Acute Bowel Research Articles

Acute Large Bowel Obstruction Post Umbilical Hernia Repair Surgery: A Case Report

Acute Large Bowel Obstruction Post Umbilical Hernia Repair Surgery: A Case Report

Dual-energy CT late arterial phase iodine maps for the diagnosis of acute non-occlusive mesenteric ischemia.

To evaluate the diagnostic accuracy of dual-energy CT (DECT) iodine maps in comparison to conventional CT series for the assessment of non-occlusive mesenteric ischemia (NOMI). We evaluated data from 142 patients (72 men; 50.7%) who underwent DECT between 2018 and 2022, with surgically confirmed diagnosis of NOMI. One board-certified radiologist performed region of interest (ROI) measurements in bowel segments on late arterial (LA) and portal venous (PV) phase DECT iodine maps as well as LA conventional series, in both ischemic and non-ischemic bowel loops, using surgical reports as reference standard, and in a control group of 97 patients. Intra- and inter-reader agreement with a second board-certified radiologist was also evaluated. Receiver operating characteristic (ROC) curve analysis was performed to calculate the optimal threshold for discriminating ischemic from non-ischemic bowel segments. Subjective image rating of LA and PV iodine maps was performed. DECT-based iodine concentration (IC) measurements showed significant differences in LA phase iodine maps between ischemic (median:0.72; IQR 0.52-0.91mg/mL) and non-ischemic bowel loops (5.16; IQR 3.45-6.31mg/ml) (P <.0001). IC quantification on LA phase revealed an AUC of 0.966 for the assessment of acute bowel ischemia, significantly higher compared to both IC quantification based on PV phase (0.951) and attenuation values evaluated on LA conventional CT series (0.828). Excellent intra-observer and strong inter-observer agreements were observed for the quantification of iodine concentration. Conversely, weak inter-observer agreement was noted for conventional HU assessments. The optimal LA phase-based IC threshold for assessing bowel ischemia was 1.34mg/mL, yielding a sensitivity of 100% and specificity of 96.48%. Iodine maps based on LA phase significantly improve the diagnostic accuracy for the assessment of NOMI compared to conventional CT series and PV phase iodine maps.

Quantification of deoxythioguanosine in human DNA with LC-MS/MS, a marker for thiopurine therapy optimisation.

In the treatment of diseases such as acute childhood leukaemia (ALL) and inflammatory bowel disease (IBD), the thiopurines azathioprine, 6-mercaptopurine, and 6-thioguanine are used. Thiopurines are antimetabolites and immunomodulators used to maintain remission in patients. They are all prodrugs and must be converted into thecompeting antimetabolites thioguanosine triphosphate and deoxythioguanosine triphosphate for final incorporation into RNA or DNA. The current therapeutic drug monitoring (TDM) method measures the sum of the formed metabolites in the sample, after acidic hydrolysis at high temperature. In this work, the goal is to measure these drugs closer to their pharmacological endpoints, once incorporated into DNA. After extracting DNA from whole blood, followed by DNA hydrolysis, 2'-deoxythioguanosine (dTG) and the complementary natural nucleobase 2'-deoxycytidine (dC) were measured. Chromatographic separation on a HSS T3 column followed by mass spectrometric detection was performed in multi-reaction monitoring (MRM) mode on a Xevo TQ-XS with ESI in positive mode, within 5 min. The concentration range for dTG was 0.04-5 nmol/L, and for dC, 0.1-12.5 µmol/L. The lower limit of detection was determined to a concentration of 0.003 nmol/L for dTG and 0.019 µmol/L for dC. The intra- and inter-assay imprecision for the quality controls ranged between 3.0 and 5.1% and between 8.4 and 10.9%, respectively. Sample stability for up to 4 years is shown. In summary, a sensitive method to quantify the thiopurines incorporated into DNA as dTG has been developed and will be used in further clinical studies for a better understanding of the mode of action of the thiopurines and the use of this method in TDM.

Laparoscopic Management of Acute Small Bowel Obstruction: A Retrospective Study at a Tertiary Center in the United Kingdom.

Objectives To present a single-center experience of laparoscopic management of acute small bowel obstruction (ASBO) based on seven years of data and demonstrate its suitability for the United Kingdom (UK). Methods A retrospective review of case notes to evaluate postoperative outcomes was conducted. All emergency small bowel obstructions treated laparoscopically were included. The cases that were converted to a laparotomy were excluded. Demographics (age, sex), American Society of Anesthesiologists (ASA) grade, indication for surgery, duration of stay, complications, requirement of stoma, requirement of intensive treatment unit/high dependency unit (ITU/HDU), reoperation/readmissions, and 30-day mortality were noted. The results were tabulated and analyzed accordingly. Results There were 119 patients studied, with a median age of 66 (range: 17-97). The sex ratio was 62 females to 57 males. Primary etiologies of adhesion bands (49.5%, 59) and hernia (31.9%, 38) werethe most common. Minor and majorcomplications were 15 (12.6%) and 37 (31%),respectively. Three (2.5%) patients passed away within 30 days of surgery. The medianlength of stay (LOS) was eight days. ThemedianLOS subgroup analysis showed nine days for adhesiolysis and six days for hernias. Discussion This study shows that there is significant heterogeneity in outcomes regarding small bowel obstruction around the world. We have demonstrated similar to better results in our center relative to other prominent centers in the UK. This can be attributed to the patient cohort, presentation, and physiological status on admission, delay to surgery, and associated co-morbidities to name a few. Conclusion This study indicates that laparoscopic surgery is a safe approach to treating ASBO, provided adequate expertise and infrastructure are available.

Chronic Gallstone Ileus Presenting as Acute Small Bowel Obstruction: A Case Study

Chronic Gallstone Ileus Presenting as Acute Small Bowel Obstruction: A Case Study

Rare complications of acute pancreatitis: Clinical cases

Background. Acute pancreatitis is recognized as a common disease, occasionally accompanied by the development of local complications that require surgical debridement. Rare complications of pancreatitis may occur in clinical practice, which is one of the reasons for their untimely diagnosis and treatment. Pancreaticopleural fistula and high small bowel obstruction develop in less than 1% of acute pancreatitis cases. Therefore, possible options for management of these complications are considered valuable. Description of clinical cases. The clinical examples, provided in the present paper, describe pancreaticopleural fistula and high small bowel obstruction that develop against the peripancreatic mass in the abdominal cavity. Patient K., 44, was hospitalized to the Regional Clinical Hospital of Emergency Medical Care, Krasnodar Krai, and preliminary diagnosed with bilateral hydrothorax and type II respiratory failure; pleural puncture was performed. Following the extended examination, a clinical diagnosis was made as follows: “Acute necrotic pancreatitis spreading to a pancreatic tail cyst. Reactive double pleurisy”. The postoperative period was indicated with repeated recurrence of right hydrothorax, and pancreaticopleural fistula (diagnosed by measuring amylase activity in the brown fluid effused from the right pleural cavity, which appeared to be 41216 IU/l (not normally determined)). The right pleural cavity and pseudocyst of the pancreatic tail were drained, resulting in obliteration of the pancreatbcopleural fistula. Patient V., 50, was hospitalized and transferred to the surgical department of the Regional Clinical Hospital No. 2, Krasnodar Krai, and diagnosed with “pancreonecrosis, extensive purulent-necrotic peripancreatitis.” The patient underwent puncture-drainage treatment. The postoperative period was complicated by acute small bowel obstruction. Surgical treatment involved Braun enteroesterostomy. The patient recovered. Conclusion. Pancreaticopleural fistula refers to a rare complication of acute pancreatitis, manifested by hydrothorax. Its diagnosis is based on the determination of amylase activity in the effusion. Drainage of the pleural cavity and pancreatic pseudocyst contributes to obliteration of the fistula. The intestinal obstruction, another complication of pancreatitis, requires open surgical treatment when a conservative therapy appears ineffective.

FP7.2 - Single centre experience of laparoscopic management of acute small bowel obstruction

Abstract Objectives The objective of this article is to present a single-centre experience of laparoscopic emergency surgery reporting outcomes by laparoscopic management of acute small bowel obstruction (ASBO). Methods A retrospective review of case notes to evaluate postoperative outcomes. 119 patients were included in this study of laparoscopic management of ASBO and data analysis was performed with SPSS software. Results There were 119 patients with primary aetiologies of adhesion bands (49.5%/59) and hernia (31.9%/38) were noted. Mortality and morbidity outcomes – 15 patients had minor complications, 37 had major complications and 3 patients had post-operative mortality. The average length of stay (LOS) was 10.86 days. The LOS Subgroup analysis showed that 13.8 days were average for adhesiolysis and 6.7 days for the hernia. Discussion On comparison with the published data global data suggest minor complications of 12.6 % (14% in this single-centre experience), major complications of 34 % (31 % in this single-centre experience) and mortality of 0.6% (2.5 % in this single-centre experience). Conclusion This study shows that this centre has comparable mortality and morbidity outcomes when compared to the global trend, but these outcomes.

WP5.6 - Beyond the Left Side: Emergency Colonic Stenting for Acute Malignant Large Bowel Obstruction

Abstract Introduction Acute malignant large bowel obstruction (LBO) is traditionally treated by surgical diversion or resection in patients who are fit enough. European guidelines suggest colonic stenting as a bridge to surgery in curative disease. The aim was to examine the safety and efficacy of a change in practice from emergency laparotomy towards colonic stenting for acute malignant LBO. Methods Patients with LBO from 01/01/2019 to 31/12/2022 were included and data was obtained from the NELA database and electronic patient records. Results 42 patients underwent emergency laparotomy (EL) for LBO. 33% (14/42) patients had right-sided tumours (n=14) and/or perforated disease (n=6) where stenting was contraindicated. 28/42 patients (22% of total) went straight to EL for clinical/ organisation factors. 73 patients were stented; 44% (32/73) were at/ proximal to splenic flexure. Perforation rate was 10% (7/73) with 4/7 requiring EL. Failure rate was 14% (10/73) with 6/10 patients requiring EL. 41% (30/73) were stented with curative intent; 70% (21/30) then underwent elective resection. The rate of stoma formation and minimally invasive surgery in patients stented with curative intent was 40% (12/30) and 60% (18/30) respectively (including 9 EL following stent complications). Compared with 88% (37/42) and 19% (8/42) in patients undergoing primary EL. Conclusion Almost 2/3 of patients presenting with acute malignant LBO were suitable for stenting. Stenting reduced the need for a stoma and enabled elective minimally invasive surgery with low complication rates. This rate of colonic stenting was achievable without a 24/7 colonic stenting rota or sub-specialty cover.

Safety of Pelvic and Abdominal Radiation Therapy for Patients With Inflammatory Bowel Disease: A Dosimetric Analysis of Acute Bowel Toxicity

ObjectivesInflammatory bowel disease (IBD) has been considered a relative contraindication to radiation therapy (RT) due to the potential greater risk of RT-induced toxicities. This study aims to assess acute toxicity outcomes in patients with IBD treated with abdominal/pelvic RT. MethodsAfter institutional review board approval, patients with IBD who received RT to the abdomen/pelvis were identified from an institutional research repository and their electronic medical records were reviewed. The IBD cohort was matched 1:1 with controls according to all of the following: radiotherapy, gender, disease site, age, and year of RT. Acute toxicity was defined as toxicity occurring within 3 months of RT. Primary outcomes were assessed via univariable logistic regression models and predicted probability of acute toxicity and acute gastrointestinal (GI) toxicity were plotted for the most significant covariates. IBD and control control cohorts were compared on demographic and toxicity variables using chi-square/Fisher's exact tests and Kruskal-Wallis tests where appropriate. ResultsWe identified 62 patients with median age of 64 years (interquartile range [IQR] 54-70) who received RT from 2006-2022. Patients were treated with intensity-modulated RT (38; 61.3%), 3-dimensional conformal RT (12; 19.4%), and stereotactic body RT/brachytherapy (12; 19.4%). After RT, 28 (45.2%) and 23 (37.1%) patients experienced grade ≥2 acute (any) and acute GI toxicity, respectively. Higher overall RT dose and RT dose to small bowel were found to be signicantly associated with increased risk of grade ≥2 acute toxicities (OR=1.041 per unit Gy, 95% CI 1.005-1.084, p=0.034 and OR=1.046, 95% CI 1.018-1.082, p=0.003, respectively). Between IBD and control cohorts, there were no significant differences in grade ≥2 acute (any) and acute GI toxicities (p=0.710 and p=0.704, respectively). ConclusionIn patients with IBD treated with abdominal/pelvic RT for malignancy, RT was effective and well-tolerated. RT treatment planning should carefully consider the location(s) of IBD inflammation and dose to bowel structures, in particular, dose to small bowel.

45 Evaluation of Acute Bowel Toxicity After Simultaneous Integrated Boost (SIB) Radiation Therapy for Pelvic Tumours

45 Evaluation of Acute Bowel Toxicity After Simultaneous Integrated Boost (SIB) Radiation Therapy for Pelvic Tumours

Erratum to: Acute large bowel obstruction

Erratum to: Acute large bowel obstruction

1993: Correlating acute bowel toxicity with RT planning objectives for high-risk prostate cancer patients

1993: Correlating acute bowel toxicity with RT planning objectives for high-risk prostate cancer patients

Effects and Mechanisms of the Xianhecao-Huanglian Drug Pair on Autophagy-Mediated Intervention in Acute Inflammatory Bowel Disease via the JAK2/STAT3 Pathway

To explore the effects and mechanisms of the Xianhecao-Huanglian drug pair on autophagy-mediated intervention in acute inflammatory bowel disease (IBD) via the JAK2/STAT3 pathway. The study examined the underlying mechanisms of action of Xianhecao (APL) and Huanglian (CR) using a mouse model of dextran sodium sulfate (DSS)-induced acute inflammatory bowel disease (IBD) and in an in vitro model of IBD induced by lipopolysaccharide (LPS). The assessment of the therapeutic efficacy of the Xianhecao-Huanglian drug combination in a mouse model of IBD caused by DSS included the following parameters: Assessment of weight loss or gain. Measurement of the disease activity index (DAI). Assessment of histological damage. Determination of organ index. Measurement of colon length. Ascertain the levels of inflammatory cytokines in the intestinal tissues and serum of mice. Immunohistochemistry (IHC) for the measurement of tight junction protein concentrations in the colon mucosa, including ZO-1, claudin-1, and occludin. Measurement of mucin levels, specifically Mucin 2 (Muc2). Hematoxylin and eosin (HE) staining for the observation of histopathological alterations in colonic tissues. Examining the effect on goblet cells using periodic acid-Schiff (PAS) labeling. Application of Western blot and immunofluorescence techniques for the detection of autophagy-related markers in colonic tissues and proteins associated with the JAK2/STAT3 pathway. A cell inflammation model of IBD was induced through LPS stimulation, and a serum containing the Xianhecao-Huanglian drug pair (referred to as ACHP-DS) was formulated. Cell viability, anti-proinflammatory cytokines, tight junction proteins, mucins, autophagy-related markers, and the JAK2/STAT3 signaling pathway were assessed. The Xianhecao-Huanglian drug pair significantly ameliorated the symptoms and survival quality of acute IBD mice, reducing the disease activity index score, raising MUC2 secretion and tight junction protein expression to improve the integrity of the intestinal barrier, and preserving goblet cell function; thus, protecting the intestines. It effectively restrained triggering the signaling pathway that involves JAK2 and STAT3, leading to the suppression of inflammation and amelioration of colonic inflammation damage. Additionally, it induced autophagy in mouse colonic tissues.The in vitro experiments demonstrated that the Xianhecao-Huanglian drug combination enhanced the viability of LOVO and NCM460 cells when exposed to LPS stimulation. Furthermore, it suppressed the production of inflammatory cytokines such as IL-6, IL-1β, as well as TNF-α, whilst increasing the production of IL-10, ZO-1, along with MUC2. These effects collectively led to the alleviation of inflammation and the restoration of mucosal integrity. The results were consistent with what was shown in the in vivo trial. Moreover, the medication demonstrated effectiveness in reducing JAK2 along with STAT3 phosphorylation levels in the LPS-induced inflammatory model of IBD cells. The intervention with either the Xianhecao-Huanglian drug combination-containing serum or the JAK2/STAT3 pathway inhibitor AG490 reversed the pro-inflammatory effects and increased autophagy levels in the LPS-stimulated cells. The Xianhecao-Huanglian drug combination modulates the JAK2/STAT3 pathway, leading to the induction of autophagy, which serves as an intervention for IBD.

Acute large bowel obstruction.

Acute large bowel obstruction.

Stereotactic Magnetic Resonance–Guided Daily Adaptive Radiation Therapy for Localized Prostate Cancer: Acute and Late Patient-Reported Toxicity Outcomes

ObjectiveTo report acute and late bowel, urinary and sexual dysfunction patient reported outcome measures (PROMS), amongst localised prostate cancer patients who underwent Stereotactic MRI-guided daily adaptive radiotherapy (SMART). MethodsAll patients who completed a baseline 12 item Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE), before undergoing 36.25 Gy in 5 fractions by SMART, were subsequently followed up with the same graded questionnaire at set time points. Latest PSA levels were recorded. The percentage of patients who reported no change from their baseline AE or reported a new ≥ ‘frequent’ or’ severe’ AE grade during follow up was calculated. The maximum PRO-CTCAE grade for each item was recorded for each patient. The percentage of toxicity levels for each separate AE item at set time points were calculated. ResultsThe total number of patients was 69 with a median follow-up of 27 months. Median age of cohort 73 (range 54-85). The median pre-treatment PSA, T stage and Gleason score was 7.5 mmol/l (4.5-32 mmol/l), T2b (T2-T3b) and Gleason Score of 7 (3+4, range: 6-9) respectively. No patient had biochemical failure during follow up. Regarding bowel symptoms, >80% of men reported no change from baseline toxicity during follow up. New ≥ frequent diarrhoea was reported in 9% of patients. ‘Almost constant’ diarrhoea peaked at 1 month but was absent at >33 months. Regarding urinary symptoms, increased urinary urgency was the most common complaint (39%). 20% of men reported new ≥ frequent urinary urgency incidence peaking at 1 month but absent at >33 months. New “severe” sexual dysfunction was seen in 26% of patients and was persistent at >33 months. ConclusionOur study is one the largest patient reported outcomes study post prostate SMART. It shows acceptable levels of toxicity even up to 2 years post treatment.

Meat Bolus Bezoar Leading To Small Bowel Obstruction: A Case Report

Introduction: Foreign body ingestion and food bolus impaction are common causes of emergency interventions. Among them, bezoars, indigestible materials accumulated in the gastrointestinal tract, constitute a rare but significant etiology of small bowel obstruction.Case Report: We present a case of a 71-year-old male with a history of gastrojejunostomy for gastric outlet obstruction due to peptic ulcer disease, admitted with abdominal distension, vomiting, and constipation. Imaging revealed acute small bowel obstruction with a transition point approximately 100 cm proximal to the ileocecal junction. Given the non-resolving small bowel obstruction, emergency emergency surgical exploration via exploratory laparotomy was done which suggested a foreign body lodged in the ileum. Enterotomy was done to successfully remove the foreign body which was found to be a meat bolus bezoar.Discussion: Bezoars, although uncommon, should be considered in cases of small bowel obstruction, with phytobezoars being the most frequently reported type. Contributing factors such as previous gastric surgery and poor mastication play a role in bezoar formation. Diagnosis typically involves imaging modalities like CT scans, with surgical intervention often necessary for resolution. Management options include enterotomy, particularly for proximally located bezoars, or bowel resection for complicated cases.Conclusion: This case underscores the importance of considering bezoars as a differential diagnosis in small bowel obstruction, particularly in patients with predisposing factors such as previous gastric surgery. Early recognition and appropriate surgical management are crucial for successful outcomes.

Closed-loop obstruction due to internal hernia: An atypical clinical presentation of acute abdomen - A case report

Abstract Internal hernia is the protrusion of a viscus through a normal or abnormal peritoneal or mesenteric aperture within the confines of the peritoneal cavity. They can be congenital or acquired after abdominal surgery. We report a case of a 58-year-old woman who presented with complaints of abdominal pain and nonbilious vomiting for 2 days. She underwent an abdominal hysterectomy 15 years ago. After baseline blood investigations and imaging, a diagnosis of subacute intestinal obstruction was made. As she clinically worsened over 24 h, CT imaging was done, which suggested acute small bowel obstruction secondary to adhesions. Surgery revealed herniation with incarceration of distal ileal loops through a defect in the sigmoid mesocolon. Bowel resection was done, and the defect was closed. The clinical presentation of internal hernias, especially transmesosigmoid hernia, is nonspecific, and they rapidly progress to bowel ischemia. Early intervention and surgical correction are prudent for good clinical outcomes.

Acute Small-bowel Obstruction: An Appraisal of Common Etiology and Management at the Federal Medical Centre, Keffi, North-central Nigeria.

Acute small intestinal obstruction is a common surgical emergency in the sub-Saharan region. Over the decades, complicated inguinal hernias have been identified as a leading cause. However, we observed from our clinical practice that complicated inguinal hernias were not the most common etiology. This study aimed to evaluate the common etiology of acute small bowel obstruction in the study center and compare our findings with that from other centers and existing literature. This was a retrospective, cross sectional study carried out over a period of five years (January 2017 to December 2021). This study looked at the patients presenting with acute, mechanical, small bowel obstruction that did not respond to conservative treatment in our hospital facility. Relevant information were extracted from patients' clinical details and entered into the proforma prepared for this study. A total of 147 patients were recruited into this study out of which 85(57.8%) were males and 62 (42.2%) were females (M:F=1.44:1). Majority (80.3%) of the patients that presented with post-operative bowel adhesion had previous appendectomy. Simple bowel obstruction was seen in 93 (63.3%) patients while strangulated obstruction and gangrenous bowel were seen in 26 (17.7%) patients and 22 (15.0%) patients respectively. Majority (47.6%) of the patients had adhesiolysis done while others had bowel resection. The common cause of acute small bowel obstruction as observed in this study is post-operative adhesions arising from previous appendectomy and laparotomies.

ACBC Study Protocol – Acute Colon Resection Versus Bridge to Colon Surgery with Stent Placement or Stoma Diversion: A Prospective Cohort Study

Abstract Background: Approximately 70% of all colon cancer emergencies result from colonic obstruction. Data from the Swedish Colorectal Cancer Registry indicate that patients undergoing emergency surgical resections for colon cancer face higher overall 30-day morbidity and increased mortality rates—5.8% at 30 days and 11.2% at 90 days—compared to those undergoing elective procedures, which have mortality rates of 1.1% and 2.0%, respectively. Other concerns about acute colon cancer resections are oncological outcomes. Long-term outcomes are significantly worse, with higher rates of recurrence and cancer-related death, regardless of the cancer stage or the use of adjuvant chemotherapy. Objectives: To evaluate the short- and long-term outcomes of primary resection for malignant colonic obstruction compared to only decompression using a self-expandable endoscopic metallic stent or diverting stomas as the first intervention (bridge to surgery) followed by later oncological resection. Design: This is a prospective observational study with data collected through the Swedish Colorectal Cancer Registry with an additional electronic case report form. Settings: Swedish multicenter study at both university and regional hospitals. Patients and Methods: Patients with suspected acute malignant large bowel obstruction due to colonic adenocarcinoma will be identified and followed. Analysis will be performed on an intention-to-treat basis. Descriptive statistics of the study cohort will be presented. Primary endpoints will be subjected to multivariate analyses adjusted for confounders. Main Outcome Measures: 30-day severe morbidity (Clavien–Dindo &gt; 3a), 30- and 90-day mortality rates, and overall survival after three and five years. Sample Size: We aim to include 1000 patients, with an interim analysis after the recruitment of 500 patients. Results: The study is ongoing. Conclusions: Acute colon obstruction is associated with substantial morbidity and mortality. We hypothesize that patients with malignant obstruction benefit from avoidance of emergency cancer resection and that bridge to surgery leads to decreased short-term morbidity and mortality and improved long-term oncological outcomes. Limitations: The main limitation is the risk of selection bias when the study is not a randomized controlled trial, which would be a standard process. A prospective observational study is, nevertheless, considered a pragmatic compromise between feasibility and ability to answer the research question. Conflicts of Interest: None.

Cross-sectional imaging of mimics of inflammatory bowel disease: not everything is Crohn's disease or ulcerative colitis.

Acute and chronic bowel pathologies can often be mistaken for manifestations of inflammatory bowel disease (IBD), and there are many entities with imaging and clinical features that overlap with IBD, making diagnosis difficult. We describe multiple inflammatory, infectious, neoplastic, and vascular entities with imaging and clinical features that may mimic IBD, and highlight differentiating features to assist in diagnosis.