Bowel Perforation Research Articles

The CT findings of extranodal natural killer/T-cell lymphoma, nasal type involving the gastrointestinal tract.

To analyze the CT imaging features of extranodal natural killer/T (NK/T)-cell lymphoma, nasal type (ENKTCL-NT) involving the gastrointestinal tract (GI), and to compare them with those of Crohn's disease (CD) and diffuse large B-cell lymphoma (DLBCL). Data were retrospectively collected from 17 patients diagnosed with GI ENKTCL-NT, 68 patients with CD, and 47 patients with DLBCL. The CT findings of ENKTCL-NT were analyzed and compared with those of CD and DLBCL. Data were analyzed using SPSS (version 25.0) and MedCalc (version 18.2.1). p < 0.05 was considered statistically significant. The 17 patients with ENKTCL-NT included 11 males (64.7%) and 6 females (35.3%) (mean age, 46.41 ± 4.12 years). The CT features of ENKTCL-NT included: circumferential symmetric thickening (100%), moderate thickening (70.6%), skip lesions (52.9%), contiguous lesion (47.1%), mucosal or layered enhancement (70.6%), moderate mural enhancement (64.7%) with non-enhanced regions (47.1%), absence of lymphadenopathy (76.5%), bowel perforation or fistula (17.6%), and peri-enteric blurred fat space (70.6%). The presence of circumferential symmetric thickening, moderate mural enhancement, and non-enhanced regions were more indicative of ENKTCL-NT than CD (17/17 vs. 17/68, 11/17 vs. 22/68, 8/17 vs. 0/68, p < 0.05). The presence of skip lesions, mucosal or layered enhancement, and absence of peri-enteric lymphadenopathy were more indicative of ENKTCL-NT than DLBCL (9/17 vs. 2/47, 12/17 vs. 1/37, 13/17 vs. 19/47, p < 0.05). CT imaging features can provide useful information for the early diagnosis of ENKTCL-NT and effectively differentiate it from CD and DLBCL. Question Extranodal natural killer/T-cell lymphoma, nasal type (ENKTCL-NT) involving the gastrointestinal tract (GI) is highly malignant but easily misdiagnosed by clinicians and endoscopic examination. Findings CT could provide useful information in the diagnosis of ENKTCL-NT involving GI and in differentiating it from Crohn's disease and diffuse large B-cell lymphoma. Clinical relevance This study will help improve the ability of radiologists to diagnose ENKTCL-NT involving GI, and a more predictive diagnosis will also alert clinicians to perform multiple deep endoscopic biopsies, which will contribute to the early diagnosis and treatment of ENKTCL-NT.

Pediatric Cylindrical Battery Ingestion

Background and Aims: Accidental ingestion of batteries is well documented in pediatric medical literature, but very few data exist in pediatric medical literature on the ingestions of cylindrical batteries (CBs). The aim of our study was to evaluate the features, clinical presentation and clinical outcome of children having ingested CBs. Methods: All children admitted for CB ingestion were retrospectively recruited. Clinical data until hospital discharge were accurately recorded, including child’s age and sex, ingestion modalities, signs and symptoms following the ingestion, type of CB, results of the neck-chest-abdominal X-ray performed to assess the retention site of CB, outcome of endoscopic removal, whether performed. Results: 45 children (males/females: 26/19; age range: 7-168 months; mean age ± standard deviation: 42 ± 33.9 months) were enrolled. Out of them, 15/45 (33.3%) had ingested AA batteries whereas 30/45 (66.6%) AAA batteries. CBs were retained in the esophagus in 2/45 (4.4%) children, in the stomach in 19/45 (42.2%) children and in the duodenum or beyond in the remaining 24/45 (53.3%) children. None of the patients who underwent endoscopic removal (12/45) had any esophageal nor gastric mucosal lesions. No cases of intestinal perforation nor surgical complications were reported. Conclusions: According to our study data, conservative management may be advised for the majority of CB ingestion. However, we acknowledge that CB should be timely removed whenever are A23 or A27 type, damaged prior to ingestion, in case of multiple ingestion, whenever protractedly retained in the stomach or whenever the child complains for any clinical signs or symptoms or had undergone prior abdominal surgery.

The Association Between Perinatal Pharmacologic Treatments and Spontaneous Intestinal Perforation in Extremely Preterm Infants: A Propensity Score Matching Study

Background: The impact of perinatal pharmacologic agents on spontaneous intestinal perforation (SIP) in extremely low-birthweight (ELBW, &lt;1000 g) preterm infants remains inconclusive based on findings from retrospective cohort or case–control studies. This study aims to address this uncertainty by using propensity score matching (PSM) to reduce bias. Methods: We retrospectively reviewed ELBW infants in our unit between 2014 and 2023 to identify SIP cases. Confirmed through medical notes, surgical consultation, and author review, each SIP case was matched at a 1:3 ratio using propensity scores on factors including the gestational age (GA), birthweight, gender, and birth year. Pharmacologic agents commonly given antenatally and postnatally were analyzed. Only medications that were started 24 h before the onset of SIP or the corresponding age (PSM-controls) were included. Results: A total of 858 ELBW infants were reviewed, 28 SIP cases (GA 25.3 ± 2.1 weeks, BW 735 ± 167 g) were identified, and 84 PSM-controls were matched. The SIP cases received hydrocortisone (25% (7/28) vs. 9.5% (8/84), p = 0.037) and combined inotropic agents (17.9% (5/28) vs. 2.4% (2/84), p = 0.020) to a significantly greater extent. No differences were observed in the use of other medications. In logistic regression, the use of hydrocortisone and combined inotropes remained independent risks for SIP, with ORs (95% CIs) of 3.4 (1.1–10.9) and 2.1 (1.2–3.8), respectively. Conclusions: This first PSM-based study supported postnatal hydrocortisone and combined inotrope use as independent risks for SIP in ELBW infants. Clinicians should be aware of these risks and remain vigilant for SIP when administering hydrocortisone and inotropes.

A Rare Presentation of Intestinal Tuberculosis with Transverse Colon Perforation in an Infant

A Rare Presentation of Intestinal Tuberculosis with Transverse Colon Perforation in an Infant

Emergency primary anastomosis with or without intraoperative colonic lavage following sigmoidectomy in sigmoid volvulus: 175-patient experience in a tertiary referral hospital

Objectives: Emergency primary anastomosis following sigmoidectomy is one of the main treatment options in sigmoid volvulus (SV). However, during this procedure, the role of intraoperative colonic lavage (ICL) is controversial. Our aim was to evaluate the role of ICL in 175-patient SV series. Methods: In Ataturk University Faculty of Medicine Department of General Surgery, ICL was applied in 76 cases (43.4%), while it was not used in the remained 99 patients (56.6%) in 58.5-year period. In a partial retrospective (first 20 years, from June 1966 to June 1986) and prospective (later 38.5 years, from June 1986 to December 2024) evaluation, some preoperative, operative, and postoperative findings were utilized. Results: As preoperative data, mean age (56.4 years vs. 57.1 years, P&gt;0.05), male/female ratio (4.8 vs. 4.2, P&gt;0.05), and rate of shock (5.3% vs. 6.1%, P&gt;0.05) were statistically similar in both groups, while mean ASA score (3.1 vs. 2.9, P&lt;0.05) was significantly lower in ICL group. Among operative findings, rates of bowel gangrene (67.1% vs. 63.6%, P&gt;0.05) and perforation (1.3% vs. 1.0%, P&gt;0.05) were statistically similar in both groups, while mean operation time (205.4 minutes vs. 176.8 minutes, P&lt;0.005) was significantly longer in ICL group. As surgical outcomes, rates of mortality (13.2% vs 12.1%, P&gt;0.05) and morbidity (39.5% vs. 28.3%, P&gt;0.05) were statistically similar in both groups, while mean hospitalization time (14.7 days vs. 9.4 days, P&lt;0.001) was significantly longer and mean cost (3,455.4 USD vs. 2,752.1 USD, P&lt;0.001) was significantly higher in ICL group. Conclusion: When compared with that of primary anastomosis with ICL, primary anastomosis without ICL provided shorter operation and hospitalization times, and less cost in addition to similar mortality and morbidity rates in the emergency treatment of SV. doi: https://doi.org/10.12669/pjms.41.2.11399 How to cite this: Altundas N, Peksoz R, Disci E, Atamanalp SS. Emergency primary anastomosis with or without intraoperative colonic lavage following sigmoidectomy in sigmoid volvulus: 175-patient experience in a tertiary referral hospital. Pak J Med Sci. 2025;41(2):603-607. doi: https://doi.org/10.12669/pjms.41.2.11399 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Giant Mesenteric Cyst of The Large Bowel: Case Report

Introduction: Mesenteric cysts are rare, benign intra-abdominal cystic lesions that arise from the mesentery, the tissue fold attaching the intestines to the abdominal wall. They can develop from the duodenum to the rectum. Mesenteric cysts have various histological origins, with lymphangiomas being more common in children and mesothelial cysts in young to middle-aged women. While they can remain asymptomatic, they may also cause complications such as intestinal obstruction or perforation. Complete resection is the preferred treatment due to its lower recurrence rate. Case Presentation: A 48-year-old female with a medical history of systemic arterial hypertension, allergies, hysterectomy, appendectomy, cesarean section, right axillary lipoma resection, and a cyst in the left zygomatic region, presented in June 2021 with dull, constant pelvic pain. Over time, her symptoms progressed to include volume increase, fatigue upon sitting, constipation, and hand tremors. Imaging studies revealed a large cystic lesion extending from the left ovary. In January 2024, an abdominal ultrasound showed a complex ovarian cyst (O-RADS 4). Surgical exploration revealed a mesenteric cyst associated with the sigmoid colon, which was resected along with a distal segment of the descending and sigmoid colon, preserving the left colic artery. The patient recovered well postoperatively, with proper colostomy function. Discussion: Mesenteric cysts are benign tumors that can occur throughout the gastrointestinal tract, most commonly in the small bowel mesentery. Their clinical presentation can range from asymptomatic to acute abdominal pain secondary to complications such as intestinal obstruction or cyst rupture. Diagnostic imaging typically involves ultrasound, CT, and MRI. Surgical resection is the treatment of choice to prevent recurrence. The prognosis following complete cyst excision is favorable, with no reported recurrences. Conclusion: Mesenteric cysts present a diagnostic challenge due to their wide range of symptoms. The recommended treatment, as supported by literature, is complete resection to minimize recurrence. Our case followed this approach, and the patient showed a positive clinical outcome

P0230 Prognostic factors and predictive model development for pediatric Inflammatory Bowel Disease with IL-10RA deficiency: A retrospective cohort study

Abstract Background Patients with IL10RA-deficient inflammatory bowel disease (IBD) generally have a poor prognosis, with high mortality and a significant rate of intestinal surgeries. Hematopoietic stem cell transplantation (HSCT) is currently the main cure, but most patients still face death after transplantation. The study analyzes the prognosis of patients without HSCT, aiming to explore factors associated with both mortality and the need for intestinal surgery, as well as to establish short-term prognostic models. Methods The study retrospectively enrolled 138 patients admitted to our center from January 2012 to July 2024. We defined death and intestinal surgery as outcomes and used competing risks analysis, cox regression models, and random survival forest algorithm to explore prognostic factors. Additionally, optimal subset regression, and logistic regression were employed to establish a short-term prognostic model, with the goal of better assessing the severity of the patients' conditions and evaluating the likelihood of long-term survival, as well as the risks of short-term death or surgery. Results The median age of onset of 138 patients was 0.3 months (range: 0.2-1 months), and the median age of admission was 8.1 months (range: 3.0-15.2 months). 21.7% had pure homozygous mutations. The most frequent was c.301C&amp;gt;T，c.537G&amp;gt;A. 32.6% of patients died, of which 73.3% were transplant-related. 35.5% of patients had undergone intestinal surgery. In patients without HSCT, most deaths occurred within the first year, while intestinal surgeries were mainly performed by age four. Cox multivariate analysis identified thalidomide used as an independent protective factor against mortality (HR = 0.09, 95% CI: 0.02-0.46, P = 0.004). Intestinal perforation was a significant risk factor (HR = 9.39, 95% CI: 3.49-25.30, P &amp;lt; 0.001) for the outcome of intestinal surgery. The random survival forest model highlighted thalidomide, mesalazine, intestinal perforation and gross bloody stool as key variables affecting mortality or surgery risk, with thalidomide having the greatest impact. Short-term death model (age of admission, ALB, intestinal perforation) was well distinguished (AUC: 0.945), but poorly calibrated; Short-term surgical models (CRP, PLT, perianal lesions) were moderately distinguished (AUC: 0.799), and the calibration was reasonable. Conclusion Long-term survival is possible for IL10RA-deficient patients without HSCT. However, due to the risk of early-life adverse outcomes, close follow-up remains essential. Thalidomide appears to have the most significant impact on prognosis and may improve disease outcomes. The short-term prognostic assessment model demonstrates good discriminatory ability for distinguishing high-risk from low-risk patients.

P0703 Risk factors and nomogram for massive postoperative gastrointestinal bleeding in patients with Crohn’s disease: a multicenter retrospective study

Abstract Background Crohn’s disease (CD) is a chronic inflammatory disease that is prone to complications such as intestinal obstruction and perforation, which often require surgical treatments. Massive postoperative gastrointestinal bleeding (MPGB) is a severe complication with a high mortality rate, deteriorating postoperative recovery and disease prognosis. However, there are few related studies and it lacks effective prevention measures. Therefore, we conducted a multicenter study to explore the risk factors for MPGB in CD patients. Methods This study was a multicenter retrospective case-control study. Inclusion criteria included: patients diagnosed with CD; aged over 16 years old; underwent gastrointestinal surgery. Exclusion criteria included: patients with massive gastrointestinal bleeding before surgery. Massive gastrointestinal bleeding is defined as: hemodynamic impairment, requiring active fluid resuscitation; decreased hemoglobin concentration, requiring blood transfusion or surgical treatment; with symptoms of gastrointestinal bleeding. The included patients were divided into a case group and a control group. By comparing medical information between two groups, risk factors for MPGB were identified through logistic regression analysis, and a nomogram was constructed. Results From January 2018 to February 2024, a total of 170 CD patients were included, including 34 patients with MPGB and 136 matched controls. Univariate logistic regression analysis showed that for albumin (P=0.001, OR=0.89), nutrition risk screening (NRS2002) scale (P=0.003, OR=1.61), predictive nutritional index (PNI) (P=0.005, OR=0.92), number of previous surgeries (P&amp;lt;0.001, OR=2.39), history of gastrointestinal bleeding (P&amp;lt;0.001, OR=8.75), international normalized ratio (INR) (P=0.004, OR=1.60), and abnormal liver function (P=0.049, OR=6.29) (P＜0.05), the difference between two groups was statistically significant. Multivariate logistic regression analysis further revealed that NRS2002 (P=0.022, OR=1.53), history of gastrointestinal bleeding (P=0.005, OR=5.71), number of previous surgeries (P&amp;lt;0.001, OR=2.43), and INR (P=0.011, OR=1.61) were associated with an increased risk of MPGB. Based on these results, a nomogram was constructed. The training and validation group achieved an area under the curve (AUC) value of 0.87 and 0.73 respectively with well-fitted Hosmer-Lemeshow calibration curves. Conclusion The risk of MPGB in CD patients will be increased with a history of gastrointestinal bleeding, more previous surgeries, a higher NRS2002 score, and a higher INR value. Strengthening the perioperative nutritional status management of CD patients may prevent the MPGB. Besides, we conduct a nomogram model, which can effectively predict the risk of MPGB in CD patients.

P0899 Previous extended colectomy is associated with particularly high risk of postoperative small bowel fistula in Crohn’s disease patients

Abstract Background Postoperative small bowel fistula is one of the most detrimental complications in abdominal surgery. Patients with Crohn’s disease seem to be at higher risk. Performing small bowel surgery in patients with previous extended colectomy, surgeons face diffuse small bowel adhesions. Moreover, patients with small bowel disease after previous (total) colectomy pose one of the most vulnerable populations. Present analysis was conducted in order to analyze the incidence of small bowel fistula following abdominal surgery in Crohn’s disease patients. Methods Consecutive patients with Crohn’s disease undergoing intestinal resection between 1992 and 2024 were included in current analysis using a prospectively maintained database. “Small bowel fistula” was defined as any small bowel perforation away from any anastomoses, strictureplasties or any other kind of small bowel sutures. “Previous extended colectomies” were total abdominal colectomies or proctocolectomies in patients’ history prior to the current surgery. Results 973 patients undergoing 1096 bowel resections were included. There were 804 ileocolic resections, 254 colonic resections and 38 other resections (small bowel resection, ileostomy resections, pouch excisions and abdominoperineal resections). Postoperative intraabdominal septic complications occurred in 162 patients (15%), 8 patients died (0.7%). Postoperative small bowel fistula occurred in 9 patients (0.8%). 52 patients attended current surgery with a history of previous (procto-)colectomy. Current surgery consisted of 13 resections of ileosigmoid or ileorectal anastomoses, 12 ileostomy resections, 10 abdominoperineal resections, 9 small bowel resections, 5 J-Pouch excisions, 1 Kock pouch excisions, 1 Redo-Pouch and 1 IPAA in the study population. 10 of 52 patients (19%) with a history of previous extended colectomy underwent laparoscopic surgery with one patient converted to open. The history of previous extended colectomy was the only factor associated with an increased risk of postoperative small bowel fistula by a multivariate analysis (7.7% vs. 0.5%, Hazard ratio 7.1, p&amp;lt;0.001) but not for all intraabdominal septic complications (15% in both groups). The risk of postoperative small bowel fistula was not increased in patients with a history of any other previous intestinal resection than extended colectomy. Conclusion Crohn’s disease patients with a history of previous total colectomy or proctocolectomy are at a particularly high risk of postoperative small bowel fistula when they undergo further surgeries. Surgeons must be aware of this complication in cases of unexpected postoperative symptoms.

Dehiscence rate and associated risk factors after gastrotomy for removal of foreign material in dogs and cats.

Identify rate and associated risk factors for dehiscence following gastrotomy for foreign material removal. Medical records from 2 private practice emergency and referral hospitals were reviewed, and history, laboratory values, intraoperative findings, and outcomes were collected on 271 dogs and 31 cats (n = 302). Hospital A performed 222 procedures and Hospital B performed 80 procedures. Three cats (3 of 31 [10%]) and 20 dogs (20 of 271 [7%]) had intraoperative intestinal perforations. Two cats (2 of 31 [6.5%]) and 7 dogs (7 of 271 [2.6%]) were diagnosed with preoperative septic peritonitis. Concurrent surgical procedures in felines included enterotomy (3 of 31 [10%]), multiple enterotomies (3 of 31 [10%]), intestinal resection and anastomosis (IR&A; 2 of 31 [6%]), and other (1 of 31 [3%]). Concurrent surgical procedures in canines included enterotomy (55 of 271 [20%]), multiple enterotomies (11 of 271 [4%]), IR&A (24 of 271 [9%]), IR&A and enterotomy (1 of 271 [0.4%]), splenectomy (11 of 271 [4%]), and other (50 of 271 [18%]). There was no proven gastrotomy dehiscence. Two patients that did not have follow-up surgery or necropsy before euthanasia developed postoperative septic peritonitis, and gastrotomy dehiscence could not be ruled out as a differential diagnosis. Assuming neither patient, 1 patient, or both patients had gastrotomy dehiscence, the gastrotomy dehiscence rate was 0% to 0.66%. However, these patients also had an IR&A. Two cases were presumed to have gastrotomy dehiscence, as the authors would rather overestimate the dehiscence rate. However, it is more likely that the IR&A was the dehiscence site rather than the gastrotomy. Gastrotomy dehiscence rate is low in cats and dogs, and the dehiscence rate reported in this study may be an overestimation.

Rare but important gastrointestinal complications after laparoscopic inguinal hernia repair: a single-center experience

Transabdominal preperitoneal patch plasty (TAPP) versus total extraperitoneal patch plasty (TEP) are surgical techniques commonly used to treat inguinal hernia. However, studies indicate that both procedures may lead to significant complications, particularly gastrointestinal complications, some of which can be life-threatening. We statistically analyzed the complications caused by adult inguinal hernia patients admitted from 2018 to 2022. We focused on gastrointestinal complications and conducted a case-by-case analysis on their causes and treatment processes. A total of 1034 patients were included in the final analysis, with 783 patients receiving TAPP treatment and 251 patients undergoing TEP. The overall complication rate for the TAPP group was slightly higher at 4.72% compared to 3.58% in the TEP group, but the difference was not statistically significant (p = 0.446). The incidence of both common and gastrointestinal complications is similar between the two groups, with no significant difference observed. Five patients (0.48%) suffered gastrointestinal complications, one with gastric perforation after TEP surgery, and four during TAPP surgery. All five cases of gastrointestinal complications were Grade III or higher according to the Clavien-Dindo classification, and all required reoperation. Gastrointestinal complications, though rare in LIHR, often require readmission and reoperation. Attempting non-operative management of such complications may lead to disastrous consequences. The majority of these complications are attributed to improper use of surgical instruments, necessitating vigilance on the part of the surgical team in preventing them.

Assessment of IL-6 Pathway Inhibition in Gastrointestinal Behçet's Disease from Immunological and Clinical Perspectives.

Behçet's disease is an autoinflammatory disorder characterized by relapsing and remitting vasculitis that can manifest in various forms, including gastrointestinal Behçet's disease (GIBD). Its complications (e.g., intestinal perforation) are among the primary causes of morbidity and mortality. GIBD pathogenesis involves the enhanced production of certain cytokines, e.g., tumor necrosis factor α and interleukin-6 (IL-6), which could serve as a target for potential therapies. This review provides an overview of GIBD, including the diagnosis and immunopathogenesis as it is currently understood, and evaluates the emerging role of the inhibition of IL-6 (classic and trans-signaling) as an alternative treatment option for patients with GIBD. Given the current paucity of data, we reflected on the potential of IL-6 inhibitors such as tocilizumab and olamkicept based on immunopathogenic considerations and available clinical data in patients with inflammatory bowel disease (IBD), in whom clinical response or remission was induced. The selective inhibition of IL-6 trans-signaling may bring new impetus to the development of this drug class, particularly regarding safety. Still, the benefits of IL-6 inhibitors for patients with GIBD need to be evaluated in appropriate proof-of-concept studies. The clinical outcomes of IL-6 inhibitors in IBD are promising and may suggest their potential relevance in GIBD.

Anti-nuclear matrix protein 2 antibody-associated juvenile dermatomyositis with gastrointestinal perforations was successfully treated with traditional therapeutic drugs combined with vedolizumab: a case report after a long-term follow-up and a review of the literature

Anti-nuclear matrix protein 2 antibody-associated juvenile dermatomyositis with gastrointestinal perforations was successfully treated with traditional therapeutic drugs combined with vedolizumab: a case report after a long-term follow-up and a review of the literature

Candiduria in Pediatric Patients: Two Case Reports and a Review of Management Strategies.

Introduction: Urinary infections, while common in intensive care and surgical units, present a unique challenge when fungal pathogens are involved. These fungal urinary infections, known as fungiuria, require a more intricate and prolonged treatment plan involving antifungal medications. This complexity underscores the need for specialized knowledge and skills in managing such cases. This study aims to present two cases of operated pediatric patients who developed urinary fungal infections following Catheterization and simultaneous treatment with two antibiotics. Results: Two pediatric patients, aged 12 and 16, underwent surgical procedures in our clinic. The first patient was treated for gangrenous appendicitis complicated by generalized peritonitis. The second patient was treated for a perforation of the small intestine caused by gangrene in a segment of the bowel, resulting from twisting around intestinal adhesions, also complicated by generalized peritonitis. Both patients, aged 12 and 16, developed urinary symptoms four days after surgery. Microbiological analysis confirmed the presence of fungal infections caused by Candida albicans. However, with the administration of antifungal medications, we were able to successfully eradicate Candida albicans from their urinary tracts, as confirmed by follow-up microbiological cultures after several weeks of therapy. This successful outcome should instill a sense of accomplishment in the audience. Conclusion: Candidiasis, a significant complication in patients undergoing prolonged Catheterization and simultaneous antibiotic therapy, requires vigilant monitoring. The challenging treatment often necessitates long-term administration of antifungal medications for successful eradication. This underscores the importance of vigilance in monitoring fungal infections in catheterized patients and adopting preventive strategies to minimize their occurrence.

Medication Blisters: A Rare Cause of Bowel Perforation

Medication Blisters: A Rare Cause of Bowel Perforation

A retrospective Study on Intestinal Injury from Blunt Abdominal Trauma

Introduction: Blunt abdominal trauma is the primary cause of morbidity and mortality. Suppose there are no indications of external trauma or changes in the patient's vital signs; blunt abdominal injuries might be complicated to identify at first. It is possible to lose a significant amount of blood without the abdomen appearing significantly different. A direct blow from blunt trauma can result in visceral damage and solid organ rupture, which can cause hemorrhage, peritonitis, and related pelvic injuries. The liver, small bowel, and spleen are the most frequently injured organs. Objectives: To find out the etiology, manifestation, anatomical distribution, diagnostic method, management, and outcome of intestinal injuries from blunt abdominal trauma. Material and Methods: About 59 individuals who had laparotomies during a 3-year period to treat intestine damage from traumatic abdominal trauma were included in the research. In a retrospective analysis, the patients' causes, presentations, anatomical distributions, diagnostic techniques, related injuries, courses of therapy, and deaths were all examined. Results: About 59 individuals with 60 significant bowel and mesentery lesions from blunt abdominal trauma were conducted. The average age was 36.78 years, and the male-to-female ratio was 5.5: 1. About 60 people sustained severe injuries. Furthermore, there were 50 minor intestinal injuries, which included 48 perforations, 12 major seromuscular injuries, and seven mesenteric, eleven colonic, and one duodenal injury. Thirty-three individuals suffered injuries from automobile incidents. The most frequent damage was a perforation at the small bowel's antimesenteric boundary. For colonic perforations, treatment included protective colostomy after resection, anastomosis, and perforation repair. There were 2 (3.38%) documented fatalities, and 10 (16.9%) individuals experienced significant problems. Conclusion: Due to its enormous infectious potential, early detection of intestinal injuries following severe abdominal trauma is crucial, even if it might be challenging. Severe injuries are frequently linked to intestinal perforations and are likely the deciding factors in survival.

A Challenging Case of Giant Gastric Perforation: Insights From a Case Report

A Challenging Case of Giant Gastric Perforation: Insights From a Case Report

Similarities and differences of clinical manifestations and prognosis between eosinophilic gastroenteritis and eosinophilic granulomatosis with polyangiitis complicating gastrointestinal involvement.

To investigate the similarities and differences of clinical manifestations and long-term prognosis between eosinophilic gastroenteritis (EGE) and eosinophilic granulomatosis with polyangiitis (EGPA) complicating GI involvement (EGPA-GI). Sixty-two EGE and 30 EGPA-GI patients were retrospectively enrolled in PUMCH from 2008 to 2023. Baseline clinical records were collected. Kaplan-Meier curves and log-rank tests were used to analyzed the relapse-free and non-adverse-outcome survival rate. Logistic regression was used to construct a predictive model for diagnosing EGE and EGPA-GI. Both diseases had a middle age onset. EGE had a shorter disease duration (3.5 vs. 11.0 months, p = 0.023), higher prevalence of distension (50.0% vs 20.0%, p = 0.007) and intestinal obstruction (32.3% vs 3.3%, p = 0.001), and lower prevalence of fever (6.5% vs 50.0%, p < 0.001) than EGPA-GI. EGPA-GI had higher prevalence of allergic diseases (86.7% vs 46.8%, p < 0.001) and higher IgE level (445.0 KU/L vs 153.0 KU/L, p = 0.003). Meanwhile, in EGPA-GI, higher ESR (25.0 mm/h vs 4.0 mm/h, p = 0.001) and hsCRP (48.9 mg/L vs 1.8 mg/L, p < 0.001) were observed. Asthma (OR 572.043, 95% CI 21.729-176,210.429, p = 0.0043), fever (OR 25.221, 95% CI 2.334-585.159, p = 0.0157), rash (OR 28.671, 95% CI 1.898-2274.543, p = 0.454), intestinal obstruction (OR 0.015, 95% CI 0.000-0.357, p = 0.0318), higher ESR (OR 1.101, 95% CI 1.035-1.208, p = 0.0099), and hsCRP (OR 1.038, 95% CI 1.010-1.081, p = 0.0208) were found to be independent discriminating factors for EGPA-GI. Both diseases presented recurrent courses. Adverse outcomes including GI perforation, organ failure, and all-cause death occurred in seven EGPA-GI patients while none in EGE (p = 0.00011). Both diseases have chronic and recurrent disease courses. Clinical manifestations and laboratory tests help to discriminate them. EGPA-GI have more unfavorable prognosis compared with EGE during long-term follow-up. Key Points •Baseline characteristics and long-term prognosis of 62 EGE and 30 EGPA patients with GI involvement (EGPA-GI) were compared in this study. •Both diseases had chronic and recurrent disease duration, eosinophilia, and increased IgE level. •EGPA-GI had higher prevalence of asthma, fever, rash, higher IgE, ESR, and CRP compared with EGE. •EGPA-GI had higher risk for severe adverse outcomes.

Unlocking the Potential of Cecostomies: A Valuable Lifesaving Procedure in Emergency Surgery for Colonic Obstructions.

Colonic obstructions present a serious medical emergency that requires prompt surgical intervention to prevent life-threatening complications. Cecostomy, a procedure involving the creation of an opening in the cecum to decompress the colon, serves as one surgical approach for managing these obstructions. The aim of this review is to evaluate the effectiveness and benefits of cecostomies in emergency surgical settings, with a focus on recent clinical studies and case reports. Cecostomy is highlighted as a bridge procedure in cases such as obstructive carcinomas, providing data on success rates, relative survival, and clinical effectiveness. The importance of the patient's condition and surgeon expertise in selecting cecostomy as a procedure is emphasized. Further comparative research is suggested to optimize the selection criteria, providing a strong, clinically oriented conclusion. A comprehensive literature review was conducted to identify studies and case reports focusing on the application of cecostomies in cases of acute colonic obstruction. Articles were selected based on their relevance to emergency surgery, the effectiveness of cecostomies, and patient outcomes in various clinical scenarios, including obstructive carcinomas and colonic pseudo-obstructions. The analysis reveals that cecostomies provide rapid decompression and effective relief from colonic obstruction, particularly when immediate intervention is needed to prevent bowel perforation or ischemia. In several cases, cecostomies act as a bridge to more definitive surgical treatments, such as resection and anastomosis, and are associated with reduced morbidity and mortality. The selection of cecostomy as a preferred procedure depends on the patient's condition, location of the obstruction, and surgeon expertise. Cecostomies play a crucial role in the emergency management of colonic obstructions, offering a viable and sometimes lifesaving alternative for rapid decompression. Understanding the indications and appropriate use of cecostomies can enhance patient outcomes and provide surgeons with effective strategies for managing acute colonic obstructions. Further research is warranted to refine selection criteria and to compare outcomes between cecostomies and other decompressive techniques in emergency settings.

Tenascin-X deficiency causing classical-like Ehlers Danlos syndrome type 1 in humans is a significant risk factor for GI and tracheal ruptures.

Classical-like Ehlers Danlos Syndrome type 1 (clEDS1) is a very rare form of Ehlers Danlos Syndrome (EDS) caused by tenascin-X (TNX) deficiency, with only 56 individuals reported. TNX is an extracellular matrix protein needed for collagen stability. Previous publications propose that individuals with clEDS1 might be at risk for gastrointestinal (GI) tract perforations and/or tracheal ruptures. To characterize complications resulting from perforations of the GI tract and/or tracheal rupture in an international case series of individuals with clEDS1 due to disease-related tissue fragility. This case series includes individuals with confirmed clEDS1 and GI perforations and/or tracheal ruptures from participating centres. Researchers who previously reported such individuals were contacted for additional information. A retrospective assessment of clinical features was performed. Fifteen individuals were included. Ten had spontaneous GI perforations, seven of whom had multiple GI perforations. Almost all had severe diverticulosis. Three individuals experienced iatrogenic tracheal ruptures. Severe GI complications, such as perforation, and tracheal rupture were observed in a substantial number of individuals with clEDS1. As these features seem significantly more common in clEDS1 than in the average population, we advise vigilance during intubation and GI endoscopic interventions of individuals with clEDS1. Routine referrals to clinical geneticists are recommended for patients with symptoms indicative of clEDS1, especially with unexplained GI perforations and connective tissue symptoms. Our findings offer valuable insights for the clinical management of clEDS1 and underscore the importance of specialized care, providing a foundation for improved clinical guidelines and preventive strategies.