Caecal Perforation Research Articles

Ogilvie syndrome with caecal perforation following cesarean section: a rare case report from Jordan

Introduction: Ogilvie syndrome is a rare condition characterized by acute colonic dilation. In 1948, H. Ogilvie first described it in medical literature. Its incidence is estimated at 100 cases per 100 000 per year in the US. Both abdominal distention and pain are considered major symptoms. Presentation of case: A 32-year-old woman, 36+1 weeks pregnant, experienced labour pain and was admitted to the hospital. Upon examination, she was in labour, but the foetus was in a breech position, necessitating a caesarean section. After 36 h later, she returned to the emergency department with severe, 1-day-old diffuse abdominal pain, accompanied by moderate bilious vomiting and significant abdominal distension. Abdominal CT with contrast revealed pneumoperitoneum, abdominal wall emphysema, and pneumatosis intestinalis involving the caecum and ascending colon, suggesting bowel necrosis. Emergency laparotomy revealed a caecal perforation, which was closed surgically without resection. Clinical discussion: Ogilvie syndrome is more common in males but can occur in females for several reasons, including pregnancy, caesarean section, pelvic surgeries, and trauma. Several factors contribute to the occurrence of this syndrome, such as pelvic fractures and cardiac events. Surgery may be required if there is suspicion of bowel perforation or ischaemia. Conclusion: OS is a rare condition in women, often seen after childbirth or pelvic surgery, with an unclear cause but believed to be related to autonomic nervous system imbalance. Patients with abdominal pain and distension, without evidence of obstruction, should be evaluated for pseudo-obstruction using abdominal pelvic CT, and treatment may involve conservative measures, medication, and colonoscopic decompression.

Hippocampal adenosine-to-inosine RNA editing in sepsis: dynamic changes and influencing factors.

Sepsis-associated encephalopathy is a diffuse brain dysfunction secondary to infection. It has been established that factors such as age and sex can significantly contribute to the development of sepsis-associated encephalopathy. Our recent study implicated a possible link between adenosine-to-inosine RNA editing and sepsis-associated encephalopathy, yet the dynamics of adenosine-to-inosine RNA editing during sepsis-associated encephalopathy and how it could be influenced by factors such as age, sex and antidepressants remain uninvestigated. Our current study analysed and validated transcriptome-wide changes in adenosine-to-inosine RNA editing in the hippocampus of different septic mouse models. Seventy-four sites in 64 genes showed significant differential RNA editing over time in septic mice induced by caecal ligation and perforation. The differential RNA editing might contribute to the RNA expression regulation of the edited genes, with 42.2% differentially expressed. These differentially edited genes, especially those with missense editing, such as glutamate receptor, ionotropic, kainate 2 (Grik2, p.M620V), filamin A (Flna, p.S2331G) and capicua transcriptional repressor (Cic, p.E2270G), were mainly involved in abnormal social behaviour and neurodevelopmental and psychiatric disorders. Significant effects of age and sex were also observed on sepsis-associated RNA editing. Further comparison highlighted 40 common differential RNA editing sites that caecal ligation and perforation-induced and lipopolysaccharide-induced septic mouse models shared. Interestingly, these findings demonstrate temporal dynamics of adenosine-to-inosine RNA editing in the mouse hippocampus during sepsis, add to the understanding of age and sex differences in the disease and underscore the role of the epigenetic process in sepsis-associated encephalopathy.

Acute colonic pseudo-obstruction in polytrauma patients.

Acute colonic pseudo-obstruction (ACPO) is characterized by severe colonic distension without mechanical obstruction. It has an uncertain pathogenesis and poses diagnostic challenges. This study aimed to explore risk factors and clinical outcomes of ACPO in polytrauma patients and contribute information to the limited literature on this condition. This retrospective study, conducted at a Level 1 trauma center, analyzed data from trauma patients with ACPO admitted between July 2009 and June 2018. A control cohort of major trauma patients was used. Data review encompassed patient demographics, abdominal imaging, injury characteristics, analgesic usage, interventions, complications, and mortality. Statistical analyses, including logistic regression and correlation coefficients, were employed to identify risk factors. There were 57 cases of ACPO, with an incidence of 1.7 per 1,000 patients, rising to 4.86 in major trauma. Predominantly affecting those older than 50 years (75%) and males (75%), with motor vehicle accidents (50.8%) and falls from height (36.8%) being the commonest mechanisms. Noteworthy associated injuries included retroperitoneal bleeds (RPBs) (37%), spinal fractures (37%), and pelvic fractures (37%). Analysis revealed significant associations between ACPO and shock index >0.9, Injury Severity Score >18, opioid use, RPBs, and pelvic fractures. A cecal diameter of ≥12 cm had a significant association with cecal ischemia or perforation. This study underscores the significance of ACPO in polytrauma patients, demonstrating associations with risk factors and clinical outcomes. Clinicians should maintain a high index of suspicion, particularly in older patients with RPBs, pelvic fractures, and opioid use. Early supportive therapy, vigilant monitoring, and timely interventions are crucial for a favorable outcome. Further research and prospective trials are warranted to validate these findings and enhance understanding of ACPO in trauma patients. Prognostic and Epidemiological; Level IV.

Spontaneous Caecal Perforation in a Male Neonate: A Case Report

BACKGROUND: Spontaneous perforation of the colon in full-term neonates is a rare case, with perforation of the cecum being rarely reported. CASE PRESENTATION: We present a rare case of spontaneous perforation of the cecum in a term neonate who presented with vomiting and flatulence on the second day of life. Surgical intervention revealed full-thickness perforation in the caecum. Histopathologically, there was no necrotizing enterocolitis and Hirschsprung’s disease. CONCLUSION: Clinica diagnosis and hopefully prompt surgical management.

The role of TLR4/MyD88/NF-κB in the protective effect of ulinastatin on the intestinal mucosal barrier in mice with sepsis

ObjectiveTo investigate the effect of the TLR4/MyD88/NF-κB (Toll-like receptor 4/myeloid differentiation factor/nuclear factor kappa B) signalling pathway on the protective effect of ulinastatin on the intestinal mucosal barrier in mice with sepsis.MethodsA mouse model of sepsis was established by classical caecal ligation and perforation. Forty-four SPF C57BL/6 mice were randomly divided into the following four groups with 11 mice in each group: the control group (Con group), ulinastatin group (Uti group), Uti + LPS (lipopolysaccharide, LPS) group (Uti + LPS group) and LPS group. Mice in the Con group and Uti group received saline or ulinastatin injected 2 h after modelling; Mice in the Uti + LPS group received LPS injected 0 h after modelling, other procedures were the same as in the Uti group; Mice in the LPS group received LPS only. At 48 h after surgery, the levels of TNF-α (tumour necrosis factor-α, TNF-α), IL-6 (interleukin-6, IL-6) and IL-1β (interleukin-1β, IL-1β) in vein, and the expression of TLR4, MyD88 and NF-κB mRNA in small intestinal mucosa tissues using ELISA and RT‒PCR.ResultsThe pathological specimens showed increased inflammatory injury in the Con and LPS groups, while these injuries and changes improved in the Uti group. The scores of intestinal mucosal injury at 48 h of Uti injection were significantly lower than those of the Con group (P < 0.001), while the scores of intestinal mucosal injury of Uti + LPS were significantly higher than those of the Uti group (P = 0.044). The expression of TNF-α, IL-6 and IL-1β in the Uti decreased significantly at 48 h after surgery than that in the Con group (P = 0.001, P = 0.014, P = 0.004), while the expression of TNF-α, IL-6 and IL-1β in the Uti + LPS group increased significantly after surgery than that in the Uti group (P = 0.026, P = 0.040, P = 0.039). The expression of TLR4, MyD88 and NF-κB mRNA in the Uti group decreased significantly compared with that in the Con group (P = 0.001, P = 0.021, P = 0.007), while the expression of TLR4, MyD88 and NF-κB mRNA in the Uti + LPS group was higher than that in the Uti group (P = 0.023, P = 0.040, P = 0.045).ConclusionThese findings indicate that the protective effect of ulinastatin on the intestinal mucosal barrier against sepsis may be mediated through the TLR4/MyD88/NF-κB pathway.

A Rare Case of Cecostomy Tube in Complicated Acute Appendicitis Leading to Fecal Peritonitis

The most common abdominal surgical emergency in the world in acute appendicitis. Most common age group involved is between first to second decades but patients at extreme age have higher mortality rate due to late presentation. We are presenting a case of appendicitis which was complicated as long history at time of first surgery which led to caecal injury which was managed with ceacostomy. 62 years gentleman was referred from private hospital with fecal discharge from the open appendectomy wound and cecostomy tube insitu. Patient was diagnosed as phlegmon sequelae of acute appendicitis. Patient underwent emergency laparotomy, peritoneal lavage, removal of cecostomy tube, primary repair of caecal perforation and diversion loop ileostomy. Patient recuperated well. This case report highlights the challenges faced and complexities associated with failure of cecostomy in managing caecal perforation following laparoscopic appendectomy. The conversion from a laparoscopic approach to an emergency open appendectomy followed with cecostomy proved to be a vital decision in the face of phlegmon sequelae of acute appendicitis. The phlegmonous nature of acute appendicitis should be managed conservatively otherwise leading to a more aggressive surgical intervention. Keywords: Acute appendicitis, cecostomy, ileostomy, fecal discharge, phlegmon, complicated appendicitis.

Plantamajoside alleviates acute sepsis-induced organ dysfunction through inhibiting the TRAF6/NF-κB axis

Context Plantamajoside (PMS) possesses rich pharmacological characteristics that have been applied to remedy dozens of diseases. However, the understanding of PMS in sepsis remains insufficient. Objective Role of PMS in sepsis-regulated organ dysfunction and potential mechanisms were investigated. Materials and methods Thirty C57BL/6 male mice were adaptive fed for three days and used to establish acute sepsis model by caecal ligation and perforation (CLP). These experimental mice were divided into Sham, CLP, CLP + 25 mg PMS/kg body weight (PMS/kg), CLP + 50 mg PMS/kg and CLP + 100 mg PMS/kg (n = 6). The pathological and apoptotic changes of lung, liver and heart tissues were observed via HE and TUNEL staining. The injury-related factors of lung, liver and heart were detected by corresponding kits. ELISA and qRT-PCR were applied to assess IL-6/TNF-α/IL-1β levels. Apoptosis-related and TRAF6/NF-κB-related proteins were determined using Western blotting. Results All doses of PMS enhanced the survival rates in the sepsis-induced mouse model. PMS remitted sepsis-mediated lung, liver and heart injury through prohibiting MPO/BALF (70.4%/85.6%), AST/ALT (74.7%/62.7%) and CK-MB/CK (62.3%/68.9%) levels. Moreover, the apoptosis index (lung 61.9%, liver 50.2%, heart 55.7% reduction) and IL-6/TNF-α/IL-1β levels were suppressed by PMS. Furthermore, PMS lowered TRAF6 and p-NF-κB p65 levels, whereas TRAF6 overexpression reversed the protective influences of PMS in organ injury, apoptosis and inflammation triggered by sepsis. Discussion and conclusions PMS suppressed sepsis-induced organ dysfunction by regulating the TRAF6/NF-κB axis, and PMS treatment may be considered as a novel strategy for sepsis-caused damage in future.

SPONTANEOUS CAECAL PERFORATION IN PREGNANT FEMALE: A RARE CASE REPORT

Caecal perforations are rare to occur spontaneously than colonic perforation. Due to physiologic changes and limitations on several diagnostic imaging modalities, preoperative diagnosis of the caecal perforation is particularly challenging in pregnant women.

Inhibition of DDX3X alleviates persistent inflammation, immune suppression and catabolism syndrome in a septic mice model.

DDX3X is involved in various pathological processes such as infection, immunity and cell death. This study aimed to investigate the effect of RK-33, a specific inhibitor of DDX3X, on the progression of sepsis to persistent inflammation, immune suppression and catabolism syndrome(PICS). The septic mice model was established using caecal ligation and perforation (CLP). The mice were randomly divided into four groups: sham group, sham+RK-33 group (20mg/kg, intraperitoneal injection, once a day), CLP group and CLP+RK-33 group (20mg/kg, intraperitoneal injection, once a day). The number of inflammatory cells in the peripheral blood, spleen and bone marrow was calculated, and inflammatory cytokines were detected using an enzyme-linked immunosorbent assay. The septic mice's body weight and skeletal muscle mass were measured, and skeletal muscle tissues were examined using eosin staining. Western blotting was performed to detect the expression levels of MuRF1, atrogin1 and NLRP3 in the skeletal muscle of septic mice. Additionally, reactive oxidative species, superoxide dismutase and malondialdehyde were measured using commercial kits. RK-33 reduced inflammatory cell counts and cytokine levels in CLP mice, ameliorated the decline in CD4 and CD8 T cells and prevented the loss of body weight and skeletal muscle mass in septic mice. Additionally, RX-33 reduced oxidative stress in the skeletal muscle of septic mice. In the established sepsis mouse model, RK-33 alleviated inflammation and oxidative stress, ameliorated CLP-induced immunosuppression and skeletal muscle atrophy and improved survival. These findings suggest that RK-33 could be a novel potential therapeutic agent for preventing the progression of sepsis to PICS.

A RIGHT ILIAC FOSSA MASS - A PERFORATED ILEAL GASTRO-INTESTINAL STROMAL-TUMOUR

GASTRO-INTESTINAL STROMAL-TUMOURs (GASTRO-INTESTINAL STROMAL-TUMOURs) are tumours of the gut found mostly in stomach and small intestine. The complications are Gastrointestinal (GI) bleeding, obstruction, pain and rarely perforation. We are reporting an abnormal presentation of GASTRO-INTESTINAL STROMAL-TUMOURS presenting as an acute abdomen pain with Right Iliac Fossa (RIF) mass in 57-year-old male. Contrast Enhanced Computed Tomography (CECT) of abdomen revealed a peripherally enhancing encapsulated abscess in RIF close to the base of caecum and surrounding peritonitis suggesting a caecal perforation. On laparotomy, a perforated ileal GASTRO-INTESTINAL STROMAL-TUMOURS was identified. Pathological examination confirmed the tumour to be a GASTRO-INTESTINAL STROMAL-TUMOUR of spindle cell type, further reiterated by immunohistochemistry. Our case report emphasizes, GASTRO-INTESTINAL STROMAL-TUMOUR are a rare differential diagnosis of RIF mass, and to have high clinical suspicion when a similar case is encountered in an emergency room, keeping in mind the poor outcome caused by delay in appropriate management of the disease.

A Clinical Study of Appendicular Perforation

INTRODUCTION: Acute appendicitis is the most common acute surgical condition of the abdomen. It is a fatal condition, and death occurs by sepsis due to peritoneal contamination with both aerobic and anaerobic organisms. The primary role of management is to control sepsis, minimize contamination, and treat the underlying cause. Surgery plays an essential role in the management of perforation. AIM: To analyse the incidence of appendicular perforation and to study the etiological factors. OBJECTIVES: To study the clinical presentation of appendicular perforation. To study various factors leading to appendicular perforation. To study the age &amp; sex incidence. METHODOLOGY: In this study total of 20 patients were included, Patients of appendicular perforation are studied prosspectively in detail. Patients were selected from admissions in GEMS, Srikakulam. Clinical diagnosis of appendicular perforation is confirmed by investigations or by laparotomy performed. RESULTS: Out of the 20 patients , 14 patients were under the age of 20 yrs, 15 were males. One patient was in 1st trimester of pregnancy and underwent spontaneous abortion along with the appendicular perforation. 5 out of them were at the base of appendix and also has caecal perforation. One patient underwent cecostomy and temporary ileostomy. One patient needed right hemicolectomy as the patient has multiple perforations at the base of appendix and was in severe sepsis and succumbed to death on POD 3. CONCLUSION: Appendicular perforation was most common in younger age groups. Early appendectomy for perforated appendicitis significantly reduced the time away from normal activities, overall adverse event rate. Drain placement appears to be helpful with late diagnosis but is of little benefit when the duration of symptoms is less than four days. Thus it is likely that drains are most useful in patients with well established and localized abscess cavities.

Late presentation of isolated caecal perforation following blunt abdominal trauma: The utility of point-of-care ultrasound

Colonic injuries after blunt trauma abdomen are a rare entity which may sometimes have a delayed presentation. In the intensive care unit (ICU), various interventions like sedation, analgesia and paralysis may confoundclinical examination findings pertaining to abdominal pathology. Computed tomography (CT) provides anexcellent diagnostic modality in blunt trauma abdomen but requirement of high ventilatory support and/orvasopressors may preclude safe transfer of patients from ICU to radiology suites. Point of care ultrasound (POCUS)provides an excellent adjunct in diagnosis of hollow viscus perforation and is considered as a reliable alternative toplain radiograph for the diagnosis of pneumoperitoneum

The HMGB1-RAGE axis induces apoptosis in acute respiratory distress syndrome through PERK/eIF2α/ATF4-mediated endoplasmic reticulum stress.

Apoptosis plays a major role in the progression of acute respiratory distress syndrome (ARDS) that may involve the interaction of the high mobility group box 1 (HMGB1) protein with the receptor for advanced glycation end products (RAGE). However, the underlying mechanism remains unclear. Thus, we aimed to explore the mechanisms of HMGB1-RAGE axis-induced apoptosis in ARDS. Blood samples from ARDS patients and healthy volunteers were collected to investigate the correlation between serum HMGB1 levels and the severity of ARDS in patients. Mouse models of ARDS induced by caecal ligation and perforation and A549 cell models established by stimulation with recombinant human HMGB1 (rHMGB1) were designed to explore lung inflammatory injury and apoptosis. Serum HMGB1 levels were significantly increased in ARDS patients compared to controls, and HMGB1 levels in the Severe group and Nonsurvival group were significantly higher than those in the Mild and Moderate group and Survival group. In vivo, compared to sham mice, ARDS mice showed significant lung inflammatory injury and apoptosis as well as upregulation of HMGB1 and RAGE and endoplasmic reticulum stress (ERs) protein expression. All injury was attenuated by treatment with an HMGB1 inhibitor GA, a RAGE blocker FPS-ZM1, and an ERs inhibitor 4-PBA. In vitro, A549 cells challenged with rHMGB1 exhibited significant increases in the levels of proteins in the RNA-like endoplasmic reticulum kinase (PERK)/eukaryotic initiation factor 2alpha (eIF2α)/activating transcription factor 4 (ATF4) pathway and in apoptosis, all of which were significantly inhibited by pre-treatment with lenti-shPERK and an anti-RAGE antibody. The HMGB1-RAGE axis induces apoptotic injury during ARDS, possibly through PERK/eIF2α/ATF4-mediated ERs.

A rare case of amoebic liver abscess with caecal perforation

Amoebic colitis is one of common infection in all groups of people in almost all geographical areas. Routinely it is easily treatable disease, but it can get complicated and then prognosis is poor. Amoebic liver abscess is a common complication of amoebiasis but along with caecal perforation it carries worst prognosis.

Acute colonic pseudo-obstruction after caesarean, an obstetrician nightmare

Acute colonic pseudo-obstruction syndrome is a condition mostly affecting the elderly aged people with comorbidities, can rarely occur in postpartum period after caesarean section resulting in massive colonic dilatation without mechanical obstruction. It may lead to intestinal perforation if not identified and treated earlier. We report a case where a low risk primi underwent emergency LSCS for obstetric indication developed caecal perforation during postoperative period requiring laparotomy.

Colocolic intussusception secondary to colonic adenocarcinoma with impending caecal perforation in an elderly patient: A rare case report.

IntroductionIntussusception is a surgical emergency in which a part of the intestine slides into the distal adjacent part. Adult colocolic intussusception secondary to a tumoral process is a rare but serious clinical condition requiring immediate surgical intervention.Case presentationWe report a case of a 65-year-old male patient presenting with abdominal pain and distention, subsequently diagnosed with colocolic intussusception in the descending colon with closed-loop bowel obstruction with impending caecal perforation. An exophytic mass on the descending colon was discovered intra-operatively, prompting a subtotal colectomy with ileosigmoidal anastomosis and loop ileostomy with the suspicion of malignancy. The histopathological examination of the surgical specimen concluded a moderately-differentiated colonic adenocarcinoma with 40% mucinous component.Clinical discussionAdult intestinal intussusception is a rare but serious condition differing greatly in etiology from its pediatric counterpart. Its preoperative diagnosis is challenging in adults, which appears to be due to its imprecise presenting signs and symptoms; thus, the condition can be mistaken for other causes of intestinal obstruction. Adenocarcinomas remain the most common cause of malignant tumors in the colon, which also makes them one of the causes for colocolic intussusception.ConclusionIntussusception can appear as a surgical emergency even in the elderly, necessitating prompt surgical intervention to avoid intestinal ischemia and gangrene. Its diagnosis can be aided to a great degree by CT imaging.

Effects of exosomes from human adipose-derived mesenchymal stem cells on pulmonary vascular endothelial cells injury in septic mice and its mechanism

Effects of exosomes from human adipose-derived mesenchymal stem cells on pulmonary vascular endothelial cells injury in septic mice and its mechanism

A rare presentation of ruptured amoebic liver abscess with caecal perforation - a case series

A rare complication of simultaneous rupture of liver abscess with caecal perforation occurs mainly in malnourished patients and carries a high mortality rate. In invasive amoebiasis, the trophozoites penetrate the intestinal mucosal layer causing amoebic colitis which is carried along the portal circulation to produce liver abscess that is more prone to rupture in cases of immunocompromised status. Here we report 4 cases of ruptured liver abscess associated with caecal gangrene which were operated at our institute. All 4 patients were male who were chronic alcoholics and presented with ruptured amoebic liver abscess and simultaneous perforation of caecum that was identified on exploratory laparotomy. The different approaches to surgical management of these patients is discussed, wherein early identification and timely intervention remain as mainstay of treatment in all cases.

Delayed caecal perforation from amoebic dysentery.

Delayed caecal perforation from amoebic dysentery.

Spontaneous caecal perforation secondary to abdominal wall abscess or vice versa - case report and review of literature

Background: Spontaneous caecal perforation secondary to abdominal wall abscess is a rare entity. There may be abdominal wall abscess due to spontaneous caecal perforation. Small and large bowel perforation in neonatal period is common secondary to necrotizing enterocolitis. But beyond neonatal caecal perforation is unusual. Case presentation: We are reporting an interesting case of spontaneous caecal perforation in two year old female child without any sign and symptoms of peritonitis or abdominal discomfort secondary to abdominal wall abscess. Or it may be vice versa, abdominal wall abscess develops secondary to caecal perforation. Conclusion: Caecal perforation in children beyond to neonatal period is extremely rare. To the best of our knowledge, I have never seen in English literature of spontaneous caecal perforation secondary to abdominal wall abscess or vice versa.