Small bowel fistula caused by ingested magnetic beads

Foreign body(FB) ingestion poses a serious challenge to children from the age of 6 months to 3 years worldwide. Most of the Foreign Bodies will spontaneously pass through the gastrointestinal tract (GIT) without any serious consequences, however, a subset of the FB ingestion may cause serious life-threatening complications. Amongst the Foreign Bodies that may serious systemic issues are the button battery, long sharp objects, magnetic beads, and sharp bones. Serial abdominal x-rays and conservative management of a patient who swallowed multiple magnetic beads are not advisable because of the strong attraction from magnets that can cause entrapping of the bowel with subsequent necrosis and a bowel perforation.We present a case of unwitnessed ingestion of magnetic beads with small bowel perforation

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran