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Injectable platelet rich fibrin, the latest innovation among platelet concentrates is obtained by centrifugation of whole blood without any anticoagulants. The initially liquid product is later converted into gel form due to conversion of fibrinogen into fibrin. This feature allows it to be used in injectable form or as topical spray. Incisional dehiscence and leakage is a potentially fatal postoperative complication of enterotomy. This study was conducted to investigate whether injectable platelet rich fibrin could be used as suture line reinforcement method in canine enterotomy. It was hypothesized that topically applied injectable platelet rich fibrin could increase the leakage pressure of enterotomy incisions. A total of 28 enterotomy incisions measuring 3 cm in length were created on the antimesenteric border of jejunum in canine cadaveric samples. The incisions were sutured with simple interrupted or simple continuous patterns and the suture line was reinforced by topical injectable platelet rich fibrin in treatment groups. Leak testing was conducted immediately and 15 minutes after suture placement in control and treatment samples respectively and initial leakage pressure and maximum intraluminal pressure was recorded along with leakage location. Although statistically insignificant, application of injectable platelet rich fibrin in the simple continuous treatment group increased the mean initial leakage pressure in comparison to simple continuous control group (15 ± 7.228 vs. 11.67 ± 26.17). Mean maximum intraluminal pressure was increased in both simple interrupted (46.29 ± 30.53 vs. 39 ± 34.54) and simple continuous (47.78 ± 9.497 vs. 35.67 ± 31.46) treatment groups in comparison to their respective control groups. Leakage was observed from the incision line and from the needle holes outside the incision line in simple interrupted and simple continuous sutured incisions respectively. Although the results indicated the feasibility of using this method but in vivo investigations are required to determine whether it could be used in clinical cases.

Background. Gallstone ileus is a pathology characterized by a variety of clinical manifestations and types of the course. Therefore, it is difficult in the diagnostic and therapeutic aspect and leads to unsatisfactory treatment results. The aim of the work is to find out the features of diagnosis and treatment of patients with gallstone ileus. Materials and methods. A retrospective analysis was performed of 51 medical records of inpatients with gallstone obstruction operated in the clinic from 1990 to 2020. Women aged 61 to 85 (median of 74.20 ± 12.95) years predominated — 44 (86.3 %). Most patients (81 %) had concomitant diseases, which in combination with gallstone ileus caused high surgical risk: coronary heart disease — 26 (51 %), essential hypertension — 11 (21.6 %), diabetes mellitus — 3 (5.9 %), obesity — 1 (2 %). Results. During the clinical, laboratory and instrumental examinations, the following preliminary diagnoses were made, for which surgical treatment was performed: acute adhesive intestinal obstruction — 29 (56.9 %), gallstone ileus — 9 (17.6 %), acute bowel obstruction — 4 (7.8 %), acute mesenteric circulatory failure — 4 (7.8 %), acute cholecystitis — 3 (5.9 %), hernia — 1 (1.9 %), peritonitis — 1 (1.9 %). Gallstone obstruction was detected at different levels: in the duodenum — in 3 (5.9 %) patients, jejunum — in 17 (33.3 %), ileum — in 23 (45.1 %) and colon — 8 (15.7 %) patients. The cause of stones in the lumen of the digestive tract was cholecystoduodenal fistula — in 48 (94.1 %) and choledochoduodenal fistula — in 3 (5.9 %) patients. Diagnosis of biliary fistulas was performed during postoperative radiological and endoscopic examination. The scope of surgery was aimed at eliminating acute intestinal obstruction; enterotomy was performed 5–10 cm distal to the site of obstruction with lithoextraction. In one patient with areas of focal necrosis at the site of stone entrapment, a loop of the small intestine was resected with entero-enterostomy “side-by-side”. In case of duodenal obstruction, lithoextraction was performed through gastrotomy. In the perioperative period, 43 (84.3 %) patients received antibiotic prophylaxis using cephalosporines, fluoroquinolones and metronidazole. Purulent-septic complications in the postoperative period developed in 9 (17.6 %) patients: suppuration of the postoperative wound in 6, infiltrate of the abdominal cavity in 1 and bronchopneumonia in 2. Two patients died, postoperative mortality was 3.9 %. Conclusions. Gallstone intestinal obstruction is difficult to diagnose due to a variety of clinical manifestations and course, and, accordingly, it is accompanied by frequent complications and high mortality. Surgical treatment should eliminate intestinal obstruction in conditions of high surgical risk without repair of biliodigestive fistula. Early detection and determination of indications for planned surgical sanitation of the biliary tract is a reliable way to prevent gallstone ileus.

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The ingestion of foreign bodies is common in small animals, especially in puppies. These objects can cause obstruction in the digestive system, leading to symptoms such as vomiting, diarrhea, constipation, and abdominal pain. Detecting and resolving the problem typically requires surgery or endoscopy. This study aims to describe the resolution of two cases of gastrointestinal obstruction in female puppy dogs through enterotomy and endoscopy. Both cases were successfully resolved. [ABSTRACT FROM AUTHOR]

Injectable platelet rich fibrin, the latest innovation among platelet concentrates is obtained by centrifugation of whole blood without any anticoagulants. The initially liquid product is later converted into gel form due to conversion of fibrinogen into fibrin. This feature allows it to be used in injectable form or as topical spray. Incisional dehiscence and leakage is a potentially fatal postoperative complication of enterotomy. This study was conducted to investigate whether injectable platelet rich fibrin could be used as suture line reinforcement method in canine enterotomy. It was hypothesized that topically applied injectable platelet rich fibrin could increase the leakage pressure of enterotomy incisions. A total of 28 enterotomy incisions measuring 3 cm in length were created on the antimesenteric border of jejunum in canine cadaveric samples. The incisions were sutured with simple interrupted or simple continuous patterns and the suture line was reinforced by topical injectable platelet rich fibrin in treatment groups. Leak testing was conducted immediately and 15 minutes after suture placement in control and treatment samples respectively and initial leakage pressure and maximum intraluminal pressure was recorded along with leakage location. Although statistically insignificant, application of injectable platelet rich fibrin in the simple continuous treatment group increased the mean initial leakage pressure in comparison to simple continuous control group (15 ± 7.228 vs. 11.67 ± 26.17). Mean maximum intraluminal pressure was increased in both simple interrupted (46.29 ± 30.53 vs. 39 ± 34.54) and simple continuous (47.78 ± 9.497 vs. 35.67 ± 31.46) treatment groups in comparison to their respective control groups. Leakage was observed from the incision line and from the needle holes outside the incision line in simple interrupted and simple continuous sutured incisions respectively. Although the results indicated the feasibility of using this method but in vivo investigations are required to determine whether it could be used in clinical cases. [ABSTRACT FROM AUTHOR]

Summary: Enterotomy of the pelvic flexure is commonly performed during colic surgery in the horse to empty the large colon of its contents. A two‐layer closure with absorbable suture material is recommended, but a consensus has not been established. Many different techniques have been described and tested to evaluate surgical time, luminal diameter reduction, bursting pressure and post‐operative complications including adhesion formation. The results of these studies vary within and between enterotomy techniques. The objective of this narrative review was to evaluate and summarise relevant published literature on pelvic flexure enterotomy techniques in the horse. [ABSTRACT FROM AUTHOR]

A bowel obstruction is a common canine problem. This study records acute small intestinal obstruction caused by the ingestion of mango seeds in three dogs. Three adult dogs were admitted to the surgery clinic with a one-day history of colicky abdominal pain, sudden episodes of vomiting, lack of appetite, no defecation, and lethargy. A swollen abdomen and widespread pain, increased bowel sounds, abdominal pain and no fever were discovered during the physical examination. Complete blood count, electrolytes and creatinine were normal. Abdominal radiography revealed many dilated small intestinal loops filled with gases and an intraluminal radio-opaque foreign body. Based upon the clinical and radiological examinations, the dogs underwent exploratory laparotomies. During laparotomy, the duodenum in all dogs was collapsed up to the jejunum, where a firm intraluminal mass was sensed. The proximal small bowel was distended. There were no obvious bowel perforations, ischemia or necrosis. The attempt to break the mass using digital compression was futile. As a result, an enterotomy was performed. Mango seeds were extracted from all dogs. The dogs recovered without compliations and were released three days following the operation. In conclusion, fresh mango seed can become lodged and create a possibly fatal intestinal obstruction in dogs. Early detection and treatment of these dogs can prevent fatal complications. This problem in dogs can be avoided by properly disposing of fallen and rotting mangoes and mango seeds in a rubbish bin rather than throwing them out in the open.

Abstract Background Feline obstipation is a clinical condition often manifested by defecation inability that results in fecal impaction. This is frequently associated with a blunt traumatic injury that affects mostly the spine and surrounding structures in the caudal part of the back leading to vertebral compression. Case presentation A 6-month-old, female, mixed-breed cat of 1.49-kg BW was presented with a history of prolonged constipation (i.e., obstipation) along with discomfort and weakness. Prior to the presentation, the cat was medically treated with dietary fibers, fecal softeners, and enemas, but obstipation persisted. Clinical examinations revealed that there was straining but not effective for defecation. In addition, the cat had poor appetite and dehydration, electrolyte abnormalities, and defects in posture and gait. The lumbosacral region showed a depression that was supposed to be the consequence of an old, untreated regional injury. Radiographic imaging indicated a marked ventral curvature in the lumbosacral spine including major deviations in the positions of the L6 and L7 vertebrae and the sacrum as well. A firm tubular structure was felt on ventral abdominal palpation, and further ultrasonography revealed the tubular impaction. Laparotomy exposed a definite large bowel impaction, and enterotomy was performed to evacuate the firm feces. Postoperatively, supportive medications and care were provided for better recovery. However, the impaction recurred within 3 months after surgery, and euthanasia was a further choice. Conclusions Traumatic injuries involving the lumbosacral spine in cats might be serious enough to lead to severe constipation and thereby bowel impaction. Therefore, treatment should be prompt and accurate in any case of spinal injury to avoid further complications.

Liposuction is one of the most commonly performed aesthetic plastic surgery procedures in the world. Although serious complications are rare, intra-abdominal complications such as bowel perforation are one of the most common causes of death after liposuction. We present a case series of six patients who sustained intra-abdominal injuries from liposuction. The acute care surgery (ACS) faculty at a single institution were surveyed for patients. Six patients were identified over a three-year period. The average age was 45 years, and all patients were female. All six underwent a cosmetic procedure in addition to their liposuction. Four (67%) had previous abdominal surgery, and five (83%) were overweight or obese. All patients presented with abdominal pain, tachycardia, and leukocytosis. All six underwent exploratory laparotomies: four patients had small bowel enterotomies, one had cecal volvulus and abdominal compartment syndrome, and one had fascial violation. They underwent an average of four ACS procedures (range 1 to 11) and had an average hospital LOS of 29 days (range 5 to 60) and an average ICU LOS of 11 days (range 1 to 39). Intra-abdominal injuries are a rare complication of liposuction; however, a high index of suspicion must be maintained to diagnose and treat these life-threatening injuries.

Introduction: Gallstone ileus (GI) is a rare complication of cholelithiasis and is one of the most irregular forms of all mechanical bowel obstructions. It is, however, a more common cause of non-strangulating mechanical small bowel obstruction, accounting for 1% to 4% of all patients and up to 25% in the elderly. The diagnosis is often delayed since symptoms may be intermittent, and investigations may fail to identify the cause of the obstruction. As a result, gallstone ileus continues to be associated with relatively high rates of morbidity and mortality. The cornerstone of healing is the removal of the stone that represents obstruction. As is the case with cholelithiasis, women are more frequently affected. Material and Methods: This article aims to review the incidence of gallstone ileus in our country in the literature, addressing the pathophysiology, clinical presentation, radiological findings, and treatment options. A literature search was done on gallstone ileus for 2005-2018. Results: The patients in the study presentation were both genders and older. They all came to INP because of abdominal pain and general nausea. All had CRP elevation present. Leukocytosis was present in only 2/3 of patients. AST was elevated in one patient and ALT in 2. All changes in laboratory parameters indicate the instability of marker changes and, consequently, the unreliability of use alone without other diagnostic methods. A CT scan was performed on all three patients, but one still needed to be uploaded to the system at the time of writing. Conclusions: Ileus due to gallstones is a rare disease. It is an uncommon cause of mechanical small bowel obstruction. It is a rare complication of chronic cholecystitis and occurs when a gallstone passes through a fistula between the gallbladder and small bowel before becoming impacted at the ileocecal valve. The use of radiological imaging is invaluable in the diagnosis of gallstone ileus. These authors recommend a low threshold for investigation. There is evidence for using AXR as a quick first-line investigation; however, CT scanning is a powerful and gold-standard tool to diagnose the condition and guide its management.

A bowel obstruction is a common canine problem. This study records acute small intestinal obstruction caused by the ingestion of mango seeds in three dogs. Three adult dogs were admitted to the surgery clinic with a one-day history of colicky abdominal pain, sudden episodes of vomiting, lack of appetite, no defecation, and lethargy. A swollen abdomen and widespread pain, increased bowel sounds, abdominal pain and no fever were discovered during the physical examination. Complete blood count, electrolytes and creatinine were normal. Abdominal radiography revealed many dilated small intestinal loops filled with gases and an intraluminal radio-opaque foreign body. Based upon the clinical and radiological examinations, the dogs underwent exploratory laparotomies. During laparotomy, the duodenum in all dogs was collapsed up to the jejunum, where a firm intraluminal mass was sensed. The proximal small bowel was distended. There were no obvious bowel perforations, ischemia or necrosis. The attempt to break the mass using digital compression was futile. As a result, an enterotomy was performed. Mango seeds were extracted from all dogs. The dogs recovered without compliations and were released three days following the operation. In conclusion, fresh mango seed can become lodged and create a possibly fatal intestinal obstruction in dogs. Early detection and treatment of these dogs can prevent fatal complications. This problem in dogs can be avoided by properly disposing of fallen and rotting mangoes and mango seeds in a rubbish bin rather than throwing them out in the open. [ABSTRACT FROM AUTHOR]

Background: Feline obstipation is a clinical condition often manifested by defecation inability that results in fecal impaction. This is frequently associated with a blunt traumatic injury that affects mostly the spine and surrounding structures in the caudal part of the back leading to vertebral compression. Case presentation: A 6-month-old, female, mixed-breed cat of 1.49-kg BW was presented with a history of prolonged constipation (i.e., obstipation) along with discomfort and weakness. Prior to the presentation, the cat was medically treated with dietary fibers, fecal softeners, and enemas, but obstipation persisted. Clinical examinations revealed that there was straining but not effective for defecation. In addition, the cat had poor appetite and dehydration, electrolyte abnormalities, and defects in posture and gait. The lumbosacral region showed a depression that was supposed to be the consequence of an old, untreated regional injury. Radiographic imaging indicated a marked ventral curvature in the lumbosacral spine including major deviations in the positions of the L6 and L7 vertebrae and the sacrum as well. A firm tubular structure was felt on ventral abdominal palpation, and further ultrasonography revealed the tubular impaction. Laparotomy exposed a definite large bowel impaction, and enterotomy was performed to evacuate the firm feces. Postoperatively, supportive medications and care were provided for better recovery. However, the impaction recurred within 3 months after surgery, and euthanasia was a further choice. Conclusions: Traumatic injuries involving the lumbosacral spine in cats might be serious enough to lead to severe constipation and thereby bowel impaction. Therefore, treatment should be prompt and accurate in any case of spinal injury to avoid further complications. [ABSTRACT FROM AUTHOR]

Summary: Horses with enterolithiasis may develop clinical signs of colic due to partial or complete obstruction of the right dorsal, transverse or small colon. Laparotomy followed by enterotomy at the site of obstruction or mobilisation of enteroliths to intestinal segments deemed more appropriate for incision is indicated in these cases. However, surgical removal of enteroliths lodged in nonexteriorisable intestinal segments and/or not amenable to mobilisation may be labour intensive and dangerous. Pneumatic impact (or ballistic) lithotripsy is a potential tool for surgical resolution of simple and complex cases of enterolithiasis in horses. This study describes the use of a pneumatic lithotripsy device for intraluminal enterolith fragmentation in five cases of enterolithiasis. Seven calculi were successfully fragmented. In four cases, fragmentation was achieved at the site of obstruction and fragments exteriorised through an enterotomy incision created for device introduction or advanced towards the rectum and removed. In two cases, enteroliths were manipulated back to the pelvic flexure, fragmented and removed. Findings of this study suggest that intraluminal enterolith fragmentation can be used to avoid long enterotomy incisions and facilitate removal of calculi lodged in bowel segments that cannot be exteriorised. However, it is important to be aware of the risks of enterolith fragmentation in nonexternalisable bowel segments that cannot be visualised for intestinal viability assessment. [ABSTRACT FROM AUTHOR]

Objective: Bezoars are foreign bodies developed due to the swallowing of indigestible substances in the stomach that accumulate in the lumen of the gastrointestinal tract. This study aimed to compare the location, size, and diameter of bezoars between patients with and without a history of previous gastrointestinal surgery and between operated and non-operated patients retrospectively. Methods: A total of 188 patients who presented to our gastroenterology clinic and in whom bezoar was suspected on clinical examination and the diagnosis confirmed through abdominal CT scans were included in the study. The patients were divided into two groups; patients with a history of previous gastrointestinal surgery were assigned to Group 1 (n = 70), and those who had no history of previous surgery (n = 118) to Group 2. Results: The mean age was found as 56.16 ± 15.75 years in Group 1 and 57.71 ± 15.95 years in Group 2. The mean bezoar width was significantly higher in Group 1 (p = 0.049). The mean bezoar length was significantly higher in Group 1 (p = 0.004). Considering localization of bezoars, the rate of patients who underwent enterotomy (80%) was statistically significantly higher than the patients who underwent gastrotomy (23.50%), gastrotomy + milking (28.60%) and milking (44.70%) in the operations performed in the jejunum. Conclusion: Bezoars are a rare cause of intestinal obstruction. The median width and length of the bezoars were significantly higher in patients with a history of previous gastric surgery. There was no significant difference in other parameters. The most common localization was jejunum. [ABSTRACT FROM AUTHOR]

Abstract Background Gastrointestinal foreign bodies are a common indication for abdominal exploratory surgery. Objectives The objective of this study was to evaluate the relationship of pre‐operative abdominal discomfort and duration of clinical signs with surgical resolution of canine small intestinal foreign body obstructions (SIFBO). Methods We performed a retrospective study of 181 canine abdominal exploratory surgeries for confirmed SIFBO at two referral hospitals. Animals were categorized into five surgical groups (gastrotomy after manipulation into the stomach, enterotomy, resection‐and‐anastomosis [R&A], manipulated into colon, already in colon) and further grouped by whether entry into the gastrointestinal tract (GIT) was required. Results Abdominal discomfort was noted in 107/181 cases (59.1%), but no significant differences in abdominal discomfort rates were present among the surgical groups or between GIT entry and no entry groups. Clinical sign duration was associated with surgical procedure; median durations were R&A = 3 days (range, 1–9), enterotomy = 2 days (range, 1–14), gastrotomy = 2 days (range, 1–6), already in colon = 1.5 days (range, 1–2), and manipulated into colon = 1 day (range, 1–7). In a pairwise comparison, differences in the duration of clinical signs were found for obstructions manipulated into the colon versus R&A, gastrotomy versus R&A, and in colon versus R&A. When patients were grouped according to GIT entry, cases with entry had a longer duration of clinical signs (median = 2 days [range, 1–14] versus 1 day [range, 1–7], respectively). Conclusions Abdominal discomfort was not associated with surgical complexity; however, the duration of clinical signs was associated with surgical complexity, with longer duration being associated with entry into the GIT and R&A. Despite statistical significance, the maximum difference of 2 days between surgical groups is unlikely to be clinically relevant.

: Trichophytobezoars have been reported in a variety of mammalian taxa, including macropods, but successful antemortem diagnosis and surgical excision in macropods is rare. : An 11-month-old, castrated male, red-necked wallaby (Notamacropus rufogriseus) was presented for evaluation of a sudden onset of lethargy, anorexia, tremoring, and ataxia. The wallaby was hospitalized and started on supportive care. Baseline bloodwork showed wa low normal white blood cell count and a low normal potassium. Abdominal radiography and computed tomography were subsequently performed and demonstrated severe gastric dilatation secondary to gastric and small intestinal foreign bodies. Based on the diagnostic imaging findings, a laparotomy with gastrotomy and enterotomy was performed to successfully remove the gastric and small intestinal foreign bodies, which were trichophytobezoars. The wallaby recovered fully from the procedure. : Abdominal radiography and computed tomography were strongly supportive of intestinal mechanical obstruction. Gastrotomy and enterotomy successfully relieved a small intestinal mechanical obstruction in a clinically ill macropod who, postoperatively, was apparently healthy for at least 14 months. Gastrointestinal bezoars should be considered a differential diagnosis for macropods with nonspecific gastrointestinal signs. [ABSTRACT FROM AUTHOR]

Gallstone ileus is a rare entity that causes bowel obstruction by gaining access through a cysto-enteric fistula. This is a case report of a 70-year-old man presenting with small bowel obstruction secondary to distal jejunal gallstone ileus impaction. He is not known to have any predisposing factors. He was managed effectively with an enterolithotomy. Early diagnosis is key to a good prognosis. Although other management options are available, enterolithotomy with or without cholecystectomy remains the gold standard of management. [ABSTRACT FROM AUTHOR]

ObjectiveThe objective of this study was to compare the occurrence of post-operative complications and survival to discharge in horses with ileal impactions resolved by manual decompression compared with jejunal enterotomy.AnimalsA total of 121 client-owned horses undergoing surgical correction of an ileal impaction at three teaching hospitals.Materials and methodsData from the medical records of horses undergoing surgical correction of an ileal impaction was retrospectively collected. Post-operative complications, survival to discharge, or post-operative reflux present were evaluated as dependent variables and pre-operative PCV, surgery duration, pre-operative reflux, and type of surgery were evaluated as independent variables. Type of surgery was divided into manual decompression (n = 88) and jejunal enterotomy (n = 33).ResultsThere were no significant differences in development of minor complications, development of major complications, presence of post-operative reflux, amount of post-operative reflux, and survival to discharge between horses that were treated with manual decompression and those treated with distal jejunal enterotomy. Pre-operative PCV and surgery duration were significant predictors of survival to discharge.Conclusions and clinical relevanceThis study showed that there are no significant differences in post-operative complications and survival to discharge in horses undergoing distal jejunal enterotomy versus manual decompression for correction of ileal impaction. Pre-operative PCV and duration of surgery were found to be the only predictive factors of survival to discharge. Based on these findings, distal jejunal enterotomy should be considered earlier in horses with moderate to severe ileal impactions identified at surgery.

A 6-yr-old captive-bred male black pine snake (Pituophis melanoleucus lodingi) weighing 0.49 kg with a snout-to-vent length of 127 cm was presented for evaluation of a caudal coelomic swelling that had been present for 3 days. Survey radiographs showed focal distention of the body wall with a mass of soft tissue and mineral opacity. Anti-inflammatory and empiric antibiotic treatments were initiated, with no significant improvement. Coelomic ultrasound showed effusion and intestinal changes consistent with an intussusception. On exploratory celiotomy, the mass was found to be a 10-cm-long colonic diverticulum. A colotomy was performed and inspissated fecal material was removed from the lumen of the diverticulum prior to its resection and closing of the bowel defect. Histological examination of the excised tissue was consistent with an intestinal diverticulum and complete absence of the smooth muscle layers, indicating nonperforating rupture of the bowel wall. The snake recovered uneventfully and began eating 5 days after surgery. On physical and ultrasound examinations 8 months after surgery, the snake's body condition had improved and there was no recurrence of clinical signs, with the snake remaining normal 30 months postsurgery at home. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal foreign bodies are a common indication for abdominal exploratory surgery. Objectives: The objective of this study was to evaluate the relationship of pre‐operative abdominal discomfort and duration of clinical signs with surgical resolution of canine small intestinal foreign body obstructions (SIFBO). Methods: We performed a retrospective study of 181 canine abdominal exploratory surgeries for confirmed SIFBO at two referral hospitals. Animals were categorized into five surgical groups (gastrotomy after manipulation into the stomach, enterotomy, resection‐and‐anastomosis [R&A], manipulated into colon, already in colon) and further grouped by whether entry into the gastrointestinal tract (GIT) was required. Results: Abdominal discomfort was noted in 107/181 cases (59.1%), but no significant differences in abdominal discomfort rates were present among the surgical groups or between GIT entry and no entry groups. Clinical sign duration was associated with surgical procedure; median durations were R&A = 3 days (range, 1–9), enterotomy = 2 days (range, 1–14), gastrotomy = 2 days (range, 1–6), already in colon = 1.5 days (range, 1–2), and manipulated into colon = 1 day (range, 1–7). In a pairwise comparison, differences in the duration of clinical signs were found for obstructions manipulated into the colon versus R&A, gastrotomy versus R&A, and in colon versus R&A. When patients were grouped according to GIT entry, cases with entry had a longer duration of clinical signs (median = 2 days [range, 1–14] versus 1 day [range, 1–7], respectively). Conclusions: Abdominal discomfort was not associated with surgical complexity; however, the duration of clinical signs was associated with surgical complexity, with longer duration being associated with entry into the GIT and R&A. Despite statistical significance, the maximum difference of 2 days between surgical groups is unlikely to be clinically relevant. [ABSTRACT FROM AUTHOR]

Purpose: Bowel injury during laparoscopic and robotic ventral hernia repair is a rare but potentially serious complication. We sought to compare bowel injury rates during minimally invasive approaches to ventral hernia repair using a national hernia registry. Methods: Patients undergoing elective laparoscopic and robotic ventral hernia repair (including cases converted-to-open) between 2013 and 2021 were retrospectively identified in the Abdominal Core Health Quality Collaborative registry. The primary outcome was bowel injury, which included partial- and full-thickness injuries and re-operations for missed enterotomies. Statistical analysis was performed using multivariate logistic regression. Results: Overall, 10,660 patients were included (4116 laparoscopic, 6544 robotic). The laparoscopic group included more incisional hernias (68% vs 62%, p < 0.001) and similar rates of recurrent hernias (23% vs 22%, p = 0.26). A total of 109 bowel injuries were identified, with more occurring in the laparoscopic group (55 [1.3%] laparoscopic vs. 54 [0.8%] robotic; p = 0.01). Specifically, there were more full-thickness and missed enterotomies in the laparoscopic group (29 laparoscopic vs. 20 robotic; p = 0.012). Bowel injury resulted in higher rates of wound morbidity and major post-operative complications including sepsis, re-admission, and re-operation. Following adjustment for recurrent and incisional hernias, prior mesh, patient age, and hernia width, bowel injury during laparoscopic repair remained significantly more likely than bowel injury during robotic repair (OR 1.669 [95% C.I.: 1.141–2.440]; p = 0.008). Conclusion: In a large registry, laparoscopic ventral hernia repair is associated with an increased risk of bowel injury compared to repairs utilizing the robotic platform. Knowing the limitations of retrospective research, large national registries are well suited to explore rare outcomes which cannot be feasibly assessed with randomized controlled trials. [ABSTRACT FROM AUTHOR]

We present a case where ingestion of multiple bead magnets caused multiple perforations of small bowel and required surgical intervention. Pressure necrosis of intervening loops of small intestine led to tiny perforations at multiple sites without contamination of the abdomen. All of those magnets were retrieved by performing enterotomy and resection & anastomosis done at few sites. If unattended or missed out they can even lead to death. [ABSTRACT FROM AUTHOR]

Copyright of Revista Cientifica de la Facultade de Veterinaria is the property of Universidad del Zulia, Facultad de Ciencias Veterinarias and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Interleukin-10 (IL10) signalling pathway deficiency results in severe very early onset inflammatory bowel disease (VEOIBD), and enterostomy is often inevitable. However, studies in these surgical populations are lacking. This study aims to determine the enterostomy characteristics, postoperative complications and related risk factors in enterostomy patients. Methods From March 1, 2015, to December 31, 2018, patients with IL10R-mutation who underwent enterostomy were recruited for analysis. We collected data on the patients’ clinical characteristics, enterostomy characteristics, postoperative complications and related risk factors. Results Twelve patients required emergency enterostomy, and 10 patients underwent elective enterostomy. Twelve patients experienced postoperative complications, including wound infection (27.3%), wound dehiscence (18.2%), reoperation (18.2%), etc. Compared with the pre-enterostomy values, there was a decrease in C-reactive protein (CRP) (P = 0.001), an increase in albumin (P = 0.001) and an improvement in the weight-for-age (P = 0.029) and body mass index (BMI) Z-scores (P = 0.004) after enterostomy. There was a significant difference between the pre-operation and postoperation medicine expenses (P = 0.002). Univariate binary logistic regression analysis revealed a statistically significant influence of CRP (OR: 1.43, 95% CI: 1.07–1.91, P = 0.016) and a tendency towards a significant influence of intestinal perforation, albumin level, BMI Z-score and weighted paediatric Crohn’s disease activity index (wPCDAI). Multivariate logistic regression analysis showed that CRP (OR: 1.40), wPCDAI (OR: 2.88) and perforation (OR: 1.72) showed a tendency to behave as independent risk factors for postoperative complications, but the results were not significant (all P > 0.05). Conclusions Surgery and enterostomy showed benefits for VEOIBD with IL-10 signalling deficiency. The timing of intervention, potential postoperative complications, economic burden and other related problems should be considered.

Gastrointestinal foreign bodies (GFB) in cats and dogs are among the life-threatening surgical diseases that require invasive surgery. This study aimed to evaluate the cases of GFB in 32 cats and dogs diagnosed and treated in Hatay Mustafa Kemal University Veterinary Health Practice and Research Hospital. Information regarding the type, breed, age, sex, clinical symptoms, characteristics of foreign bodies (FB), localization, prognosis, type of treatment administered, and conditions determined in postoperative controls was collected. The cases were aged between 1 and 7 years and adult animals were also included. The rate of FB incident was the same in male and female cats, whereas male dogs had a higher rate of FB incident. Strings/ropes and metallic objects were the most common foreign objects found in animals. Early diagnosis and treatment were important in preventing complications in the cases, FB was usually found in the stomach, and vomiting was the most common clinical symptom. Further, surgical intervention (gastrostomy/enterotomy) was the most common treatment method with a rate of 53.13 % for treating FB in the gastrointestinal system that yielded successful results. Thus, to avoid complications and for a good prognosis, owners must be conscious and seek for diagnosis and treatment as soon as they notice the incidence of swallowing a FB, so as to ensure early diagnosis and treatment.

Purpose: In this study, a three-step novel surgical technique was developed for incisional hernia, in which a laparoscopic procedure with a mini-laparotomy is combined: so-called 'three-step incisional hybrid repair'. The aim of this study was to reduce the risk of intestinal lacerations during adhesiolysis and recurrence rate by better symmetrical overlap placement of the mesh. Objectives: To evaluate first perioperative outcomes with this technique. Methods: From 2016 to 2020, 70 patients (65.7% females) with an incisional hernia of > 2 and ≤ 10 cm underwent a elective three-step incisional hybrid repair in two non-academic hospitals performed by two surgeons specialised in abdominal wall surgery. Intra- and postoperative complications, operation time, hospitalisation time and hernia recurrence were assessed. Results: Mean operation time was 100 min. Mean hernia size was 4.8 cm; 45 patients (64.3%) had a hernia of 1–5 cm, 25 patients (35.7%) of 6–10 cm. Eight patients had a grade 1 complication (11.4%), five patients a grade 2 (7.1%), two patients (2.8%) a grade 4 complication and one patient (1.4%) a grade 5 complication. Five patients had an intraoperative complication (7.0%), two enterotomies, one serosa injury, one omentum bleeding and one laceration of an epigastric vessel. Mean length of stay was 3.3 days. Four patients (5.6%) developed a hernia recurrence during a mean follow-up of 19.5 weeks. Conclusion: A three-step hybrid incisional hernia repair is a safe alternative for incisional hernia repair. Intraoperative complications rate was low. [ABSTRACT FROM AUTHOR]

Bouveret’s syndrome is a rare form of gallstone ileus. It refers to gastric outlet or small bowel obstruction caused by the formation of a biliary enteric fistula with subsequent migration and impaction of a large gallstone into stomach or small intestine. Its diagnosis is often delayed or overlooked. Diagnosis is based on the clinical manifestations, presence of pneumobilia, visualisation of stone and demonstration of small bowel obstruction on imaging. Enterotomy or gastrotomy with or without cholecystectomy and fistula repair is the most common surgical therapy. The aim of this case series was to analyse the presentation of Bouveret’s syndrome and strategise the optimum surgical approach based on the available literature and authors experience. Authors hereby report three cases of Bouveret’s syndrome encountered within last two years with clinical presentation, surgical approaches and operative findings. Computed Tomography (CT) scan is most commonly used to diagnose this rare entity. Early detection and optimum timing of surgery plays crucial role in outcome. It has high success rate, with acceptable surgical morbidity and mortality. Heightened awareness of this syndrome may lead to decreased morbidity and mortality. [ABSTRACT FROM AUTHOR]

PICO question In dogs with gastrointestinal foreign-body obstruction undergoing surgical correction, is the mortality rate in the perioperative period for those receiving resection and anastomosis higher, lower, or equivalent to those receiving an enterotomy? Clinical bottom line Category of research question Outcome The number and type of study designs reviewed Four retrospective studies were reviewed Strength of evidence Weak Outcomes reported It would appear that the mortality rate for resection and anastomosis for the purpose of foreign-body removal is higher than that of enterotomies performed for the same reason Conclusion There is insufficient evidence directly comparing enterotomies with resection and anastomoses in foreign-body obstructions to definitively state that the mortality rate is higher among resection and anastomosis procedures How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Bouveret’s syndrome is a rare form of gallstone ileus. It refers to gastric outlet or small bowel obstruction caused by the formation of a biliary enteric fistula with subsequent migration and impaction of a large gallstone into stomach or small intestine. Its diagnosis is often delayed or overlooked. Diagnosis is based on the clinical manifestations, presence of pneumobilia, visualisation of stone and demonstration of small bowel obstruction on imaging. Enterotomy or gastrotomy with or without cholecystectomy and fistula repair is the most common surgical therapy. The aim of this case series was to analyse the presentation of Bouveret’s syndrome and strategise the optimum surgical approach based on the available literature and authors experience. Authors hereby report three cases of Bouveret’s syndrome encountered within last two years with clinical presentation, surgical approaches and operative findings. Computed Tomography (CT) scan is most commonly used to diagnose this rare entity. Early detection and optimum timing of surgery plays crucial role in outcome. It has high success rate, with acceptable surgical morbidity and mortality. Heightened awareness of this syndrome may lead to decreased morbidity and mortality.

Foreign body ingestion is common in young children. Very few cases require surgical exploration for removal. We report a case of superabsorbent gel ball ingestion causing intestinal obstruction, managed by a combination of endoscopic and open surgical removal under intraoperative ultrasound guidance.

Gastrointestinal foreign bodies are commonly encountered in veterinary pathology. The patient may present a variety of clinical signs, depending on the shape of the swallowed object, as well as the site and extent of obstruction. The aim of this study is to describe an unusual case of linear gastrointestinal foreign body, in a 3-year-old cat, referred to the Faculty of Veterinary Medicine Iasi, Surgery Department. The anamnesis and clinical examination suggested a gastrointestinal foreign body, subsequently confirmed by ultrasonography, therefore surgical intervention was the treatment of choice. After anesthesia, oral examination revealed an anchored thread around the base of the tongue which couldn't be extracted by conservative methods, due to the traction resistance. Exploratory celiotomy and enterotomy were performed, the thread being entirely removed after it was freed from the tongue. The patient recovered uneventfully without postoperative complications. [ABSTRACT FROM AUTHOR]

Gallstone ileus is a rare complication of cholelithiasis that occurs as a result of occlusion of the intestinal lumen by a large sized gallstone accounting for 1-4% cases of small bowel obstruction. The aim of this work is to introduce a case report that emphasize the diagnostic and therapeutic management of gallstone ileus with an enterolith impacted in jejunum (an uncommon site).

The creation of leakage holes in the intestinal wall by four types of swaged-on needles used to close enterotomy incisions in canine cadavers was studied. Twenty-four enterotomies were performed in 10 cm jejunal sections obtained from five dogs following euthanasia. After placement of Doyen intestinal forceps to the ends of each section, a 3 cm antimesenteric incision was performed and closed using 4-0 polydioxanone suture armed in a swaged-on needle in a simple interrupted pattern. One group served as control, with no enterotomies performed. The four groups that we used consisted of six sections each: group CC was closed with a polydioxanone suture armed in a conventional cutting needle, group RC was closed with a reversed cutting needle, group TPP was closed with a taper point plus needle, and group TC was closed with a taper cutting needle. Leak testing was performed by infusion of 13.5 mL methylene blue solution into the intestinal lumen. Significant differences between leakage and non-leakage sections of group CC were detected (P=.027). No statistical differences were detected among other groups. Conventional cutting needles seem to create leaking holes in cadaveric healthy jejunum during needle passage for closing an enterotomy incision.

The objective of this study was to evaluate the effects of cruciate mattress suture pattern on the healing of colotomy closure in conventional and laparoscopical surgery. Twelve adult local breed bucks apparently healthy were used, it was divided randomly into two equal main groups. In group A (Conventional group), the colotomy incision was created and closed by cruciate mattress suture pattern while in group B (Laparoscopic group), the colotomy closure by same pattern intracorporeally using 3-0 Polygalactin-910. Clinical follows up a long period of experiment and microscopic evaluation at 1 and 3 weeks post operation to evaluate the colotomy healing process. The results of clinical evaluation and physiological parameter indicate that there was no significant change and restore to the normal level within 2-3 and 3-4 post-operative days in group B and A respectively. Histopathological evaluation revealed that, advance healing in laparoscopic group when compared with conventional group. In conclusion, the study clearly demonstrated the healing process in laparoscopical technique superior to that occur in in conventional technique. [ABSTRACT FROM AUTHOR]

Background: Interleukin-10 (IL10) signalling pathway deficiency results in severe very early onset inflammatory bowel disease (VEOIBD), and enterostomy is often inevitable. However, studies in these surgical populations are lacking. This study aims to determine the enterostomy characteristics, postoperative complications and related risk factors in enterostomy patients.Methods: From March 1, 2015, to December 31, 2018, patients with IL10R-mutation who underwent enterostomy were recruited for analysis. We collected data on the patients' clinical characteristics, enterostomy characteristics, postoperative complications and related risk factors.Results: Twelve patients required emergency enterostomy, and 10 patients underwent elective enterostomy. Twelve patients experienced postoperative complications, including wound infection (27.3%), wound dehiscence (18.2%), reoperation (18.2%), etc. Compared with the pre-enterostomy values, there was a decrease in C-reactive protein (CRP) (P = 0.001), an increase in albumin (P = 0.001) and an improvement in the weight-for-age (P = 0.029) and body mass index (BMI) Z-scores (P = 0.004) after enterostomy. There was a significant difference between the pre-operation and postoperation medicine expenses (P = 0.002). Univariate binary logistic regression analysis revealed a statistically significant influence of CRP (OR: 1.43, 95% CI: 1.07-1.91, P = 0.016) and a tendency towards a significant influence of intestinal perforation, albumin level, BMI Z-score and weighted paediatric Crohn's disease activity index (wPCDAI). Multivariate logistic regression analysis showed that CRP (OR: 1.40), wPCDAI (OR: 2.88) and perforation (OR: 1.72) showed a tendency to behave as independent risk factors for postoperative complications, but the results were not significant (all P > 0.05).Conclusions: Surgery and enterostomy showed benefits for VEOIBD with IL-10 signalling deficiency. The timing of intervention, potential postoperative complications, economic burden and other related problems should be considered. [ABSTRACT FROM AUTHOR]

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The objective of this retrospective study was to evaluate the positive and negative predictive values (PPV and NPV) of sonographic evidence of intestinal wall layering damage as a predictor for the operative necessity to perform enterectomy in dogs and cats with obstructive intestinal foreign bodies. Forty seven dogs and 5 cats with sonographic evidence of obstructive intestinal foreign bodies were used in this study. Sonographic reports of patients diagnosed with intestinal foreign body and treated surgically, between the years 2013-2018 were reviewed. Subjects were divided into two groups based on the integrity of their intestinal wall layering: Group I were subjects with sonographic loss of intestinal layering (LWL) and Group II were subjects with intact intestinal layering (IWL). Records were reviewed and the surgical procedure was classified as "Enterectomy" or "Enterotomy". Sensitivity, specificity, PPV and NPV of the sonographic evidence of loss of intestinal wall layering were calculated as a predictor for the enterectomy or enterotomy procedure. Enterectomies were performed in 36% (8/35) of the IWL and 89% (15/17) of the LWL cases. The sensitivity and specificity of the sonographic evidence of loss of intestinal wall layering as a predictor of enterectomy were 66% and 94% respectively. PPV calculated to be 89% and NPV 78%. Septic peritonitis was evident in 55% of LWL and 6% of IWL surgeries. It was concluded that sonographic evidence of loss of intestinal wall layering in dogs and cats with intestinal foreign bodies may serve as predictor suggestive for the need to select enterectomy versus enterotomy at the site of the intestine with questionable viability of the intestinal wall. The prevalence of septic peritonitis in cases with sonographic evidence of loss of intestinal wall layering was relatively high. A surgeon experienced with enterectomy techniques will help provide the best prognosis to the patient. [ABSTRACT FROM AUTHOR]

Despite improvements in the development of sutures and surgical techniques of laparorrhaphy and enterorrhaphy, complications resulting from the process of intestinal and muscular healing after simple enterorrhaphy or enteroanastomoses followed by laparorrhaphy are still frequent. The poliglecaprone 25 (PG) suture is commonly used in this type of surgical procedure due to the induction of little tissue reaction, rapid absorption by hydrolysis, and the absence of capillarity. The chitosan (CG) yarn, despite promising results in in vivo tests, is still rarely used. The objective of this study was to evaluate the use of CG in the procedures of medium laparorrhaphy and cecorrhaphy in rabbits. A total of 42 rabbits were allocated in two groups (n = 21), one referring to raffia procedures using CG and another to postoperatively PG. Macroscopic and microscopic evaluations occurred postoperatively on days 5, 15, and 25. The incidence of postoperative complications such as fibrin accumulation, granulomas, partial dehiscence of the muscular wound, and formation of adhesions was similar in the study groups. In the microscopic evaluation, abdominal muscle healing presented granulation tissue at higher intensity and lower fibrosis at 15 days postoperatively in the CG animals, as well as a greater intensity of polymorphonuclear (PMN) cells in the rabbits' cecorrhaphy area, also at 15 days when compared to PG animals. The conclusion is that the CG yarn comprises biomaterial useful to the laparorrhaphy and cecorrhaphy procedures in rabbits, representing a promising alternative for use in other species and anatomical locations. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2102–2108, 2019. [ABSTRACT FROM AUTHOR]