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The broad use of natural products and the accompanied incidences of gastrointestinal injury have attracted considerable interest in investigating the responsible toxic ingredients. Computer models are efficient tools to predict toxicity, but research on drug-induced gastrointestinal injury (DIGI) related to the use of natural products remains lacking. In the present study, a total of 1295 compounds were retrieved from SIDER and AdisInsight databases to investigate whether they cause diseases such as colitis, intestinal perforation, intestinal obstruction, irritable bowel syndrome, intestinal bleeding, inflammatory bowel disease, colon cancer, colorectal cancer and duodenal ulcer as datasets. The ANN and SVM algorithms were evaluated to construct a series of classification prediction models, and finally, a computer model was built based on an ANN algorithm to rapidly screen DIGI induced by natural products. A dataset containing 201 toxic components was established, and the ANN model was used to screen 104 potential DIGI ingredients. Finally, based on molecular docking and CCK-8 methods, the intestinal injury effects of veratramine, emodin and euphobiasteroid were verified. The results of the molecular docking showed that these three components could bind well with the intestinal injury targets PIK3CA, SLC9A3, ACTG2 and HSP90AA1. According to NCM-460 cell experiments, the IC50 values of veratramine, emodin and euphobiasteroid were 75.13, 340.9 and 339.6 μmol L−1, respectively. The study findings further proved the accuracy of the ANN model in screening DIGI components caused by natural products. [ABSTRACT FROM AUTHOR]

Background: Crohn's disease (CD) is a chronic inflammatory condition primarily affecting the digestive system. When dealing with complex cases like intestinal blockages or perforations, surgery becomes the primary treatment option. However, surgery doesn't offer a complete cure, and the possibility of recurrence remains. To manage CD recurrence after surgery, various treatment choices are available, including steroids, monoclonal antibodies, immunomodulators, and further surgery. Regrettably, the current body of evidence doesn't definitively establish which of these treatments is the most effective and safe. Thus, our research aims to provide insights into the Validity and security of different treatment approaches for managing CD recurrence after surgery. Methods: Search of EMBASE, PubMed, Web of Science Core Collection and the Cochrane Central Register of Controlled Trials will be conducted to include researches that examine the validity of treatments for recurrent CD after surgery. Our analysis will distinguish between two types of studies: randomized controlled trials (RCTs) and non-randomized studies with at least two different treatments, each evaluated separately. We will employ Bayesian network meta-analyses to systematically compare the effectiveness and safety of these treatments. Additionally, subgroup analyses will be performed according to recurrence status and postoperative prophylactic medication. To clarify the variation of studies, sensitivity analyses will be performed. And we may use meta-regression as an additional approach if relevant data are available. We will also rigorously access the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Discussion: This analysis will provide a comprehensive assessment of the latest evidence on available treatments for patients with postoperative recurrence of CD, which will provide recommendations for clinical practice. Trial registration: Systematic review registration INPLASY2023110021. (DOI: 10.37766/inplasy2023.11.0021). [ABSTRACT FROM AUTHOR]

Background: Following surgery for Gastrointestinal (GI) perforation, there is an increased occurrence of Surgical Site Infections (SSI). The beneficial effect of employing delayed primary skin closure (DPC) on severely contaminated incisions subsequent to surgery for GI perforation remains unverified. Objective: To systematically evaluate the advantages of the DPC management in surgery for GI perforation. Methods: A literature search was performed using ClinicalTrials.gov, Pubmed, Embase, Cocharane, and Web of Science identified all eligible English-language studies related to surgery for GI perforation through October 2023. Randomized clinical trials (RCTs) comparing DPC with primary skin closure (PC) in surgery for GI perforation were included. Two investigators independently performed the inclusion work, and a third investigator was consulted for resolving conflicts. Data were extracted by multiple independent investigators and pooled in a random-effects model. The primary outcome was SSI, defined in accordance with the original studies. The secondary outcome was the length of stay (LOS). RESULTS: Final analysis included 12 RCTs which included a total of 903 patients were randomizing divided into either DPC or PC, including 289 patients with gastroduodenal perforation (32%), 144 patients with small intestine perforation (15.96%), 60 patients with colon perforation (6.64%), and 410 patients with appendix perforation (45.4%). The rates of SSI was significantly decreased after DPC management (OR:0.31, 95%CI:0.15–0.63, p < 0.01), no significant differences were observed between the DPC group and PC group in terms of LOS (MD: − 0.37, 95% CI: − 1.91–1.16, p = 0.63). Conclusion: These results point to the efficacy of DPC management in reducing SSI in patients under surgery for GI perforation, and this strategy did not increase the LOS. This systematic review and meta-analysis may contribute to informed decision-making in the management of severely contaminated wounds associated with GI perforation. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to clarify the validity of laparoscopic surgery for lower gastrointestinal perforation by comparing the clinical outcomes of laparoscopic and open emergency surgery. Methods: We reviewed the data of patients who underwent surgery for lower gastrointestinal perforation. Patients were categorized into two groups: the laparoscopic group who underwent laparoscopic surgery, and the open group who underwent laparotomy. Clinical and operative outcomes between the two groups were evaluated. Results: A total of 219 patients were included in the study. There were 66 and 153 patients with small bowel and colorectal perforations, respectively. The median operative time in the laparoscopic group was shorter than that in the open group (126 min vs. 146 min, p =.049). The mean amount of intraoperative blood loss was significantly lower in the laparoscopic group (50.4 mL vs. 400.1 mL, p <.001). The incidence of postoperative complication was higher in the open group (20.0% vs. 66.5%, p <.001), especially wound infection (0% vs. 26.3%, p =.002). Median hospital stays were 14 days and 24 days in the laparoscopic and open groups, respectively (p <.001). In the laparoscopic group, hospital mortality was 0%. Conclusions: The laparoscopic approach for small bowel and colorectal perforation in an emergency setting is a safe procedure in carefully selected patients and may contribute to decreased intraoperative blood loss, shortened hospital stay, and decreased incidence of postoperative complications, especially wound infection. [ABSTRACT FROM AUTHOR]

Purpose: Hiatal hernia may development after esophagectomy or Gastrectomy. Post- esophago-gastric hiatal hernia is a rare but challenging condition. Nearly half of reported cases involve emergent situations, underscoring the urgency of addressing this condition. However, there is currently no consensus on the optimal treatment approach for this type of hernia. Methods: All consecutive patients who underwent repair for Post- esophago-gastric hiatal hernia over the past five years were retrospectively reviewed. Patient characteristics and perioperative data were collected. The primary outcomes, repair methods, and surgical results following post-esophago-gastric hiatal repair were analyzed. Results: A total of eight patients with post-esophago-gastric hiatal hernia were included in this study. All patients presented with emergent conditions, specifically bowel obstruction. Laparoscopic repair was successful in four cases, with a conversion rate to open surgery of 50% (4 out of 8). Primary suture was performed in three cases, while biological mesh repair was carried out in four cases, and one case was left unrepaired. Bowel gangrene and perforation occurred in one case. The most notable postoperative complications included wound infection and pleural fluid collection. Importantly, there were no instances of hernia recurrence during the follow-up period, which ranged from 2 to 55 months, with a 100% follow-up rate observed. Conclusion: Post-esophago-gastric hiatal hernia is a rare yet significant condition, often presenting emergently and linked to higher morbidity and mortality rates. Therefore, symptomatic patients warrant surgical repair, and immediate intervention should be provided to those with acute-onset symptoms and clinical signs of bowel obstruction. Primary suture repair, with or without biological mesh, appears to be a durable method of repair. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course. Background: The finding of pneumoperitoneum frequently leads to operative management for diagnosis and treatment. The etiology of pneumoperitoneum includes perforated viscus, such as perforated peptic ulcers, small or large intestinal perforations, appendicitis, and complicated sigmoid diverticulitis. We describe the preoperative, intraoperative, and postoperative course of a patient with perforated Meckel's diverticulitis presenting with pneumoperitoneum. This unusual presenting finding highlights that Meckel's diverticulum should be included in the differential diagnosis in adolescents and young adults presenting with pneumoperitoneum. Case Report: We describe a case of an 18-year-old male who presented with 1 day of abdominal pain, found to have pneumoperitoneum during workup, attributed to perforated Meckel's diverticulum. CT scans of the abdomen and pelvis were performed, confirming pneumoperitoneum, an inflamed segment of distal ileum, and a non-visualized appendix, which made the diagnosis difficult. Perforated Meckel's diverticulum, likely due to infection, was confirmed by diagnostic laparoscopy. The Meckel's diverticulum was then exteriorized and removed by segmental small bowel resection with primary anastomosis. The final pathology report confirmed perforated Meckel's diverticulum with gastric oxyntic-type mucosa. Conclusions: This case illustrates an uncommon presentation of Meckel's diverticulum in an adolescent with pneumoperitoneum. Pneumoperitoneum requires broadening the diagnosis to include other causes, including Meckel's diverticulum, especially in the setting of an acute abdomen. This case highlights that a high index of suspicion should be kept for Meckel's diverticulum, even in adolescents and young adults with pneumoperitoneum. [ABSTRACT FROM AUTHOR]

Objective: Rare coexistence of disease or pathology. Background: Gas in the portal venous system, or hepatic portal venous gas, is a rare occurrence associated with ischemic colitis, inflammatory bowel disease, or any cause of bowel perforation, including from a necrotic tumor. This report presents the case of a 72-year-old man with diabetes who had carcinoma of the ileocecal region, sepsis due to Klebsiella pneumoniae, and hepatic portal venous gas. Case Report: A 72-year-old man with ileocecal cancer was admitted to our hospital for preoperative diabetes control. He developed a fever and septic shock, without abdominal symptoms or signs of peritoneal irritation. Klebsiella pneumoniae was detected in blood cultures. Abdominal ultrasonography showed hepatic portal venous gas, and a simple computed tomography scan revealed gas in the vasculature and hepatic portal vein in the lateral segment, which led us to believe that the ileocecal mass was the source of infection, and emergency surgery was performed. The patient was discharged from the hospital on postoperative day 34 with good progress despite dehydration due to high-output syndrome. Conclusions: Sepsis due to necrosis of ileocecal cancer is often difficult to diagnose because it is not accompanied by abdominal symptoms, as in our case. However, abdominal ultrasound is useful because it allows for a broad evaluation. This report has demonstrated and highlighted that the findings of hepatic portal venous gas on imaging should be regarded seriously, requiring urgent investigation to identify the cause and commence treatment in cases of infection or sepsis. [ABSTRACT FROM AUTHOR]

Background: On April 18, 2024, the U.S. Food and Drug Administration officially required updating of the "boxed warning" for T cell malignancies for all chimeric antigen receptor T cell (CAR-T) therapies. Given the clinical significance of these therapies, a rigorous safety assessment is paramount. However, comprehensive real-world safety studies have been lacking for the newly marketed CAR-T products idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (ciltacel), which target B cell maturation antigen, especially regarding the risk of secondary malignancies. Therefore, we aimed to thoroughly analyze the adverse events (AEs) information in the FDA Adverse Event Reporting System (FAERS) database to comprehensively understand the safety risks of ide-cel and cilta-cel. Methods: We extracted AE reports related to ide-cel and cilta-cel from the FAERS database (https://fis.fda.gov/extensions/FPD-QDE-FAERS/FPD-QDEFAERS. html.) from January 1, 2019 to December 31, 2023. Disproportionality analysis and Bayesian analysis were used to identify risk signals across subgroups and specific cases (including for death and secondary malignancies). Weibull distribution analysis was employed to determine the time to AE onset. Results: A total of 695 AE reports for ide-cel and 848 for cilta-cel were included in the FAERS database. This analysis identified 81 positive signals for ide-cel and 74 for cilta-cel. Notably, comparisons with the drug labels revealed "unexpected signals," including febrile bone marrow aplasia (reporting odds ratio=69.10; confidence interval 39.12-122.03) and plasma cell myeloma (12.45; 8.18-18.95) for ide-cel, and increased serum ferritin (24.98; 8.0-77.58) and large intestine perforation (18.57; 5.98-57.69) for cilta-cel. Both drugs showed a higher AE incidence among male recipients and patients aged =65 years, although female recipients faced a greater risk. Most AEs occurred at the early stage of administration. However, secondary malignancies were detected for both drugs, primarily occurring one-year post-administration. Conclusion: This study provides a foundation for understanding the safety profile of CAR-T cell therapy, particularly in relation to the emergence of secondary malignancies. Such insights are helpful for clinical decision-making and the safe and effective utilization of these therapeutic agents. [ABSTRACT FROM AUTHOR]

This document discusses Köhlmeier-Degos (KD) disease, a rare vasculopathy that can manifest as either a benign or malignant form. The disease primarily affects the gastrointestinal and central nervous systems. The presence of specific skin plaques is a characteristic feature of KD disease and should prompt immediate referral to a dermatologist and specialized center. Malignant transformation of lesions is common and can lead to high mortality if left untreated. Treatment options are limited, and early recognition and monitoring are important for improving outcomes. The document also presents a case study of a patient with the malignant form of KD disease, highlighting the challenges and limited treatment options. [Extracted from the article]

Aim Method Results Conclusions The type of surgical procedure used in rectal cancer treatment may affect cancer recurrence. The aim of this study was to determine whether the type of procedure influences oncological outcomes in rectal cancer surgery.We gathered data from the Swedish Colorectal Cancer Registry regarding patients with TNM Stage I–III rectal cancer who underwent R0/R1 surgery from 2013 to 2017. The outcomes after Hartmann's procedure (HP), anterior resection (AR) and abdominoperineal resection (APR) were compared, and a multivariable Cox regression analysis was performed. The primary outcome of the study was the local recurrence rate. The secondary outcomes were distant metastasis, disease‐free survival and overall survival at 5 years as well as risk factors for local recurrence.A total of 4741 patients were included in the study: 614 underwent HP, 3075 underwent AR and 1052 underwent APR. Multivariable Cox regression revealed no difference in local recurrence, distant metastasis or disease‐free survival. Overall survival was higher following AR (OR 0.62, CI 0.54–0.72). Risk factors for local recurrence were intraoperative bowel perforation (OR 2.41, CI 1.33–4.40), a pT4 tumour (OR 1.93, CI 1.11–3.4) and a positive circumferential resection margin (OR 5.62, CI 3.28–9.61).This nationwide study showed that the type of procedure did not affect the local recurrence rate or distant metastasis. In patients who are unfit for restorative surgery, HP is a viable alternative with oncological outcomes similar to those of APR. [ABSTRACT FROM AUTHOR]

Background: Radiotherapy (RT) is effective for cervical cancer but causes late side effects (SE) to nearby organs. These late SE occur more than 3 months after RT and are rated by clinical findings to determine their severity. While imaging studies describe late gastrointestinal (GI) SE, none demonstrate the correlation between the findings and the toxicity grading. In this study, we demonstrated the late GI toxicity prevalence, CT findings, and their correlation. Methods: We retrospectively studied uterine cervical cancer patients treated with RT between 2015 and 2018. Patient characteristics and treatment(s) were obtained from the hospital's databases. Late RTOG/EORTC GI SE and CT images were obtained during the follow-up. Post-RT GI changes were reviewed from CT images using pre-defined criteria. Risk ratios (RR) were calculated for CT findings, and multivariable log binomial regression determined adjusted RRs. Results: This study included 153 patients, with a median age of 57 years (IQR 49–65). The prevalence of ≥ grade 2 RTOG/EORTC late GI SE was 33 (27.5%). CT findings showed 91 patients (59.48%) with enhanced bowel wall (BW) thickening, 3 (1.96%) with bowel obstruction, 7 (4.58%) with bowel perforation, 6 (3.92%) with fistula, 0 (0%) with bowel ischemia, and 0 (0%) with GI bleeding. Adjusted RRs showed that enhanced BW thickening (RR 9.77, 95% CI 2.64–36.07, p = 0.001), bowel obstruction (RR 5.05, 95% CI 2.30–11.09, p < 0.001), and bowel perforation (RR 3.82, 95% CI 1.96–7.44, p < 0.001) associated with higher late GI toxicity grades. Conclusions: Our study shows CT findings correlate with grade 2–4 late GI toxicity. Future research should validate and refine these findings with different imaging and toxicity grading systems to assess their potential predictive value. [ABSTRACT FROM AUTHOR]

Zinc (Zn) is a vital trace element that plays a pivotal role in protein synthesis, cellular growth, and differentiation and is involved as a cofactor of metalloenzymes, performing a wide variety of metabolic, immune, and synthesis roles. Zn is required at all stages of an infant's and child's development, and severe Zn deficiency has been reported to lead to slower physical, cognitive, and sexual growth. Preterm neonates are at a higher risk of developing zinc deficiency for a variety of reasons, including low Zn intake from enteral feeds containing breast milk, relative malabsorption due to immaturity of the gastrointestinal tract with limited absorptive capacity, increased urinary loss of zinc, and increased demand during the early developmental stages. Moreover, premature infants are at risk of gastrointestinal diseases like necrotizing enterocolitis (NEC), which can limit absorption capacity and potentially lead to malabsorption. TPN is frequently used in preterm infants to provide them with sufficient nutrients and calories. However, it has its own complications, including cholestasis, especially if used for prolonged periods. In this case report, we are presenting the case of a male preterm infant who was delivered by caesarean section at 26 weeks' gestation. The baby developed an intestinal perforation due to NEC, for which he underwent surgery for resection of the necrotic bowel and the creation of a high ileal stoma and was put on prolonged total parenteral nutrition (TPN), which led to the development of zinc deficiency. [ABSTRACT FROM AUTHOR]

Introduction: Recently, antibiotics use in uncomplicated acute diverticulitis (AD) has been controversial in Europe. The American Gastroenterological Association (AGA) in their 2015 guidelines recommend their selective use. Our study highlights their role in outpatient management. Methods: We queried the Diamond Network through TriNetX‐Research Network including 92 healthcare organizations. We included large intestine diverticulitis without perforation, abscess or bleeding. Exclusion criteria included any of sepsis criteria, CRP > 15 mg/L, immunodeficiency or HIV, coronary artery disease, chronic kidney disease, history of Crohn's disease or ulcerative colitis, heart failure, hypertension, diabetes or any of the following in the 3 months before study date; clostridium difficile (C. diff) infection, diverticulitis or antibiotics. Patients with AD were divided into two cohorts; patients on antibiotics, and patients not on antibiotics. Cohorts were compared after propensity‐score matching (PSM). Results: 214,277 patients met inclusion criteria. 58.9% received antibiotics, and 41% did not. After PSM, both cohorts had 84,320. Rate of hospital admission was lower in the antibiotic group (3.3% vs 4.2%, p <.001). There was a statistical difference between ICU admission (0.1% vs 0.15%, p <.01) and the rate of bowel perforation, peritonitis, abscess formation or bleeding (1.3% vs 1.4%, p =.044). There was no difference in mortality (0.1% vs 0.1%, p =.11), C. diff (0.1% vs 0.1%, p =.9), colectomies (0.2% vs 0.2%, p =.33), or Acute Kidney Injury (AKI) (0.1% vs 0.1%, p =.28). Conclusion: Outpatient use of antibiotics in patients with uncomplicated AD is associated with lower rates of hospital admissions and complications without changing mortality rate or surgical intervention. [ABSTRACT FROM AUTHOR]

Objective: To investigate the diagnostic value of balloon-assisted small enteroscopy and other examination methods for Meckel's diverticulum of the small intestine. Methods: A retrospective analysis was conducted on 87 patients diagnosed with Meckel's diverticulum at the First Affiliated Hospital of Nanjing Medical University from January 2010 to December 2023. Data regarding demographics, clinical presentations, diagnostic methods, treatments, and pathological findings were collected. Clinical characteristics were summerized, and the diagnostic efficacy of balloon-assisted small enteroscopy was compared with other examination methods for detecting Meckel's diverticulum. Results: A total of 87 patients with Meckel's diverticulum were included, with 55 patients had complications such as gastrointestinal bleeding, intestinal obstruction, diverticulitis, and intestinal perforation. Compared to patients without complications, those with complications had a younger median age(P=0.003), longer diverticulum diameter [(5.2 ± 2.6) cm vs. (3.3 ± 1.4) cm, P=0.001], wider opening [(2.4 ± 1.1) cm vs (.1.6 ± 0.7) cm, P=0.002], and higher surgery rate [(89.1% vs. 56.3%, P < 0.001]. The diagnostic sensitivity of different examination methods for Meckel's diverticulum were as follows: balloon-assisted small enteroscopy 94.4%, nuclide imaging(ectopic gastric mucosal imaging) 58.3%, capsule endoscopy 30.0%, small intestine CT 9.4%, abdominal CT 8.2%, and digital subtraction angiography 0%. Conclusion: Young patients with longer diverticulum diameter and wider opening of small intestine Meckel's diverticulumin are more prone to complications such as diverticulitis, perforation, bleeding, and obstruction. Balloon-assisted small enteroscopy has the highest preoperative diagnostic value for Meckel's diverticulum and should be the preferred examination method for patients suspected of having small intestine Meckel's diverticulum. [ABSTRACT FROM AUTHOR]

Objective: To compare the risk of gastrointestinal perforation (GIP), a rare but serious adverse event, in patients who a JAK inhibitor (JAKi; tofacitinib, baricitinib, upadacitinib, or filgotinib) versus adalimumab (tumor necrosis factor inhibitor) among a comprehensive real‐world population of patients with rheumatic diseases. Methods: We conducted a nationwide population‐based cohort study of the French national health data system, the exposed group that received a JAKi and the comparison group adalimumab. We included all individuals with a rheumatic disease who had their first dispensation of these treatments from July 2017 to December 2021. The primary endpoint was the occurrence of GIP (end of follow‐up May 2022). Weighted hazard ratios (wHRs) were estimated with the inverse probability of treatment weighting method to account for confounding factors. Concomitant administration of systemic glucocorticoids, nonsteroidal anti‐inflammatory drugs, and proton‐pump inhibitors were time‐varying variables. Results: The cohort included 39,758 patients: 12,335 and 27,423 in the groups that received a JAKi and adalimumab (mean age 58.2 and 47.3 years; female 76% and 58%; rheumatoid arthritis 85.3% and 27.3%, and psoriatic arthritis/axial spondyloarthritis 14.7% and 72.7%), respectively. During follow‐up, 38 and 42 GIPs occurred in the groups that received a JAKi and adalimumab groups; incidence rates were 2.1 (95% confidence interval [CI] 1.5–2.8) and 1.1 (95% CI 0.8–1.5) per 1,000 person‐years, respectively. Rates of GIP did not differ between the groups that received a JAKi and adalimumab: wHR 1.1 (95% CI 0.7–1.9; P = 0.65). Despite the lack of power in some subgroup analyses, results were consistent whatever the subgroup of a type of JAKi received or subgroup with a type of rheumatic disease. Conclusion: In this nationwide cohort study, the rates of GIPs did not differ between groups of patients who received JAKi and adalimumab treatment. These results need to be confirmed in other observational studies. [ABSTRACT FROM AUTHOR]

Background: There is a discrepancy in the surgical and endoscopic literature for managing duodenal perforations. Although often managed conservatively, surgical repair is the standard treatment for duodenal perforations. This contrasts with the gastroenterology literature, which now recommends endoscopic repair of duodenal perforations, which are more frequently iatrogenic from the growing field of advanced endoscopic procedures. This study aims to provide a scoping review to summarize the current literature content and quality on endoscopic repair of duodenal perforations. Methods: The protocol for performing this scoping review was outlined by the Joanna Briggs Institute. All studies that reported primary outcomes of patients who had undergone endoscopic repair of duodenal perforations before February 2022, regardless of perforation etiology or repair type were reviewed, with studies after 1999 meeting inclusion criteria. The study excluded articles that did not report clinical outcomes of endoscopic repair, articles that did not describe where in the gastrointestinal tract the endoscopic repair occurred, pediatric patients, and animal studies. Results: 7606 abstracts were screened, with 474 full articles reviewed and 152 studies met inclusion criteria. 560 patients had duodenal perforations repaired endoscopically, with a technical success rate of 90.4% and a survival rate of 86.7%. Most of these perforations (74.5%) were iatrogenic from endoscopic procedures or surgery. Only one randomized control trial (RCT) was found, and 53% of studies were case reports. Conclusion: These results suggest that endoscopic repair could emerge as a viable first-line treatment for duodenal perforation and highlight the need for more high-quality research in this topic. [ABSTRACT FROM AUTHOR]

Purpose: The primary objective was to evaluate the impact of necrotising enterocolitis (NEC) and spontaneous intestinal perforation (SIP) on mortality and neurodevelopmental outcomes at 2 years' corrected age (CA) in infants born before 32 weeks' gestation (WG). Methods: We studied neurodevelopment at 2 years' CA of infants with NEC or SIP who were born before 32 WG from the EPIPAGE-2 cohort study. The primary outcome was death or the presence of moderate-to-severe motor or sensory disability defined by moderate-to-severe cerebral palsy or hearing or visual disability. The secondary outcome was developmental delay defined by a score < 2 SDs below the mean for any of the five domains of the Ages and Stages Questionnaire. Results: At 2 years' CA, 46% of infants with SIP, 34% of infants with NEC, and 14% of control infants died or had a moderate-to-severe sensorimotor disability (p < 0.01). This difference was mainly due to an increase in in-hospital mortality in the infants with SIP or NEC. Developmental delay at 2 years' CA was more frequent for infants with SIP than controls (70.8% vs 44.0%, p = 0.02) but was similar for infants with NEC and controls (49.3% vs 44.0%, p = 0.5). On multivariate analysis, the likelihood of developmental delay was associated with SIP (adjusted odds ratio = 3.0, 95% CI 1.0–9.1) but not NEC as compared with controls. Conclusion: NEC and SIP significantly increased the risk of death or sensorimotor disability at 2 years' CA. SIP was also associated with risk of developmental delay at 2 years' CA. [ABSTRACT FROM AUTHOR]

• Megacolon is a rare clinical condition consisting of an abnormally dilated colon in the absence of mechanical obstruction. • Megacolon can complicate pregnancy in terms of maternal morbidity and mortality and obstetrical outcomes. Pregnancy, on the other hand, can exacerbate chronic constipation through hormonal and mechanical mechanisms. • A case of megacolon is reportedpresenting accidentally during the routine mid-trimester fetal ultrasound as a suspicious pelvic mass of unknown aetiology (mean diameter > 10 cm). • Chronic constipation in women of reproductive age should receive greater clinical attention during pre- and periconception care. • A multi-disciplinary approach, timely diagnosis and delivery planning are fundamental to ensure favourable outcomes for both the mother and fetus when dealing with megacolon during pregnancy. Megacolon is a rare clinical condition consisting of an abnormally dilated colon in the absence of mechanical obstruction. Megacolon can complicate pregnancy in terms of maternal morbidity and mortality (volvulus, ileus, systemic toxicity, bowel perforation, sepsis) and obstetrical outcomes (preterm birth, premature rupture of membranes, dystocia). Pregnancy, on the other hand, can exacerbate chronic constipation through hormonal and mechanical mechanisms. A case of megacolon, first detected during pregnancy in an otherwise healthy nulliparous woman, is reported. The diagnosis was suspected on observation of a pelvic mass of unknown aetiology (mean diameter > 10 cm) constricting and dislocating the gravid uterus contralaterally during a routine mid-trimester fetal ultrasound. The diagnostic work-up and management are discussed. Chronic constipation in women of reproductive age should receive greater clinical attention during pre- and periconception care. A multi-disciplinary approach, timely diagnosis and delivery planning are fundamental to ensure favourable outcomes for both the mother and fetus when dealing with megacolon during pregnancy. [ABSTRACT FROM AUTHOR]

The article provides brief information on the characteristics of treatment tactics and rehabilitation during necrotic enterocolitis (NEC) in children, and shares the successes and experience gained in the study of this problem in recent years. The relevance of NEC is determined by the fact that the mortality among operated newborns is high, ranging from 18 % to 40 %, and reaches 95-100 % in the case of intestinal necrosis. Determining criteria for surgical treatment is one of the most complex issues. Practically all surgeons agree that intestinal perforation and necrosis are indications for surgery. Under ideal conditions, the operation can be performed only after the precise delimitation of the necrotic zones, but before the development of perforation. However, the diagnosis of the intestine before the development of perforation is very complicated. The choice of treatment tactics during NEC depends on the severity of the child's condition and the stage of the process. Interest in examinations conducted to investigate the problem of necrotic enterocolitis does not weaken. Studying the pathogenesis of this disease, searching for new diagnostic criteria, and developing preventive measures for patients at risk of developing necrotic enterocolitis are among the most urgent issues. [ABSTRACT FROM AUTHOR]

Background: Naldemedine is an orally available peripherally acting μ-opioid receptor antagonist approved to treat opioid-induced constipation (OIC). It is contraindicated for patients with known or suspected gastrointestinal obstruction to protect against naldemedine-induced perforation. Here, we report a clinical case of suspected perforation of a diverticulum in the sigmoid colon associated with naldemedine. Case presentation: The patient was a 65-year-old man with a history of oral cancer who had been prescribed oxycodone (20 mg/day) for cancer pain. On day 0, the patient started naldemedine 0.2 mg once daily before bedtime for OIC. The dose of oxycodone was increased for pain control up to 60 mg/day. On day 35 of naldemedine treatment, the patient developed fever and abdominal pain, and his frequency of defecation had decreased. Initial laboratory results showed a C-reactive protein (CRP) level of 28.5 mg/dL and white blood cell (WBC) count of 13,500/µL. On day 37, the patient still had tenderness in his lower abdomen. Abdominal computed tomography revealed free air in the abdominal cavity suggesting an intestinal perforation. A Hartmann procedure was performed. Histopathological findings showed numerous diverticula in the sigmoid colon, some of which were perforated. Conclusions: These results suggest that the effects of OIC may have compressed the intestinal tract, which was followed by naldemedine-activation of peristalsis, which led to the onset of intestinal perforation. In patients with pre-existing diverticular disease, we should monitor for increased WBC counts and CRP levels after the initiation of treatment with naldemedine, and consider performing appropriate tests early in the event of abdominal complaints. [ABSTRACT FROM AUTHOR]

This letter published in the Blood Cancer Journal discusses the clinical presentation, outcomes, and management of chimeric antigen receptor T-cell (CAR-T) therapy-associated hemophagocytic lymphohistiocytosis (HLH) syndrome. The study found that 3% of patients receiving CAR-T therapy developed CAR-T-associated HLH. The document provides detailed information on the clinical presentation, treatment strategies, and outcomes in adult patients with CAR-T-associated HLH. It includes a table with information on different treatment options, toxicities, and laboratory markers. The article emphasizes the importance of early recognition and intervention to prevent fatal outcomes. [Extracted from the article]

Background: With the prevalence of coronavirus disease 2019 (COVID-19), many severe cases have been discovered worldwide. Here, a case of concurrent pneumomediastinum, pneumoretroperitoneum, and intestinal perforation was reported. This case was the first report on COVID-19-induced related complications. Case presentation: A 74-year-old female patient was hospitalized for COVID-19. Air leakage was unexpectedly found during imaging reexamination. Considering the unobvious subjective feeling of the patient, a conservative treatment was given at the early stage, and finally, sigmoid colon perforation was surgically confirmed. The family gave up the treatment at last, because the patient could not be taken off the ventilator. Coincidentally, the patient also had abnormal renal anatomical position. This situation led to an abnormal air leakage direction and the atypical manifestations of peritonitis. It was also one of the important reasons for the delayed diagnosis and treatment of the disease. Conclusions: Clinicians should be vigilant for spontaneous gastrointestinal perforation in patients with COVID-19, particularly those undergoing treatment with glucocorticoids and tocilizumab. The case is shared to highlight this rare and fatal extrapulmonary manifestation of COVID-19 and further assist clinicians to raise their awareness and timely implement imaging investigation and multidisciplinary intervention so as to facilitate early discovery, diagnosis and treatment and reduce the mortality. [ABSTRACT FROM AUTHOR]

Objective: The objective of this research is to scrutinize adverse events (AEs) linked to Trifluridine/Tipiracil (TFTD/TPI), using data from the FDA Adverse Event Reporting System (FAERS) database. Methods: The AEs data related to TFTD/TPI were collected from the fourth quarter of 2015 through the fourth quarter of 2023. After normalizing the data, multiple signal quantification techniques including Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), Bayesian approaches such as Bayesian Confidence Propagation Neural Network (BCPNN) and the Multi-item Gamma Poisson Shrinker (MGPS) were used for overall and subgroup analysis and visualization analyses were performed. Results: From the FAERS database, we analyzed 13,520,073 reports, identifying 8,331 as primary suspect (PS) AEs for TFTD/TPI, occurring across 27 organ systems. The study retained 99 significant disproportionality Preferred Terms (PTs) across four algorithms and unveiled unexpected serious AEs such as iron deficiency and intestinal perforation, hepatic failure, cholangitis and so on. The median onset of TFTD/TPI-associated AEs was 44 days (IQR 20-97 days), with most occurring within the first 30 days of treatment. Conclusion: This research uncovers critical new safety signals for TFTD/TPI, supporting its clinical monitoring and risk identification. [ABSTRACT FROM AUTHOR]

Background: Perforation peritonitis is the most common surgical emergency encountered in India. Due to late presentation, perforations lead to diffuse peritonitis, resulting in high morbidity and mortality.Assessment of nutritional status of these patients can help in reducing the adverse outcomes.Serum albumin level is a readily available clinical parameter that gives an insight to patients’ nutritional status. In this study, we used pre-operative serum albumin level to assess post-operative outcomes in patients of perforation peritonitis who underwent emergency laparotomy. Methodology: This prospective observational study was conducted in the Department of General Surgery at Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Amritsar. 70 patients were included in the study. Pre-operative serum albumin levels were obtained and correlation was drawn with the post-operative outcomes in terms of delayed wound healing, wound dehiscence, surgical site infection and 30 day mortality. Results: In our study, out of 70 patient, 87.1% had hypoalbuminemia. The mean serum albumin of patients with normal wound healing was statistically more than that of patients with delayed wound healing. As per Southampton Grading System, statistically significant SSI were encountered among patients with hypoalbuminemia. Statistically significant number of patients with hypoalbuminemia had wound dehiscence according to WUWHS-SWD wound grading system. Additionally, statistically significant mortality was observed in patients having pre-operative hypoalbuminemia. Conclusion: Pre-operative serum albumin levels can be used as a clinical parameter to predict post-operative outcomes in patients undergoing emergency laparotomy for perforation peritonitis. [ABSTRACT FROM AUTHOR]

We present a case of a 60-year-old male with known seropositive rheumatoid arthritis and cerebral vasculitis who presented to the emergency room with abrupt onset lower back and abdominal pain. The patient developed peritonitis which led to an abdominal laparotomy where jejunal ischemia, necrosis, and perforation were found, requiring bowel resection. On pathology examination, the patient had mesenteric vessel intramural inflammation indicative of vasculitis. He developed an anastomotic leak on postoperative Day 4 and elected hospice care. A high index of suspicion for mesenteric vasculitis should be considered in patients presenting with abdominal pain in the setting of known rheumatoid arthritis associated vasculitis, especially patients with long-standing rheumatoid arthritis. The high mortality represented by gastrointestinal involvement in rheumatoid arthritis associated vasculitis warrants investigation in high-risk patients, despite its low prevalence. Treatment may consist of high-dose corticosteroids, immunosuppressive agents, biologic therapies that target the underlying autoimmune process, and in severe cases, bowel resection. [ABSTRACT FROM AUTHOR]

The spectrum of surgical techniques in the repair of nasal septal defects is wide. The objective of this study was to assess the feasibility of using a diced cartilage in fascia (DC-F) graft for successful closure of nasal septal perforations and to evaluate symptom reduction. This was a retrospective study of 18 patients undergoing surgical repair of symptomatic nasoseptal perforations of different etiologies using a DC-F graft from 2020 until 2021. The procedure was feasible in all of the 18 patients. Reconstruction of septal defects with a DC-F graft led to reduction of crust formation, reduction of epistaxis, and improvement of nasal breathing in 13 out of the 18 patients when seen for their 2-month follow-up. Reperforation occurred in three cases, leaving defects of 1, 7, and 5 mm in diameter. In one case, the reperforation was symptomatic. A DC-F graft proved to be a reliable and reproducible method for the closure of nasoseptal perforations of variable sizes, of different locations, and of different etiologies. [ABSTRACT FROM AUTHOR]

Endoscopic submucosal dissection (ESD) is a curative treatment for laterally spreading tumors (LSTs). However, the outcomes of ESD for LSTs with hemorrhoids remain largely unknown. Our study aimed to evaluate the usefulness of ESD in managing LSTs with hemorrhoids. We retrospectively collected 418 consecutive LST patients treated with ESD between 2011 and 2023. A retrospective comparative analysis was conducted. There were 85 patients included in the hemorrhoids group and 333 patients included in the other group. The en-bloc resection rate, R0 resection rate, and curative resection rate were comparable in these two groups (p > 0.05). The LSTs with hemorrhoids have a significantly higher intraoperative bleeding rate during ESD when compared to the other group (12.9% vs. 5.4%, p = 0.028). Rates of intraoperative perforation and anal pain in the hemorrhoid group were significantly higher than those in the no-hemorrhoid group (2.4% vs. 0%, p = 0.041; 9.4% vs.0.6%, p < 0.001; respectively). Moreover, most of the related manifestations caused by hemorrhoids were relieved to various degrees after ESD. ESD is a safe and effective treatment strategy for LSTs with hemorrhoids. A multi-center and prospective study should be conducted in the future to validate our results. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Abdominal cocoon syndrome is a rare cause of bowel obstruction, with variable presentation. It needs a high index of suspicion for diagnosis. Surgical management with the release of adhesions is the preferred option for a healthy bowel. Iatrogenic bowel perforation is a possibility during bowel manipulation and the release of thick fibrous adhesions resulting in bowel resection. Abdominal cocoon syndrome, also known as encapsulating peritoneal sclerosis, is a rare cause of intestinal obstruction in which the small intestine may be entirely or partially wrapped in a thick sac of fibrous tissue that resembles a cocoon. We present a male Ethiopian patient, 60 years of age, who had a 6‐day history of symptoms of intermittent intestinal obstruction. Before his current presentation, he had a 6‐month history of sporadic vomiting and periodic abdominal pain. These symptoms would go away on their own. An exploratory laparotomy was performed for the preoperative diagnosis of small intestine obstruction secondary to primary small bowel volvulus after a plain abdomen x‐ray confirmed the small bowel obstruction diagnosis. But during surgery, we discovered something unexpected: a mass formed by the encasing membrane over the small bowel. En bloc resection of the mass and distal ileum with ileo‐transverse anastomosis was performed. The patient was discharged after 5 days of an uneventful post‐operative stay. The morbidity and mortality of this rare instance can be decreased by awareness, prompt diagnosis, and appropriate intervention. We discuss diagnostic and therapeutic challenges encountered during the management of this patient. [ABSTRACT FROM AUTHOR]

Background Surgical wound dehiscence (SWD) in neonates is a life-threatening complication. The aim was to define risk factors of postoperative incision dehiscence in this population. Methods Data of 144 patients from 2010 to 2020 were analyzed retrospectively. All full-term newborns or preterm newborns up to 42 weeks of amenorrhea (adjusted) who had a laparotomy within 30 days were included. Descriptive patient information and perioperative data were collected. SWD was defined as any separation of cutaneous edges of postoperative wounds. Results Overall, SWD occurred in 16/144 (11%) patients, with a significantly increased incidence in preterm newborns (13/59, 22%) compared with full-term newborns (3/85, 4%; p < 0.001). SWD was significantly associated with exposure to postnatal steroids (60% vs. 4%, p < 0.001) and nonsteroidal anti-inflammatory drugs (25% vs. 4%, p < 0.01), invasive ventilation duration before surgery (median at 10 vs. 0 days, p < 0.001), preoperative low hemoglobin concentration (115 vs. 147 g/L, p < 0.001) and platelet counts (127 vs. 295 G/L, p < 0.001), nonabsorbable suture material (43% vs. 8%, p < 0.001), the presence of ostomies (69% vs. 18%, p < 0.001), positive bacteriological wound cultures (50% vs. 6%, p < 0.001), and relaparotomy (25% vs. 3%, p < 0.01). Thirteen of 16 patients with SWD presented necrotizing enterocolitis/intestinal perforations (81%, p < 0.001). Conclusion This study identified prematurity and a number of other factors linked to the child's general condition as risk factors for SWD. Some of these can help physicians recognize and respond to at-risk patients and provide better counseling for parents. [ABSTRACT FROM AUTHOR]

This study aimed to examine the characteristics of nasal and imaging findings of sinonasal lesions in granulomatosis with polyangiitis (GPA) patients and how these lesions change over time in both the active and remission phases of the disease. We retrospectively reviewed GPA patients with sinonasal lesions who were followed up at our department between January 2005 and December 2020. The following data were collected: age, sex, symptoms at initial presentation, anti-neutrophil cytoplasmic antibody (ANCA) type, and histopathological, nasal (initial and follow-up), and imaging (initial and follow-up) findings. This study included 17 patients with GPA aged 30 to 79 years. Computed tomography (CT) of the sinuses showed mucosal thickening in 16 patients, bone thickening in 12, bone destruction in 4, and an orbital invasion mass in 3 at the time of diagnosis. After initiating treatment, mucosal thickening of the sinuses improved in 3 of 16 patients and remained unchanged in 13. Bone thickening at the time of diagnosis remained unchanged in 10 of 12 patients and worsened in 2; 1 patient displayed newly developed bone thickening. Destructive nasal findings on CT were positive for proteinase 3-ANCA. Our study revealed that mucosal thickening, bone thickening, bone destruction, and orbital invasion mass were major CT findings in patients with GPA. Intranasal findings such as granulations, crusting, and necrosis were seen in the active phase; moreover, saddle nose, loss of turbinate, and nasal septal perforation were subsequently seen in the course of the disease. Sinonasal findings of GPA vary depending on the disease stage and period. [ABSTRACT FROM AUTHOR]

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Purpose: This study aimed to present the institutional experience and algorithm for performing biliary interventions in liver transplant patients using the modified Hutson loop access (MHLA) and the impact of percutaneous endoscopy via the MHLA on these procedures. Methods: Over 13 years, 201 MHLA procedures were attempted on 52 patients (45 liver transplants; 24 living and 21 deceased donors) for diagnostic (e.g., cholangiography) and therapeutic (e.g., stent/drain insertion and cholangioplasty) purposes. The most common indications for MHLA were biliary strictures (60%) and bile leaks (23%). Percutaneous endoscopy was used to directly visualize the biliary-enteric anastomosis, diagnose pathology (e.g., ischemic cholangiopathy), and help in biliary hygiene (removing debris/casts/stones/stents) in 138/201 (69%) procedures. Technical success was defined as cannulating the biliary-enteric anastomosis and performing diagnostic/therapeutic procedure via the MHLA. Results: The technical success rate was 95% (190/201). The failure rate among procedures performed with and without endoscopy was 2% (3/138) versus 13% (8/63) (P = 0.0024), and the need for new transhepatic access (to aid the procedure) was 12% (16/138) versus 30% (19/63) (P = 0.001). Despite endoscopy, failure in 2% of the cases resulted from inflamed/friable anastomosis (1/3) and high-grade stricture (2/3) obstructing retrograde cannulation of biliary-enteric anastomosis. Major adverse events (bowel perforation and injury) occurred in 1% of the procedures, with no procedure-related mortality. Conclusions: MHLA-based percutaneous biliary intervention is a safe and effective alternative to managing complications after liver transplant. Percutaneous endoscopy via the MHLA improves success rates and may reduce the need for new transhepatic access. Level of Evidence Level 4 [ABSTRACT FROM AUTHOR]

Purpose : Intussusception is a common pediatric surgical emergency and non-operative reduction is its first line of management. We aimed to compare 3 contemporary techniques of intussusception reduction. Methods : A retrospective study was performed in 3 tertiary care centers in India from January 2017 through December 2019. In the 3 centers, the primary reduction techniques were ultrasound-guided saline reduction (USR), fluoroscopy-guided pneumatic reduction (FPR), and fluoroscopy-guided barium reduction (FBR), respectively. As per these techniques used, we compared clinical characteristics, such as the successful reduction. Results : A total of 255 patients underwent one of the 3 reduction techniques in the study period. Reduction was successful in 90.3%, 85.1%, and 87.7% in the USR, FPR, and FBR groups, respectively (P = 0.961). Mean time to reduction was shorter in the FPR group (30.8 ± 8.9 seconds), compared with the USR (575.0 ± 242.3 seconds) and FBR groups (495.0 ± 118.4 seconds; P < 0.001). Recurrence rates were 11.8%, 20.3%, and 15.8% in the USR, FPR, and FBR groups, respectively (P = 0.522). No association was found between the patients’ age or symptom duration and the successful reduction. One patient in the USR group, 3 in the FPR group, and 4 in the FBR group reported second recurrences. Perforation occurred in 1 patient in the FPR group while no complications occurred in the other groups. There was no in-hospital mortality. Conclusion : All 3 techniques are equally effective, with FPR requiring a shorter time than the other 2 techniques. The reduction technique should be chosen based on the strengths and weaknesses of each technique, as well as local availability.

Abstract Background Naldemedine is an orally available peripherally acting μ-opioid receptor antagonist approved to treat opioid-induced constipation (OIC). It is contraindicated for patients with known or suspected gastrointestinal obstruction to protect against naldemedine-induced perforation. Here, we report a clinical case of suspected perforation of a diverticulum in the sigmoid colon associated with naldemedine. Case presentation The patient was a 65-year-old man with a history of oral cancer who had been prescribed oxycodone (20 mg/day) for cancer pain. On day 0, the patient started naldemedine 0.2 mg once daily before bedtime for OIC. The dose of oxycodone was increased for pain control up to 60 mg/day. On day 35 of naldemedine treatment, the patient developed fever and abdominal pain, and his frequency of defecation had decreased. Initial laboratory results showed a C-reactive protein (CRP) level of 28.5 mg/dL and white blood cell (WBC) count of 13,500/µL. On day 37, the patient still had tenderness in his lower abdomen. Abdominal computed tomography revealed free air in the abdominal cavity suggesting an intestinal perforation. A Hartmann procedure was performed. Histopathological findings showed numerous diverticula in the sigmoid colon, some of which were perforated. Conclusions These results suggest that the effects of OIC may have compressed the intestinal tract, which was followed by naldemedine-activation of peristalsis, which led to the onset of intestinal perforation. In patients with pre-existing diverticular disease, we should monitor for increased WBC counts and CRP levels after the initiation of treatment with naldemedine, and consider performing appropriate tests early in the event of abdominal complaints.

Abstract Background With the prevalence of coronavirus disease 2019 (COVID-19), many severe cases have been discovered worldwide. Here, a case of concurrent pneumomediastinum, pneumoretroperitoneum, and intestinal perforation was reported. This case was the first report on COVID-19-induced related complications. Case presentation A 74-year-old female patient was hospitalized for COVID-19. Air leakage was unexpectedly found during imaging reexamination. Considering the unobvious subjective feeling of the patient, a conservative treatment was given at the early stage, and finally, sigmoid colon perforation was surgically confirmed. The family gave up the treatment at last, because the patient could not be taken off the ventilator. Coincidentally, the patient also had abnormal renal anatomical position. This situation led to an abnormal air leakage direction and the atypical manifestations of peritonitis. It was also one of the important reasons for the delayed diagnosis and treatment of the disease. Conclusions Clinicians should be vigilant for spontaneous gastrointestinal perforation in patients with COVID-19, particularly those undergoing treatment with glucocorticoids and tocilizumab. The case is shared to highlight this rare and fatal extrapulmonary manifestation of COVID-19 and further assist clinicians to raise their awareness and timely implement imaging investigation and multidisciplinary intervention so as to facilitate early discovery, diagnosis and treatment and reduce the mortality.

Abdominal tuberculosis (TB) remains a significant health concern globally, particularly in regions with high endemicity such as North Africa and Morocco. Despite advances in diagnostic modalities, the nonspecific presentation of abdominal TB poses challenges for timely diagnosis and management. Here, we report a case of abdominal TB in a critically state of a young man from Morocco, presenting with acute abdominal pain and signs of sepsis. Radiological investigations revealed features suggestive of intestinal perforation complicating peritoneal TB. Urgent laparotomy confirmed the diagnosis, yet the patient succumbed to advanced sepsis postoperatively. This case underscores the complexity of abdominal TB diagnosis and management, necessitating a high index of suspicion and multidisciplinary collaboration. With evolving surgical techniques and ongoing research efforts, optimizing strategies for early detection and treatment of abdominal TB remains imperative, particularly in endemic regions.

This retrospective study aims to analyze the baseline characteristics and factors associated with poor outcomes in patients with necrotizing enterocolitis (NEC) complicating respiratory syncytial virus (RSV) infection. Using the Virtual Pediatric Systems data registry, patients under 2 years admitted to the pediatric intensive care unit (PICU) were screened. Patients with documented RSV infection and NEC, intestinal perforation, noninfectious gastroenteritis/colitis, or pneumatosis intestinalis occurring around the timing of RSV bronchiolitis diagnosis were included. Out of the screened patients, 41 were analyzed. Most patients (93%) were aged 30 days to 2 years, one-third had baseline anatomical cardiac defects, and 20% history of prematurity. Median PICU length of stay was 11.7 days. Seven patients died before hospital discharge. While not statistically significant, nonsurvivors tended to exhibit higher PRISM-3 scores, more acidemia, and lower systolic blood pressure. These findings emphasize the need for cautious assessment of gastrointestinal symptoms in critically ill patients with RSV infection. [ABSTRACT FROM AUTHOR]

Perforation of the bowel can be a life-threatening condition and is usually clinically diagnosed when a patient presents with such features as severe abdominal pain, tenderness, and tachycardia. Bowel perforation may be corroborated by various conventional imaging modalities, including X-ray, ultrasonography, computed tomography, and magnetic resonance imaging. Nuclear medicine imaging modalities seldom have a role to play in these settings. Rarely diagnosis of perforation may be missed if it is concealed and does not present with the usual signs. Mostly the perforation will eventually be diagnosed if they develop signs and symptoms and is taken up for an exploratory laparotomy. A delay in diagnosis can later lead to significant patient morbidity or even mortality. This report describes a case where possible intestinal perforation was suspected on a 99mTc-DTPA renogram in a postoperative patient with significant urine leak, the presence of which was confirmed intraoperatively. To our knowledge, this was the first such case in the literature.

Abstract Background Waiting time for emergency abdominal surgery have been known to be linked to mortality. However, there is no clear consensus on the appropriated timing of surgery for gastrointestinal perforation. We investigated association between wait time and surgical outcomes in emergency abdominal surgery. Methods This single-center retrospective cohort study evaluated adult patients who underwent emergency surgery for gastrointestinal perforations between January 2003 and September 2021. Risk-adjusted restricted cubic splines modeled the probability of each mortality according to wait time. The inflection point when mortality began to increase was used to define early and late surgery. Outcomes among propensity-score matched early and late surgical patients were compared using percent absolute risk differences (RDs, with 95% CIs). Results Mortality rates began to rise after 16 h of waiting. However, early and late surgery groups showed no significant differences in 30-day mortality (11.4% vs. 5.7%), ICU stay duration (4.3 ± 7.5 vs. 4.3 ± 5.2 days), or total hospital stay (17.4 ± 17.0 vs. 24.7 ± 23.4 days). Notably, patients waiting over 16 h had a significantly higher ICU readmission rate (8.6% vs. 31.4%). The APACHE II score was a significant predictor of 30-day mortality. Conclusions Although we were unable to reveal significant differences in mortality in the subgroup analysis, we were able to find an inflection point of 16 h through the RCS curve technique. Trial registration Formal consent was waived due to the retrospective nature of the study, and ethical approval was obtained from the institutional research committee of our institution (B-2110–714-107) on 6 October 2021.

Abstract Colorectal cancer (CRC) in pregnancy is sporadic. We reported a case of a woman at 23 + 4 weeks of gestation who presented with abdominal pain. The patient underwent an ultrasound and MRI, during which a colonic mass was noted. Considering a probable incomplete intestinal obstruction, a colonoscopy, biopsy, and colonic stenting were performed by a multidisciplinary team. However, sudden hyperthermia and CT demonstrated intestinal perforation, and an emergency caesarean section and colostomy were conducted. The histological analysis confirmed moderately high-grade adenocarcinoma.

Regorafenib is a multikinase inhibitor approved for treatment of patients with metastatic Colo-Rectal Cancer (mCRC) and Gastro-Intestinal Stromal Tumor (GIST) progression after the administration of other tyrosine-kinase inhibitors such as imatinib and sunitinib.Only a handful of severe side effects such as intestinal perforations and fistulas have been described in the literature in patients undergoing multikinase inhibitor treatment. We report a case of a patient with peritoneal mCRC who experienced an intestinal perforation during the administration of Regorafenib and review the literature. A 48-year-old man with previously resected sigmoid colon cancer and peritoneal metastatic disease under Regorafenib treatment presented to our Emergency Department with severe abdominal pain and asthenia. Abdominal X-ray and contrast-enhanced computed tomography examination revealed an intestinal perforation. The patient underwent emergency surgery which demonstrated acute diffuse peritonitis, necrosis, and perforation of a distal ileal loop affected by peritoneal metastatic disease. The necrosis of peritoneal implants on bowel walls could be regarded as a potential factor leading to intestinal perforation in metastatic colorectal cancer patients undergoing Regorafenib treatment complaining of severe abdominal pain and asthenia.Surgeons, radiologists and oncologists should always keep in mind this rare adverse event during Regorafenib administration. Appropriate diagnostic tests and treatments should be carried out.

Simple Summary: Given the wide usage of Bevacizumab in current oncological practice, it is very important to compare the "real-world" results to those obtained in controlled clinical trials. This study aims to describe the clinical experience of using Bevacizumab in a large cohort of cancer patients in "non-controlled real-world" conditions regarding effectiveness, safety, and cost of therapy. For this purpose, we conducted an open, observational, retrospective study involving all patients treated for solid malignant tumors in the Bucharest Institute of Oncology with "Prof. Dr. Al. Trestioreanu" with Bevacizumab-based systemic therapy, between 2017 and 2021. Bevacizumab re-mains a high-cost therapy, but it can add to clinical benefits (like overall survival, progression-free survival, and response rate) when used in conjunction with standard chemotherapy. Similar results as those presented in various controlled trials are observable even on unselected cohorts of patients in the uncontrolled conditions of "real-world" oncological practice. Overall, it is estimated that more than 3,500,000 patients have received Bevacizumab as part of systemic oncologic treatment. Bevacizumab and its biosimilars are currently marketed in over 130 countries. Given the wide usage of Bevacizumab in current oncological practice, it is very important to compare the "real-world" results to those obtained in controlled clinical trials. This study aims to describe the clinical experience of using Bevacizumab in a large cohort of cancer patients in "non-controlled real-world" conditions with regard to effectiveness, safety, and cost of therapy. Methods: For this purpose, we conducted an open, observational, retrospective study involving all patients treated for solid malignant tumors in the Bucharest Institute of Oncology with "Prof. Dr. Al. Trestioreanu" with Bevacizumab-based systemic therapy, between 2017 and 2021. Results: The study consisted of 657 treatment episodes in 625 patients (F/B = 1.62/1, with a median age of 57.6 years) which were treated for malignant tumors (majority colorectal, non-small cell lung, ovarian, and breast cancer). First-line treatment was administered in 229 patients, and the rest received Bevacizumab as second or subsequent lines of treatment. The overall response rate to Bevacizumab-based therapies was around 60–65% across all indication except for subsequent treatment lines in colorectal and ovarian cancers, where lower values were recorded (27.1%, and 31.5% respectively). Median PFS for the entire cohort was 8.2 months (95% CI 6.8–9.6), and the median OS was 13.2 months (95% CI 11.5–14.9). Usual bevacizumab-related toxicities were observed, including bleeding, hypertension, wound-healing complications, gastrointestinal perforation, other types of fistulas, septic complications, and thromboembolic events. Although the clinical benefits are undeniable, the addition of Bevacizumab to standard chemotherapy increased the overall treatment cost by 213%. Conclusions: Bevacizumab remains a high-cost therapy, but it can add to clinical benefits (like overall survival, progression-free survival, and response rate) when used in conjunction with standard chemotherapy. Similar results as those presented in various controlled trials are observable even on unselected cohorts of patients in the uncontrolled conditions of "real-world" oncological practice. Off-label usage is encountered in clinical practice, and this aspect should be monitored given the potential adverse effects of the therapy. [ABSTRACT FROM AUTHOR]

Purpose: Family history is one of the strongest risk factors for inflammatory bowel diseases (IBD) while studies about the clinical phenotype of familial IBD are limited. This study aimed to compare the phenotypic features of familial Crohn's disease (CD) with sporadic CD. Methods: Familial CD was defined as CD patients having one or more first, second, third, fourth degree, or above relatives with CD. Sporadic CD patients hospitalized during the same period were matched 1:3 by age and gender. Differences in clinical characteristics, phenotype distribution, extraintestinal manifestations, and complications at diagnosis, as well as treatment regimen and surgery, were compared between familial and sporadic CD. Results: The familial CD was associated with a higher rate of past appendectomy history (P = 0.009), more intestinal perforation at onset (P = 0.012), more MRI results of anal lesion (P = 0.023), and gastrointestinal perforation (P = 0.040) at diagnosis, higher rate of past intestinal surgery history (P = 0.007), more number of intestinal surgeries (P = 0.037), longer duration of follow-up (P = 0.017), lower rate of taking biologicals for current maintenance (P = 0.043), lower tendency to upgrade to biologicals during follow-up (P = 0.013), higher possibility to experience gastrointestinal obstruction (P = 0.047), and abdominal abscess during follow-up (P = 0.045). Conclusion: Familial CD is associated with a more aggressive clinical phenotype. [ABSTRACT FROM AUTHOR]

Background: Gallbladder perforations are challenging to manage for surgeons due to their high morbidity and mortality, rarity, and surgical approach. Laparoscopic cholecystectomy (LC) is now included with open cholecystectomy in surgical managing gallbladder perforations. This study aimed to evaluate the factors affecting conversion from laparoscopic to open cholecystectomy in cases of type I gallbladder perforation according to the Modified Niemeier classification. Methods: Patients who met the inclusion criteria were divided into two groups: LC and conversion to open cholecystectomy (COC). Demographic, clinical, radiologic, intraoperative, and postoperative factors were compared between groups. Results: This study included 42 patients who met the inclusion criteria, of which 28 were in the LC group and 14 were in the COC group. Their median age was 68 (55–85) years. Age did not differ significantly between groups (p = 0.218). However, the sex distribution did differ significantly between groups (p = 0.025). The location of the perforation differed significantly between groups (p < 0.001). In the LC group, 22 patients were perforated from the fundus, four from the trunk, and two from the neck. In the COC group, two patients were perforated from the fundus, four from the trunk, and eight from the neck. Surgical procedure times differed significantly between the LC (105.0 min [60–225]) and COC (125.0 min [110–180]) groups (p = 0.035). The age of the primary surgeons also differed significantly between the LC (42 years [34–63]) and COC (55 years [36–59]) groups (p = 0.001). Conclusions: LC can be safely performed for modified Niemeier type I gallbladder perforations. The proximity of the perforation site to Calot's triangle, Charlson comorbidity index (CCI), and Tokyo classification are factors affecting conversion from laparoscopic to open surgery of gallbladder perforations. [ABSTRACT FROM AUTHOR]

An 84-year-old female was admitted to our hospital with a chief complaint of abdominal pain and vomiting. Emergency operation was performed as abdomen CT suggested gastrointestinal perforation. During the procedure, many tumorous lesions of the small intestine were found, and one of them was perforated. We suspected malignant lymphoma of the small intestine with perforation, and so performed partial resection of the small intestine, and parts of the specimens were examined by flow cytometry in the fresh state, without formalin fixation. On post operative day 4, flow cytometry revealed that large B-cell antigen was strongly positive, and combined with the pathological examination, we finally diagnosed diffuse large B-cell lymphoma of the small intestine. She was discharged 20 days after emergency surgery for chemotherapy, without any complications. Malignant lymphoma of the small intestine is sometimes diagnosed after surgery for gastrointestinal perforation, and is considered to have a poor prognosis. Therefore, rapid diagnosis of the type of lymphoma and introduction of chemotherapy might be needed. It is suggested that examination of the surgical specimen by flow cytometry in the fresh, not in formalin, may be useful for the rapid diagnosis of the type of malignant lymphoma. [ABSTRACT FROM AUTHOR]

Introduction: Complicated intra-abdominal infection (cIAI) still has a high mortality rate due to organ dysfunction despite advances in supportive care. Unlike other sources of septicemia, cIAI requires source control surgery, which is crucial for improving outcomes. The strategy for source control varies depending on the degree of inflammation associated with cIAI; the more severe the inflammation, the less aggressive the surgery needs to be. Therefore, we need a reliable parameter to predict the degree of inflammation before any physiological rearrangement or organ dysfunction occurs due to excessive inflammation from surgery. The literature shows that CRP, procalcitonin, lactate, and albumin are associated with the degree of inflammation. Thus, it's necessary to study about mentioned parameters for being reference determination strategy of surgery in cIAI, classical definitive laparotomy, or rapid source control laparotomy (RSCL). Methods: We have collected data from CIAI patients at Dr. Soetomo Regional General Hospital in Surabaya, Indonesia, covering November 2022 to April 2024. Our primary focus is assessing the inflammation level associated with the compensated or decompensated phase. The decompensated phase signifies an excessive inflammatory response, with one indication being in-hospital mortality. Subsequently, we performed univariate and multivariate analyses using the SPSS program to determine which laboratory parameters (CRP, Procalcitonin, Lactate, and Albumin) are most associated with in-hospital mortality. Results: Between November 2022 and April 2024, there were 309 patients with complicated intra-abdominal infections (cIAI). Among the patients, 61.8% were male and 38.2% were female. The majority of patients (27.17%) were aged 61-70. The causes of cIAI included perforated appendicitis (22.65%), perforated peptic ulcer (21.69%), complications from previous surgeries (18.13%), large bowel perforation (12.29%), small bowel perforation (11.33%), intraperitoneal abscess (11.33%), and other causes (2.58%). Statistically, lactate was found to be the most accurate predictor of intraoperative hemodynamic instability (p-value < 0.001; correlation coefficient of 0.481), followed by albumin (p-value < 0.001; correlation coefficient of 0.357). CRP and Procalcitonin were less accurate, with correlation coefficients of 0.182 and 0.272, respectively. The determined cut-off points for lactate and albumin were 1.94 and 2.73, for CRP and Procalcitonin were 23,24 and 47,95. Abnormal laboratory finding in our study mean CRP above cut off point, Procalcitonin above cut off point, lactate above cut off point and albumin below cut off point. More than 2 laboratories finding, in-hospital mortality 66,7%, 2 laboratory finding in-hospital mortality 42,8% and only 1 laboratory finding in-hospital mortality 28,4%. Conclusions: CRP, Procalcitonin, Lactate and Albumin have relation statistically significant with in-hospital mortality. Lactate and albumin are better than CRP and procalcitonin in our study, and consider RSCL for more than 2 parameter abnormal laboratory findings CRP, procalcitonin, lactate or albumin. [ABSTRACT FROM AUTHOR]

Perforation of the bowel can be a life-threatening condition and is usually clinically diagnosed when a patient presents with such features as severe abdominal pain, tenderness, and tachycardia. Bowel perforation may be corroborated by various conventional imaging modalities, including X-ray, ultrasonography, computed tomography, and magnetic resonance imaging. Nuclear medicine imaging modalities seldom have a role to play in these settings. Rarely diagnosis of perforation may be missed if it is concealed and does not present with the usual signs. Mostly the perforation will eventually be diagnosed if they develop signs and symptoms and is taken up for an exploratory laparotomy. A delay in diagnosis can later lead to significant patient morbidity or even mortality. This report describes a case where possible intestinal perforation was suspected on a 99mTc-DTPA renogram in a postoperative patient with significant urine leak, the presence of which was confirmed intraoperatively. To our knowledge, this was the first such case in the literature. [ABSTRACT FROM AUTHOR]

Introduction and Importance: Long-term mechanical complications after inferior vena cava (IVC) filter placement include embedded or tilted filters, erosion of the vena cava, filter thrombosis. In the setting of caval thrombosis, patients may subsequently develop venous hypertension and post-thrombotic syndrome (PTS). Here we present three unique cases of IVC filter complications and surgical management. Case Presentation: A 30-year-old female presented with acute abdominal pain, revealing a duodenal perforation caused by an IVC filter eroding into her duodenum. A 42-year-old female with an IVC filter in place for 20 years due to a prior pulmonary embolism underwent laser-assisted retrieval of the filter due to concerns of caval adherence. A 48-year-old male with a history of DVT, venous stasis ulcer, and an IVC filter presented for filter retrieval. Clinical Findings and Investigations: The surgical techniques described in this report include complicated IVC filter retrieval, performed in cases of filter complications including migration, fracture, duodenal perforation and IVC thrombosis resulting in PTS. One case, requiring open retrieval, is explained and the surgical technique is provided. There are images and videos of these procedures to enrich the learning experience. Intervention and Outcomes: The surgical techniques described in this report include complicated inferior vena cava filter retrieval, performed in cases of filter complications including migration, fracture, duodenal perforation and IVC thrombosis. One case, requiring open retrieval, is explained and the surgical technique is provided. There are images and videos of these procedures to enrich the learning experience. Relevance and Impact: Endovascular retrieval of long-term complicated IVC filters is challenging, but it can be a safely performed in many patients. However, open surgery may be necessary in selected patients. [ABSTRACT FROM AUTHOR]

This article discusses a case of chronic nonbacterial osteomyelitis (CNO) complicated by recurrent erythema nodosum (EN) and its successful treatment with salazosulfapyridine (SASP). CNO is a condition characterized by bone lesions and can also present with mucocutaneous symptoms. EN is a skin condition associated with inflammation of the subcutaneous tissue. The patient initially received naproxen for treatment but experienced persistent symptoms. SASP was then introduced and led to remission of both CNO and EN. The use of SASP as a second-line treatment for refractory CNO and EN is suggested. [Extracted from the article]