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OBJECTIVE To determine the survival to discharge rate of rabbits with gastrointestinal obstructions treated with lidocaine constant rate infusion (CRI) and other factors associated with survival. ANIMALS Cases of gastrointestinal obstruction in rabbits (n = 56, including 64 events) that had presented to a veterinary teaching hospital from 2012 to 2021. METHODS This was a retrospective study in which data on rabbits with evidence of gastrointestinal obstruction were extracted from veterinary teaching hospital medical records over a 9-year period. Systemic lidocaine treatment, breed, sex, age, temperature at presentation, blood glucose at presentation, and time to discharge or death were evaluated with univariate and multivariate logistic regression to identify factors significantly associated with survival to hospitai discharge in rabbits with gastrointestinal obstruction. RESULTS Comparatively, 89.7% of rabbits treated with lidocaine CRI (n = 39) survived to hospital discharge, while only 56% of rabbits that were not treated with lidocaine CRI (25) survived. In the final multivariate analysis, 2 factors were associated with survival to discharge: rabbits treated with systemic lidocaine and male rabbits had increased odds of survival compared to those not treated with systemic lidocaine and female rabbits, respectively. CLINICAL RELEVANCE Results demonstrated that rabbits with gastrointestinal obstruction and treated with a lidocaine CRI were more likely to survive compared to rabbits not treated with lidocaine CRI. [ABSTRACT FROM AUTHOR]

Background. Self-expandable metal stents (SEMS) are widely used in gastrointestinal (GI) tract obstructive lesions. Planning and stent placement control can be performed with using roentgenological, endoscopic or combined method. The choice of the method depends on doctor’s preferences and clinic’s traditions, but endoscopic one is used more often. Comparison of the above methods efficacy in a single-institution material was not found in the literature. Objective: to compare clinical and roentgenological results of GI stenting depending on the method used. Material and methods. In 2016–2021, 267 cases of GI stenting were performed in Botkin Municipal Clinical Hospital. In 70 (26%) of them an endoscopic method was used, in 97 (36%) – a roentgenological one, and in 100 (37%) – a combined one. All patients underwent X-ray control postop. Results were analyzed statistically. Results. The implementation of X-ray diagnostics solo or in combination with endoscopy in GI SEMS planning and placement provided better results in comparison with endoscopic method only. Total SEMS expansion was achieved in 99% of cases versus 79% after only endoscopic procedures, correct stent placement – in 98% and 75%, respectively, evacuation was restored in 98% and 70%, respectively. All differences were statistically significant (p < 0.001). It is evident that X-ray methods are not useful for preliminary marking in decompensated patients with GI stenosis. But after elimination of such cases from analysis, the difference between the groups remained statistically significant (p < 0.05). Conclusion. The data obtained substitute expediency of X-ray method solo or with endoscopic one. Significant improvement of the results can be referred to more exact preoperative selection of SEMS type and size with X-ray method.

Abstract Background In mynahs with foreign body ingestion, delayed diagnosis increases the risk of poor outcomes. Objective The aim of this study was to evaluate various radiologic features on plain and contrast radiographs in mynahs for assessing the presence of ingested foreign bodies. Methods In our cross‐sectional study, a total of 41 mynahs were included. The diagnosis was made by history, surgery, excision by forceps or excretion in the faeces. Overall, 21 mynahs were considered not to have a foreign body in their gastrointestinal tract. Plain and post‐contrast [oral administration of barium sulphate colloidal suspension of 25% weight/volume (20 mg/kg)] lateral and ventrodorsal radiographs from the cervical and coelomic cavity were taken. Different parameters including oesophageal, proventricular, and small intestinal diameters and opacities were assessed. Image evaluation was performed by two national board‐certified radiologists blinded to the final diagnoses. Results The inter‐ and intra‐observer reliabilities of the diagnostic features were significant (p < 0.001). The diagnosis of the foreign body was highly accurate [90.2% (95% CI: 76.9%, 92.3%)] with the sensitivity, specificity, and area under the representative characteristic curve of 90.0%, 90.5%, and 0.93%, respectively for plain radiographs. The size and opacity of the oesophagus, proventriculus, and intestinal loops as well as serosal details were significantly different between mynahs with and without foreign body intake (p < 0.05). Conclusions Lateral and ventrodorsal plain radiographs are highly reliable for diagnosing the presence of non‐opaque obstructing objects in the gastrointestinal tract of mynahs. Attention should be paid to the size and opacity of the oesophagus, extension, and opacity of the proventriculus, segmental opacity of intestinal loops, and decrease in serosal details.

Background: In mynahs with foreign body ingestion, delayed diagnosis increases the risk of poor outcomes. Objective: The aim of this study was to evaluate various radiologic features on plain and contrast radiographs in mynahs for assessing the presence of ingested foreign bodies. Methods: In our cross‐sectional study, a total of 41 mynahs were included. The diagnosis was made by history, surgery, excision by forceps or excretion in the faeces. Overall, 21 mynahs were considered not to have a foreign body in their gastrointestinal tract. Plain and post‐contrast [oral administration of barium sulphate colloidal suspension of 25% weight/volume (20 mg/kg)] lateral and ventrodorsal radiographs from the cervical and coelomic cavity were taken. Different parameters including oesophageal, proventricular, and small intestinal diameters and opacities were assessed. Image evaluation was performed by two national board‐certified radiologists blinded to the final diagnoses. Results: The inter‐ and intra‐observer reliabilities of the diagnostic features were significant (p < 0.001). The diagnosis of the foreign body was highly accurate [90.2% (95% CI: 76.9%, 92.3%)] with the sensitivity, specificity, and area under the representative characteristic curve of 90.0%, 90.5%, and 0.93%, respectively for plain radiographs. The size and opacity of the oesophagus, proventriculus, and intestinal loops as well as serosal details were significantly different between mynahs with and without foreign body intake (p < 0.05). Conclusions: Lateral and ventrodorsal plain radiographs are highly reliable for diagnosing the presence of non‐opaque obstructing objects in the gastrointestinal tract of mynahs. Attention should be paid to the size and opacity of the oesophagus, extension, and opacity of the proventriculus, segmental opacity of intestinal loops, and decrease in serosal details. [ABSTRACT FROM AUTHOR]

Introduction: the administration of enteral nutrition through a nasogastric tube can cause potentially serious complications. We present a case of esophageal obstruction due to an enteral nutrition bezoar. Case report: the 77-year-old patient was admitted to our center in the intensive care unit for COVID pneumonia. The patient received enteral nutrition through a nasogastric tube (NGT), presenting difficulty passing it after a month of follow-up. After removal of the tube and attached to it, an esophageal mold for enteral nutrition was extracted. Later, a solvent solution is administered through a new SNG and the formula is modified for a hydrolyzed one. Discussion: enteral nutrition bezoars are a rare but can be a life-threatening complication. [ABSTRACT FROM AUTHOR]

Lymphoma in the gastrointestinal tract most commonly occurs in the stomach, small intestine and around the ileocecal region. Usually gastrointestinal lymphoma occurs secondary to widespread nodal disease and is rarely found to be the primary site. Of the different types of lymphoma, diffuse large B-cell non-Hodgkin's lymphoma makes up the majority of lymphomas in the gastrointestinal tract. Primary colorectal lymphoma is even less common and accounts for 3% of all gastrointestinal lymphomas and to our knowledge, gastrointestinal lymphoma involving 2 different regions in the GI tract has not been discussed in the literature. Herein, we are presenting a rare case of diffuse large B-cell lymphoma presenting as a malignant mass in both the duodenum and ascending colon.

Abstract Background We experienced the critical aspiration pneumonia during induction of anesthesia in elective abdominal surgery which standard fasting period was complied with. Case presentation A 64-year-old male was scheduled for gastrojejunostomy because of gastrointestinal obstruction. He fasted from the night before surgery. General anesthesia was induced, and cricoid pressure was applied during intubation. However, he vomited huge amount of gastric contents. The scheduled surgery was performed without surgical complications, and postoperatively respiratory management, including mechanical ventilation with prone positioning, was performed in high care unit. He was extubated on postoperative day 2. He was discharged from the hospital on POD 25. Conclusion The standard fasting period can prevent aspiration pneumonia in most cases. However, even in elective cases without abdominal symptoms, we consider that massive-volume gastric residual contents, especially in susceptible cases. We suggest that point-of-care gastric ultrasonography be performed in suspicious cases before induction of anesthesia.

Objective: The aim of this study was to assess rates of palliative care (PC) involvement in the care of patients with malignant gastrointestinal obstruction (GIO) and its influence on interdisciplinary team involvement. Background: Malignant GIO is an advanced oncologic diagnosis with associated poor prognosis. Data regarding PC and interdisciplinary team involvement in these patients is lacking. Methods: We identified consecutive surgical consultations for GIO in cancer patients at a single institution from August 2017 to July 2019. Clinical characteristics were collected. Rates of PC consultation, ACP discussion, code status change to do not resuscitate, and interdisciplinary service consultation were evaluated. Results: We identified 200 patients with consultations for GIO, of whom 114 (57%) had malignant GIO and were included in our study. Of these patients, 95 (83%) had stage IV disease; 68 (60%) had peritoneal metastasis, and 70 (61%) had other intra-abdominal recurrence or metastasis. PC consultation was obtained in 69 patients (61%). PC consultation was associated with higher rates of ACP discussion (64% vs 29%; P < 0.001), code status change to do not resuscitate (30% vs 2%; P < 0.001), nonsurgical procedure (46% vs 11%; P < 0.001), discharge to hospice (30% vs 7%; P < 0.001), and involvement of spiritual care (48% vs 22%; P = 0.01), social work (77% vs 42%, P < 0.001), psychology/psychiatry (42% vs 4%, P < 0.001), nutrition (86% vs 62%, P = 0.006), physical therapy (54% vs 31%, P = 0.02), and occupational therapy (42% vs 16%, P = 0.004). Conclusions: PC consultation benefits patients with malignant GIO by facilitating comprehensive interdisciplinary care, ACP discussions, and transition to hospice care, where appropriate. Diagnosis of malignant GIO should be a trigger for PC consultation or, in facilities with limited PC resources, consideration of deliberately broad interdisciplinary consultation. [ABSTRACT FROM AUTHOR]

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Background: The horizontal beam (HB) view has been used in the identification of pneumothorax, pleural effusion and pneumoperitoneum in small animals. Based on the literature, there were no published data evaluating the utility of HB radiography in vomiting dogs to differentiate between patients with or without mechanical gastrointestinal ileus. Aim: The purpose of this prospective pilot study was to determine the utility of HB radiograph as an additional view in vomiting dogs to differentiate patients with or without mechanical gastrointestinal ileus; and describe if there are any radiographic image characteristics associated with the HB view for patients with mechanical gastrointestinal ileus. Methods: A prospective study was performed on dogs presented with acute vomiting. For all dogs, four radiographic views (ventrodorsal, right lateral, left lateral and left to right lateral HB in sternal recumbency) of the abdomen and abdominal ultrasound were obtained. If a mechanical ileus was detected ultrasonographically, an exploratory laparotomy or endoscopy was performed, otherwise medical treatment was elected. Results: A total of 22 patients were recruited, 11 diagnosed with mechanical ileus and 11 without mechanical ileus. Three blinded reviewers independently assessed the radiographs in three sets: vertical beam (VB) views, HB view alone, and a combination of both views. No statistical difference was found in the differentiation between patients with or without mechanical gastrointestinal ileus between HB view alone or added to VB views. Conclusion: This study suggests, the HB view in sternal recumbency may be an alternative for patients which are not stable enough to be positioned in lateral or ventrodorsal recumbency.

A 42-year-old female was admitted with upper abdominal pain. Imaging studies and laboratory tests were performed to consider acute lipogenic pancreatitis. After symptomatic treatment, her abdominal pain was significantly relieved. However, the patient was accompanied by upper gastrointestinal obstruction, which was gradually relieved after long-term fasting, gastrointestinal decompression, and fluid rehydration. The patient developed dizziness and ataxia, which worsened. Cranial magnetic resonance imaging (MRI) indicated patchy abnormal signal shadows in the bilateral thalami and dorsal brainstem and suggested metabolic encephalopathy. Wernicke's encephalopathy (WE) was the initial diagnosis of suspicion, adequate vitamin B1 was immediately replenished until the complete resolution of symptoms, and the patient made a rapid and dramatic recovery.

Gastrointestinal Basidiobolomycosis is a rare manifestation of Basidiobolus ranarum infection. In this report, we present two cases of gastrointestinal Basidiobolomycosis. The first patient presented with obstructive symptoms, fever, and weight loss. The diagnosis of Basidiobolomycosis was not made until after surgery, when Liposomal amphotericin-B combined with itraconazole were administered, leading to the resolution of laboratory markers of inflammation and patient's symptoms. The second case involves a young woman who presented with hematochezia, perianal induration, and abdominal pain. The patient had previously been diagnosed with Crohn's disease and treated accordingly, but her symptoms did not improve. Due to the endemicity of tuberculosis in Iran, the patient was treated for TB but still showed no improvement. However, a perianal biopsy sample revealed the Splendore Hoeppli phenomenon and fungal elements in GMS staining, leading to the diagnosis of gastrointestinal Basidiobolomycosis. Treatment with itraconazole and co-trimoxazole led to a significant improvement in symptoms and laboratory indices after one week, including the resolution of perianal induration. The key takeaway from this report is the importance of considering rare infections in the differential diagnosis of gastrointestinal conditions such as IBD and GI obstruction.

Gastroduodenal intussusception is a rare but important cause of gastric outlet obstruction, particularly in elderly patients. We present the case of an 81-year-old female who arrived at the emergency department with complaints of epigastric pain, nausea, and vomiting. A CT scan revealed gastroduodenal intussusception, while subsequent endoscopy identified a submucosal mass, raising suspicion for either a gastrointestinal stromal tumor (GIST) or pancreatic rest. This case report highlights the diagnostic process, therapeutic considerations, and clinical outcomes, with a review of the relevant literature., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest. There are no financial or personal relationships with other individuals or organizations that could inappropriately influence (bias) the content of this report. No funding was received to assist with the preparation of this manuscript., (Copyright © 2024. Published by Elsevier Inc.)

Appendicitis is defined as an inflammation of the appendix and is one of the most common presentations to the general surgical team. The presence of right iliac fossa pain associated with a rise in inflammatory markers raises the suspicion of appendicitis in young, healthy patients. Colitis and bowel obstruction would be considered lower down on the list of differentials. Other common differentials to take into consideration include ovarian pathology and pelvic inflammatory disease in females and diverticulitis in the other population. Investigation for these patients includes ultrasound scans, computed tomography, magnetic resonance imaging or diagnostic laparoscopy. Imaging modality can help narrow down differentials; however, diagnostic laparoscopy can prove to be fruitful when there is diagnostic uncertainty.  Meckel's diverticulum is commonly encountered within general surgery, more so within the paediatric population. Complications include bleeding, inflammation and obstruction, although this is less common in the adult population.  We present a rare case of small bowel obstruction with the transition point noted to be at the location of a Meckel's diverticulum masquerading as possible appendicitis., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Patel et al.)

Background: We experienced the critical aspiration pneumonia during induction of anesthesia in elective abdominal surgery which standard fasting period was complied with. Case presentation: A 64-year-old male was scheduled for gastrojejunostomy because of gastrointestinal obstruction. He fasted from the night before surgery. General anesthesia was induced, and cricoid pressure was applied during intubation. However, he vomited huge amount of gastric contents. The scheduled surgery was performed without surgical complications, and postoperatively respiratory management, including mechanical ventilation with prone positioning, was performed in high care unit. He was extubated on postoperative day 2. He was discharged from the hospital on POD 25. Conclusion: The standard fasting period can prevent aspiration pneumonia in most cases. However, even in elective cases without abdominal symptoms, we consider that massive-volume gastric residual contents, especially in susceptible cases. We suggest that point-of-care gastric ultrasonography be performed in suspicious cases before induction of anesthesia. [ABSTRACT FROM AUTHOR]

Background : There have been cases reporting anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) and associated serious gastrointestinal (GI) adverse drug reactions (gastrointestinal obstruction, perforation, and ulceration). These adverse drug reactions are not in the drug package inserts, and the drug relationships are not proven in the literature. Aim: We aimed to examine the potential association between GI obstruction, perforation, and ulceration, and ALK-TKIs by data mining of the US FDA Adverse Event Reporting System (FAERS). Method : We conducted a disproportionality analysis of GI obstruction, perforation, and ulceration by estimating the reporting odds ratios (ROR) and the information component (IC) with 95% confidence intervals. Results : A total of 279 cases of ALK-TKI-associated GI obstruction, perforation, and ulceration from January 1, 2011, to December 31, 2020, were identified. GI obstruction, perforation, and ulceration cause 16% of cases of death. A significantly increased reporting rate for GI obstruction [ROR 1.77 (1.45–2.15); IC 0.82 (0.53–2.03)] and perforation [ROR 1.61 (1.28–2.02); IC 0.68 (0.35–1.92)] was observed for ALK-TKIs as a drug class. The signal of GI ulceration was detected only in crizotinib [ROR 1.23 (1.01–1.50); IC 0.29 (0.01–1.51)]. A statistically significant ROR and IC emerged for the site of the esophagus. Conclusion : Overall, the pharmacovigilance study of the FAERS indicates slightly increased reporting of GI obstruction and perforation, which may cause severe or even fatal outcomes among ALK-TKIs users. [ABSTRACT FROM AUTHOR]

Background: The horizontal beam (HB) view has been used in the identification of pneumothorax, pleural effusion, and pneumoperitoneum in small animals. Based on the literature, there were no published data evaluating the utility of HB radiography in vomiting dogs to differentiate between patients with or without mechanical gastrointestinal ileus. Aim: The purpose of this prospective pilot study was to determine the utility of HB radiograph as an additional view in vomiting dogs to differentiate patients with or without mechanical gastrointestinal ileus; and describe if there are any radiographic image characteristics associated with the HB view for patients with mechanical gastrointestinal ileus. Methods: A prospective study was carried out on dogs presented with acute vomiting. For all dogs, four radiographic views [ventrodorsal (VD), right lateral, left lateral, and left-to-right lateral HB in sternal recumbency] of the abdomen and abdominal ultrasound were obtained. If a mechanical ileus was detected ultrasonographically, an exploratory laparotomy or endoscopy was performed, otherwise medical treatment was elected. Results: A total of 22 patients were recruited, 11 diagnosed with mechanical ileus and 11 without mechanical ileus. Three blinded reviewers independently assessed the radiographs in three sets: vertical beam (VB) views, HB view alone, and a combination of both views. No statistical difference was found in the differentiation between patients with or without mechanical gastrointestinal ileus between HB views alone or added to VB views. Conclusion: This study suggests that the HB view in sternal recumbency may be an alternative for patients who are not stable enough to be positioned in lateral or VD recumbency. [ABSTRACT FROM AUTHOR]

Extranodal Lymphomas are most commonly located in gastrointestinal tract. The most common cause of small intestinal obstruction in children is intussusception. However GI lymphomas are a rare cause of intussusception. So we are reporting a case of extranodal lymphoma in a female child presenting as intussusception of small intestine. a 9 years old female child presented with features of subacute intestinal obstruction. On examination a lump was felt in the abdomen. On further evaluation, a computed tomography (CT) revealed a possibility of lymphoma. The bowel segment was excised and sent for histopathological examination. On gross examination a growth was seen along with satellite lesion. 10 lymph nodes were also identified. Representative sections were taken. Microscopic examination showed the presence of medium size to large size lymphoid cells. After immunohistochemical staining a diagnosis of Non Hodgkins Lymphoma (Extranodal Marginal Zone) was made. 1 lymph node was positive for tumour invasion while other 9 were showing reactive hyperplasia. Since both lymphomas and intussesception are common in pediatric age group, lymphoma should always be kept as a differential diagnosis while dealing with a case of intussusception in pediatric age group. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to analyze the etiology, symptom frequency, management, and surgical outcome of gastrointestinal obstruction in the first month of life.Methods: A total of 72 neonates with gastrointestinal obstruction were reviewed over a period of 16 months.Results: The male to female ratio was 2.4:1. In this study, 75% of the neonates were presented in the first 7 days of life. The mean gestational age was 39.25 weeks. In addition, 68 of the neonates were term babies. The most common cause of admission was anorectal malformation (22%); furthermore, small bowel atresia was observed in 15% of the cases. Vomiting was the most common symptom of gastrointestinal obstruction reported in 31% of the cases, followed by abdominal distension. In this study, the overall mortality after surgery was 17%. The significant determining cause of mortality was sepsis reported in 33% of the cases.Conclusion: Early referral, diagnosis, and treatment of gastrointestinal obstruction in neonates are needed to improve the survival outcome. The most common cause of neonatal gastrointestinal obstruction was found to be imperforate anus.

Background: Conventionally, it is well accepted that the intestinal obstructions in children, especially gastric outlet obstruction are associated with significant metabolic derangement which has impact on its outcome. The study aimed to compare the metabolic profile and treatment outcome of pre- and post-ampullary gastrointestinal obstruction in children at a tertiary care setting. Materials and Methods: A prospective observational study was conducted on 30 children with intestinal obstruction and categorised into Group 1 (pre-ampullary, n = 11) and Group 2 (post-ampullary, n = 19) as per their anatomical site of pathology. Patients were evaluated at both pre- and post-operative period (Day 1 and 10) with haematological, biochemical and blood gas. The pre- and post-operative metabolic profile, resuscitative time and outcome were compared in two groups. Results: Except mild leucocytosis (Group II > I), rest of the pre-operative and post-operative haematological parameters were within normal range and statistically comparable among groups. Although the pre-operative sodium values were within the normal limit in both groups, it was relatively higher in Group I (Group I = 137.82 ± 4.238 vs. Group II = 134.26 ± 4.653), (P = 0.04). The mean bicarbonate values were within the normal limit in both groups (22.49 and 19.34), but the difference was statistically significant (P = 0.031). Mean partial pressure of carbon dioxide level was higher than normal range in Group I (38.464 ± 20.6493) but was comparable with Group II (P = 0.15). The time required for pre-operative resuscitation was 16.6 versus 24.87 h in Group I versus Group II (P = 0.02). In Group I, all children were improved, whereas four children expired in Group II. Conclusion: Metabolic profile in both pre- and post-ampullary intestinal obstruction was found to be normal in majority of the scenario. Children with post-ampullary obstruction need extensive pre-operative resuscitation and have relatively poor outcome.

Abstract A case of abdominal aortic aneurysm appeared to be compression of the antrum of the stomach and was suspected of causing a gastric obstruction. However, an upper gastrointestinal endoscopy to rule out an obstruction by a tumor revealed a gastric tumor, thus avoiding unnecessary intervention, such as open surgery.

A small bowel obstruction (SBO) involves partial or complete blockage of the small intestine. Complete high-grade or closed-loop obstructions constitute acute surgical emergencies necessitating urgent intervention to prevent severe complications. Several probable etiologies of SBO have been identified, including malignancy, stool impaction, and inflammatory bowel disease; however, post-surgical adhesion is the most prevalent cause in the developed world. A SBO can be diagnosed clinically after a physical examination, but imaging is needed for surgical assessment and management. Misdiagnosis and inadequate management of SBO can cause several complications, such as intestinal necrosis and perforation. Therefore, when required, rapid diagnosis and surgical intervention are critical to avoiding mortality. Computer tomography (CT) and small bowel follow-through (SBFT) are widely utilized imaging modalities for confirmatory diagnosis of SBO. This case series features three patients who had exploratory laparotomies following extensive clinical evaluations and a radiologically confirmed diagnosis of SBO. All three cases involved numerous surgeries. The patients presented with severe abdominal discomfort and received surgical intervention after a CT scan confirmed the diagnosis and conservative therapy failed. In this case, all patients had different presentations but responded adequately to the same treatment modalities with no postoperative complications., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mayow et al.)

Drug-induced gastrointestinal obstruction (DIGO) and gastrointestinal perforation (DIGP) may be the result of gastrointestinal hypomotility and severe constipation, which may lead to potentially fatal complications of bowel ischemia, sepsis and perforation. We evaluated the onset profile of DIGs (DIGO and DIGP) associated with prescription drugs by analyzing data in the Japanese Adverse Drug Event Report (JADER) database. We selected 161 DIG-related drugs and categorized them into 19 classes based on the Anatomical Therapeutic Chemical (ATC) Classification System. Finally, we focused on 58 drugs and conducted subsequent analyses for the time-to-onset and outcomes. We extracted 79 preferred terms (PTs) with the strings “ileus,” “stenosis,” “obstruction,” “obstructive,” “impaction,” “perforation,” “perforated,” “hypomotility,” and “intussusception” from the Standardized Medical Dictionary for Regulatory Activities (MedDRA) Queries (SMQs) of SMQ20000104: gastrointestinal perforation, ulcer, hemorrhage, obstruction non-specific findings/procedures; SMQ20000105: gastrointestinal obstruction; and SMQ20000107: gastrointestinal perforation. Among the 667, 729 reports in the JADER database submitted between April 2004 and November 2020, we identified 11,351 occurrences of DIGs. The reporting odds ratios (RORs) (95% confidence interval) of “barium sulfate containing X-ray media,” “drugs for treatment of hyperkalemia and hyperphosphatemia,” and “oral bowel cleanser” were 142.0 (127.1–158.6), 25.8 (23.1–28.8), and 29.7 (24.8–35.6), respectively. The median number of days (interquartile range) until the onset of an adverse event caused by each drug category was as follows: barium sulfate containing X-ray contrast media [2.0 (1.0–3.0)], diazepines, oxazepines, thiazepines, and oxepines [8.0 (8.0–18.5)], drugs for treatment of hyperkalemia and hyperphosphatemia [29.0 (8.0–55.0)], non-selective monoamine reuptake inhibitors [19.0 (7.0–47.5)], and oral bowel cleanser [0.0 (0.0–0.0)]. Depending on the drug, the time to onset of side effects ranged from days to several months. Our results highlighted the need to perform detailed monitoring of each drug for possible association with DIGs, which might otherwise have fatal consequences.

Drug-induced gastrointestinal obstruction (DIGO) and gastrointestinal perforation (DIGP) may be the result of gastrointestinal hypomotility and severe constipation, which may lead to potentially fatal complications of bowel ischemia, sepsis and perforation. We evaluated the onset profile of DIGs (DIGO and DIGP) associated with prescription drugs by analyzing data in the Japanese Adverse Drug Event Report (JADER) database. We selected 161 DIG-related drugs and categorized them into 19 classes based on the Anatomical Therapeutic Chemical (ATC) Classification System. Finally, we focused on 58 drugs and conducted subsequent analyses for the time-to-onset and outcomes. We extracted 79 preferred terms (PTs) with the strings "ileus," "stenosis," "obstruction," "obstructive," "impaction," "perforation," "perforated," "hypomotility," and "intussusception" from the Standardized Medical Dictionary for Regulatory Activities (MedDRA) Queries (SMQs) of SMQ20000104: gastrointestinal perforation, ulcer, hemorrhage, obstruction non-specific findings/procedures; SMQ20000105: gastrointestinal obstruction; and SMQ20000107: gastrointestinal perforation. Among the 667, 729 reports in the JADER database submitted between April 2004 and November 2020, we identified 11,351 occurrences of DIGs. The reporting odds ratios (RORs) (95% confidence interval) of "barium sulfate containing X-ray media," "drugs for treatment of hyperkalemia and hyperphosphatemia," and "oral bowel cleanser" were 142.0 (127.1–158.6), 25.8 (23.1–28.8), and 29.7 (24.8–35.6), respectively. The median number of days (interquartile range) until the onset of an adverse event caused by each drug category was as follows: barium sulfate containing X-ray contrast media [2.0 (1.0–3.0)], diazepines, oxazepines, thiazepines, and oxepines [8.0 (8.0–18.5)], drugs for treatment of hyperkalemia and hyperphosphatemia [29.0 (8.0–55.0)], non-selective monoamine reuptake inhibitors [19.0 (7.0–47.5)], and oral bowel cleanser [0.0 (0.0–0.0)]. Depending on the drug, the time to onset of side effects ranged from days to several months. Our results highlighted the need to perform detailed monitoring of each drug for possible association with DIGs, which might otherwise have fatal consequences. [ABSTRACT FROM AUTHOR]

Background: Digestive tumours are among the leading causes of morbidity and mortality. Many cancer patients cannot maintain oral feeding and develop malnutrition. The authors aim to: review the endoscopic, radiologic and surgical techniques for nutritional support in cancer patients; address the strategies for nutritional intervention according to the selected technique; and establish a decision-making algorithm to define the best approach in a specific tumour setting. Summary: This is a narrative non-systematic review based on an electronic search through the medical literature using PubMed and UpToDate. The impossibility of maintaining oral feeding is a major cause of malnutrition in head and neck (H&N) cancer, oesophageal tumours and malignant gastric outlet obstruction. Tube feeding, endoscopic stents and gastrojejunostomy are the three main nutritional options. Nasal tubes are indicated for short-term enteral feeding. Percutaneous endoscopic gastrostomy (PEG) is the gold standard when enteral nutrition is expected for more than 3–4 weeks, especially in H&N tumour and oesophageal cancer patients undergoing definite chemoradiotherapy. A gastropexy push system may be considered to avoid cancer seeding. Radiologic and surgical gastrostomy are alternatives when an endoscopic approach is not feasible. Postpyloric nutrition is indicated for patients intolerant to gastric feeding and may be achieved through nasoenteric tubes, PEG with jejunal extension, percutaneous endoscopic jejunostomy and surgical jejunostomy. Oesophageal and enteric stents are palliative techniques that allow oral feeding and improve quality of life. Surgical or EUS-guided gastrojejunostomy is recommended when enteric stents fail or prolonged survival is expected. Nutritional intervention is dependent on the technique chosen. Institutional protocols and decision algorithms should be developed on a multidisciplinary basis to optimize nutritional care. Conclusions: Gastroenterologists play a central role in the nutritional support of cancer patients performing endoscopic techniques that maintain oral or enteral feeding. The selection of the most effective technique must consider the cancer type, the oncologic therapeutic program, nutritional aims and expected patient survival.

The small bowel is the least common site for diverticula in the entire gastro-intestinal tract. Chronic upper intestinal obstruction due to diverticula is very rare. We report a case of multiple small bowel diverticula causing mechanical obstruction of the duodenojejunal flexure.

Extranodal Lymphomas are most commonly located in gastrointestinal tract. The most common cause of small intestinal obstruction in children is intussusception. However GI lymphomas are a rare cause of intussusception. So we are reporting a case of extranodal lymphoma in a female child presenting as intussusception of small intestine. a 9 years old female child presented with features of subacute intestinal obstruction. On examination a lump was felt in the abdomen. On further evaluation, a computed tomography (CT) revealed a possibility of lymphoma. The bowel segment was excised and sent for histopathological examination. On gross examination a growth was seen along with satellite lesion. 10 lymph nodes were also identified. Representative sections were taken. Microscopic examination showed the presence of medium size to large size lymphoid cells. After immunohistochemical staining a diagnosis of Non Hodgkins Lymphoma (Extranodal Marginal Zone) was made. 1 lymph node was positive for tumour invasion while other 9 were showing reactive hyperplasia. Since both lymphomas and intussesception are common in pediatric age group, lymphoma should always be kept as a differential diagnosis while dealing with a case of intussusception in pediatric age group. [ABSTRACT FROM AUTHOR]

The small bowel is the least common site for diverticula in the entire gastrointestinal tract. Chronic upper intestinal obstruction due to diverticula is very rare. We report a case of multiple small bowel diverticula causing mechanical obstruction of the duodenojejunal flexure. [ABSTRACT FROM AUTHOR]

Abdominal volvulus represents a critical condition characterized by the abnormal twisting of the GI tract, potentially leading to obstruction and vascular compromise. Prompt recognition and appropriate management are essential to prevent complications and improve patient outcomes. This comprehensive review examines the anatomy, pathophysiology, clinical presentation, and diagnostic evaluation of, and management strategies for abdominal volvulus. Non-operative techniques, including detorsion and decompression, as well as surgical interventions, such as laparoscopic and open approaches, are discussed. Additionally, the importance of multidisciplinary collaboration and postoperative care is emphasized. Despite significant advancements, unresolved issues remain, necessitating further research to refine diagnostic and therapeutic approaches. Future directions, including exploring emerging technologies, offer promise for enhancing the management of this challenging condition. Overall, this review provides clinicians with valuable insights into the optimal management of abdominal volvulus, aiming to improve patient outcomes and enhance clinical practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Chauhan et al.)

A 21-year-old man developed non-bilious emesis and 40-pound weight loss over two months. Initial endoscopy revealed stomach distension and inability to advance beyond the first portion of the duodenum. He underwent exploratory laparotomy, which showed no clear cause of obstruction, and was transferred to a quaternary care pediatric hospital for further care. MRI showed high-grade proximal duodenal obstruction and a suspected duodenal web. Repeat endoscopy demonstrated a pinpoint hole in the proximal duodenum, confirming duodenal web. After endoscopic dilation, open duodenotomy with web lysis and closure in Heineke-Mikulicz fashion was performed. Post-operatively, the patient resumed a regular diet and had gained 50 pounds by his five-month follow-up visit. Predominantly diagnosed in infancy, duodenal web is an important cause of gastrointestinal obstruction with characteristic radiographic and endoscopic findings and should be considered in patients of all ages with unexplained proximal bowel obstruction.

Body packing was first described in 1973 and refers to the intracorporeal concealment of illegal drugs, which are swallowed or placed in anatomical cavities and/or body orifices. The body packer can be asymptomatic or can have signs of systemic drug toxicity (neurological, cardiac, abdominal, renal and cutaneous) due to rupture of the packet(s) or symptoms of gastrointestinal obstruction or perforation. The diagnosis is established based on a suggestive history, findings on physical examination and laboratory findings and/or imaging. The vast majority of patients are asymptomatic and are treated conservatively. However, complex situations may require surgical intervention. We present a case of a 50-year-old man who was admitted in the emergency department with a generalized tonic-clonic seizure and vomiting with plastic film, which raised the suspicion of foreign body ingestion, confirmed by imaging and laboratory tests. He underwent exploratory laparotomy to remove the packages.

Grazia Leonello,1 Antonio Giacomo Rizzo,1 Viviane Di Dio,2 Antonio Soriano,3 Claudia Previti,3 Grazia Giulia Pantè,3 Claudio Mastrojeni,1 Sebastiano Pantè1 1Department of Human Pathology of Adults and Evolutive Era “Gaetano Barresi”, University of Messina, Messina, Italy; 2Health Research Institute Bonino Pulejo, Piemonte Hospital, Messina, Italy; 3Department of Medical and Surgery Science, University of Messina, Messina, Italy Abstract: Enteral nutrition (EN) is preferred in order to provide nutrition and reduce catabolism in critically ill patients. Recent studies suggest that the use of EN is successful and complications are rare. However, an underestimated mechanical complication of tube feedings seen in critically ill patients is the coagulation and solidification of the EN causing gastrointestinal obstruction. This report describes two clinical cases (1.23% of all cases seen at our clinic) of obstruction and perforation of the small bowel secondary to the solidification of EN. The understanding and early recognition of this potential complication are essential for the prevention and successful treatment of this condition. Keywords: enteral nutrition, gastrointestinal contents, intestinal obstruction, small-bowel bezoar

Background: The aim of this study was to analyze the etiology, symptom frequency, management, and surgical outcome of gastrointestinal obstruction in the first month of life. Methods: A total of 72 neonates with gastrointestinal obstruction were reviewed over a period of 16 months. Results: The male to female ratio was 2.4:1. In this study, 75% of the neonates were presented in the first 7 days of life. The mean gestational age was 39.25 weeks. In addition, 68 of the neonates were term babies. The most common cause of admission was anorectal malformation (22%); furthermore, small bowel atresia was observed in 15% of the cases. Vomiting was the most common symptom of gastrointestinal obstruction reported in 31% of the cases, followed by abdominal distension. In this study, the overall mortality after surgery was 17%. The significant determining cause of mortality was sepsis reported in 33% of the cases. Conclusion: Early referral, diagnosis, and treatment of gastrointestinal obstruction in neonates are needed to improve the survival outcome. The most common cause of neonatal gastrointestinal obstruction was found to be imperforate anus. [ABSTRACT FROM AUTHOR]

Background: Conventionally, it is well accepted that the intestinal obstructions in children, especially gastric outlet obstruction are associated with significant metabolic derangement which has impact on its outcome. The study aimed to compare the metabolic profile and treatment outcome of pre- and post-ampullary gastrointestinal obstruction in children at a tertiary care setting.Materials and Methods: A prospective observational study was conducted on 30 children with intestinal obstruction and categorised into Group 1 (pre-ampullary, n = 11) and Group 2 (post-ampullary, n = 19) as per their anatomical site of pathology. Patients were evaluated at both pre- and post-operative period (Day 1 and 10) with haematological, biochemical and blood gas. The pre- and post-operative metabolic profile, resuscitative time and outcome were compared in two groups.Results: Except mild leucocytosis (Group II > I), rest of the pre-operative and post-operative haematological parameters were within normal range and statistically comparable among groups. Although the pre-operative sodium values were within the normal limit in both groups, it was relatively higher in Group I (Group I = 137.82 ± 4.238 vs. Group II = 134.26 ± 4.653), (P = 0.04). The mean bicarbonate values were within the normal limit in both groups (22.49 and 19.34), but the difference was statistically significant (P = 0.031). Mean partial pressure of carbon dioxide level was higher than normal range in Group I (38.464 ± 20.6493) but was comparable with Group II (P = 0.15). The time required for pre-operative resuscitation was 16.6 versus 24.87 h in Group I versus Group II (P = 0.02). In Group I, all children were improved, whereas four children expired in Group II.Conclusion: Metabolic profile in both pre- and post-ampullary intestinal obstruction was found to be normal in majority of the scenario. Children with post-ampullary obstruction need extensive pre-operative resuscitation and have relatively poor outcome. [ABSTRACT FROM AUTHOR]

Aim: Gastric cancer patients are normally treated with oral fluoropyrimidine and cisplatin or oxaliplatin; however, treating patients who also have a gastrointestinal obstruction is often difficult because of their poor oral intake. Instead, a modified (m)FOLFOX‐6 regimen is administered, even to patients with gastrointestinal obstructions. The aim of this study was to assess the efficacy of mFOLFOX‐6 for gastric cancer patients with a gastrointestinal obstruction. Methods: Patients with a poor oral intake because of a gastrointestinal obstruction who received mFOLFOX‐6 as systemic chemotherapy were retrospectively analyzed. Poor oral intake was defined as receiving a daily intravenous drip infusion due to a gastrointestinal obstruction. Results: Eighteen patients received mFOLFOX‐6; the median progression‐free survival was 6.8 months (95% confidence interval [CI], 1.9–9.7), the median overall survival was 8.0 months (95% CI, 2.8–20.8) and the median time to treatment failure was 2.2 months (95% CI, 1.2–5.7). An improved oral intake was observed in 13 of the 18 treated patients, with 12 of these continuing treatment as outpatients. Conclusions: A mFOLFOX‐6 treatment regimen seems promising for gastric cancer patients who have a gastrointestinal obstruction. [ABSTRACT FROM AUTHOR]

Background: The ingestion of foreign objects by animals is a familiar problem to veterinary practitioners and birds are no exception to this phenomenon. The clinical findings, diagnostic approach, management and outcomes are described in this case report for three pet conure birds. An 8-year-old and a 2-year-old green-cheeked conure (Pyrrhura molinae), and a 4-year-old jenday conure (Aratinga jandaya) presented independently for examination with variable, nonspecific signs; feather destructive behavior, regurgitation, lethargy, falling from the perch and excessive drinking. Diagnostic radiographs identified dilation of the proventriculus in all individuals. A foreign object in the proventriculus was diagnosed on gastroscopy in one bird and on necropsy in the other two birds. Surgical removal of the foreign material was attempted in one patient but was not successful. All three patients died secondary to obstruction with synthetic fibers from a plush, commonly available, tent-like hut sold as a sleeping area for birds. Clinical signs of gastrointestinal obstruction may be non-specific in birds but clinicians should have a higher suspicion in conures particularly if patients have had known access to this product. [ABSTRACT FROM AUTHOR]

CASE REPORT A female spayed Pug-cross was presented for unproductive retching and trembling after eating approximately 200 g of dried pitted apricots 6 h prior. Conservative management with intravenous fluids and pain relief was unsuccessful. The patient was taken to surgery and on their removal the apricots were found to be too engorged to pass through the pylorus, thereby causing a gastric obstruction. The patient made a full recovery and was discharged after 3 days in hospital. CONCLUSION Dehydrated apricots are hygroscopic in nature because of their high sugar content and have the potential to expand within the gastrointestinal tract and cause obstruction, rather than being broken down by gastric acid as initially expected. This is the first reported case of dehydrated fruit causing both food engorgement and gastric outflow obstruction in a dog. [ABSTRACT FROM AUTHOR]

Abstract Heterotopic pancreas (HP) is a rare entity. HP is rarely diagnosed during the neonatal period, and only a few neonatal cases of HP causing gastrointestinal obstruction have been reported. We herein describe a rare case of HP causing jejunal obstruction in the early neonatal period and discuss the association of an inflammatory process in this case. Highlights • An HP is usually found incidentally during various laparotomies. • Jejunal HP is an extremely rare cause of gastrointestinal obstruction, especially in the neonatal period. • With respect to the etiology in our case, we suggest that pancreatic juice from the HP had affected the surrounding tissue and that pancreatitis had caused the gastrointestinal obstruction. [ABSTRACT FROM AUTHOR]

A 10‐month‐old German Shepherd Dog presented for evaluation of intermittent vomiting. Abdominal radiographs revealed a marked right cranial mass effect. Initial differentials included abscess/cyst or less likely neoplasia from undetermined origin. On abdominal ultrasound the mass appeared cystic and thin walled. Computed tomography revealed a large cystic lesion originating from the pyloroduodenal junction causing pyloric outflow obstruction. A noncommunicating duodenal duplication cyst was found on exploratory laparotomy and further confirmed with histopathology and immunohistochemistry. Enteric duplication cyst should be considered as a differential in young dogs with gastrointestinal signs and a cystic abdominal mass detected with different imaging modalities. [ABSTRACT FROM AUTHOR]

Brunner’s gland hamartomas are small benign lesions that are most commonly found in the bulb of the duodenum. They are very uncommon, and most are found incidentally during upper gastrointestinal series or esophagogastroduodenoscopy. The lesions tend to be asymptomatic, but patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Histologically, a Brunner's gland hamartoma consists of the components of Brunner's gland cells, as well as glandular, adipose and muscle cells. In this study, we report the case of a 30-year-old man who presented with upper gastrointestinal bleeding and obstructive symptoms due to a giant Brunner's gland hamartoma in the duodenal bulb. The hamartoma was successfully removed by endoscopic resection. No significant complications were observed. Microscopically, the lesion was found to be entirely composed of variable Brunner's glands and adipocytes.

A 5 day old baby, with known left hydronephrosis which discovered by prenatal US presented with gastrointestinal tract obstruction. Laboratory work up demonstrated abnormal renal function and metabolic acidosis combined with hyperkalemia. Radiology tests showed bilateral hydronephrosis with huge left renal pelvis crossing the midline and causing deviation of the gut laterally. This acute presentation beside inability to receive oral feeding made us prefer immediate left renal drainage with pyelostomy in order to restore renal function, relieve the pressure effect of the huge renal pelvis and stabilize the baby. Dismembered pyeloplasty was done at age of 3 months.

The case of a 77-year-old woman with symptoms of gastric outlet obstruction is presented. Transabdominal ultrasonography findings were suspicious of Bouveret's syndrome. Upper endoscopy confirmed this diagnosis. Bouveret's syndrome is a rare complication of gallstone disease caused by a bilioenteric fistula leading to gastric outlet obstruction by a gallstone and should be suspected in any patient who presents with pneumobilia without recent endoscopic retrograde cholangiopancreatography or biliary surgery.

We report an unusual case of alpha-fetoprotein (AFP)-producing gastric carcinoma with enteroblastic differentiation. A 75-year-old woman was admitted to our hospital with occasional upper abdominal discomfort. We performed gastroscopy and observed a type 2 tumor, primarily in the pyloric region. Histological examination of biopsies confirmed gastric adenocarcinoma. Based on these findings, we diagnosed gastric adenocarcinoma and performed laparoscopic distal gastrectomy with lymph node dissection. Histological examination revealed an invasive lesion composed of adenocarcinoma with a tubulopapillary growth pattern. Tumor cells were cuboidal in shape with characteristically clear cytoplasm rich in glycogen. Two regional lymph node metastases were seen microscopically. Immunohistochemically these cells were positive for AFP, carcinoembryonic antigen, caudal-type homeobox transcription factor 2 and common acute lymphoblastic leukemia antigen. The final diagnosis was AFP-producing gastric carcinoma with enteroblastic differentiation. 26 months after initial surgery, the patient was readmitted to our hospital for gastrointestinal obstruction due to lymph node recurrence.

A 50-year-old man with advanced pancreatic cancer was admitted for intractable severe vomiting 5-6 times a day, continuing over a week. He had been treated for advanced pancreatic cancer with chemotherapy for 6 months, and had undergone self-expandable metalic stent placement for obstructive jaundice due to the pancreatic cancer 4 months before admission. No abnormal findings suggesting gastrointestinal obstruction or brain metastasis were revealed on diagnostic imaging. We performed endoscopic ultrasound-guided celiac ganglia neurolysis twice by injecting ethanol into the celiac ganglion. After the treatments, the vomiting disappeared, and his eating habits gradually returned to normal. The patient died 7 months after treatment due to the advanced pancreatic cancer without recurrence of the vomiting. [ABSTRACT FROM AUTHOR]

Objective: To determine the survival to discharge rate of rabbits with gastrointestinal obstructions treated with lidocaine constant rate infusion (CRI) and other factors associated with survival., Animals: Cases of gastrointestinal obstruction in rabbits (n = 56, including 64 events) that had presented to a veterinary teaching hospital from 2012 to 2021., Methods: This was a retrospective study in which data on rabbits with evidence of gastrointestinal obstruction were extracted from veterinary teaching hospital medical records over a 9-year period. Systemic lidocaine treatment, breed, sex, age, temperature at presentation, blood glucose at presentation, and time to discharge or death were evaluated with univariate and multivariate logistic regression to identify factors significantly associated with survival to hospital discharge in rabbits with gastrointestinal obstruction., Results: Comparatively, 89.7% of rabbits treated with lidocaine CRI (n = 39) survived to hospital discharge, while only 56% of rabbits that were not treated with lidocaine CRI (25) survived. In the final multivariate analysis, 2 factors were associated with survival to discharge: rabbits treated with systemic lidocaine and male rabbits had increased odds of survival compared to those not treated with systemic lidocaine and female rabbits, respectively., Clinical Relevance: Results demonstrated that rabbits with gastrointestinal obstruction and treated with a lidocaine CRI were more likely to survive compared to rabbits not treated with lidocaine CRI.