Search

Background: Anastomotic leakage (AL) is the main complication of colorectal surgeries. Recent studies have assessed the effects of the ghost ileostomy on preventing complications related to a defunctioning stoma (DS) in high-risk anastomoses. In this study, we aimed to review patients who underwent ghost ileostomy and assess their colon leakage score (CLS) and Dutch leakage score (DULK) to evaluate their preoperative AL risk and post-operative AL diagnostic score, respectively. We examined whether the suggested cut-off points of these scores (>11 for CLS and >4 for DULK) could be appropriate criteria for determining when to insert ghost ileostomy and when to convert it to a DS. Methods: All patients from three referral hospitals in Shiraz, Iran who underwent colorectal surgery with ghost ileostomy during 2019-2020 were enrolled in this retrospective case series. We calculated preoperative CLS and post-operative DULK scores for all patients and assessed what diagnostic and therapeutic measures were performed for them based on their scores. Results: AL was diagnosed in two of 34 patients. Eight patients had a total CLS score of 11 and above, but only one of them experienced AL. The other case of AL had a CLS score of 10. The DULK score of these two patients increased during hospitalization. Conclusion: Because of the importance of accurately identifying high-risk patients for ghost ileostomy, it is imperative to undertake additional research aimed at determining the optimal cut-off value for CLS or devising alternative valid scoring systems. DULK score could be an appropriate post-operative monitoring tool to reduce morbidity. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Patients with chronic functional constipation have some problems such as weakness of pelvic floor muscles, and a lack of coordination of pelvic floor and abdominal muscles has been seen. The goal of this study was to investigate the lumbar proprioception and the core muscle recruitment pattern. Methods: The study type is a cross-sectional case–control study. There were 30 participants (case, n = 15, and control, n = 15). Electromyography of the core muscles was recorded while the subjects were getting up from the chair accompanied by lifting a weight, to check the pattern of muscle recruitment. Moreover, the lumbar proprioception was evaluated by an isokinetic device in both groups. The study was analyzed using independent t test and Mann–Whitney U test, and a nonparametric Friedman test was performed followed by Bonferroni pairwise comparison. Results: The comparison of muscle activity delay between the two groups showed that there was a significant difference between the two groups regarding the abdominal muscles, anal sphincter, and erector spinae (p < 0.05). However, there was no significant difference in the rectus femoris and gluteal muscles between the two groups (p > 0.05). Moreover, the proprioception of the lumbar region showed a significant difference (p < 0.05) between the two groups. Conclusions: The results of this study demonstrated that the lumbar proprioception sense was reduced in the case group. This result can be justified, based on the problems in constipation (lack of coordination of muscles, weakness of pelvic floor muscles). The coordination of core muscles changed in patients with chronic functional constipation during a functional task. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Abdominal cocoon syndrome and Chilaiditi syndrome are rare etiologies of bowel obstruction which have to be considered in patients with obstructive symptoms. Patients can profit from surgical management rather than non‐surgical approach. Encapsulating peritoneal sclerosis or abdominal cocoon syndrome (ACS) is an uncommon cause of intestinal obstructions associated with encapsulation of the small bowel by a fibro collagenous sac. Clinical presentations of ACS are unspecific and most patients are diagnosed intraoperatively. Moreover, Chilaiditi syndrome is another rare cause of bowel obstruction defined by interposition of colon and liver. There is no reported relation between these two conditions and surgical intervention is the suggested approach for severe bowel obstruction following them individually. We present a case with both conditions and describe our approach. A 47‐year‐old male presented with complaints of colic abdominal pain and distention, nausea and several attacks of bilious and nonbilious vomiting, anorexia, and constipation in the last 10 days before his admission. Laboratory data were normal and abdominal X‐ray showed large dilation at the distal part of the bowel without air fluid level. The patient underwent explorative laparotomy and a mass‐like lesion containing necrotic bowel and a whitish spleen accompanied by a complete anterior‐rotated liver was found. The encapsulated bowel and the spleen were resected followed by the complete resolution of symptoms in the patient. The intestinal obstruction caused by ACS is mostly approached by surgery to prevent the fatal sequela of this condition. [ABSTRACT FROM AUTHOR]

Background Empowering adolescents in the field of puberty health is one of the important goals of public health programs. The present study was carried out with the aim of determining the effect of peer-led training on puberty-related behavior and its determinants using social cognitive theory., Methods: A total of 245 teenage girls were randomly divided into two groups: the intervention group and the comparison group. The questionnaire measuring puberty-related behavior and its determinants was self-administered and completed before and 2 months after training in the two groups. One session for parents, four sessions for peer educators, and four sessions for participants were conducted for 1 month., Results: In the intervention group, unlike the comparison group, the mean scores of knowledge, outcome expectations, self-efficacy, self-control, social support, and behavior increased significantly after training (p <0.05). Based on regression analysis, outcome expectations and social support were the main determinants of puberty-related behavior (adjusted R 2 = 0.464)., Conclusion: The findings of this study support the effectiveness of the peer-led educational intervention based on social cognitive theory in the improvement of puberty-related behavior and its determinants, which can be used in the design of puberty-related health promotion programs. Further research to assess the longer-term outcomes and to examine other theories of behavior change are suggested., Competing Interests: Conflicts of Interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier Masson SAS.)