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Lenvatinib is a medication that targets multiple tyrosine kinases and is commonly used to treat various types of cancer. With its frequent usage, monitoring and assessing its potential adverse effects has become crucial. This study utilizes the US Food and Drug Administration Adverse Event Reporting System (FAERS) database to analyze the possible link between lenvatinib and gastrointestinal perforation. FAERS was used to analyze adverse drug reactions (ADRs) linked with lenvatinib from the first quarter of 2015 to the last quarter of 2022. The association between lenvatinib and gastrointestinal perforation was evaluated using disproportionality analyses. This study included 464 patients who developed gastrointestinal perforation after using lenvatinib. Perforation involved the entire digestive tract, with the colon among the most commonly affected perforation sites, and previously undetected esophageal perforation was frequently observed. Patients with uterine and liver cancer were at a higher risk of developing gastrointestinal perforation; patients with liver cancer experienced a shorter onset time, whereas patients with endometrial cancer had a slower onset time. Middle‐aged and elderly patients exhibited a higher propensity for developing gastrointestinal perforation than younger adults. Patients with gastrointestinal perforation were found to have a significantly higher mortality rate than patients without gastrointestinal perforation. This study has identified several gastrointestinal perforation events not included in the drug instructions. It has also described the perforation site and clinical characteristics based on various types of cancer. These results could provide valuable insights for developing safer and more effective regulatory strategies concerning the use of lenvatinib. [ABSTRACT FROM AUTHOR]

The article focuses on a case of spontaneous intestinal perforation (SIP) in a preterm infant born to a mother with a history of cocaine use and placental abruption. Topics discussed include the pathophysiology, incidence, presentation, radiologic imaging, management, and differential diagnosis of SIP. On day of life 15, a surgical consult was obtained, and a cross-table lateral view revealed a pneumoperitoneum, leading to the diagnosis of SIP.

Colonoscopy is the most sensitive and specific test for detecting colon cancer and is a common procedure performed in over 19 million people annually in the United States as of 2017. Though the incidence of complications from colonoscopy is low, there are several important complications that may require surgical intervention including bowel perforation, bleeding, splenic injury, and diverticulitis. Post-polypectomy coagulation syndrome (PPCS) is an uncommon complication of colonoscopy however, clinical presentation mimics bowel perforation and the differentiation between the two is vital as the management differs. Herein we present a case of a 43-year-old female with abdominal pain after undergoing colonoscopy and developed PPCS. • Post-polypectomy coagulation syndrome is a rare complication following colon polypectomy using electrocauterization. • Patients with abdominal pain after colonoscopy should be evaluated with cross-sectional imaging to rule out perforation. • Focal mural wall thickening with surrounding fat infiltration and absence of extraluminal air are imaging hallmarks of PPCS. [ABSTRACT FROM AUTHOR]

Background: Minimal access surgery (MAS) has suggested improvements in clinical outcomes compared to open surgery in several abdominal elective and emergency surgeries. The aims of this study were to compare England with the United States in the utilisation of MAS and mortality from four common abdominal surgical emergencies.Methods: Between 2006 and 2012, the rate of MAS and in-hospital mortality for appendicitis, incarcerated or strangulated abdominal hernia, small or large bowel and peptic ulcer perforation were compared between England and the United States. Univariate and multivariate analyses were performed to adjust for differences in baseline patient demographics.Results: 132,364 admissions in England were compared to an estimated 1,811,136 admissions in the United States. Minimal access surgery was used less commonly in England for appendicitis (odds ratio (OR) 0.27, 95% CI 0.267-0.278), abdominal hernia (OR 0.16, 95% CI 0.15-0.17), small or large bowel perforation (OR 0.33, 95% CI 0.32-0.35) and peptic ulcer perforation (OR 0.93, 95% CI 0.87-0.99). In-hospital mortality was increased in England compared to the United States for all four conditions: appendicitis (OR 2.11, 95% CI 1.66-2.68), abdominal hernia (OR 3.25, 95% CI 3.10-3.40), small or large bowel perforation (OR 3.88, 95% CI 3.76-3.99) and peptic ulcer perforation (OR 3.09, 95% CI 2.94-3.25). In England, after adjustment for patient demographics, open surgery was associated with increased in-hospital mortality for abdominal hernia (OR 1.80, 95% CI 1.26-2.71), small or large bowel perforation (OR 1.59, 95% CI 1.37-1.87) and peptic ulcer perforation (OR 2.31, 95% CI 1.91-2.82).Conclusions: Minimal access surgery was performed less commonly and in-hospital mortality was increased in England compared to the United States for common abdominal surgical conditions. Therefore, strategies to enhance adoption of MAS in emergency conditions in England need to be optimised and include appropriate patient selection and improved surgeon MAS training. [ABSTRACT FROM AUTHOR]

Background: Desmoid tumors (or aggressive fibromatosis) are locally infiltrative connective-tissue tumors that can arise in any anatomic location; they can be asymptomatic, or they can result in pain, deformity, swelling, and loss of mobility and/or threaten visceral organs with bowel perforation, hydronephrosis, neurovascular damage, and other complications. Existing clinical trial endpoints such as the Response Evaluation Criteria in Solid Tumors (version 1.1) and progression-free survival are inadequate in capturing treatment efficacy. This study was designed to develop a novel clinical trial endpoint by capturing patient-reported outcomes (PROs).Methods: Following best practices in qualitative methodology, this study used concept elicitation (CE) interviews to explore desmoid patients' perspectives on key disease-related symptoms and impacts. Qualitative analysis was performed to determine the relative frequency and disturbance of symptoms and impacts as well as other characteristics of these concepts. A draft PRO scale was then developed and tested with cognitive interviewing. Information from the interviews was subsequently incorporated into the refined PRO scale.Results: CE interviews with desmoid patients (n = 31) helped to identify salient concepts and led to a draft scale that included symptom and impact scales. Cognitive interviews were completed with additional patients (n = 15) across 3 phases. Patient input was used to refine instructions, revise and/or remove items, and modify the response scale. This resulted in an 11-item symptom scale and a 17-item impact scale.Conclusions: This is the first disease-specific PRO instrument developed for desmoid tumors. The instrument is available as an exploratory endpoint in clinical trials. This study highlights the feasibility and challenges of developing PRO instruments for rare diseases. [ABSTRACT FROM AUTHOR]

Intestinal tuberculosis (ITB) and Crohn's disease (CD) very closely resemble each other in symptomatology, imaging, appearance, and pathology. While ITB is rare in the United States, its prevalence is significantly higher in endemic areas, thus presenting a diagnostic dilemma in immigrant populations from high-risk countries. This patient was diagnosed with CD and treated with anti-TNF agents after indeterminate screening for latent tuberculosis. He was then admitted with septic shock and intestinal perforation due to disseminated tuberculosis. This case demonstrates the importance the consideration of ITB when a patient with risk factors for TB fails to respond to treatment for CD. [ABSTRACT FROM AUTHOR]

Background Time to intervention is suggested to be a crucial factor for a number of surgical conditions. In this study, we aim to examine the postoperative outcomes associated with the timing of surgical intervention in patients with perforated bowel. Materials and methods Cross-sectional study using the Nationwide Inpatient Sample database, 2003-2010. The study population included adult (≥18 y) inpatients who had perforated intestine or colon and underwent bowel surgery. Results A total of 5412 (64.6%) patients who had an early surgical intervention on same day of admission and 2985 (35.4%) patients who had a delayed surgery were included. Patients with comorbidities or those in hospitals in the Northeast region of the United States were more likely to have a delayed intervention ( P < 0.01). In low-risk patients who are aged <65 y old and with no comorbidities, the timing of surgery did not associate with the risk of postoperative complications ( P = 0.77) and mortality ( P = 0.08), whereas in high-risk patients who are aged ≥65 y old or with comorbidities, an early surgical intervention was associated with a lower risk of complications (odds ratio: 0.77; 95% CI: 0.69-0.87; P < 0.001), and a lower mortality risk (odds ratio: 0.79; 95% CI: 0.68-0.92; P = 0.002). Patients with a delayed intervention were associated with a hospital stay >15 d ( P < 0.001) and a higher cost of health services ( P < 0.01). Conclusions Patients treated in the Northeast of the United States were more likely to experience a delayed surgery. Delay of surgical intervention is associated with unfavorable outcomes only in older patients or those with comorbidities. [ABSTRACT FROM AUTHOR]

Objective:Mother's own milk and donor human milk use is increasing as a means of necrotizing enterocolitis (NEC) prevention. Early onset of enteral feeding has been associated with improvement of many outcomes but has not been shown to reduce the incidence of NEC. Better definition of the window of risk for NEC by gestational strata should improve resource management with respect to donor human milk and enhance our understanding of NEC timing and pathogenesis. Our objective was to establish a NEC dataset of sufficient size and quality, then build a generalizable model of NEC onset from the dataset across gestational strata.Study Design:We used de-identified data from the Pediatrix national dataset and filtered out all diagnostic confounders that could be identified by either specific diagnoses or logical exclusions (example dual diagnoses), with a specific focus on NEC and spontaneous intestinal perforation (SIP) as the outcomes of interest. The median day of onset was plotted against the gestational age for each of these diagnoses and analyzed for similarities and differences in the day of diagnosis.Result:Onset time of medical NEC was inversely proportional to gestation in a linear relationship across all gestational ages. We found the medical NEC dataset displayed characteristics most consistent with a homogeneous disease entity, whereas there was a skew towards early presentation in the youngest gestation groups of surgical NEC (suggesting probable SIP contamination).Conclusion:Our national dataset demonstrates that NEC onset occurs in an inverse stereotypic, linear relationship with gestational age at birth. Medical NEC is the most reliable sub-cohort for the purpose of determining the temporal window of NEC risk. [ABSTRACT FROM AUTHOR]

Abstract: Personal watercrafts (PWC), also known as jet skis, seadoos, and wave-runners have risen in popularity since their introduction in the 1970s. Hydrostatic rectal injury is a rare presentation of passengers thrown off a PWC. The perforation of the rectum is owing to the excessive hydrostatic force of water exerted through the anal canal. We present the first case of rectosigmoid perforation secondary to PWC hydrostatic injury in Canada. A 14-year-old female passenger presented to the pediatric trauma center with severe abdominal pain and blood per rectum following a fall off the back of a PWC at a local lake. Computed tomography of the abdomen and pelvis demonstrated a laceration in the anterolateral rectal wall at the rectosigmoid junction with associated free intra-peritoneal air and profuse free fluid. At exploratory laparotomy, a full thickness perforation was identified at the rectosigmoid junction. The rectum was oversewn as a Hartman pouch, and a proximal end colostomy was performed to divert the fecal stream. Management of traumatic pediatric rectal injuries involves detailed perineal examination with proctoscopy, and if warranted, exploratory laparotomy. Despite the rare occurrence of hydrostatic rectal perforations in Canada, it is a serious and potentially devastating injury. In the United States, the National Transportation Safety Board recommends wet suit bottoms for all pediatric PWC operators and passengers. In Canada, similar recommendations have not been made. The use of PWC in Canada is less common than in the US. However, it is steadily increasing, especially on local lakes. Education regarding potential injuries and prevention is recommended. [Copyright &y& Elsevier]

Reports on debate concerning the cost-effectiveness of colonoscopy colon cancer screening test. Cost-effectiveness studies of the colonoscopy technique; Inadequacy of cost-effectiveness analyses as basis for policy making; Questions regarding the relative safety of colonoscopy; Importance of compliance measures in analyses.