented with a Morel-Lavallée lesion to the left anterior thigh and hip two weeks after receiving emergency care after an accident where he was thrown from his motorcycle. It is paramount that physicians consider this diagnosis when evaluating post-traumatic patients to mitigate lesion expansion, overlying skin necrosis, underlying fracture exposure and subsequent infection.

Introduction: Bowel obstruction is a rare but well reported complication of blunt abdominal trauma (BAT). Obstruction is most often seen acutely caused by bowel wall hematomas and chronically as a result of post-traumatic strictures. Here, we present a novel case of BAT causing a subacute obstructing bowel wall hematoma.Case Report: A healthy, 32-year-old male presented to our emergency department with three days of nausea and vomiting. Chart review revealed he had been seen two weeks prior after a high-speed motor vehicle collision. During that initial visit, the patient had a benign abdominal exam and was discharged without imaging. On this return visit, the patient was found to have a large, obstructing colonic hematoma.Conclusion: Because emergency physicians care for patients in both the acute and subacute phases of trauma, clinicians should recognize the more subtle sequelae of BAT.

A 60-year-old woman sustained right femur fracture and presented to us after taking native massage therapy for 6 weeks. Radiographs showed suspected posteromedial soft tissue shadow. Further imaging confirmed a rare pseudoaneurysm of the superficial femoral artery. After vascular surgery consultation, a single-stage procedure was planned. Through medial approach to distal femur, Pseudo aneurysm was haemodynamically isolated, opened and its contents evacuated. Neck of pseudo aneurysm is located and ligated. Distal femur plating (broad DCP) was done through the same exposure. Since traumatic pseudoaneurysms are rare entities, surgeons should have a high degree of suspicion for preoperative identification. It facilitates simultaneous vascular repair and fracture fixation. It avoids two-stage incisions, two incisions, intraoperative or postoperative catastrophe, and medicolegal complications. Hence, we advocate to look out for vascular injury in distal femur fractures at a delayed presentation.

Mapping and ablation guided by patient ECG biomarkers of arrhythmia source location improv... ••• 5. Keywords: Troponin; CK-MB; kinetics; delayed presentation; renal dysfunction EN Troponin CK-MB kinetics delayed presentation renal dysfunction 354 357 4 06/12/23 20230601 NES 230601 ••• 1. Proof-of-concept patient-specific ECG biomarker mapping of arrhythmia source location in p... •••. [Extracted from the article]

Background: The most common type of duodenal atresia (DA) (Type I), also known as duodenal web or membrane can present later in infancy or early childhood if the membrane or web is fenestrated. We describe six patients with delayed presentation of DA. Materials and Methods: Retrospective review of hospital records of six patients with delayed presentation of DA due to fenestrated web managed in Paediatric Surgery Department at a tertiary care institute over a period of 2 years (January 2019 to December 2020) was done. The data of these patients were analysed on the basis of age at presentation, clinical presentation, associated anomalies, radiological findings, intra-operative findings, management and postoperative course. Results: The median age at presentation was 6.5 months (range: 1 month to 10 years). There were four males and two females. The most common presentation was emesis seen in all six patients. Two patients had Down syndrome. Associated congenital anomalies were cardiac in one patient, anterior ectopic anus in one patient and malrotation of midgut in one patient. Upper gastrointestinal contrast suggested incomplete duodenal obstruction in all patients. At laparotomy, fenestrated duodenal membrane was observed in all patients – preampullary in three patients and postampullary in three patients. Lateral duodenotomy, web excision and transverse closure was done in all six patients. The postoperative period was uneventful in all patients and mean duration of hospital stay was 9 days. Conclusion: Fenestrated duodenal webs present a diagnostic challenge to the paediatric surgeons because of delayed and variable clinical presentation. A modification of the present classification of DA has been proposed in this study which would help in better reporting of epidemiology and aid in early diagnosis of this congenital anomaly. [ABSTRACT FROM AUTHOR]

In the present report, we have described the case of a significantly delayed presentation of a pseudoaneurysm (PSA) and subsequent mass effect causing an acute deep vein thrombosis (DVT). The patient had presented with a mass in the right groin and edema of the right lower extremity prompting further imaging studies. The imaging studies demonstrated a superficial femoral artery PSA and an acute femoral vein DVT. Our patient had no history of recent trauma or femoral access procedures performed in the last ≥5 years. Surgical repair of the PSA was performed, and the DVT was managed with anticoagulation therapy.

Delayed presentation of lower cervical facet dislocations is uncommon, and there is no standardized way to approach these neglected injuries. The literature on neglected lower cervical facet dislocations is limited to case reports and few retrospective studies. This justifies the need for a comprehensive review of this condition. Our purpose was to elaborate a review on the epidemiology, clinical and radiological presentation, and treatment techniques and approach to these neglected injuries. Middle-aged adults from 30 to 50 represent 73.8% of reported cases, and most of them are males (72.0%). The most affected level is C5–C6 (43.0%). While most delays are due to missed injuries (52.1%) and ineffective non-operative treatment (36.2%), the other reason for delay is negligence in seeking medical care (11.7%). Patients present with variable degrees of neurological deficit, persistent neck pain, and neck stiffness. Reported approaches and techniques to reduce and stabilize these injuries are highly variable and depend on the surgeon’s judgment, experience, and preference. Fibrotic tissues and bony fusion around the dislocated facet joint contribute to the reduction challenge, and 77.0% of closed reduction attempts fail. Anterior and posterior approaches to the cervical spine are used selectively or in combination for surgical release, reduction, and stabilization. Despite the lack of standardized treatment guidelines and different approaches, most of the authors reported improvement in pain, balance, and neurology post-surgery. Starting with the posterior surgical approach aims to achieve reduction compared to the anterior approach which largely aims at spinal decompression. Given the existing controversies, the need for quality prospective studies to determine the best treatment approach for lower cervical facet dislocations presenting with delay is evident.

Introduction: Delayed presentations and nonunion of lateral condyle of Humerus (LCH) fractures in children are common. It is recommended to gain elbow movements before placing single screw for late presenting LCH fractures. We examined the efficacy of a percutaneously placed screw in delayed presenting LCH fractures and LCH nonunion in children who presented with varying degree of elbow stiffness without waiting for improvement in elbow movements. Material and Methods: Sixteen children with LCH fractures presenting after six weeks of fracture, without signs of union, and with frank nonunion were treated with percutaneous placement of the cancellous screw. There was a delay of 1.5 to18 months before presenting to us. The results were assessed by Dhillon criteria. Results: All the patients at presentation had flexion deformity (avg 290) and restricted flexion ((avg 1000). Successful radiological union was achieved in fifteen patients. All the patients had full recovery of extension. Fifteen patient regained full flexion and one patient has only 100 flexion restriction (p value < 0.001). At the final follow-up, fifteen patients had excellent and one had a good overall Dhillon score. There was no clinically evident varus or valgus deformity. Conclusion: We could achieve union in a majority of the patients with delayed presentation and established nonunion of LCH fractures with simple percutaneous screw placement, thereby avoiding open surgery, big scar, bone grafting, and AVN of LCH. We did not wait for an improvement in elbow movements before screw fixation and still all our patients regained full elbow movements with improved Dhillon scores. [ABSTRACT FROM AUTHOR]

Background: The deadline for early laparoscopic cholecystectomy (ELC) in patients with acute calculous cholecystitis (ACC) is the subject of much debate. The aim of this study was to assess outcomes of ELC in patients with more than 7 days of symptoms. Methods: It is a retrospective analysis of 564 patients having undergone ELC for ACC between January 2003 and June 2021. Patients were divided into two groups according to the timing between the onset of symptoms and surgery: group 1 (G1), within the first 7 days of symptoms, and group 2 (G2) after day 7 of symptoms. Results: Apart from a longer operative time (G1 80 min vs. G2 90 min; p = 0.016), there were no significant differences regarding conversion rate (G1 14.5% vs. G2 13.2%; p = 0.748), both intra- and postoperative complications, mainly bile duct injuries (G1 0.2% vs. G2 0%; p = 1) and bile leakage (G1 1.2% vs. G2 0%; p = 1) and postoperative length of stay (G1 2 days [1–3] vs. G2 2 days [1–4]; p = 0.125). Conclusion: Early laparoscopic cholecystectomy could be proposed for patients with acute calculous cholecystitis even beyond 7 days of symptoms. [ABSTRACT FROM AUTHOR]

In developing countries delayed presentation following major vascular injury is common due to limited vascular trauma units; delay in diagnosis and time lost in transit which pose a major challenge for limb salvage. Aim of this study was to assess limb survival and complications after delayed revascularization of extremity following major vascular injury. 20 patients, (19 males and 1 female, mean age 31.55 years) with major extremity vascular injury who presented >8 h after vascular trauma were included in this study. All patients had road traffic accidents as the cause of extremity injury. These patients were operated by primary vascular repairs, thrombectomy and/or interposition vein graft along with fixation of concomitant skeletal trauma. The commonest vessel injured was popliteal artery. The mean time of limb revascularization was 30.8 h. Limb salvage rate was 95% and there was no perioperative mortality. 9 patients developed postoperative complications including sloughing of leg muscles (4), foot drop (3) pseudo aneurysm (1) and reperfusion injury (1). At 6 months follow-up all the patients were able to walk with full weight bearing and there was no chronic ischemia, pain or sinuses. Limb salvage can be achieved with good results in patients with delayed revascularization in selected cases. However; delayed revascularization leads to long and protracted postoperative course with high chances of vascular and neurological complications. [ABSTRACT FROM AUTHOR]

We studied the outcome of dorsal spanning plate for complex carpometacarpal fracture-dislocation management as a feasible option in nine patients, even on delayed presentation with substantial metacarpal shortening. However, patients must be informed about the need for plate removal., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: In previous pandemics such as the Ebola virus outbreak in West Africa, it has been observed that patients with non-pandemic related complaints, delay their presentation to hospital. Similarly, delayed presentation of patients with chest pain during the COVID-19 pandemic has been documented. This qualitative study identified the COVID-19 related reasons which lead to this delay. Methods: A qualitative study based on 10 individual patient interviews. Half of these were conducted at a public hospital emergency centre (EC) and the other half at a private EC. Results: A variety of psychosocial factors were identified as themes for delayed presentation. Interestingly, the fear of contracting COVID-19 at the hospital was not found to be an important theme in our study. Rather, confusion around hospital protocols during the pandemic was identified as a recurrent theme. Discussion: This study found that confusion about COVID-19 hospital protocols was the major pandemic related delaying factor. A number of themes unrelated to COVID-19 were also identified.

Introduction: Severe malaria is a leading cause of mortality due to late presentation to health facilities. Hence, there is a need to identify and mitigate factors promoting delayed presentation with severe malaria. Objective: This study aimed to evaluate determinants of delayed presentation of children with severe malaria in a tertiary referral hospital. Methods: This study adopted a descriptive, cross-sectional design. The participants were children with a diagnosis of severe malaria, based on WHO diagnostic criteria. Delayed presentation was defined as presentation at the referral centre at >3 days of illness. Inferential analyses were done to identify factors associated with delayed presentation. P < 0.05 was considered statistically significant. Results: A total of 126 children with severe malaria participated in the study; their mean (standard deviation) age was 4.2 (5.3) years. The prevalence of delayed presentation in this study is 37.3%. Socio-economic class (P = 0.003); marital status (P = 0.015) and the number of health facilities visited before admission in the referral centre (P = 0.008) were significantly associated with delayed presentation. Children from upper socio-economic class were thrice more likely to present late, compared to those from lower social class (odds ratio [OR] = 3.728, 95% confidence interval [CI]: 1.694–8.208; P = 0.001). Likewise, the Yorubas were more delayed than the Binis (OR = 0.408, 95% CI: 0.180–0.928; P = 0.033). There was a negative correlation between caregivers' perception of treatment (r = −0.113, P = 0.21) of convulsion in severe malaria and timing of presentation. Conclusions: Delayed presentation is common with multifactorial determinants in the setting. Health education of caregivers on the consequences of delayed presentation in severe malaria is desirable.

Background: The present study aims to report the outcomes of a multidisciplinary, minimally invasive approach to treating patients with delayed presentation of oesophageal perforation. Patients and Methods: The present study is a retrospective analysis of prospectively maintained data at a tertiary care centre. All patients with oesophageal perforation presenting over 48 h after the onset of symptoms and without oesophageal obstruction were included in the study. Self-expanding Metallic Stent (SEMS) or endoscopic clip placement was performed in all the patients, followed by video-assisted thoracoscopic surgery (VATS) debridement and decortication of pleural cavity collection. 'Success' was defined as, discharge without the need of oesophageal diversion and complete healing of leak site at 8 weeks with successful removal of the stent. Results: Between March 2012 and December 2019, 12 patients (10 males, median age of 55 years– range of 39–71 years) with oesophageal perforation and delayed presentation underwent treatment with this approach. Ten patients had spontaneous perforation (83.3%) and one patient each had upper gastrointestinal endoscopy-induced and post-traumatic perforation. The median duration of symptoms was 8 days (range 3–31 days). SEMS was placed in ten patients and, in two patients, an over-the-scope clip was used. VATS decortication was done in ten patients (83.3%) and the remaining two (16.7%) underwent VATS debridement. One patient required oesophageal diversion and another patient expired due to sepsis. The overall success with this approach was 83.3%. Conclusion: This multidisciplinary, minimally invasive approach is feasible in patients with thoracic oesophageal perforation and delayed presentation, with a high success rate.

Colonic atresia is a rare cause of neonatal intestinal obstruction which is usually diagnosed and corrected during the neonatal period. An even rarer entity is isolated intraluminal membrane causing partial obstruction which is usually suspected antenatally or diagnosed early postnatal with a contrast enema. However, there is no consensus regarding operative management for these cases described in literature. We present a three-month male with a rare subtype of colonic atresia presented repeatedly with ambiguous symptoms. Exclusion of associated Hirschsprung's disease and primary anastomosis was performed. It was safe to perform primary colonic anastomosis in our delayed presentation case. Patient showed complete resolution of symptoms and thrived well after surgery.

To describe the socioeconomic profile, awareness level and reasons for the delay in accessing timely eye care for cataract surgery in patients of lens-induced glaucoma (LIG). This cross-sectional observational study included all patients with LIG who presented to a tertiary eye care centre in central rural India between March 2019 to February 2020. Data were collected through a questionnaire. Out of the 731 patients included in the study, the majority were females (69.36%). The mean age of the patients at presentation was 62.66 ± 10.37 years. Only a few participants, 193 (26.40%) were aware of LIG. Lower socioeconomic profile, older age, female gender and illiteracy were found to be strongly associated with awareness about LIG (p <.001). Patients waiting for the winter season (58.27%) to get operated was the major reason for delayed presentation to the hospital. Other reasons for the delayed presentation were – need not felt (feeling that intervention was not necessary) due to good vision in other eye (14.36%), financial issues (11.63%), long travelling distance (7.11%), no caretaker (6.89%), medical illness (1.78%) and fear of surgery (0.55%). Delayed reporting for eye healthcare in patients of LIG is found to be multifactorial. Most patients preferred waiting for the winter season to get their eyes operated, which throws light on the mindset and ignorance of the patients in this part of central rural India. We further emphasize on strengthening the education and counseling efforts in the community to enable patients to access services in a timely fashion. [ABSTRACT FROM AUTHOR]

Aim: Validated clinical decision rules on neuroimaging are not available for children who are evaluated more than 24 h after a minor head trauma. We compared clinically important traumatic brain injuries in children who presented with a minor head trauma within or after 24 h. Methods: This was a retrospective analysis of patients aged 0–17 years, who were evaluated for minor head traumas by five paediatric emergency departments in Northern Italy between January 2019 and June 2020. Children with clinically important traumatic brain injuries were divided into those who had presented within and after 24 h. Results: The study comprised 5981 children (59.9% boys), with a median age of 2 years, including 243 (4.1%) who had presented more than 24 h after their minor head trauma. Neuroimaging was performed on 448 (7.5%) patients and the time of presentation had no impact on the rates of clinically important traumatic brain injuries. Multiple logistic regression did not show any association between clinically important traumatic brain injuries and late presentation. Conclusion: Delayed presentation to a paediatric emergency department after a minor head trauma did not alter the risk of clinically important traumatic brain injuries and the same neuroimaging rules could apply. [ABSTRACT FROM AUTHOR]

BackgroundSupracondylar humeral fractures (SHF) are the most common type of fracture occurring at the distal humerus in children. In patients with delayed presentation of SHF, closed reduction is challenging to achieve with traditional reduction maneuvers. This study aimed to report the clinical results of pediatric SHF delayed over 14 days treated by closed reduction with a minimally invasive technique and external fixation and evaluate the efficacy of this technique.MethodsBetween October 2010 and September 2018, children with delayed presentation of SHF over 14 days were retrospectively included in this study. The patients received closed reduction with a minimally invasive technique followed by external fixation. The demographics and radiographic data were collected. The Mayo Elbow Performance Score (MEPS) and the Flynn criteria were used to evaluate the clinical outcomes of treatments.ResultsA total of 11 children (aged 4–13 years) with delayed presentation (range, 14–22 days) were recruited. They received surgery using closed reduction with a minimally invasive technique followed by external fixation. None of the surgery was done with the open method. After surgery, the patients' carrying angle returned to normal. The radiological union was evident in 8 to 12 weeks in all fractures without complications. Every patient had a good to excellent score on the MEPS and the Flynn criteria.ConclusionsThe results of this series indicated a satisfactory outcome in children with delayed more than 14 days of supracondylar humeral fractures. The closed reduction with a minimally invasive technique followed by external fixation is an alternative treatment for such injury.

A 6-month-old boy presented with features of intestinal obstruction. Laparotomy revealed Type IIIa jejunal atresia. The proximal and distal bowel loops were in continuity through multiple fistulae between the adjoining bowel loops. To the best of our knowledge, it is the first report of congenital Type IIIa intestinal atresia surviving beyond the neonatal age without surgery.

Background: The present study aims to report the outcomes of a multidisciplinary, minimally invasive approach to treating patients with delayed presentation of oesophageal perforation. Patients and Methods: The present study is a retrospective analysis of prospectively maintained data at a tertiary care centre. All patients with oesophageal perforation presenting over 48 h after the onset of symptoms and without oesophageal obstruction were included in the study. Self-expanding Metallic Stent (SEMS) or endoscopic clip placement was performed in all the patients, followed by video-assisted thoracoscopic surgery (VATS) debridement and decortication of pleural cavity collection. 'Success' was defined as, discharge without the need of oesophageal diversion and complete healing of leak site at 8 weeks with successful removal of the stent. Results: Between March 2012 and December 2019, 12 patients (10 males, median age of 55 years-- range of 39-71 years) with oesophageal perforation and delayed presentation underwent treatment with this approach. Ten patients had spontaneous perforation (83.3%) and one patient each had upper gastrointestinal endoscopy-induced and post-traumatic perforation. The median duration of symptoms was 8 days (range 3-31 days). SEMS was placed in ten patients and, in two patients, an over-the-scope clip was used. VATS decortication was done in ten patients (83.3%) and the remaining two (16.7%) underwent VATS debridement. One patient required oesophageal diversion and another patient expired due to sepsis. The overall success with this approach was 83.3%. Conclusion: This multidisciplinary, minimally invasive approach is feasible in patients with thoracic oesophageal perforation and delayed presentation, with a high success rate. [ABSTRACT FROM AUTHOR]

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