Abdominal Distension Research Articles

The effect of early mobilization on constipation after abdominal surgery: A systematic review

Background/Aim: Constipation can occur after abdominal procedures. In this study, we investigated whether early mobilization after abdominal surgery is effective for treating constipation. Methods: We conducted a systematic review of studies implementing early and planned mobilization after abdominal surgical procedures. We extracted studies published from 2012–2022 from six electronic databases: PubMed, Google Scholar, Science Direct, Cochrane, TürkMedline, and Ulakbim. The data were collected by two reviewers following a pre-designed subtraction form. We made use of narrative synthesis when presenting our results. Results: We examined 10 articles that satisfied the inclusion criteria; patients underwent a cesarean section in four studies, bariatric surgery (gastric bypass) in one study, liver resection in one study, radical cystectomy in two studies, cholecystectomy in one study, and a kidney transplant in one study. The studies were characterized by differences in the early mobilization programs applied to patients after abdominal surgery. In two of the studies, the patients were mobilized accordingly to daily step goals; in five studies only early stimulation and walking attempts were utilized. In three of the studies, the patients were mobilized within the scope of mobilization programs prepared in detail after surgery, and the targets were determined in terms of distance walked. All of the studies stipulated that physical activity should gradually increase over time. Conclusion: Early and planned mobilization programs applied after surgery had positive effects on first gas/first stool output time, the severity of abdominal distension, the occurrence of nausea/vomiting, and the onset of oral intake.

Findings of Abdominal Computed Tomography In COVID-19 Patients with Abnormal Abdominal Symptoms In Siriraj Hospital

Background: The coronavirus (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Chest imaging findings of COVID-19 disease have been widely published. Only a few studies of abdominal imaging findings have been documented. The majority of these studies demonstrate thrombotic events associated with COVID-19. Previous studies were mainly conducted in the USA, Europe and China which limited the applicability in Southeast Asia (SEA) including Thailand. Objective: To provide a summary of various abdominal imaging findings of COVID-19 patients admitted to xxx Hospital with findings associated with clinical outcomes. Materials and Methods: All CT abdominal imaging of adult patients who tested positive for COVID-19 performed from January 1st, 2020 to August 31st, 2022 were retrospectively reviewed. We collected clinical data, abdominal signs and symptoms, laboratory data and various CT findings, for example; bowel-wall thickening, bowel ischemia, fluid-filled colon and bleeding manifestations. The clinical outcomes were gathered as death confirmation, invasive mechanical ventilation, days of invasive mechanical ventilation and days of hospitalization. Results: A large number of patients who had stage 3-5 chronic kidney disease (CKD), abdominal distension, abnormal bowel findings and longer days of hospitalization were significantly observed in a group with worse clinical outcomes. Abnormal intestinal imaging findings were related to a higher risk of worse outcomes, invasive mechanical ventilation, death and days of hospitalization without statistical significance. Conclusion: Abdominal CT scans performed on COVID-19 patients frequently revealed abnormal bowel findings, which were strongly associated with poor clinical outcomes. Radiologists need to be concerned about abnormal bowel findings and point them out to clinicians and surgeons.

HEMANGIOSARCOMA IN RED WOLVES (CANIS RUFUS) AND GRAY WOLVES (CANIS LUPUS) IN HUMAN CARE: SIX CASES.

Wolves are commonly housed in zoological institutions and captive breeding facilities that are essential for maintaining genetic diversity and for the recovery of declining populations. Neoplasia is a common cause of mortality in wolves, but hemangiosarcoma has not previously been described. This condition was diagnosed in four red wolves (Canis rufus) and two gray wolves (Canis lupus) housed at five different institutions between 2008 and 2018. Animals were 11-16 yr of age at the time of presentation. Clinical signs included loss of body condition, abdominal distension, lethargy, weakness, ataxia, and hyporexia. Three animals were mildly anemic. All animals were humanely euthanized within an average of 3 d from onset of clinical signs. Two animals had primary splenic tumors, two had pelvic tumors with one originating from the aorta, and one had a cranial mediastinal mass. Diagnosis was made on postmortem histologic examination in all cases. Four wolves had evidence of metastases with foci in the lungs, lymph nodes, mesentery, liver, subcutis/skeletal muscle, kidney, adrenal, and thyroid gland. Hemangiosarcoma should be considered in geriatric wolves presenting with nonspecific signs, particularly if abdominal distension, free peritoneal fluid, or anemia is present.

Cholangiocarcinoma: Consistent clinical, cytological, hematological, and biochemical findings and pathomorphology of the liver and kidney in five exotic dog breeds in Abeokuta, Nigeria

Background and Aim: Cholangiocarcinomas are malignant neoplasms that originate from any part of the bile duct epithelium. It is one of the most common liver tumors in dogs. This study described the clinical, cytological, hematological, biochemical, and pathomorphological findings of five cholangiocarcinoma cases in exotic breed dogs aged 2–5 years to aid in clinical diagnosis. Materials and Methods: This study used dogs presented at different times from 2012 to 2021 at the Veterinary Teaching Hospital, Federal University of Agriculture, Abeokuta. History, clinical signs, and vital parameters were recorded. Blood samples were collected for hematology and serum chemistry. Abdominocentesis was performed for cytological diagnosis. All dogs died during treatment, and postmortem examinations were performed. At postmortem, fine needle aspirates were collected from the liver and mesenteric lymph nodes and liver and kidney samples were fixed in 10% neutral-buffered formalin. Results: The dogs showed signs of severe malnutrition, jaundice, and bloating. The hematological analysis indicated anemia, neutrophilia without band neutrophils, and lymphopenia, indicative of a stress hemogram. The serum biochemistry test revealed lower levels of total proteins, albumin, and globulin and higher levels of serum enzymes. Abdominal fluid and mesenteric lymph node cytology revealed clusters of epithelial neoplastic cells. A postmortem examination revealed the liver’s nodular enlargement with the presence of button-like ulcers. Neoplastic epithelial cells are solid masses with hyperchromatic nuclei surrounded by fibrous connective tissues. Conclusion: Cholangiocarcinoma, diagnosed over a period of time in five exotic breeds of dog, consistently presents with the same clinical and postmortem findings, aiding in clinical diagnosis. However, the diagnosis of the disease is not possible in the early stage because of the absence of specific clinical signs. In dogs and possibly other animal species presenting with emaciation, lethargy, icterus, and distended abdomen, cholangiocarcinoma should be suspected, and cytological examination of the abdominal fluid and lymph node aspirates should be performed despite the absence of advanced equipment. Keywords: biochemical indices, cholangiocarcinoma, clinical signs, cytological findings, hematological findings, histopathology, malignancy, Nigeria, postmortem finding.

Unusual renal displacement due to massive splenomegaly: a rare case report and review of literature

Here, the case of a female patient in her late 60s, who presented to hospital for a scheduled health check relating to a history of myelofibrosis for the previous 9 years, is described. She recently experienced weight loss and abdominal distention. Physical examination revealed no abnormality or tenderness. Laboratory examination showed decreased blood cells, platelets and haemoglobin, and normal renal function. Ultrasound and computed tomography scans revealed a massively enlarged spleen and displaced and compressed left kidney with abnormal features, but normal right kidney. The patient declined surgery and her myelofibrosis was treated with ruxolitinib, with a recommendation of annual follow-up observation. Despite many recorded cases of left renal displacement caused by splenomegaly, it is very rare for the left kidney to be pushed across the midline to the right side by an enlarged spleen. This article explores the causes and management of this uncommon condition and provides a review of previous literature reports with the aim of enhancing the understanding of unusual renal displacement due to massive splenomegaly, and its potential treatment options.

Ulcer Symptoms Concealing Primary Jejunal Follicular Lymphoma: A Case Report

<p>胃腸道淋巴瘤的臨床表現多樣且非特異，往往難以區分良性或惡性。內視鏡和放射學檢查的表現也不具特定性。在胃腸道，淋巴瘤是一種相對罕見的腫瘤，佔胃腸道惡性腫瘤的1%–8%，初發性胃、小腸和十二指腸淋巴瘤的比例約為10:3:1。濾泡性淋巴瘤主要發生在十二指腸，瀰漫性大B細胞淋巴瘤在胃和迴腸，黏膜相關淋巴組織淋巴瘤在胃，套細胞淋巴瘤在末端迴腸、空腸和結腸，而腸病相關T細胞淋巴瘤多在空腸。對於濾泡性淋巴瘤，觀察也是一種選擇，手術介入通常僅適於複雜的臨床狀況，如腸阻塞或穿孔。</p> <p>本篇病例報告一位74歲男性個案，十八年前出現反覆性上腹痛、腹部脹氣、打嗝、腹瀉，偶有便秘，多次上消化道內視鏡檢查診斷胃與十二指腸潰瘍，治療後症狀仍然存在。兩年後出現嘔吐，全套血液、生化、糞便檢驗皆無異常，上消化道內視鏡顯示多發性胃與十二指腸潰瘍，無幽門桿菌感染。腹部超音波顯示明顯胃擴張，電腦斷層檢查未發現腸阻塞或狹窄。小腸鏡顯示第三至第四部分十二指腸狹窄，組織切片為B細胞型態淋巴瘤。個案接受手術，術中發現在屈氏韌帶下方約5 cm處近端空腸有一4.8 cm × 3.0 cm × 1.3 cm環狀腫瘤併腸繫膜數顆腫大淋巴結，予以切除9.8 cm空腸與淋巴結並接受腸道吻合。病理診斷為第2級濾泡性淋巴瘤。術後接受化學治療及定期追蹤。至今已過十六年，病人情況良好。定期追蹤檢查並無復發。</p> <p>藉此病例報告提醒基層醫師面對反覆性消化性潰瘍時，必需將消化道淋巴瘤列入鑑別診斷。</p> <p> </p><p>It is challenging to distinguish benign gastrointestinal tumors from malignant ones due to their diverse and nonspecific symptoms, and endoscopic and radiological findings often lack specificity. Lymphoma is relatively uncommon in the gastrointestinal tract, constituting 1%-8% of malignant tumors with a primary tumor ratio of approximately 10:3:1 for the stomach, small intestine, and duodenum. Follicular lymphomas mainly occur in duodenum, diffuse large B-cell lymphomas in stomach and ileum, MALT lymphomas in stomach, mantle cell lymphomas in terminal ileum, jejunum, and colon, and enteropathy-associated T-cell lymphomas in jejunum. For the treatment of follicular lymphomas, observation remains a viable option, while surgical intervention is usually reserved for complicated clinical conditions, such as intestinal obstruction or perforation. </p> <p> This case report features a 74-year-old male with recurrent epigastric pain, abdominal distention, hiccups, diarrhea and occasional constipation since he was diagnosed with duodenal ulcers eighteen years ago. Repeated panendoscopic examinations showed gastric and duodenal ulcers. Symptoms persisted after treatment and were followed by vomiting two years later. Comprehensive blood, biochemical, and stool analyses revealed no abnormalities. Panendoscopic examination showed multiple ulcers in the stomach and duodenum without Helicobacter pylori infection. Abdominal ultrasound indicated significant gastric dilation, and computed tomography scan revealed neither intestinal obstruction nor stenosis. Small intestinal fiberscope found stenosis in the third to fourth portions of the duodenum, and tissue biopsy suggested B-cell lymphoma. Intraoperatively, a circumferential tumor measuring 4.8 cm × 3.0 cm × 1.3 cm was identified, located approximately 5 cm proximal to the Ligament of Treitz. It was accompanied by enlarged mesenteric lymph nodes. The excision of 9.8 cm of the jejunum, along with lymph node dissection, was followed by anastomosis. Surgical pathology confirmed grade II follicular lymphoma. Postoperatively, the patient receives chemotherapy and undergoes regular follow-up. The patient has remained in good medical condition over these sixteen years. Follow-up examinations did not show tumor recurrence. This case report aims to remind primary care physicians to consider gastrointestinal lymphoma early in the differential diagnosis of recurrent peptic ulcers.</p> <p> </p>

The overall outcome of aortoduodenal syndrome following endovascular vs open surgical interventions

ObjectiveAortoduodenal syndrome (ADS) is a direct compression of an abdominal aortic aneurysm against the superior mesenteric artery or the abdominal wall, causing mechanical bowel obstruction. The first such case was reported by Canadian Professor William Osler in 1905. This clinical condition is mainly treated surgically to relieve the obstruction either by open aneurysm repair or gastrointestinal bypasses and, recently, by endovascular interventions. This systematic review aimed to assess the outcomes of different interventions in terms of symptomatic improvement thoroughly, peri- and post-intervention aneurysmal size, and overall survival rates. MethodsGoogle Scholar, Pubmed, and the Cochrane Library databases were searched by two independent reviewers to collect case reports and short case series on aortodudenal syndrome written in English and published from January 2000 to July 2023. ResultsThis review was conducted on 28 articles published from 2001 to 2023, with a total of 30 cases included. The mean age of the patients was 73.76 ± 7.7 years; nausea and vomiting (97%), abdominal pain (73%), abdominal distention (63%) were the most common symptoms among presentation. Twenty-four patients (80%) had comorbidities; only 7 of them were known to have abdominal aortic aneurysm. The aneurysmal sac at presentation ranged from 3.8 to 11.0 cm, with a mean size of 7.2 ± 2.2 cm. Eleven patients (36.7%) underwent endovascular aortic repair (EVAR), and 17 patients (56.7%) had open aortic repair, and 2 patients (6.6%) had a gastrointestinal bypass, either gastrojejunostomy or Roux-en-Y gastric bypass. The size of the aneurysmal sac was reported for eight patients who underwent EVAR ranging from 3.8 to 11.0 cm with a mean size of 7.27 ± 2.65 cm before the intervention; after the intervention, the mean size was 6.48 ± 2.26 cm. Mortality was reported in two patients; one underwent gastrojejunostomy and the other underwent EVAR. ConclusionsAortoduodenal syndrome remains a rare condition; the choice of surgical intervention is affected by patient factors, surgeon experience, and resource availability. That necessitates tailoring a management plan for each patient.

Internal hernia through the Treitz fossa after robotic pancreatoduodenectomy: pathogenesis and preventive measures.

Internal hernia through the Treitz fossa following robotic pancreatoduodenectomy is a rare but potentially serious complication. In our review of 328 cases of robotic pancreatoduodenectomies, two patients (0.6%) required repeat surgery due to internal herniation of the entire small bowel through the Treitz fossa. This complication can present as afferent loop syndrome, with symptoms including nausea, vomiting, and abdominal distension, possibly leading to cholangitis and pancreatitis. Timely diagnosis and intervention are paramount, as conservative management often fails. Preventive measures involve closing the peritoneal defect in the Treitz fossa at the end of robotic pancreatoduodenectomy, particularly in lean patients with thin mesentery who are at increased risk of internal hernia due to increased mobility of the small bowel. This technical note elucidates the pathogenesis of Treitz hernia following robotic pancreatoduodenectomy and underscores the importance of closing the peritoneal breach to prevent this rare yet potentially serious complication.

Comparative Analysis of Early Versus Traditional Feeding Protocols in Elective Lower Segment Cesarean Sections.

Background Postoperative care following elective lower segment cesarean section (LSCS) traditionally involves delayed oral feeding. However, recent evidence suggests that early feeding may enhance recovery and improve patient outcomes. This study aimed to compare the recovery outcomes of elective LSCS patients between early feeding and traditional feeding protocols. Methods This prospective, comparative study was conducted at the Department of Obstetrics and Gynecology, Government Medical College (GMC) Budaun, over nine months. Women aged 18 to 40 years undergoing elective LSCS with singleton pregnancies and gestational ages between 37 and 42 weeks were included. Participants were randomized into two groups: the early feeding group (EFG) and the traditional feeding group (TFG). The EFG received oral intake as early as two hours post-surgery, progressing to a regular diet within six to eight hours. The TFG followed standard postoperative protocols, beginning oral intake after 12-24 hours. Primary outcomes included time to return of bowel function and length of hospital stay. Secondary outcomes were patient satisfaction and complication rates. Data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY), with p-values < 0.05 considered statistically significant. Results The study included 94 participants (EFG: n = 44, TFG: n = 50). The EFG showed significantly faster return of bowel function, with time to first flatus (23.9 ± 6.2 vs. 34.1 ± 8.8 hours, p < 0.0001) and first stool (54.6 ± 8.5 vs. 91.3 ± 12.3 hours, p < 0.0001). Length of hospital stay was shorter in the EFG (4.3 ± 1.1 vs. 6.7 ± 1.4 days, p < 0.0001). Visual analog scale (VAS) scores before discharge were higher in the EFG (94.4 ± 8.7 vs. 81.4 ± 9.5, p < 0.0001), indicating greater patient satisfaction. Complication rates, including nausea, vomiting, abdominal distension, and wound infections, did not differ significantly between groups. Conclusion Early feeding post-elective LSCS significantly enhances recovery, as evidenced by quicker return of bowel function, reduced hospital stay, and higher patient satisfaction without increasing complication rates. These findings support revising postoperative care protocols to incorporate early feeding strategies.

Abdomen Malignant Myxoid Leiomyosarcoma with PDGFRA and TP53 Missense Mutation: A Case Report

Background: Malignant myxoid leiomyosarcoma (MMLS) is most commonly found in the uterus but can also occur in other areas, such as the extremities, vulva, chest wall, and abdominal cavity. This cancer is more prevalent in women and has a poor prognosis with a high rate of recurrence and a significant percentage of metastasis. Case Representation: Herein, we report the case of a 64-year-old female patient who presented with 3-month history of left lower abdominal mass. The patient underwent abdominal malignancy resection and was subsequently diagnosed with myxoid leiomyosarcoma. The patient experienced a recurrence and metastasis with significant ascites after the initial surgery and did not respond to treatment with oral Anrotinib in combination with Tislelizumab immunotherapy. Further genetic testing using next-generation sequencing (NGS) identified missense mutations in the PDGFRA and TP53 genes in the patient's plasma, but no mutations in the KIT gene were detected. Immunohistochemical analysis of the tumor tissue also revealed a negative expression of PD-L1. As a result, we altered her targeted therapy to Avapritinib, which resulted in significant improvement in her symptoms, including abdominal distension and pain, a decrease in ascites, and the KPS score increased from 60 points before treatment to 90 points after treatment SD (stable disease) was achieved for three months after treatment. Conclusion: In this case report, we present the instance of a patient with malignant myxoid leiomyosarcoma with a missense mutation in both the PDGFRA and TP53 genes. We found that targeted therapy with Avapritinib was effective in achieving a positive outcome in this patient. Our findings suggest that genetic detection is possible to better understand the biological behavior, genetic characteristics, and patient's response and tolerance to certain drugs, thus selecting the best treatment plan for the patient. Avapritinib may be a promising new treatment option for leiomyosarcoma patients with similar genetic mutations.

Risk factors for long-term urination and sexual function impairment following laparoscopic resection of presacral lesions

BACKGROUNDPresacral cysts are rare congenital lesions predominantly affecting females. Surgery is often recommended after diagnosis due to the risk of malignant transformation and complications associated with cyst enlargement. Laparoscopic excision is increasingly favored due to its enhanced visualization and precision.AIMTo assess long-term urinary, sexual function outcomes and quality of life in female patients undergoing laparoscopic resection of presacral cysts.METHODSWe conducted a retrospective review of female patients who underwent laparoscopic resection of presacral cysts between August 2012 and May 2020. Patient demographics, surgical outcomes, and postoperative complications were analyzed. The urinary function was assessed using the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Module (ICIQ-FLUTS), the sexual function was evaluated using the Female Sexual Function Index (FSFI), and quality of life was assessed using the 36-item Short-Form Health Survey (SF-36).RESULTSAmong the 32 female patients included, 10 experienced postoperative urinary incontinence, predominantly of the mixed type. The risk factors for urinary incontinence included abdominal distension and the proximity of the cyst to the rectum. Notably, urinary incontinence significantly impacted the overall lower urinary tract symptoms and quality of life. Additionally, seven patients reported postoperative sexual dysfunction, with previous abdominal or pelvic surgery and cyst location under S3 identified as risk factors, affecting the mental health aspects of their quality of life.CONCLUSIONLaparoscopic cyst resection in females poses risks of urinary and sexual dysfunction, potentially impacting quality of life. Thus, tailored management approaches are crucial.

Diagnostic Approach of Mesenteric Cyst in Children: A Case Report

Background: Mesenteric cysts are intra-abdominal masses that arise from obstructed lymphatic drainage within the mesentery. Early diagnosis can be challenging, as it is often difficult to recognize based solely on clinical findings. The diagnosis is frequently made following imaging studies or during surgery. Despite their generally benign nature, delayed diagnosis can lead to serious complications. This case report aims to share our experience on the diagnostic approach for mesenteric cysts in children. Case: A 2-year-old boy presented with a 14-month history of slowly progressive abdominal distension and signs of bowel obstruction, including weight loss. Abdominal ultrasound revealed thin-walled, well-demarcated, septated fluid sacs consistent with a cyst. Abdominal CT-Scan showed massive ascites filling the intraperitoneal cavity and pushing the intestine upward along the thickened mesentery, causing bowel obstruction. Histopathological examination confirmed the diagnosis of cyst lymphangioma derived from mesentery. The cyst was successfully excised via laparotomy, and histological examination confirmed it as a cystic lymphangioma. Discussion: Our diagnostic approach focused on exclusion of differential diagnosis for abdominal distention in children, including ascites, abdominal tuberculosis, mesenteric cysts, and intra-abdominal masses. The absence of constitutional symptoms and lack of response to anti-tuberculosis therapy made it an unlikely diagnosis. While the CT-scan suggested ascites, the ultrasound results suggested a mesenteric cyst. Despite its large size, a complete excision of the cyst was successfully performed via laparotomy. Conclusion: The nonspecific nature of mesenteric cysts often delays diagnosis, making abdominal ultrasound an essential initial imaging modality for patients suspected of having this condition.

MANAGEMENT OF JALODARA (ASCITES) THROUGH AYURVEDIC PRINCIPLES: A CASE STUDY

The accumulation of fluid in the peritoneum is called ascites. It is the most prevalent sign of liver damage. In contemporary medicine, there is currently no proven cure for ascites patients. It only relieves symptoms, and recurrence occurs over time. Such cases benefit from the side-effect-free results of ayurvedic treatment. Eight categories of Udara roga are stated in Ayurveda, and this case is correlated with Jalodara. A 44-year-old male patient came to Rognidan OPD in Government Ayurveda College, Nagpur, India, with symptoms including abdominal distension, anorexia, bipedal edema, icterus, dyspnea on exertion, interrupted sleep, and overall weakness. In addition to being a persistent alcoholic, the patient had no prior history of diabetes or hypertension. He was treated in accordance with the Jalodara therapeutic principles as stated in the Charaka Samhita, which included nitya virechana (daily purgation) using Ayurvedic medicines, strotoshodhana (microchannel cleaning), and a few hepatoprotectives. After receiving therapy for one month, the patient's symptoms showed significant improvement; hence, it was concluded that Ayurvedic treatments benefit Jalodara.

Managing multidrug-resistant Acinetobacter baumannii in a premature neonate with sepsis: A case report

Background: Neonatal sepsis, which is a systemic response to infection, is a significant cause of morbidity and mortality in newborns, with an incidence of 1 to 8 per 1,000 live births. Acinetobacter baumannii is a common nosocomial pathogen, often associated with antibiotic resistance, complicating treatment and worsening outcomes [1,2]. Case Description: A neonate born prematurely at 34 weeks due to eclampsia (Apgar score 5/7, birth weight 2100 grams), presented with signs of severe infection, including fever, abdominal distension, seizures, and hypotonia. Laboratory results indicated severe thrombocytopenia, and elevated CRP. Blood cultures identified Acinetobacter baumannii resistant to 10 antibiotics. The patient was treated with oxazolidinones and third-generation cephalosporins for 21 days, resulting in gradual clinical improvement. Conclusion: Blood culture remains the gold standard for diagnosing neonatal sepsis. This case highlights the importance of comprehensive antibiotic sensitivity testing in managing multidrug-resistant infections, ensuring appropriate and effective therapy.

The effect of Orem's Self-Care Deficit Theory-based care during pregnancy and postpartum period on health outcomes: A systematic review and meta-analysis.

To examine the effect of the provision of care on health outcomes when provided based on Orem's Self-Care Deficit Theory during perinatal period. The perinatal period is a process with multidimensional care needs for the mother, baby and family. Care based on nursing theories can improve the quality of perinatal care. A systematic review and meta-analysis. Studies on this topic from 2006 to 2020 have been accessed by nine database searches. The methodological quality of the studies was assessed using the Critical Appraisal Checklists for experimental and quasi-experimental studies, developed by the Joanna Briggs Institute. This study was conducted by following the Preferred Reporting System for Systematic Reviews and Meta-Analyses. This systematic review included nine studies with a total sample size of 839 women. These studies showed that care based on Orem's theory significantly helped prolong the mean duration of pregnancy, reduced the incidence of preterm labor, improved hygiene behaviour and increased empowerment. Concerning the perinatal period, this intervention significantly improved self-care and readiness for hospital discharge, adaptation and breastfeeding self-efficacy and reduced nipple pain and pain due to abdominal distension. The implementation of this theory into care during the perinatal period can contribute to improved health outcomes. What is already known about this topic? The quality of pregnancy and postpartum care is important for the maternal health. The use of nursing theories-which nursing knowledge is produced-improves care quality and ensures that care is organized systematically. What this paper adds? There is insufficient research that supports Orem's theory of self-care deficit in pregnancy and postpartum care and also no systematic review about this topic, but the current meta-analysis showed that postnatal and prenatal treatments based on Orem's theory have a positive impact on the self-care agency. The implications of this paper: The use of Orem's theory helps nurses understand women and their needs during pregnancy and postpartum periods. Integrating Orem's theory of self-care deficit into pregnancy and postpartum nursing care services can help increase women's self-care power.

Use of Traditional Japanese Herbal Medicine Daikenchuto for the Treatment of Abdominal Distention in Very-Low-Birth-Weight Infants.

Background: Very-low-birth-weight (VLBW) infants often experience feeding intolerance owing to organ immaturity, and the most frequent sign is the presence of abdominal distention. Daikenchuto (DKT), a traditional Japanese herbal medicine, is used to improve gastrointestinal function, particularly in adults. The aim of this study was to investigate the effectiveness of DKT in reducing abdominal distention and intestinal gas in VLBW infants. Methods: This study involved a retrospective chart review of 24 VLBW infants treated with DKT at Hamamatsu University Hospital between April 2016 and March 2021. The effects of DKT treatment at a dose of 0.3 g/kg/day were evaluated through clinical parameters and abdominal radiography. Results: Before treatment, marked abdominal distention was observed in 46% of the infants, which reduced to 4% within a week of DKT administration. The gas volume score (GVS) decreased in 92% of the patients within the first week of treatment and markedly decreased by ≥20% in 46% of the patients. The effects of improving abdominal distention and decreasing the GVS on radiography persisted for 1-2 weeks after treatment initiation. No clinical parameters affecting a GVS reduction of ≥20% and no notable adverse effects were observed. Conclusions: While the preliminary findings suggest that DKT may help manage abdominal distention in VLBW infants, further studies with placebo-controlled trials, larger sample sizes, use of advanced image processing software, and consideration of additional influencing factors are required to substantiate these results and identify predictors of treatment response.

Peritoneal-dialysis-associated peritonitis due to Staphylococcus sciuri: a case report and literature review

BackgroundPeritoneal-dialysis-associated peritonitis is a serious complication of peritoneal dialysis; prevention and treatment are crucial to reduce patient morbidity and mortality. Staphylococcus sciuri is an organism that, although present in several animal species, rarely causes disease in humans, particularly in patients undergoing peritoneal dialysis.Case presentationA 54-year-old man with end-stage kidney disease on continuous ambulatory peritoneal dialysis was admitted to the emergency department with nausea, vomiting, slight abdominal distention, and cloudy peritoneal dialysis effluent. Relevant medical history included occupational exposure to different animal species. The white blood cell count in the peritoneal dialysis fluid sample was 11,200 cells/mm3 with 90% polymorphonuclear cells. Peritoneal-dialysis-associated peritonitis was diagnosed. Empirical antibiotic treatment was started according to the International Society for Peritoneal Dialysis guidelines. Staphylococcus sciuri was identified in the peritoneal dialysis effluent culture by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The treatment was modified on the basis of the sensitivity results. Medical cure was established on the basis of the negative result of the dialysate culture and absence of alterations in the cell count with differential after the end of treatment. The patient was instructed to be careful when administering peritoneal dialysis, especially in the care involved in being in contact with animals.ConclusionsThis article highlights the importance of Staphylococcus sciuri as a significant pathogen due to its virulence and antibiotic resistance, especially in patients undergoing peritoneal dialysis. Prevention strategies as well as timely diagnosis and treatment compliance according to the International Society for Peritoneal Dialysis are essential for successful outcomes.

GPER expression prevents estrogen-induced urinary retention in obese mice

Long-term administration of exogenous estrogen is known to cause urinary retention and marked, often fatal, bladder distention in both male and female mice. Estrogen-treated mice have increased bladder pressure and decreased urine flow, suggesting that urinary retention in estrogen-treated mice is due to infravesicular obstruction to urine outflow. Thus, the condition is commonly referred to as bladder outlet obstruction (BOO). Obesity can also lead to urinary retention. As the effects of estrogen are mediated by multiple receptors, including estrogen receptors ERα and ERβ and the G protein-coupled estrogen receptor (GPER), we sought to determine whether GPER plays a role in estrogen-induced BOO, particularly in the context of obesity. Wild type and GPER knockout (KO) mice fed a high-fat diet were ovariectomized or left ovary-intact (sham surgery) and supplemented with slow-release estrogen or vehicle-only pellets. Supplementing both GPER KO and wild type obese mice with estrogen for 8 weeks resulted in weight loss, splenic enlargement, and thymic atrophy, as expected. However, estrogen-treated obese GPER KO mice developed abdominal distension, debilitation, and ulceration of the skin surrounding the urogenital opening. At necropsy, these mice had prominently distended bladders and hydronephrosis. In contrast, estrogen-treated obese wild type mice only rarely displayed these signs. Our results suggest that, under conditions of obesity, estrogen induces BOO as a result of ERα-driven pathways and that GPER expression is protective against BOO.

MEGACÓLON PSICOGÊNICO EM PACIENTE PORTADOR DO TRANSTORNO DO ESPECTRO AUTISTA: UM RELATO DE CASO

Introduction: Psychogenic megacolon (PM) is a rare dysfunction usually found during childhood. This condition is characterized as an abnormal and irreversible dilation of the intestinal colon of psychogenic etiology, that is, such motility disorder is linked to some emotional disorder. A full understanding of this disorder is still a long way off due to its scarce description in the medical literature, however, authors such as Liu et al (2019) define it as a persistent dilation of the colon in the absence of any underlying organic or physiological causes, highlighting its diagnosis as purely eliminatory due to its symptomatic similarity with congenital megacolon (Hirschprung's disease). Objectives: The following case report aims at a retrospective and cross-sectional study, arising from the analysis of the patient's medical records, in order to lay scientific foundations for future research addressing the thematic axis of MP in conjunction with the development of new, more effective therapeutic proposals for the disease. Methods: The data provided in this study were obtained from the active collection of information from the patient's medical record, analyzed in line with others extracted from an interview with the person responsible, however, a literature review was carried out using data platforms as sources of good origin such as Scielo Platform, Google Scholar and PubMed. Results: The case describes a 3-year-old male patient, diagnosed with autism spectrum disorder (ASD) and with a history of previous hospitalizations related to urinary tract infection (UTI) and médium acute otitis (MAO). In the current history, the patient was admitted due to an acute infectious condition unrelated to MP, however, a distended and painless abdomen was found with increased peristalsis with decreased frequency of bowel movements and the presence of a large fecal cake. via ultrasound, with the diagnosis of megacolon, the clinic was related to the diagnosis of ASD and the patient's difficulty in adapting to the hospital environment, making the hypothesis of MP very likely. Conclusion: The report above describes a highly suggestive picture for MP, while this study seeks to raise the hypothesis of its correlation with ASD, while this neurodevelopmental disorder can influence the bowel habits of those patients historically included within the age group conducive to the manifestation of this disease.

Gastric Perforation from Bag-Valve-Mask Ventilation Resulting in Tension Pneumoperitoneum and Arterial Insufficiency

We report the case of a 44-year-old woman who suffered gastric perforation after receiving bag-valve-mask (BVM) ventilation in the setting of alcohol intoxication. She had a markedly distended abdomen and cold, dusky lower extremities upon arrival to the emergency department. Imaging revealed a large volume intra-abdominal accumulation of air with compression of the aorta. Needle decompression relieved symptoms of lower extremity arterial insufficiency. However, the patient quickly decompensated and subsequent exploratory laparotomy confirmed gastric rupture. A subtotal gastrectomy was performed but the patient ultimately passed on post-operative day two due to multi-organ dysfunction. Although BVM ventilation is commonplace in both the hospital and field, there is a lack of awareness of the serious complications of abdominal air accumulation due to their rareness in the adult population. Checking for abdominal distention during resuscitation ought to be routine in all patients. Signs of arterial insufficiency accompanying abdominal distention, once confirmed by diagnostic imaging that shows extensive pneumoperitoneum, are indicators of having reached a life-threatening level of air accumulation, calling for immediate needle decompression and exploratory laparotomy.