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This case report provides an account of transcutaneous ventriculo-peritoneal (VP) shunt extrusion with silent bowel perforation occurring 2 years post digestive surgery. A 22-year-old man treated since childhood for post-infectious hydrocephalus was referred to our neurosurgery department for an inflammatory wound to the right hypochondrium caused by an abandoned calcified VP shunt. This VP shunt was surgically removed without complications. The perforated bowel required no direct repair. Progress is favorable at 1 year follow-up. [ABSTRACT FROM AUTHOR]

Background: Ascites in the fetal period persisting into the neonatal period is a rare condition occurring due to a variety of causes, including urinary, bilious, chylous, congenital infections, peritonitis, gastrointestinal malformations, or metabolic diseases. Gastrointestinal malformations account for very few such cases. Clinical Description: We report a rare case of a preterm male newborn, delivered at 31 + 1 weeks with antenatal suspicion of fetal hydrops and oligohydramnios. The baby was born with isolated massive ascites with respiratory distress, though was hemodynamically stable. There was no pallor, and air entry was reduced in both lungs with normal cardiovascular evaluation. Management and Outcome: He underwent a complete evaluation for isolated fetal ascites, including echocardiography, ultrasound, and blood investigations. Erect abdominal X-ray showed air under the diaphragm, following which the newborn underwent laparotomy, which confirmed gastric perforation. Surgical repair resulted in the resolution of ascites. Postoperatively, supportive care, mechanical ventilation, total parenteral nutrition, and intravenous antibiotics were provided. The baby gradually tolerated enteral feeds by day 15 and was discharged on day 38. Conclusion: Gastric perforation in the intrauterine period should be kept as one of the differential diagnoses in newborns presenting with isolated ascites, the perforation may be spontaneous or idiopathic.

Percutaneous nephrolithotomy (PCNL) is the procedure of choice for large kidney stones, but serious complications such as bowel perforation may occur. We discuss the diagnosis and management of colonic and small-bowel perforations due to PCNL and suggest principles for care and prevention. We emphasize the significance of imaging tools to direct percutaneous access, the importance of early diagnosis, and the relatively high success rate for conservative management. Patient summary: Large kidney stones are usually treated with a keyhole surgery procedure called percutaneous nephrolithotomy (PCNL). A rare but serious complication of this procedure is puncture of the bowel. We discuss how to prevent, diagnose, and treat this complication in patients undergoing PCNL.

Introduction: Although patients with Rapunzel syndrome are often asymptomatic, rare complications such as isolated gastric or duodenal perforation, pancreaticobiliary or intestinal obstruction, and intussusception have been described. Case presentation: A 5-year-old female with no known medical history presented after nearly two weeks of worsening constipation, abdominal distension, and abdominal pain. A CT scan demonstrated a large gastric bezoar, pneumoperitoneum, and large volume complex free fluid. The patient was taken to the operating room for an abdominal exploration. We found a large gastric trichobezoar with hair extending into the small bowel, consistent with Rapunzel syndrome. The gastric trichobezoar was connected to a mid-ileal trichobezoar through interdigitating hair fibers. At multiple locations along the small bowel, garroted linear perforations had occurred due to tension created by the intestinal peristalsis along the interconnecting hair fibers, creating mucosal ulcerations and transmural pressure necrosis that required an extensive small bowel resection. Ultimately, we did one end-end small bowel anastomosis and placed a gastrostomy tube. Gastrostomy tube feeds were started on postoperative day 6 after confirming with a contrast study that there were no intestinal leaks. She developed a superficial wound infection that was managed with antibiotics and negative pressure wound therapy. She was discharged tolerating regular diet on post-operative day 23, and is undergoing psychiatric therapy. Conclusion: Although rare, Rapunzel syndrome can lead to severe complications. When two trichobezoars are present, interconnecting hair fibers can cause small bowel perforations.

Background: The gastrointestinal (GI) tract represents one of the main targets of typical hemolytic uremic syndrome (HUS) in children. In this observational study, we tried to establish (1) the main features of GI complications during STEC-HUS and (2) the relationship between Escherichia coli serotypes and Shiga toxin (Stx) variants with hepatopancreatic involvement. Methods: A total of 79 STEC-HUS patients were admitted to our pediatric nephrology department between January 2012 and June 2021. Evidence of intestinal, hepatobiliary, and pancreatic involvements was reported for each patient, alongside demographic, clinical, and laboratory features. Frequency of gastrointestinal complications across groups of patients infected by specific E. coli serotypes and Stx gene variants was evaluated. Results: Six patients developed a bowel complication: two developed rectal prolapse, and four developed bowel perforation which resulted in death for three of them and in bowel stenosis in one patient. Acute pancreatitis was diagnosed in 13 patients. An isolated increase in pancreatic enzymes and/or liver transaminases was observed in 41 and 15 patients, respectively. Biliary sludge was detected in three, cholelithiasis in one. Forty-seven patients developed direct hyperbilirubinemia. Neither E. coli serotypes nor Shiga toxin variants correlated with hepatic or pancreatic involvement. Conclusions: During STEC-HUS, GI complications are common, ranging from self-limited elevation of laboratory markers to bowel perforation, a severe complication with a relevant impact on morbidity and mortality. Hepatopancreatic involvement is frequent, but usually short-lasting and self-limiting. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This report emphasizes the significance of acknowledging infrequent yet severe complications such as bowel perforation and transanal protrusion post ventriculoperitoneal shunt (VPS) surgery. VPS patients should be observed for atypical indicators and manifestations that could suggest the presence of such complications, even in the lack of traditional clinical signs of peritonitis or bowel perforation. Placing an intracranial shunt, may be a reasonable approach to decrease the complications of hydrocephalus and it can be done either simultaneous to cranioplasty or not. Ventriculoperitoneal shunts were first proposed in 1905 and has been used since. Similar to any other procedure, there are different complications to this surgery. Abdominal complications, including peritoneal pseudocysts, intestinal volvulus, protruding in hernial sac or extrusion through vagina, scrotum, umbilicus or gastrointestinal tract, are rare but according to previous studies happen in 5%–47% of cases. Bowel perforation is a rare complication and can happen in 0.01%–0.07% of patients. It's also worth mentioning that only 25% of patients with bowel perforation experience the classic clinical symptoms of peritonitis or bowel perforation. This particular complication should not be overlooked since it can cause a high mortality rate of 15%. Here we present a case of transanal protrusion of ventriculoperitoneal shunt after an asymptomatic bowel perforation, in an adult who has undergone surgery after a traumatic brain injury. The patient has undergone surgery and lastly the shunt was manually removed from anus. He was monitored for 3 days and eventually discharged. [ABSTRACT FROM AUTHOR]

Gastrointestinal tract perforation is uncommon in children, accounting for <10% of cases of blunt abdominal trauma. Diagnosis of bowel perforation in children can be challenging due to poor diagnostic imaging accuracy. Intra-abdominal free air is found only in half of the children with bowel perforation. Ultrasound findings are nonspecific and suspicious for perforation in only two-thirds of cases. A computer tomography (CT) scan has a sensitivity and specificity of 50% and 95%, respectively. Surgical decisions should be made based on clinical examination despite normal CT results. Management of bowel perforation in children includes primary repair in 50–70% and resection with anastomosis in 20–40% of cases. [ABSTRACT FROM AUTHOR]

Magnetic foreign body ingestion poses a threat especially if more than one is ingested. If consumed alone, small magnetic foreign bodies are likely to pass without significant event; however, when multiple magnets are ingested, they can be attracted to each other through the intestinal wall, which may lead to serious consequences and complications, including bowel perforation, obstruction, peritonitis, and death. We report a case of a 2-years male child patient presented with multiple small round magnetic beads ingestion from a magnetic pendant that appeared like a necklace pearl after conglomeration on abdominal radiograph. On exploration, we found multiple perforations involving ileum, cecum, and transverse colon, with multiple conglomerated beads extruding from the perforation sites. [ABSTRACT FROM AUTHOR]

Toxic megacolon (TM) is a severe condition characterized by acute colonic dilation, with specific radiological and clinical signs. The multifactorial etiology of TM is primarily associated with inflammatory bowel disease and infections. However, TM remains a challenging complication due to its potential for rapid progression to life-threatening conditions. This report describes a rare case of TM in a 25-year-old male with a history of recurrent constipation and chronic cocaine consumption. Examination and imaging indicated acute intestinal obstruction with dilated colon segments and fecal impaction, necessitating an urgent laparotomy. Surgery revealed pan-colonic dilatation and sigmoid perforations, leading to a total colectomy and ileostomy. Chronic constipation, often perceived as benign, can escalate into a critical situation, possibly exacerbated by cocaine-induced muscle weakness and hypoxia. Evidence suggests that cocaine negatively affects the intestinal mucosa, potentially leading to ischemia. Chronic factors, including the use of enemas, may have contributed to megacolon development and perforation. Overall, this report underscores the critical elements of diagnosis and the importance of patients’ medical history, particularly those with unusual risk profiles. In addition, it highlights the need for further research to fully understand the implications of these cases.

Bowel perforation secondary to a levonorgestrel-releasing intrauterine device is exceptionally rare. We present the case of a woman who exhibited abnormal findings during a colonoscopy examination. Despite undergoing an intrauterine device (IUD) insertion procedure for contraception in 2000, attempts for its removal in 2007 were unsuccessful due to the inability to locate the IUD. In 2022, she presented with intermittent hematochezia and lower left abdominal pain. Subsequent colonoscopy and abdominal computed tomography confirmed the presence of the IUD penetrating the uterine wall and entering the colon. Laparoscopic anterior resection was performed, and the patient's postoperative recovery was uneventful, indicating the viability of laparoscopic treatment as a valuable option. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Brucellosis, caused by gram‐negative coccobacilli of the genus Brucella, is a zoonotic disease with bone and joint complications being common. However, acute abdomen with intestinal perforation is rare. We present a case of a 69‐year‐old man diagnosed with acute diffuse peritonitis and intestinal perforation due to Brucella infection. Surgical intervention revealed ileocecal perforation with wheel spoke‐like necrosis. The patient underwent partial resection, ileum closure, and ileostomy. Positive blood culture and Brucella agglutination confirmed the diagnosis. Targeted tetracycline and aminoglycoside treatment led to recovery. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Delayed intestinal perforation has various manifestations. For peritonitis with delayed treatment and multi‐bacterial peritonitis, we should be alert to the occurrence of this rare complication. Abdominal CT examination and imaging results judgment based on clinical conditions are particularly important for diagnosis. Delayed intestinal perforation of peritoneal dialysis catheter is a rare but serious complication. We reported a 49‐year‐old patient who had been hospitalized twice within 3 months due to poor drainage of the peritoneal dialysis catheter. During the first hospitalization, peritoneal dialysis‐related peritonitis was diagnosed, and a variety of bacterial infections were cultivated. However, at that time, the actual peritoneal dialysis catheter‐related intestinal perforation was missed, and he was discharged after anti‐infection treatment until a clinical cure was met. After more than 2 months of normal peritoneal dialysis after returning home, the patient again had poor drainage of the peritoneal dialysis catheter, accompanied by the outflow of yellowish‐brown sediment. It was found that the peritoneal dialysis catheter had evidence of intestinal perforation. After the removal of the catheter and intestinal repair, he recovered and was discharged from the hospital and received long‐term hemodialysis treatment. In the case of delayed intestinal perforation, peritoneal dialysis was maintained normally for more than 2 months, which was an unprecedented situation in previous case reports. In addition, we should be alert to the occurrence of this rare complication, especially when we find the occurrence of polybacterial Peritonitis. Abdominal CT examination and imaging results judgment based on clinical conditions are particularly important for diagnosis. [ABSTRACT FROM AUTHOR]

Key Clinical Message This report emphasizes the significance of acknowledging infrequent yet severe complications such as bowel perforation and transanal protrusion post ventriculoperitoneal shunt (VPS) surgery. VPS patients should be observed for atypical indicators and manifestations that could suggest the presence of such complications, even in the lack of traditional clinical signs of peritonitis or bowel perforation. Abstract Placing an intracranial shunt, may be a reasonable approach to decrease the complications of hydrocephalus and it can be done either simultaneous to cranioplasty or not. Ventriculoperitoneal shunts were first proposed in 1905 and has been used since. Similar to any other procedure, there are different complications to this surgery. Abdominal complications, including peritoneal pseudocysts, intestinal volvulus, protruding in hernial sac or extrusion through vagina, scrotum, umbilicus or gastrointestinal tract, are rare but according to previous studies happen in 5%–47% of cases. Bowel perforation is a rare complication and can happen in 0.01%–0.07% of patients. It's also worth mentioning that only 25% of patients with bowel perforation experience the classic clinical symptoms of peritonitis or bowel perforation. This particular complication should not be overlooked since it can cause a high mortality rate of 15%. Here we present a case of transanal protrusion of ventriculoperitoneal shunt after an asymptomatic bowel perforation, in an adult who has undergone surgery after a traumatic brain injury. The patient has undergone surgery and lastly the shunt was manually removed from anus. He was monitored for 3 days and eventually discharged.

Sclerosing encapsulating peritonitis also known as cocoon abdomen is a rare chronic inflammatory condition of the peritoneum in which the bowel loops are encircled by a membrane (cocoon formation) within the peritoneal cavity leading to intestinal obstruction. It can be primary (idiopathic) or secondary (chemotherapy, beta-blockers, peritoneal dialysis, shunts, tuberculosis, systemic lupus erythematosus, etc.). The symptomatology report includes recurrent episodes of abdominal pain and vomiting. We present here a case of a 32-year-old male who presented with complaints of being unable to pass stools, vomiting (3–4 times), and abdomen pain for 4 days. This case is considered worth mentioning due to its rarity, lack of identification of secondary causes, and diminutive mention of histopathological aspect.

Key Clinical Message Brucellosis, caused by gram‐negative coccobacilli of the genus Brucella, is a zoonotic disease with bone and joint complications being common. However, acute abdomen with intestinal perforation is rare. We present a case of a 69‐year‐old man diagnosed with acute diffuse peritonitis and intestinal perforation due to Brucella infection. Surgical intervention revealed ileocecal perforation with wheel spoke‐like necrosis. The patient underwent partial resection, ileum closure, and ileostomy. Positive blood culture and Brucella agglutination confirmed the diagnosis. Targeted tetracycline and aminoglycoside treatment led to recovery.

Lymphangioleiomyomatosis is a rare cystic lung disease primarily affecting premenopausal females and may be exacerbated by pregnancy. We conducted a literature review of lymphangioleiomyomatosis during pregnancy with a specific focus on related maternal morbidity and obstetrical outcomes. We also report a case of lymphangioleiomyomatosis that presented as an acute spontaneous pneumothorax in the third trimester of pregnancy, followed by significant maternal morbidity. A 37-year-old primigravid woman who presented at 29 weeks 5 days gestation with chest pain was diagnosed with spontaneous pneumothorax. Further imaging demonstrated cystic lung lesions and renal angiomyolipomas. She developed severe abdominal pain concerning for placental abruption that led to an urgent cesarean delivery at 30 weeks 2 days gestation. Her course was complicated by recurrent pneumothorax, superimposed preeclampsia, and significant ileus and bowel dilation complicated by bowel perforation. For patients with a clinical suspicion of lymphangioleiomyomatosis in pregnancy, prompt recognition, diagnosis, and referral to appropriate multidisciplinary subspecialists is critical to mitigate complications and optimize outcomes both during and after pregnancy.

Key Clinical Message Delayed intestinal perforation has various manifestations. For peritonitis with delayed treatment and multi‐bacterial peritonitis, we should be alert to the occurrence of this rare complication. Abdominal CT examination and imaging results judgment based on clinical conditions are particularly important for diagnosis. Delayed intestinal perforation of peritoneal dialysis catheter is a rare but serious complication. We reported a 49‐year‐old patient who had been hospitalized twice within 3 months due to poor drainage of the peritoneal dialysis catheter. During the first hospitalization, peritoneal dialysis‐related peritonitis was diagnosed, and a variety of bacterial infections were cultivated. However, at that time, the actual peritoneal dialysis catheter‐related intestinal perforation was missed, and he was discharged after anti‐infection treatment until a clinical cure was met. After more than 2 months of normal peritoneal dialysis after returning home, the patient again had poor drainage of the peritoneal dialysis catheter, accompanied by the outflow of yellowish‐brown sediment. It was found that the peritoneal dialysis catheter had evidence of intestinal perforation. After the removal of the catheter and intestinal repair, he recovered and was discharged from the hospital and received long‐term hemodialysis treatment. In the case of delayed intestinal perforation, peritoneal dialysis was maintained normally for more than 2 months, which was an unprecedented situation in previous case reports. In addition, we should be alert to the occurrence of this rare complication, especially when we find the occurrence of polybacterial Peritonitis. Abdominal CT examination and imaging results judgment based on clinical conditions are particularly important for diagnosis.

Key Clinical Message: Fetal meconium periorchitis (MPO) is rare prenatal diagnosis associated with meconium peritonitis. The prenatal ultrasound finding consists of an enlarged fetal scrotum with echogenic fluid and debris. In this report, we describe a case in which a prenatal diagnosis of MPO was accurately made at 32 weeks of gestation. The neonate delivered without complications, underwent immediate evaluation followed by major surgery, and ultimately had a favorable outcome. An accurate prenatal diagnosis is important to counsel the patient in a multidisciplinary approach. This case highlights the prenatal ultrasound findings as well as the neonatal presentation and the possibility for conservative management by pediatric urology. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Tuberculosis has been declared a global emergency by the World Health Organization (WHO) and is the most important communicable disease worldwide. The disease may involve any system of the body but abdomen is one of the commonest sites of involvement after lungs. Most patients with abdominal TB can be treated with anti TB therapy alone but some may require surgery to relieve the obstruction either by stricturoplasty or resection and anastomosis. AIM AND OBJECTIVES: To observe the incidence of Intestinal Tuberculosis among all the cases presenting to the acute surgical care, Osmania General Hospital as intestinal obstruction, various modes of management and outcome among these cases. MATERIALS AND METHODS: A retrospective study of 41 patients presenting to the acute surgical care unit of the upgraded department of General Surgery of Osmania General Hospital, Hyderabad, with Intestinal Obstruction due to Tuberculosis, from 2011 to 2014. The main inclusion criteria being the histopathological positivity of the specimen for tuberculosis. All cases of TB Peritonitis, Perforation due to TB have been excluded. RESULTS & CONCLUSION: Bowel obstruction resulting from intestinal tuberculosis is one of the most common abdominal surgical emergencies and contributes significantly to high morbidity and mortality. Young age at presentation, delayed presentation and high morbidity and mortality are among the hallmarks of the disease. A high index of suspicion, proper evaluation and therapeutic trial in suspected patients is essential for an early diagnosis and timely definitive treatment, in order to decrease the morbidity and mortality associated with this disease. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Epstein–Barr virus (EBV) is a commonly asymptomatic widespread human herpes virus affecting over 90% of the population. It mostly originates complications like simple sore throat and infectious mononucleosis but severe manifestations are rare. Herein we report a 30‐year‐old immunocompetent man who presented with fever, sore throat, general weakness, and drowsiness. The diagnosis was formulated based on the positive RT‐PCR test for EBV DNA and serological detection of IgM antibody against viral capsid antigen. The patient developed severe meningoencephalitis, myocarditis, and bowel perforation and passed away after 72 days of hospitalization. [ABSTRACT FROM AUTHOR]

Gastrointestinal tract perforation is uncommon in children, accounting for

Key Clinical Message Fetal meconium periorchitis (MPO) is rare prenatal diagnosis associated with meconium peritonitis. The prenatal ultrasound finding consists of an enlarged fetal scrotum with echogenic fluid and debris. In this report, we describe a case in which a prenatal diagnosis of MPO was accurately made at 32 weeks of gestation. The neonate delivered without complications, underwent immediate evaluation followed by major surgery, and ultimately had a favorable outcome. An accurate prenatal diagnosis is important to counsel the patient in a multidisciplinary approach. This case highlights the prenatal ultrasound findings as well as the neonatal presentation and the possibility for conservative management by pediatric urology.

Key Clinical Message Epstein–Barr virus (EBV) is a commonly asymptomatic widespread human herpes virus affecting over 90% of the population. It mostly originates complications like simple sore throat and infectious mononucleosis but severe manifestations are rare. Herein we report a 30‐year‐old immunocompetent man who presented with fever, sore throat, general weakness, and drowsiness. The diagnosis was formulated based on the positive RT‐PCR test for EBV DNA and serological detection of IgM antibody against viral capsid antigen. The patient developed severe meningoencephalitis, myocarditis, and bowel perforation and passed away after 72 days of hospitalization.

Introduction: Ehlers–Danlos syndromes (EDS) comprise a rare variety of genetic disorders, affecting all types of collagen. Herein, we describe a case of the vascular type of EDS, with coexisting segmental absence of intestinal musculature, while simultaneously performing a narrative review of the existing literature. Case Presentation: A 23-year-old male patient with a history of multiple abdominal operations due to recurrent bowel perforations and the presence of a high-output enterocutaneous fistula was admitted to our surgical department for further evaluation and treatment. After detailed diagnostic testing, the diagnosis of vascular-type EDS (vEDS) was made and a conservative therapeutic approach was adopted. In addition, a comprehensive review of the international literature was carried out by applying the appropriate search terms. Results: The diagnosis of vEDS was molecularly confirmed by means of genetic testing. The patient was treated conservatively, with parenteral nutrition and supportive methods. Thirty-four cases of bowel perforation in vEDS have been reported so far. Interestingly, this case is the second one ever to report co-existence of vEDS with Segmental Absence of Intestinal Musculature. Conclusions: Establishing the diagnosis of vEDS promptly is of vital significance in order to ensure that patients receive appropriate treatment. Due to initial non-specific clinical presentation, EDS should always be included in the differential diagnoses of young patients with unexplained perforations of the gastrointestinal tract. [ABSTRACT FROM AUTHOR]

Purpose: Exposure to immune checkpoint inhibitors (ICIs) can predispose to immune-related adverse events (irAEs) involving the gastrointestinal tract. The association between ICIs and bowel perforation has not been well studied. We aimed to describe the clinical course, complications, treatment, and outcomes of patients experiencing bowel perforation during or after ICI treatment. Methods: This retrospective, single-center study included adult cancer patients with bowel perforation that occurred between the first dose of ICI treatment and up to 1 year thereafter between 1/1/2010 and 4/30/2021. Patients' clinical course, imaging, treatment, and outcomes related to bowel perforation were collected and analyzed. Results: Of the 13,991 patients who received ICIs during the study period, 90 (0.6%) met the inclusion criteria. A majority were male (54.4%), the most common cancer type was melanoma (23.3%), and most patients had received PD-1/L1 inhibitor treatment (58.8%). Onset of perforation occurred after a median of four ICI treatment cycles. The most common symptom was abdominal pain (95.5%). The colon was the most common location for the perforation (37.7%). Evidence of diverticulitis, enterocolitis, or appendicitis was seen in 32 (35.6%) patients, and 6 (6.6%) patients had luminal cancer involvement at the time of perforation. The overall hospitalization rate related to perforation was 95.5%, with mortality of 15.5% during the same admission. Antibiotics were given in 95% of our sample; 37.8% of patients also required surgical/interventional radiology intervention. Forty-six patients (51.1%) had perforation-related complications (e.g., sepsis, fistula, abscess), which were associated with a higher mortality rate (30%). Conclusion: Our findings suggest a low incidence of bowel perforation after ICI treatment (0.6%), with 40% of patients having coexisting bowel inflammation as a potential contributing factor. Patients with bowel perforation had an aggressive disease course and high rates of hospitalization, complications, and mortality. Early recognition and prompt intervention is critical to improve patient outcomes. Future studies are warranted to further investigate the cause, predictive markers, and optimal treatment for this patient population. [ABSTRACT FROM AUTHOR]

In the literature, only 11 Enterococcus gallinarum group meningitis has been reported so far. The Enterococcus gallinarum group was shown for the first time in a pediatric patient presenting with meningitis after bowel perforation, a complication of a ventriculoperitoneal shunt. A 30-month-old male patient presented with vomiting and fever, with the ventriculoperitoneal shunt distal catheter protruding from the anal orifice. The patient was diagnosed with intestinal perforation and meningitis. Enterococcus gallinarum group bacterial yield in cerebrospinal fluid culture. A total of 6 weeks of intravenous antibiotic treatment was given in the hospital. After the treatment, the patient was re-ventriculoperitoneal shunt and was discharged. Among the shunt complications, meningitis with intestinal perforation is rare. It should be kept in mind that meningitis in such patients may be caused by very rare microbiological factors such as Enterococcus gallinarum group. Antibiotherapy should be given according to the culture result. Then planning should be made for a permanent shunt. [ABSTRACT FROM AUTHOR]

We present a case of severe bowel perforation during lenvatinib treatment for advanced hepatocellular carcinoma. Although the Hartmann’s procedure was performed, the patient died 48 h after the operation. The histopathological findings suggested that lenvatinib was involved in the etiology of bowel perforation in this case.

Jariya Waisayarat,1 Chayakamon Niyasom,2 Soamarat Vilaiyuk,2 Sani Molagool3 1Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Jariya Waisayarat, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajathevee, Bangkok, 10400, Thailand, Tel +66 2 201 1432, Fax +66 2 354 7266, Email jariya.wai@mahidol.ac.thAbstract: Polyarteritis nodosa (PAN) is a rare systemic necrotizing vasculitis affecting small- to medium-sized arteries. The most common gastrointestinal manifestation of PAN is postprandial abdominal pain from mesenteric arteritis causing bowel ischemia. When transmural ischemia develops, there may be ischemic necrosis and perforation of the bowel wall, which are life-threatening. Severe, life-threatening gastrointestinal involvement is relatively rare in pediatric PAN and may require different management in adult patients. We report a pediatric PAN case in a patient who presented with acute abdominal pain and superimposed cytomegalovirus enteritis with jejunoileal perforation. The patient improved with emergency small intestinal resection followed by conventional immunosuppressive drugs of a corticosteroid and cyclophosphamide, and anti-viral drugs. Before increasing the immunosuppressive drug dosage, initial screening of infectious cytomegalovirus and comprehensive evaluation for surgical conditions are essential in pediatric PAN with severe gastrointestinal involvement. Early aggressive treatment for acute abdomen is useful in reducing morbidity and mortality in pediatric PAN.Keywords: polyarteritis nodosa, cytomegalovirus enteritis, abdominal pain, bowel perforation

Abstract Aim Oncologic emergencies such as perforation and obstruction associated with colorectal cancer are serious diseases that can lead to sepsis. Peritoneal dissemination and other factors may cause cancer progression and worsen the patients’ long‐term prognosis. In this study, we investigated the effect of colorectal cancer presenting as oncologic emergencies on the patients’ clinical course. Methods We performed a retrospective study that included 448 patients with colorectal cancer who underwent primary resection at our institution between January 2014 and December 2018. The primary outcome was overall survival, while secondary outcomes were 30‐day mortality and postoperative complications. Cox regression was used to estimate the hazard ratio (HR) for overall survival. Results We identified 56 patients who presented with oncologic emergencies (OE group) and 392 patients who presented with no emergencies (NE group). Propensity‐score matching yielded 56 patients in the OE group and 55 in the NE group with balanced baseline covariates. We found a strong association between overall survival (OS) and oncologic emergencies (HR = 2.4; 95% confidence interval [CI], 1.1‐5.5). The 30‐day mortality was not significantly different between the OE and NE groups (4% vs 0%, P = .25). The incidence of severe postoperative complications (Clavien‐Dindo classification ≥grade 3) did not differ significantly between the groups (25% vs 15%, P = .23). Conclusion Colorectal cancer presenting as an oncologic emergency could be safely operated on without increasing the 30‐day mortality rate and the incidence of severe postoperative complications. However, the long‐term prognosis was poor.

Abstract Background Gastrointestinal complications are becoming increasingly more common and pose a significant risk on the health of children with compromised immunity caused by various etiologies such as chemotherapy and posttransplantation immunosuppression. We aim to review abdominal complications in immunocompromised children and their respective management. Main body This is a scoping review of the literature. PubMed, MEDLINE, Google Scholar, and Scopus libraries were searched for relevant articles. Extracted data included the etiologies of immunocompromised immunity, gastrointestinal and abdominal complications in immunocompromised children, diagnosis, and treatment of these pathologies. Examples of gastrointestinal complications in immunocompromised children include, but not limited to, neutropenic enterocolitis, acute appendicitis, bowel perforation, acalculous cholecystitis, and acute pancreatitis. Our literature review showed that bacterial and fungal infections are the major causes of exacerbation and mortality. The main cause of immunosuppression in children with neutropenic enterocolitis and acute pancreatitis is chemotherapy, and management of these pathologies using intravenous fluids, antibiotic therapy, and granulocyte-stimulating factors is the current standard of care. Surgical intervention is uncommon and reserved for complicated cases. That said, in acute appendicitis and bowel perforation, laparoscopy is the mainstay treatment. However, in systemic infections, nonsurgical interventions such as transfusion and bowel rest are the gold standard. As for acalculous cholecystitis, percutaneous cholecystectomy is superior to laparotomy and other surgical interventions. Conclusion Timely diagnosis and management of gastrointestinal complications in the immunocompromised children is key in reducing mortality and morbidity. Both surgical and nonsurgical interventions are needed and should be further studied in order to improve outcomes.

BackgroundAs the demand for kidney transplants continues to increase globally, healthcare institutions face a challenge to bridge the gap between patients waitlisted for kidney transplants and the number of donors. A major factor influencing the donor's decision is the operative risk and potential complications of the surgery. Open surgical approaches have been vastly replaced with laparoscopic donor nephrectomies as the standard of practice. However, there is a growing body of evidence pointing towards its potential superiority over laparoscopic methods. In this study, we aim to present our experience on outcomes of Robotic-Assisted Live Donor Nephrectomies (RALDN), the first series of its kind in the United Arab Emirates (UAE).MethodsWe retrospectively collected data from patients who underwent RALDN at Mediclinc City Hospital. Demographic data, laboratory investigations, and operative details were collected and analyzed.ResultsSeven patients underwent RALDN between 2021 and April 2022 at our facility. Four donors were male while three were female. Median length of hospital stay was 4 days. In our study, one of the patients suffered from a Clavien-Dindo grade IV complication which necessitated prolonged admission.ConclusionWe conclude that RALDN is a safe method for donor kidney procurement, carrying a low risk of morbidity and mortality. This method could potentially evolve the number of kidney donors to address the issue of high kidney transplant demand.

Introduction: Extracorporeal wave lithotripsy (ESWL) is considered a first-line treatment for renal and ureteral stones up to 10–20 mm in diameter. Complications are uncommon, with a reported rate of 0–6% in the literature. Bowel perforation has only been described in a few case reports but requires rapid diagnosis and treatment. Methods: A review of the literature from PubMed/Medline, Embase, Cochrane, and Web of Science databases was performed including studies reporting bowel perforation secondary to ESWL between January 1990 and June 2022. Results: We found 16 case reports of intestinal perforation in the literature. Although some patients had previously undergone abdominal surgery or had inflammatory intestinal disease, others were without comorbidities that could lead to complications. Abdominal pain was the main symptom and imaging was required to confirm the diagnosis, which usually necessitated a surgical intervention. As regards the ESWL technique, it appears that the combination of a high energy level and the prone position constitutes a risk factor for these rare complications. At the authors' centre, only one case has been reported among 24,000 ESWL procedures over 20 years: A 59-year-old female who underwent ESWL for a distal right ureteral stone presented acute abdominal pain and free intraperitoneal pelvic fluid on ultrasound. A CT scan revealed a small bowel perforation requiring open laparotomy with primary closure. Conclusions: In conclusion, although bowel perforation after ESWL is rare, progressive abdominal pain with tenderness at physical examination requires proper imaging evaluation to exclude bowel perforation and prompt intervention if required. [ABSTRACT FROM AUTHOR]

Abstract Background In patients with systemic lupus erythematosus (SLE), lengthy treatment and long-term steroid use are the main risk factors for developing aortic aneurysms or aortic dissections. In patients with cardiac tamponade, hemodynamic collapse may lead to acute renal and hepatic failure. Case presentation We report the successful treatment of a 55-year-old woman with SLE since the age of 21. She suddenly felt chest pain approximately 2 weeks before developing fever and vomiting and was admitted to our hospital. Initially, she had severe liver dysfunction and was admitted to the hepatology department, where treatment for fulminant hepatitis was initiated. However, computed tomography (CT) showed an acute aortic dissection (DeBakey type II) and severe bloody pericardial effusion. Therefore, we performed emergency pericardial drainage. Plasma exchange therapy was initiated as emergency aortic surgery was deemed impossible due to impaired liver function tests and coagulation. Ten days later, the patient developed peritonitis due to small bowel perforation, and laparotomy was performed for abscess drainage and perforation closure. She had received steroid pulse therapy at the age of 21. At 40 years of age, she developed deep vein thrombosis due to antiphospholipid antibodies and was prescribed prednisolone. She was ambulatory at 3 months after the onset of acute aortic dissection, and CT revealed a rapidly enlarging true aneurysm in the distal arch. We performed elective aortic surgery. Although there were no antiphospholipid antibodies, surgery could have led to a devastating antiphospholipid syndrome. Therefore, we decided to treat the patient with triple therapy. Methylprednisolone was intravenously administered intraoperatively and at 1 day postoperatively. The patient was discharged without complications after returning to her usual oral prednisolone regimen. Conclusions The patient described herein had a systemic circulatory failure due to cardiac tamponade, accompanied by liver failure. This condition is a significant cause of death in patients with aortic dissection-associated SLE and is extremely dangerous. However, multi-specialty intervention helped the patient recover, and she has been attending the outpatient clinic. Aortic surgery requiring hypothermia in SLE patients with antiphospholipid syndrome and a history of thrombocytopenia or thrombosis requires a multi-disciplinary treatment team, including cardiac surgeons and medical experts.

Abstract Background Pneumoperitoneum is defined as the presence of free air in the peritoneal cavity. It is a surgical emergency that represents in 90% of the cases with a hollow viscus perforation and its feared consequences of sepsis and death. On the other hand, spontaneous pneumoperitoneum is a benign surgical entity occurring in newborns that requires no surgical intervention. Cases presentation In this series, we report three cases of benign spontaneous pneumoperitoneum in neonates treated at Jordan University Hospital between 2004 and 2021. Two of them were treated by exploration laparotomy but no gross pathology could be identified; one case was successfully treated conservatively with observation alone. Conclusion This case series recognizes the presence of such entity which can be treated conservatively, eliminating the unnecessary burden of morbidity and mortality of surgery in such age group.

Abstract Background Shanghai fever is a rare community-acquired enteric illness with sepsis caused by Pseudomonas aeruginosa. Cases of Shanghai fever in pediatric patients have been reported; however, to the best of our knowledge, there are no reports of adult cases. Case presentation A 65-year-old man visited the emergency department with sudden onset of abdominal pain. He was diagnosed as treatment-related myelodysplastic syndrome after treatment of follicular lymphoma. Moderate tenderness in the middle right abdominal quadrants was noted. Computed tomography showed abdominal free air with a small amount of effusion to the surrounding edematous small intestine, and we performed emergency exploration. During operation, we found multiple bowel perforations with patchy necrotic lesions. The patient was admitted to an intensive care unit postoperatively. Blood culture showed Pseudomonas aeruginosa. His condition improved; however, on the 8th postoperative day, the abdominal drain tube showed turbid drainage. We performed re-operation and found anastomotic leakage with two new bowel perforations. After the re-operation, the patient showed signs of septic shock and his general condition got worse, and the patient died due to multiple organ failure on the 12th postoperative day. Conclusion Shanghai fever may occur in an adult patient with neutropenia.

RATIONALE Hollow organ perforation is an urgent problem in abdominal surgery. According to the literature, the incidence of perforation is from 0.37% to 2.3% of cases among various acute surgical pathologies of the abdominal organs. The greatest attention in the literature is paid to the problem of perforated gastroduodenal ulcers. At the same time, a much smaller number of publications, both Russia and foreign, are devoted to other, more rare types of perforations. This situation is most likely explained by the low prevalence of other types of perforations, which, in turn, does not make them a less urgent problem in emergency surgery, which requires a modern approach to the treatment of this group of patients.PURPOSE OF THE STUDY Analysis of domestic and foreign literature on the diagnosis and treatment of rare types of benign intestinal perforations.MATERIAL AND METHODS A literature review was performed for the period from 1994 to 2020 in Russian and in English, available on Pubmed, Medline, Springer, Scopus, E-library, on topics such as perforated diverticula of the small intestine, perforation of Meckel’s diverticulum, perforated ulcers of the small intestine, perforation of the intestine by a foreign body. RESUltS With all the variety of surgical techniques for various types of perforation of the gastrointestinal tract, currently in the literature there are no specific criteria for choosing a particular method of intervention with regard to the cause, level, and duration of perforation.CONCLUSION The lack of unified approaches in the diagnosis and treatment of patients with rare GIT perforations dictates the need for a more in-depth study of this issue in order to apply and optimize the technique of videolaparoscopic approach, develop a treatment and diagnostic algorithm for patients with suspected perforations of the gastrointestinal tract using the video laparoscopic method.

There are few studies on medical treatment for perforation occurring as a complication of UC (ulcerative colitis), and there are very few cases where medical treatment has shown good results. Accordingly, we introduce a case in which UC-related perforation was successfully treated with medical treatment using Ustekinumab. A 69-year-old man presented with symptoms of severe diarrhea with hematochezia and abdominal pain. He had a history of UC diagnosed 8 months ago. At the time of admission to the hospital, the patient showed hypotension, fever, and tachycardia. Initial laboratory tests showed severe anemia and elevated inflammatory markers. Abdominal computed tomography (CT) revealed deep ulcerative lesions in the rectum and peri-rectal free airs which are compatible with rectal ulcer perforation. Sigmoidoscopy revealed extensive deep ulcerations with hemorrhage throughout the rectum and sigmoid colon. We clinically diagnosed rectal ulcer perforation secondary to acute severe UC and sepsis. Considering the patient’s old age, underlying disease, and septic condition, the postoperative mortality rate was thought to be very high. Infliximab is a representative second-line medical therapy for severe UC, but we ruled out the use of infliximab because an active, uncontrolled infection is contraindication. We decided to administer Ustekinumab, an anti-interleukin antibody, as second-line medical therapy for severe UC. Three days after administering Ustekinumab, the patient showed hemodynamic stability and clinical symptoms. The follow up CT and sigmoidoscopy showed improvement, revealing a matured wall in the lesion where the perforation had occurred. 17 days after administering Ustekinumab, clinical remission was achieved, and the patient was discharged. This case suggests that Ustekinumab is not only an effective treatment that reduces the surgical treatment rate in patients with severe UC, but may also be an effective alternative treatment in patients with severe UC who require surgical treatment but cannot undergo surgical treatment. [ABSTRACT FROM AUTHOR]

Although patients with Rapunzel syndrome are often asymptomatic, rare complications such as isolated gastric or duodenal perforation, pancreaticobiliary or intestinal obstruction, and intussusception have been described. A 5-year-old female with no known medical history presented after nearly two weeks of worsening constipation, abdominal distension, and abdominal pain. A CT scan demonstrated a large gastric bezoar, pneumoperitoneum, and large volume complex free fluid. The patient was taken to the operating room for an abdominal exploration. We found a large gastric trichobezoar with hair extending into the small bowel, consistent with Rapunzel syndrome. The gastric trichobezoar was connected to a mid-ileal trichobezoar through interdigitating hair fibers. At multiple locations along the small bowel, garroted linear perforations had occurred due to tension created by the intestinal peristalsis along the interconnecting hair fibers, creating mucosal ulcerations and transmural pressure necrosis that required an extensive small bowel resection. Ultimately, we did one end-end small bowel anastomosis and placed a gastrostomy tube. Gastrostomy tube feeds were started on postoperative day 6 after confirming with a contrast study that there were no intestinal leaks. She developed a superficial wound infection that was managed with antibiotics and negative pressure wound therapy. She was discharged tolerating regular diet on post-operative day 23, and is undergoing psychiatric therapy. Although rare, Rapunzel syndrome can lead to severe complications. When two trichobezoars are present, interconnecting hair fibers can cause small bowel perforations. [ABSTRACT FROM AUTHOR]

Abstract Background Hypereosinophilic syndrome (HES) is an extremely uncommon group of disorders. It rarely presents with coagulopathy without cardiac involvement. Case presentation A 33-year-old previously healthy male with no history of atopic disease presented with abdominal pain, hematochezia, peripheral eosinophilia as high as 10,000 eos/µL, right and left portal vein, mesenteric, and splenic vein thrombi with ischemic colitis resulting in hemicolectomy and small bowel resection. Despite an extensive workup for primary and secondary etiologies of hypereosinophilia by hematology/oncology, infectious disease, rheumatology and allergy/immunology, no other clear causes were identified, and the patient was diagnosed with idiopathic HES. His eosinophilia was successfully treated with high-dose oral corticosteroids (OCS) and subsequently transitioned to anti-IL-5-receptor therapy with benralizumab. He has continued this treatment for over a year with no recurrence of eosinophilia or thrombosis while on benralizumab. Conclusion In patients with an unexplained coagulopathy and eosinophilia, eosinophilic disorders such as HES should be considered. Corticosteroid-sparing agents, such as benralizumab show promise for successfully treating these patients.

Common bile duct drainage (CBDD) following operative common bile duct exploration (CBDE) is routinely performed. Primary choledochotomy closure with trans-sphinteric endobiliary stent (EBS) is a popular technique. A 72-year-old woman presented with abdominal pain, peritonism, and sepsis a month after an elective right hemicolectomy with concurrent cholecystectomy and CBDE with EBS placement. Radiological investigations implied a detrimental consequence from migrated EBS. Surgical exploration revealed the cause to be ileal perforation by the EBS. She had a resection of the aggravated bowel segment and a double-barreled stoma was matured from the resected ends. The stoma was reversed 6 weeks after the laparotomy and the patient is currently under regular surveillance for colon cancer. Migration of EBS precipitating enteric perforation are uncommon, recognised complications. Natural, congenital, and acquired luminal and mural causes have been documented. Primary choledochotomy closure without CBDD, alternative EBS which are smaller or softer, and the utilization of T-Tube CBDD are valid options when treating patients with recognised increased risk of EBS-related bowel perforation. [ABSTRACT FROM AUTHOR]

Background: Bowel perforation is a severe complication of Hirschsprung disease (HD) that necessitates prompt diagnosis and aggressive management to reduce mortality and morbidity. This study aimed to provide insights into the clinical management of neonatal HD cases complicated by bowel perforation., Methods: A retrospective review was conducted on neonates diagnosed with HD and bowel perforation at Beijing Children's Hospital from January 2007 to January 2024. Inclusion criteria included neonates ≤ 28 days old with confirmed HD diagnosis based on postoperative histology. Data collected included perinatal history, patient characteristics, HD classification, clinical presentations, surgical interventions, and outcomes. Statistical analysis was performed using SPSS 26.0., Results: Among 300 neonates diagnosed with HD, 18 (6.0%) developed preoperative bowel perforation. Most perforations were in the proximal ganglionic bowel, with short-segment HD (7/18, 38.9%) and long-segment HD (9/18, 50.0%) being most common. All patients received timely surgical intervention upon the discovery of bowel perforation, with 94.4% (17/18) requiring stoma creation. Postoperative complications included stoma retraction, Hirschsprung disease-associated enterocolitis, and adhesive bowel obstruction, but no mortality was reported., Conclusion: The incidence of preoperative bowel perforation in neonates with HD was 6.0%, primarily in cases of short-segment and long-segment HD. Perforations were mainly located in the proximal ganglionic segments. Prompt surgical intervention, particularly stoma creation, resulted in favorable outcomes for most patients., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Throughout the literature, many cases of vascular Ehlers-Danlos were reported with a variation of its clinical presentation. This disease may present in many forms and aspects and some even die before seeking medical care and getting the right diagnosis due to its hard effect on patients., Case Presentation: We report a case of a 25-year-old female patient with a history of multiple bowel perforations that were operated on urgently numerous times and received many courses of a large spectrum of antibiotics for various infections., Clinical Discussion: Further investigations showed that the patient had multiple aneurysms due to her disease, a hepatic aneurysm, a paraspinal, and a severally symptomatic wrist aneurysm. The patient presented a de novo variant in the COL3A1 gene. A management plan was personalized, and a family genetic investigation was carried out., Conclusion: This article contains a full history of this patient including all the surgical, medical, and radiological interventions., Competing Interests: Declaration of competing interest The authors have nothing to disclose., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)