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Purpose: Postoperative management for colonic perforation is an important prognostic factor, but whether intensivists perform postoperative management varies between institutions. Methods: We investigated 291 patients with colonic perforation between 2018 and 2022. Patients were divided into those managed by an intensivists (ICU group; n = 40) and those not managed by an intensivists (non-ICU group; n = 251). We examined how management by intensivists affected prognosis using inverse probability weighting, and clarified which patients should consult an intensivists. Results: The ICU group showed a significantly higher shock index (1.15 vs. 0.75, p < 0.01), higher APACHE II score (16.0 vs. 10.0, p < 0.001), and more severe comorbidities (Charlson Comorbidity Index 5.0 vs. 1.0, p < 0.001) and general peritonitis (85% vs. 38%, p < 0.001). Adjusted risk differences were − 24% (-34% to -13%) for 6-month mortality rate. Six-month mortality was improved by ICU intensivist management in patients with general peritonitis (risk difference − 22.8; 95% confidence interval − 34 to -11); APACHE II score ≥20 (-0.79; -1.06 to -0.52); lactate ≥1.6 (-0.38; -0.57 to -0.29); shock index ≥1.0 (-40.01; -54.87 to -25.16); and catecholamine index ≥10 (-41.16; -58.13 to -24.19). Conclusions: Intensivists were involved in treating patients in poor general condition, but prognosis was extremely good. Appropriate case consultation with intensivists is important. [ABSTRACT FROM AUTHOR]

Background: Complications during colonoscopy such as perforation or bleeding may occur. Colonic perforation must be detected early in order to manage and reduce morbidity and mortality. Conservative, endoscopic, or surgical (laparoscopy or laparotomy) management techniques are available. The objective of this case report is to describe the management of a patient with post-colonoscopy polypectomy colonic perforation using a robotic platform approach. Case presentation: A 59-year-old male presented with a medical history significant for hypertension and hyperlipidemia, and he had several polyps removed with colonoscopy the day before admission. He started to have some left-sided abdominal pain which worsened and then moved to the right side. The primary diagnoses, interventions, and outcomes: CT scan was performed and revealed a small volume pneumoperitoneum, consistent with hollow viscus perforation and peritoneal signs on physical exam. He was taken to the OR for emergency robotic diagnostic laparoscopy, and proximal transverse colon repair with peritoneal lavage was successfully completed. There were no intraoperative complications or need for open conversion. The patient was discharged after 2 days and he did not suffer postoperative complications and did not need readmission. Conclusion: The robotic platform offers advantages that overcome the limitations of the laparoscopic approach including visualization, stability, dexterity, and precision. We believe that these advantages are maximized in the acute surgery setting. This case report proves that in experienced hands, the robotic platform is safe and effective for acute complex surgery cases. Further studies are recommended to determine the specific benefits of robotic laparoscopy in colonic emergency procedures. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aimed to determine the risk factors associated with postoperative major morbidity, anastomotic/suture leakage, re-surgery and mortality in patients undergoing emergency surgery for colonic perforation. Methods: A total of 204 adult patients treated surgically for colonic perforation from 2016 to 2021 at the University Hospital Erlangen were included in a retrospective analysis. Patient demographics and pre-, intra- and postoperative parameters were obtained and evaluated among various outcome groups (in-hospital major morbidity, anastomotic/suture leakage, re-surgery and 90-day mortality). Results: Postoperative in-hospital major morbidity, anastomotic/suture leakage, need of re-surgery and 90-day mortality occurred in 45%, 12%, 25% and 12% of the included patients, respectively. Independent risk factors for in-hospital major morbidity were identified and included the presence of any comorbidity, a significantly reduced preoperative general condition, the localization of perforation in the right hemicolon and the need for an intraoperative blood transfusion. The only independent risk factor for anastomotic/suture leakage was the presence of any comorbidity, whereas no independent risk factors for re-surgery were found. An age > 65 years, a significantly reduced preoperative general condition and the need for an intraoperative blood transfusion were independent risk factors for 90-day mortality. Conclusions: Our study identified risk factors impacting postoperative outcomes in patients undergoing emergency surgery for colonic perforation. These patients should receive enhanced postoperative care and may benefit from individualized and targeted therapeutic approaches. [ABSTRACT FROM AUTHOR]

Colonoscopy has a limited field of view because it relies solely on a small camera attached to the end of the scope and a screen displayed on a monitor. Consequently, the quality and safety of diagnosis and treatment depend on the experience and skills of the gastroenterologist. When a novice attempts to insert the colonoscope during the procedure, excessive pressure can sometimes be applied to the colon wall. This pressure can cause a medical accident known as colonic perforation, which the physician should prevent. We propose an assisting device that senses the pressure applied to the colon wall, analyzes the risk of perforation, and warns the physician in real time. Flexible pressure sensors are attached to the surface of the colonoscope shaft. These sensors measure pressure signals during a colonoscopy procedure. A simple signal processor is used to collect and process the pressure signals. In the experiment, a colonoscope equipped with the proposed device was inserted into a simulated colon made from a colon extracted from a pig. The processed data were visually communicated to the gastroenterologist via displays and light-emitting diodes (LEDs). The device helps the physician continuously monitor and prevent excessive pressure on the colon wall. In this experiment, the device appropriately generated and delivered warnings to help the physicians prevent colonic perforation. In the future, the device is to be improved, and more experiments will be performed in live swine models or humans to confirm its efficacy and safety. [ABSTRACT FROM AUTHOR]

Background and Objectives: Spontaneous colonic perforations (SCPs) in teenagers and young adults are extremely rare. Common underlying conditions, such as colonic tumors and diverticulitis, are absent at that age. The vascular type of Ehlers–Danlos Syndrome (vEDS) is one cause of SCP. Methods: A 23-year-old male presented with an acute abdomen. The abdominal CT showed pneumoperitoneum with a large amount of fluid in the pelvis and abdomen, indicating hollow viscus rupture. At the level of the sigmoid colon, a defect in the intestinal wall and gas bubbles were seen. Results: Exploratory laparotomy confirmed sigmoid colon perforation without underlying pathology. Loop sigmoid colostomy was performed. Revisional surgery was undertaken due to clinical deterioration and intra-abdominal free fluid with small-bowel distension and air-liquid levels on abdominal CT 6 days later. Ileal subserosal hematomas were found, and many had ruptured, leaving a "zebra" pattern with lines of residual hematomas on the borders of subserosal hematomas. Genetic analysis confirmed vEDS. Conclusions: SCP in young adults or teenagers, in the absence of colonic disease, with clinical manifestations of connective tissue disorders should trigger genetic investigations for vEDS. SCP with a known vEDS could be treated with total colectomy to prevent further SCPs in the remaining colon. If segmental resections are performed, further SCP should be immediately excluded with any significant abdominal pain. [ABSTRACT FROM AUTHOR]

Pneumoperitoneum is a common complication after penetrating abdominal trauma, gastric ulcer, or colitis in which free air is present in the peritoneal or retroperitoneal space. Sole pneumoretroperitoneum, which refers to gas in the retroperitoneal space, is a rare entity, and when significant, results in a characteristic radiographic sign known as “Dirty Mass.” Common causes include penetrating trauma or perforation of the retroperitoneal portions of the gastrointestinal tract (duodenum, ascending colon, descending colon, and rectum). Our case describes a 59-year-old female admitted for sudden onset RLQ abdominal pain with Dirty Mass sign on abdominal KUB. Early recognition of these key radiographic findings accelerates management and reduces the risk of developing complications.

Surgical abdominal emergencies among patients with cerebral palsy (CP) are infrequently reported. The most commonly reported reason for urgent and emergent abdominal surgery among patients with CP is intestinal volvulus. Intestinal volvulus leads to obstruction and vascular compromise, potentially resulting in life-threatening ischemia and necrosis. Volvulus typically presents with abdominal pain and decreased bowel function. When patients are nonverbal and have baseline bowel dysfunction, symptoms of volvulus can be difficult to diagnose. Here, we present a case of an adult female patient with CP who presented with ischemic colitis with perforation and underwent emergency total colectomy and end-ileostomy. Her postoperative course was complicated by two episodes of intestinal volvulus that occurred one and three months after the initial operation. At the second presentation, she had global bowel ischemia due to the volvulus, which led to her death. We have reviewed and summarized the current literature regarding abdominal emergencies among patients with CP. [ABSTRACT FROM AUTHOR]

We report a case of a 72-year-old female who presented with fever, abdominal pain, and diarrhea accompanied by leukopenia, anemia, and thrombocytopenia. The diagnosis of acute aplastic anemia was confirmed through bone marrow aspiration. Treatment included glucocorticoids, immunoglobulin therapy, and plasma exchange. Subsequently, the patient developed gastrointestinal bleeding and abdominal Computed Tomography (CT) revealed perforation of the transverse colon. Pathological examination of surgically removed diseased tissue confirmed mucor infection. Despite receiving antifungal therapy with amphotericin B, the patient's condition deteriorated due to the sepsis progression. Mucor infection in immunocompromised patients should be vigilant, and early diagnosis may help improve prognosis.

Colonoscopy has a limited field of view because it relies solely on a small camera attached to the end of the scope and a screen displayed on a monitor. Consequently, the quality and safety of diagnosis and treatment depend on the experience and skills of the gastroenterologist. When a novice attempts to insert the colonoscope during the procedure, excessive pressure can sometimes be applied to the colon wall. This pressure can cause a medical accident known as colonic perforation, which the physician should prevent. We propose an assisting device that senses the pressure applied to the colon wall, analyzes the risk of perforation, and warns the physician in real time. Flexible pressure sensors are attached to the surface of the colonoscope shaft. These sensors measure pressure signals during a colonoscopy procedure. A simple signal processor is used to collect and process the pressure signals. In the experiment, a colonoscope equipped with the proposed device was inserted into a simulated colon made from a colon extracted from a pig. The processed data were visually communicated to the gastroenterologist via displays and light-emitting diodes (LEDs). The device helps the physician continuously monitor and prevent excessive pressure on the colon wall. In this experiment, the device appropriately generated and delivered warnings to help the physicians prevent colonic perforation. In the future, the device is to be improved, and more experiments will be performed in live swine models or humans to confirm its efficacy and safety.

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection, typically caused by preexisting conditions such as trauma, complicated intraabdominal infections, or even small wounds. However, it is very rare for NF to occur as a result of perforated colon cancer (CC). Diagnosis primarily relies on clinical findings, imaging, and laboratory tests. Early diagnosis and treatment are crucial for patient survival. In this study, we present a case of an 82-year-old female a known case of CC diagnosed 1 month ago. She presented with hip pain persisting for 10 days duration, along with skin changes over the proximal anterolateral aspect of the thigh. The patient was diagnosed with NF associated with an iliopsoas abscess caused by perforated CC that was managed with surgical debridement, left hemicolectomy, and end colostomy along with broad-spectrum antibiotics. [ABSTRACT FROM AUTHOR]

Introduction: Hemolytic uremic syndrome (HUS) usually presents with mild gastrointestinal symptoms, typically managed medically. We describe 3 patients with challenging clinical presentations diagnosed with colonic perforation, review the literature, and discuss lessons learned. Case presentation: Case 1: A 5-year-old girl presented with symptoms of HUS. Three weeks later, with new fevers and tachycardia, computerized tomography (CT) revealed pneumoperitoneum. She underwent resection of necrotic small bowel and sigmoid, with a second look resection and creation of multiple stomas. After 5 months, she was discharged on total parenteral nutrition (TPN) and hemodialysis. She later had restoration of intestinal continuity and renal transplantation. Case 2: A 2-year-old boy with HUS underwent, over 3-weeks, 9 ultrasounds, percutaneous ascites aspiration, and 2 CT scans before diagnosis of colonic necrosis and perforation. A laparotomy revealed necrotic colon with a thick rind encasing the bowel, rendering full exploration and stoma creation impossible. Drains were placed, and he was discharged on TPN after 2 months. He underwent colo-colonic anastomosis and a TPN wean after one year with full renal recovery. Case 3: A 3-year-old boy with HUS developed worsening distension. After one week, he suffered cardiopulmonary arrest and CT showed bowel hypoenhancement. He underwent resection of necrotic colon with transverse colostomy creation. After 4 months, he was discharged on hemodialysis. He underwent subsequent colostomy closure and renal transplantation. Conclusion: Bowel ischemia is difficult to diagnose in HUS. CT with intravenous contrast is critical for diagnostic accuracy. Frequent re-evaluation by pediatric surgery is important to avoid missing a surgical emergency.

Pneumomediastinum and subcutaneous emphysema usually result from alveolar rupture and rarely from colonic perforation. Although steroid use has been shown to increase the risk of complicated diverticulitis, there is limited data on the role Addison's disease may play in the development of colonic perforation. We present a rare case of a patient with Addison's disease who presented with hoarseness and was found to have massive subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum secondary to complicated diverticulitis. [ABSTRACT FROM AUTHOR]

Background Colonoscopy is a commonly utilized procedure in gastroenterology, but it carries risks of complications, with perforation being the most dreaded. The management of colonic perforation remains a topic of debate, as it can be effectively treated through surgical or non-surgical approaches. Our objective is to detail clinical presentations, diagnostic methods, and potential therapeutic options. Cases For this study, we gathered clinical and radiological data from two cases of colonic perforation following colonoscopy. We examined clinical presentations, diagnostic methods employed, and the different therapeutic approaches used for each case. In both cases, patients exhibited symptoms of colonic perforation following colonoscopy. The first case was managed conservatively, with progressive clinical improvement. The second case showed signs of pneumoperitoneum, but no perforation was found during laparoscopic intervention. Both patients recovered well and experienced no complications during follow-up. Conclusions Our study highlights the importance of understanding the risks associated with colonoscopy, particularly in patients with risk factors. It also underscores the diversity of available treatment approaches for iatrogenic colonic perforation, emphasizing the significance of a multidisciplinary approach in determining the optimal therapeutic strategy.

Purpose: To describe and update stercoral colitis clinical risk factors, relative frequency, location, and CT imaging features correlated with surgical and pathological results. Methods: CT reports over a 5-year period (05/2017–05/2022) at a single medical center were searched. Main inclusion criteria were luminal distention with formed stool, wall thickening, and surrounding inflammation. Positive cases were graded as mild (early or developing stercoral colitis) versus moderate-to-severe based on CT findings. Medical records were reviewed for risk factors and outcome data in moderate-to-severe cases. P-values were tabulated for comparison. Results: 545 total cases (71 (60, 82) years, 278 males) were identified on CT, including 452 mild (82.9%) and 93 moderate-to-severe cases (17%, 67 (55, 79) years, 48 females). Twenty cases showed evidence of perforation (3.7% total cohort, 22% moderate-to-severe cohort). Diagnosis as an incidental finding was frequent (46.0% of mild cases). Most cases involved the rectum (97.6% of mild cohort and 69% of moderate-to-severe cohort). The sigmoid was involved in 31% of moderate-to-severe cases, but 95% of the perforated subcohort (19/20, 13/20 without rectal involvement). Among the moderate-to-severe cohort, perforation was associated with slightly increased wall thickness (6.4 vs. 5.7 mm, p = 0.03), opioid use (50 vs. 23%, p = 0.04), and disease-specific mortality (11 vs. 0%, p =0.04). Perforation was less associated with major neurocognitive disorders (20 vs. 60%, p = 0.003), institutionalized status (5 vs. 38%, p = 0.005), and a prescribed bowel regimen (30 vs. 63%, p = 0.01). Conclusion: Stercoral colitis may be under-reported. Perforation tends to favor sigmoid involvement and a less traditional patient cohort. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Collagenous colitis (CC) is generally benign, and serious complications are rare. It is important to note that spontaneous perforation of CC is a possible complication. In the case of colon perforation of unknown origin, CC should be considered. [ABSTRACT FROM AUTHOR]

Wondwossen Amtataw Zerefa, Feven Berhanu Feleke, Surafel Mulatu Djote Department of Surgery, Yekatit 12 Hospital Medical College, Addis Ababa, EthiopiaCorrespondence: Wondwossen Amtataw Zerefa, Email wossenamtataw@gmail.comAbstract: Sigmoid volvulus is one of the causes of large-bowel obstruction that is usually common in males, and the management outcome depends on the patient’s clinical condition upon presentation. Open or laparoscopic surgery is the mainstay of management for sigmoid volvulus, except for some conditions where conservative management is given priority, eg, patients unfit for surgery. Rectal deflation is one of the options for conservative management for simple sigmoid volvulus for patients visiting the emergency outpatient department to optimize the patient for semi-elective or elective procedures as management for patients unfit for surgery. In our case, the patient’s clinical condition on his first visit was smooth and he was diagnosed to have simple sigmoid volvulus, for which deflation was tried but failed. The patient was operated on on the third day of failed deflation, and the intraoperative finding was colonic perforation distal to the obstruction associated with perforated appendicitis. Although the colonic perforation was assumed to be due to a secondary rectal tube deflation attempt, the cause of the perforated appendicitis was not clear, ie, whether the appendicitis was primary or secondary, as well as there being no report on perforated appendicitis in common complications of sigmoid volvulus.Keywords: sigmoid volvulus, appendicitis, colonic perforation

Harsimrandeep Bhatti, Enkhbileg Batbileg, Srijisnu De, Glen Friedman, Suresh Antony Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USACorrespondence: Harsimrandeep Bhatti, Department of Internal Medicine, Las Palmas Del Sol Medical Center, 10175 Gateway W. Suite 100, El Paso, TX, 79925, USA, Tel +1 915-539-4346, Email Harsimrandeep.Bhatti@hcahealthcare.comAbstract: Histoplasma capsulatum is an opportunistic pathogen which can lead to a wide variety of clinical presentations in the immunocompromised host. Post-transplant histoplasmosis in hematopoietic cell transplant recipients is exceedingly rare, with an incidence of < 1%. We present a case of acute caecal perforation resulting from disseminated histoplasmosis in a patient who had undergone autologous bone marrow transplant for plasma cell dyscrasia. This is a 71-year-old patient who initially presented due to progressive weakness associated with shortness of breath.Keywords: infectious disease, bone marrow transplant, pancytopenia, disseminated histoplasmosis, colonic perforation, surgery

Key Clinical Message Collagenous colitis (CC) is generally benign, and serious complications are rare. It is important to note that spontaneous perforation of CC is a possible complication. In the case of colon perforation of unknown origin, CC should be considered.

Résumé: La diverticulose colique, anomalie anatomique définie par la présence de diverticules, hernies de la muqueuse et de la sous-muqueuse au travers de la musculeuse colique, est extrêmement fréquente dans les pays industrialisés. Sa prévalence augmente avec l'âge et elle demeure classiquement asymptomatique. Cependant, dans 30 % des cas, la survenue de complications infectieuses ou hémorragiques va être responsable de l'entrée dans la maladie diverticulaire, celle-ci constituant une des urgences digestives les plus fréquentes, pouvant aller jusqu'à la mise en jeu du pronostic vital. Les complications infectieuses sont les plus fréquentes, et le scanner est la pierre angulaire de leur diagnostic. Il va permettre de distinguer les diverticulites non compliquées, dont le traitement va être symptomatique et ambulatoire, des formes compliquées de perforation, de fistule, ou d'abcès, dont la prise en charge va, la plupart du temps, être hospitalière. En phase aiguë, toutefois, les indications de recours à la chirurgie en urgence sont en diminution et sont aujourd'hui principalement limitées aux formes compliquées de péritonite. Enfin, la Haute Autorité de Santé a publié en 2017 des recommandations permettant de préciser les indications de chirurgie prophylactique des récidives, au décours d'une poussée. Si ces indications sont moins fréquentes que lors de dernières décennies, la chirurgie à froid reste très fréquemment indiquée et permet une diminution du risque de récidive et une amélioration de la qualité de vie. Colonic diverticulosis, anatomically defined by the presence of one or more diverticula, constituted of a mucosal and sub-mucosal hernia through the colonic muscular layer, is extremely frequent in industrialized countries. Its prevalence increases with age, but its occurrence remains asymptomatic. However, in 30% of the cases, the occurrence of infectious or hemorrhagic complications will be responsible for the entry into the diverticular disease, which is one of the most frequent gastro-intestinal emergencies and might lead to life-threatening situations. Infectious complications are the most frequent and computed tomography is the cornerstone of their diagnosis, allowing distinguishing non-complicated diverticulitis, whose treatment will be symptomatic and ambulatory, from complicated diverticulitis with perforation, abscess or fistula, which will require a hospitalization. In acute phase, indications of emergency surgery are scarce and mainly limited to patients with peritonitis. Finally, in 2017 the Haute Autorité de Santé published practice guidelines to clearly define the indications of prophylactic surgery following an acute flare. If these indications are less frequent than during the previous decades, prophylactic surgery is nevertheless still frequently required and allows a significant reduction of recurrence risk and improvement of quality of life of these patients. [ABSTRACT FROM AUTHOR]

Aim: Iatrogenic colonic perforation (ICP) is a rare serious complication of colonoscopy, where standard treatment is controversial. This study aimed to characterize diagnostic ICP (DICP) compared to therapeutic ICP (TICP) and determine the possible indication of endoscopic repair. Methods: We studied patients with ICP over 7 years starting in 2011. Their demographics and data regarding perforation, treatment, and outcome were investigated by retrospective review of medical records, and the diagnostic and therapeutic groups were compared. Results: Among 29,882 patients who underwent colonoscopy, ICP was identified in 28 (0.09%: diagnostic, 15/24,758, 0.06%; therapeutic, 13/5124, 0.25%). A total of 56 patients (33 DICP and 23 TICP) including 28 referred cases were analyzed. Mean age was 62.3 ± 11.4 years, and 24 were men. Perforations occurred mostly in the rectosigmoid region and half were detected during or immediately after colonoscopy. Endoscopic treatment was successful in 22 cases and 34 required surgery. Mortality occurred in 4 (7.1%). Compared to TICP, DICP was more prevalent in females and rectosigmoid region and more frequently detected immediately (all p < 0.05); DICP tended to occur in older patients, be larger and have better chance of endoscopic repair. Regardless of type of ICP, female predominance, smaller perforation, more frequent immediate detection, and shorter hospital stay (all p = 0.01) were found in the endoscopic repair group. Conclusion: DICP was more frequent in the rectosigmoid area in older women and could be detected immediately. Immediate detection and small perforation size could be important factors for endoscopic repair. Careful attention and gentle manipulation should be required. [ABSTRACT FROM AUTHOR]

Background: Despite the relative prevalence of small bowel and proximal colon perforation in the neonatal period, recto-sigmoid perforation is extremely rare. Full-term neonates experience intestinal perforation less frequently than premature infants. Here we report a neonate with sigmoid perforation and simultaneous Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection.Case Presentation: A 2550 g female neonate born at 38-weeks' gestation from a coronavirus disease-2019 (COVID-19) infected mother by cesarean section. Despite a good Apgar score in the first and fifth minutes, she was admitted to the neonatal intensive care unit with grunting and mild respiratory distress. She underwent antibiotics and oxygen by head box resulting in an Oxygen Saturation rate of 94%. The patients' respiratory distress decreased during the second day, resulting once breastfeeding without tolerance. While she passed meconium in the first 2 days, she developed abdominal distention on day 3. The nasopharyngeal SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) was performed with positive results. Surgical consultation was requested and a thoraco-abdominal X-Ray was performed at this stage, which suspected to be a gastrointestinal perforation. Due to clinical deterioration and persistent abdominal distention, a contrast study was performed with water-soluble contrast, which confirmed intestinal perforation. However, the surgical exploration revealed perforation of the sigmoid colon at the posterior segment. The patient underwent antibiotic therapy, abdominal lavage, and colostomy, immediately. She was discharged in good condition approximately 14-days later.Conclusion: To our knowledge, this is the first report of sigmoid colon perforation in a term neonate following COVID-19. [ABSTRACT FROM AUTHOR]

Objectives: Surgery for colonic perforation has high morbidity and mortality rates. Predicting complications preoperatively would help improve short-term outcomes; however, no predictive risk stratification model exists to date. Therefore, the current study aimed to determine risk factors for complications after colonic perforation surgery and use machine learning to construct a predictive model. Methods: This retrospective study included 51 patients who underwent emergency surgery for colorectal perforation. We investigated the connection between overall complications and several preoperative indicators, such as lactate and the Glasgow Prognostic Score. Moreover, we used the classification and regression tree (CART), a machine-learning method, to establish an optimal prediction model for complications. Results: Overall complications occurred in 32 patients (62.7%). Multivariate logistic regression analysis identified high lactate levels [odds ratio (OR), 1.86; 95% confidence interval (CI), 1.07-3.22; p = 0.027] and hypoalbuminemia (OR, 2.56; 95% CI, 1.06-6.25; p = 0.036) as predictors of overall complications. According to the CART analysis, the albumin level was the most important parameter, followed by the lactate level. This prediction model had an area under the curve (AUC) of 0.830. Conclusions: Our results determined that both preoperative albumin and lactate levels were valuable predictors of postoperative complications among patients who underwent colonic perforation surgery. The CART analysis determined optimal cutoff levels with high AUC values to predict complications, making both indicators clinically easier to use for decision making.

Prostate cancer presentation with perforation peritonitis due to rectal infiltration is quite rare. We report a 53-year-old man who presented with rectal growth resulting in bowel obstruction and transverse colon perforation, for which emergent exploration was performed. Postoperative evaluation with imaging, serum tumor markers, and histopathological examination including immunohistochemistry revealed it to be prostate cancer infiltrating to surrounding structures including the rectum. It is rare to observe such advanced cases in the era of serum prostate-specific antigen screening, but a high index of suspicion is necessary for adequate diagnosis and treatment, eventually benefitting the patient.

Abstract Background Necrotizing enterocolitis (NEC), while classically discussed in preterm and low birth weight neonates, also occurs in the term infant and accounts for 10% of all NEC cases. Despite there being fewer reported cases of NEC in term infants, these presentations demonstrate differences in the onset, severity and risk factors from the classic presentation observed in premature infants. We present a novel case of term NEC that contravenes the reported literature making departures from clinical presentation, risk factors and location of perforation in an otherwise healthy term two-day old infant born after an uncomplicated pregnancy who presented with hematochezia. Case presentation A healthy term baby born after an uneventful pregnancy presented with bloody stool at 2 days of life who was otherwise well. Investigations revealed pneumoperitoneum from a large proximal transverse colonic perforation secondary to NEC. No typical risk factors for NEC were found. Conclusion Given the life-threatening potential of an unrecognized perforation we recommend the inclusion of NEC on the differential for neonatal hematochezia.

Vascular Ehlers-Danlos syndrome (vEDS) is a rare autosomal dominant connective tissue disease. Patients with vEDS are at a high risk of developing severe complications (such as arterial aneurysm, arterial rupture, intestinal rupture) at an early age. We report a case of colonic perforation in a vEDS patient with no family history of that disease. A 28-year-old man with abdominal pain arrived at our hospital in an ambulance. The preoperative diagnosis was panperitonitis due to gastrointestinal perforation. Although his parents had not suffered from vEDS, he had been diagnosed with the disease at 25 years of age because of his history of arterial dissection. We performed an emergency operation using Hartmann's procedure to construct a descending colostomy. There remains a lack of consensus on surgical management in vEDS patients with gastrointestinal perforation because of the limited number of reported cases.

Disc and button battery ingestion in children is common. In fact, data reports a dramatic increase in battery ingestion during the coronavirus disease 2019 pandemic likely as a result of increased household population density and electronic product utilization. These batteries often remain lodged in the esophagus causing potentially devastating complications if they are not removed urgently. Batteries that are passed beyond the esophagus usually do not cause any complications. We present the case of a 15-month-old male who underwent a colostomy takedown 2 months following a posterior sagittal anorectoplasty for imperforate anus. He recovered quickly, was advanced on his diet, and was discharged to home on postoperative day 3. On postoperative day 5 following the stoma closure, he presented with an acute abdomen, pneumoperitoneum and an abdominal X-ray that revealed a 21 mm disc battery in the left lower quadrant. He underwent exploration and the battery was found perforating the anastomosis. There was significant fibropurulent exudate and inflammation. The battery was removed, the anastomosis was excised, and a colostomy with Hartman's pouch was performed. The toddler recovered uneventfully. This case offers an opportunity to discuss the concerns of battery ingestion and postoperative care following intestinal surgery in children. We could find no other similar reports in the world's literature of a disrupted colonic anastomosis due to battery ingestion.

We report a case of a 72-year-old female who presented with fever, abdominal pain, and diarrhea accompanied by leukopenia, anemia, and thrombocytopenia. The diagnosis of acute aplastic anemia was confirmed through bone marrow aspiration. Treatment included glucocorticoids, immunoglobulin therapy, and plasma exchange. Subsequently, the patient developed gastrointestinal bleeding and abdominal Computed Tomography (CT) revealed perforation of the transverse colon. Pathological examination of surgically removed diseased tissue confirmed mucor infection. Despite receiving antifungal therapy with amphotericin B, the patient's condition deteriorated due to the sepsis progression. Mucor infection in immunocompromised patients should be vigilant, and early diagnosis may help improve prognosis., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Major burns complicated by stress ulceration and perforation of the stomach or duodenum is a recognized clinical phenomenon. Colonic perforation in burns patients is not common, and the overall incidence, diagnosis, intervention undertaken and mortality is incompletely described in the literature.Method: We performed a systematic review of the literature on severe burns resulting in colonic perforation during the initial admission period. Relevant studies from January 1975 to June 2020 were retrieved from MEDLINE and EMBASE databases. Patient demographics, co-morbidities, total body surface area (TBSA) and anatomical region of burn, site of colonic perforation and management, nutrition, sepsis and microbiology, length of stay and overall outcome were extracted. We present a case series of five burns patients who had colonic perforations in our Specialist Burns Center.Results: We identified 54 studies, of which nine (two case series and seven case reports) met the inclusion criteria. Colonic perforation following burns was most common in middle-aged male patients with a proportion of patients having a history of mental health issues. In most cases, the TBSA associated with a colonic perforation was ≥30% (11/16 patients, 69%). Perforations mainly affected the right side of the colon (12/16 patients, 75%), usually occurring after the second week of admission (13/16 patients, 81%). Right-sided colonic perforations were associated with an increased mortality rate compared to left-sided perforations (42% vs 25%).Conclusions: The current literature is mainly limited to case series and case reports and confirms that colonic perforations in burns patients are rare. Colonic perforations are related to the systemic effect of burn injuries including sepsis and gastrointestinal stasis. We have identified patients who are at higher risk of developing colonic perforations and have described the common findings in these patients. Through greater awareness early diagnosis and prompt intervention may be achieved to improve outcomes and reduce associated morbidity and mortality. [ABSTRACT FROM AUTHOR]

The parasite Entamoeba histolytica , the causal agent of amebiasis, is considered a worldwide emergent disease and still represents an important cause of death in Mexico. Here, we describe a clinical case, involving an inflammatory response to both Coronavirus Infectious Disease 2019 (COVID-19) and intestinal amebiasis 54-year-old, COVID-positive Mexican gentleman was admitted to surgery following 6 days of hematochezia. An exploratory laparotomy and colonoscopy revealed multiple fibrous and amebic ulcerations (5–10 cm in diameter), with necrotic tissue predominantly localized in the sigmoid, descending and ascending colon. We discuss the pathophysiological interplay of both COVID-19 and intestinal amebiasis with the aim of highlighting a potentially novel aggravating mechanism in surgical patients suffering from colonic perforation in the setting of abdominal sepsis. [ABSTRACT FROM AUTHOR]

Objective Through retrospective analysis of the neonates with colon perforation caused by necrotizing enterocolitis. to explore the best choice of surgical methods. Methods Neonates with colon perforation caused by necrotizing enterocolitis from May 1.2018 to May 1.2020 were selected as the research objects, and they were divided into resection group (control group. n=21) and repair group (observation group.-26). The curative effect and clinical outcome were analyzed by SPSS20, 0 soft ware. Results The emergency operation time of the observation group was significantly shorter than that of the control group. while the inflammatory recovery time and the ostomy closure time of the observation group were longer than those of the control group: There were no statistically significant differences in mechanical ventilation time, feeding time, parenteral nutrition time-hospital stay time and postoperative complications between the two groups (P-0, 04.0. 01.-0.01). Conclusion Both methods can be used as the treatment of colonic perforation caused by necrotizing enterocolitis in neonates. The choice of surgical methods de pends on the state of the newborn at the time of surgery. Enteroplasty is an option for neonates with poor basic conditions and un stable hemodynamics, while enterotomy is an option for neonates with stable vital signs. [ABSTRACT FROM AUTHOR]

Hemolytic uremic syndrome (HUS) usually presents with mild gastrointestinal symptoms, typically managed medically. We describe 3 patients with challenging clinical presentations diagnosed with colonic perforation, review the literature, and discuss lessons learned. Case 1 : A 5-year-old girl presented with symptoms of HUS. Three weeks later, with new fevers and tachycardia, computerized tomography (CT) revealed pneumoperitoneum. She underwent resection of necrotic small bowel and sigmoid, with a second look resection and creation of multiple stomas. After 5 months, she was discharged on total parenteral nutrition (TPN) and hemodialysis. She later had restoration of intestinal continuity and renal transplantation. A 2-year-old boy with HUS underwent, over 3-weeks, 9 ultrasounds, percutaneous ascites aspiration, and 2 CT scans before diagnosis of colonic necrosis and perforation. A laparotomy revealed necrotic colon with a thick rind encasing the bowel, rendering full exploration and stoma creation impossible. Drains were placed, and he was discharged on TPN after 2 months. He underwent colo-colonic anastomosis and a TPN wean after one year with full renal recovery. A 3-year-old boy with HUS developed worsening distension. After one week, he suffered cardiopulmonary arrest and CT showed bowel hypoenhancement. He underwent resection of necrotic colon with transverse colostomy creation. After 4 months, he was discharged on hemodialysis. He underwent subsequent colostomy closure and renal transplantation. Bowel ischemia is difficult to diagnose in HUS. CT with intravenous contrast is critical for diagnostic accuracy. Frequent re-evaluation by pediatric surgery is important to avoid missing a surgical emergency. [ABSTRACT FROM AUTHOR]

Abstract Background Collagenous colitis (CC) is a clinicopathologic syndrome characterized by chronic watery diarrhea and distinctive histopathologic features. Spontaneous perforation of CC is extremely rare, because CC is usually managed medically, and the need for surgical intervention is rare. We report a surgical case of spontaneous colonic perforation of CC with acute abdomen disease. Case presentation A 77-year-old man was admitted to our hospital for abdominal pain and watery diarrhea. Computed tomography (CT) showed a thickened bowel wall with edema involving free air around the splenic flexure of the colon. Therefore, we performed emergency surgery with a diagnosis of colonic perforation. Intraoperative findings revealed colonic necrosis at the splenic flexure, so we performed a left hemicolectomy. Histopathological examination revealed typical findings of CC, a thick subepithelial collagenous band and deep ulcers with perforation. The postoperative course was uneventful, and the patient was discharged on the 28th postoperative day. After changing the proton pump inhibitor (PPI) from lansoprazole (LPZ) to rabeprazole (RPZ), he has not complained of diarrhea symptoms. Conclusions Although spontaneous perforation is a rare complication of CC, it is possible to be diagnosed by symptom of acute abdomen disease. This is the seventh case of spontaneous colonic perforation of CC worldwide.

The clinical features of corona virus disease 2019 (COVID-19) are variable, but the majority of patients experience mild flu-like symptoms. The cases of severe disease include complications such as progressive pneumonia, acute kidney injury, multi-organ failure, and even death. This paper explores the association between COVID-19 and its effect on multiple organ systems and how the subsequent treatment of this disease can itself lead to morbidity and mortality. We present a case which emphasizes the life threatening gastrointestinal complications associated with treatment of acute kidney injury (AKI) in a patient with COVID-19. We conclude that the patients whose treatment regimens utilize medical resins should be closely monitored for gastrointestinal complications so as to mitigate the known adverse effects associated with these drugs, such as colonic mucosal ulceration, perforation, or even death.

Prostate cancer presentation with perforation peritonitis due to rectal infiltration is quite rare. We report a 53-year-old man who presented with rectal growth resulting in bowel obstruction and transverse colon perforation, for which emergent exploration was performed. Postoperative evaluation with imaging, serum tumor markers, and histopathological examination including immunohistochemistry revealed it to be prostate cancer infiltrating to surrounding structures including the rectum. It is rare to observe such advanced cases in the era of serum prostate-specific antigen screening, but a high index of suspicion is necessary for adequate diagnosis and treatment, eventually benefitting the patient. [ABSTRACT FROM AUTHOR]

Tocilizumab, a monoclonal antiinterluekin-6 receptor antibody, has been empirically used in the treatment of cytokine release syndrome associated with severe coronavirus disease 2019 infections. The efficacy and safety of these medications for these patients is unknown. The purpose of this report was to present a case of acute large bowel perforation in a morbidly obese patient with coronavirus disease 2019 pneumonia who received empiric Tocilizumab. This case report analyzes the risks of acute large bowel perforation after using this medication empirically and discusses the appropriate management of this adverse event. [ABSTRACT FROM AUTHOR]

Background: One of the most common surgical procedures, cesarean section, can cause adhesion bands in the abdomen. Intestinal injury is a complication of repeat cesarean sections, particularly in the presence of adhesion bands. Occurrence of extensive cervical, subcutaneous, and mediastinal emphysema following colon perforation is a rare condition. This report presents a very rare case of cervical and mediastinal emphysema as the primary sign following colon perforation caused by a cesarean section. Case: A 27-year-old woman undergoing cesarean section was referred to an emergency room due to crepitus palpation. A physical examination revealed that she had "snowball" crepitation in her neck and upper chest. A chest-X ray revealed that she had mediastinal emphysema. In an abdominal exploration, her sigmoid colon was found sticking to her abdominal wall in the left corner of a Pfannenstiel incision while that colon had a small laceration and fistula to the abdominal wall. The sigmoid colon was released from the fascia and repaired with some Gambee stitches. Then, the pneumomediastinum space was drained from her neck by a collar incision. Results: The patient's granulation tissue gradually appeared at the incision line over the intestine and lateral wound. The skin in the upper and lower parts of the midline incision were approximated, and the lateral wound was left open for spontaneous closure. A few days after the surgery, the subcutaneous and mediastinal emphysema disappeared. She was discharged with instructions on taking a daily bath and dressing the lateral surgical wound. After 4 weeks, the lateral surgical wound had closed. Conclusions: Adhesion bands occur in repeat cesarean sections due to intestinal injuries, even though an optimal technique is used. A sufficient pressure gradient between the intestinal duct and the subcutaneous space following perforation and the presence of dead spaces in fascia resulting in surgical wounds are important factors in development of subcutaneous emphysema due to intestinal perforation. [ABSTRACT FROM AUTHOR]

Aim: Type IV Ehlers Danlos Syndrome (EDS) is a connective tissue disorder affecting approximately 1 per 100,000‐200,000 people. Life expectancy is reduced secondary to spontaneous vascular rupture or colonic perforation. Surgery carries significant morbidity and mortality. While strategies to manage colonic perforation include primary repair with or without a defunctioning stoma, Hartmann's procedure, total abdominal colectomy with end ileostomy and ileorectal anastomosis, evidence is contradictory and has not previously been evaluated in order to form a treatment strategy. We aim to review the published literature and identify outcome data relating to operative management of colonic perforation in type IV EDS. Methods: Pubmed, EM‐BASE, Cochrane library and Google Scholar were searched with the following details: Ehlers Danlos Syndrome AND colonic surgery. The main outcome measure was re‐perforation rates following colonic surgery on patients with type IV EDS. If the nature of surgery and follow up were reported, data were recorded in a SPSS database according to PRISMA guidelines. Results: One hundred and nine operations have been described in 51 patients in 44 case series. There were 26 visceral re‐perforations, 2 affecting the small intestine and 24 colonic. Survival analysis favoured total abdominal colectomy compared with operations where the colon was left in situ. Conclusions: Total abdominal colectomy with end ileostomy or ileorectal anastomosis are the safest strategies after colonic perforation in type IV EDS. Anastomotic leak rates are high. End colostomy is high risk for colonic re‐perforation and anastomotic leak rates are extremely high. Restoration of colonic continuity should be avoided. [ABSTRACT FROM AUTHOR]

Colonic perforation is a medical emergency that may be fatal if surgery cannot be performed in a timely manner. Colonic rupture in adults is caused by primary (idiopathic) and secondary factors. Although the segmental absence of muscularis propria (SAMP) is a recognized cause of secondary colonic rupture in neonates and infants, few cases have been reported in adults. Here, we present the case of a large colonic rupture caused by SAMP in a 60-year-old woman and a review of the literature. We suggest that SAMP should be included in the differential diagnosis of large perforation and/or periperforation membranous thinning of the colonic wall in adults.