Complicated Cases Research Articles

Postoperative recovery in peroral versus intravenous antibiotic treatment following laparoscopic appendectomy for complicated appendicitis: a substudy of a cluster randomized cluster crossover non-inferiority study.

Acute appendicitis is the most common cause of abdominal pain requiring surgery, usually managed with laparoscopic appendectomy. In Denmark, the standard postoperative treatment for complicated cases involves intravenous antibiotics. This study compares peroral versus intravenous antibiotics in the context of fast-track surgery and Enhanced Recovery After Surgery (ERAS) protocols. Our objective is to evaluate the impact of peroral versus intravenous antibiotics on patient-reported outcomes following laparoscopic appendectomy for complicated appendicitis. This was a sub-study within a broader Danish cluster-randomized non-inferiority trial conducted at Zealand University Hospital, focusing on adult patients undergoing laparoscopic appendectomy for complicated appendicitis. Participants were randomized into two groups: one receiving a three-day course of peroral antibiotics and the other intravenous antibiotics after surgery. Recovery quality was assessed on the third postoperative day using the Quality of Recovery-15 (QoR-15) questionnaire. The study included 54 patients, 23 in the peroral and 31 in the intravenous groups. The peroral group reported significantly better recovery outcomes, with higher QoR-15 scores (mean difference of 12 points, p < 0.001). They also experienced shorter hospital stays, averaging 47 h less than the intravenous group (p < 0.001). No significant differences between the groups were observed in readmissions or severe postoperative complications. Peroral antibiotic administration after laparoscopic appendectomy for complicated appendicitis significantly improves patient recovery and reduces hospital stay compared to intravenous antibiotics. These results advocate a potential shift towards peroral antibiotic use in postoperative care, aligning with ERAS principles. ClinicalTrials.gov NCT04803422.

Infectious Complications after Osteosynthesis of Long Bones of the Lower Limbs: Clinical and Nosological Aspects

Summary. The number of complications in the treatment of bone fractures, including infectious ones, remains significant. Therefore, there is a need to carry out all measures aimed at improving the treatment results for this category of patients. Objective. The objective of our study was to determine the frequency and structure of infectious complications in patients after osteosynthesis of the long bones of the lower limbs depending on the location and type of osteosynthesis. Material and Methods. For our study, 140 cases of infectious complications after osteosynthesis of long bones of the lower limbs were analyzed. Results. An integral analysis of the distribution of the retrospective array of studies based on localization in the femur revealed that the infectious process is most often localized in patients with 32B hip fractures. This type of damage was observed in 29.0% of patients of the general array, where it took the first place. Infectious complications after plate osteosynthesis also prevailed, but were detected less often, in 21.2% of cases. Among the patients after blocking intramedullary osteosynthesis, 32B was detected in more than half of the cases, which is 2.5 times more often than among the patients with plate fixation. Similar results were found in patients with damage to the shin. Conclusions. The results of the analysis indicate that in cases of infectious complications after osteosynthesis of the bones of the lower extremities, damage to the diaphyseal part of the hip was detected most often. This indicates that the development of infectious complications was significantly influenced by the patient’s condition and the intervention performed.

Clinical Outcome of Endoscopically Assisted Mini-open Carpal Tunnel Release.

Background: Carpal tunnel syndrome (CTS) can be treated surgically. Although the minimally invasive open surgical method is widely used, it is not possible to directly visualise the entire length of the carpal tunnel, especially the proximal end, which is on the side away from the skin incision. In this study, we performed a mini-open carpal tunnel release with endoscopic assistance to release the entire length of the carpal tunnel under direct vision and investigated the treatment outcomes. Methods: The surgical method included an incision of ≤2 cm in the palm, cutting of the transverse carpal ligament under direct vision and cutting of the forearm fascia under endoscopic vision. A uniquely designed sheath was used for the endoscopic resection. We investigated the sex, age, medical history, symptoms, examination findings, anaesthesia method, operation time, thenar motor branch variation, postoperative complications, presence or absence of pillar pain and final examination findings of the target patients. Results: A total of 100 hands (85 patients) were included. Anatomical variations of the thenar motor branches were observed in 19 hands. At the final follow-up, hand numbness improved in all patients, while mild numbness was observed in 25 hands. The abductor pollicis brevis muscle improved in all patients with paresis, but 8 of the 27 hands remained completely paralysed. Pillar pain was observed in 36 hands at 8 weeks postoperative, but the condition improved in all patients. The clinical outcomes of this study were good with no cases of major complications or reoperation. Conclusions: The minimally invasive open surgical method described here can be reliably used to release the forearm fascia proximal to the carpal tunnel. The thenar motor branch can also be confirmed under direct visualisation, making it a relatively safe and useful approach. Level of Evidence: Level Ⅳ (Therapeutic).

Risk of appendiceal neoplasm in patients with appendix disorders

The most common appendicular disease is acute appendicitis, with a lifetime risk of 7%–8%. Complicated cases, which can occur in 2%–7% of patients, can significantly impact the severity of the condition and may require different management approaches. Nonoperative management with possible delayed appendectomy has been suggested for selected patients, however, there is a non-negligible risk of missing an underlying malignancy, which is reported to be as high as 11%. Diagnostic work-up is paramount to achieve optimal treatment with good results.

6957 5-Year Follow-Up of Acute, micro, and Macrovascular Complications of Patients With Type 2 Diabetes Managed by a Multi-Disciplinary Team In A Hospital in Northeastern Mexico

Abstract Disclosure: M. Romero Ibarguengoitia: None. D.P. Morales Rodríguez: None. A. Garza-Silva: None. A. Rivera-Cavazos: None. I. Fernández-Chau: None. A. Cepeda-Medina: None. A. González-Cantú: None. Type 2 Diabetes Mellitus (T2DM) is a condition associated with various acute and chronic complications, which constitute the leading cause of disability, morbidity and mortality globally. During the SARS-CoV-2 pandemic, vulnerable individuals such as those with T2DM faced a restriction in access to primary healthcare services. Therefore, we decided to compare the presence of micro and macrovascular complications before and during the SARS-CoV-2 pandemic, as well as the incidence of acute complications. A retrospective observational cohort study from 2018 to 2022 was conducted in a hospital in northeastern Mexico on patients with T2DM who were treated by a multidisciplinary team composed of an internist or geriatrician based on the patient's age, endocrinologist, nutritionist, and other diabetes-related specialties. Levels of HbA1C, fasting serum glucose (FSG), low-density lipoprotein cholesterol (LDLc), blood pressure (BP), and microalbuminuria were analyzed. Consequently, presence of micro and macrovascular complications and incidence of acute complications was described. A total of 999 subjects were analyzed, 516 (51.7%) males, with an average age (SD) of 60.1 (12.7) years. There was an increase in the proportion of patients with adequate glycemic control based on HbA1C of 15.2% between 2018 and 2022 (p&amp;lt;0.001) and a 42.3% increase in FSG control during the same period (p&amp;lt;0.001). LDLc showed a decrease in the control proportion of 5.1% between 2018 and 2022 (p&amp;lt;0.001). Systolic BP control in 2018 was 82.7% and 80.1% in 2022 (p&amp;lt;0.001). Diastolic BP control in 2018 was 89.6%, with an increase to 91.4% in 2022 (p=0.01). Microalbuminuria control increased from 80.5% in 2018 to 89% in 2022 (p=0.002). There were 78 (7.8%) cases of microvascular complications, with diabetic neuropathy being the most prevalent (n=35, 3.6%), and a higher incidence in 2021 with 15 (1.6%) cases. A total of 15 (1.5%) patients presented a macrovascular complication, with ischemic heart disease being the most frequent with 11 (1.1%) subjects, and a higher incidence of cases in 2021 (n=4, 0.4%). Hypoglycemia was found to be the most frequent acute complication with 14 (1.4%) cases, with a higher incidence in 2020 (n=5, 0.5%). The low incidence of complications in our population, emphasizes the importance of coordinating patient’s care between a multidisciplinary team to maintain an overall disease control, optimize T2DM treatment and enhance patient’s quality of life. Presentation: 6/1/2024

8751 Radiofrequency Thermal Ablation in 32 Patients with Toxic Adenomas with Resolution of Hyperthyroidism in All Cases

Abstract Disclosure: L.G. Amato: None. E.M. Volpi: None. L.D. Volpi: None. P.M. Carani: None. A. Rahal: None. Introduction: In the general population, thyroid nodules are found in 3-7% of individuals on physical examination and in 20-76% on ultrasound. Around 8-10% of benign nodules may present autonomous behavior, being called hot nodules, causing symptoms of hyperthyroidism and being called toxic adenomas (TA). In TAs, autonomous hormone production can be caused by somatic activating mutations of genes regulating thyroid growth and hormone synthesis caused by somatic activating mutations of genes regulating thyroid growth and hormone synthesis. Classically, the proposed treatment for autonomous nodules was surgical resection or radioiodine ablation (RAI). In this context, the prevalence of hypothyroidism after the procedure varies from 2% to 3% following lobectomy, and lower after isthmusectomy in the unique circumstance in which the TA is confined to the thyroid isthmus. A study following 684 patients with TA treated with RAI reported a progressive increase in overt and sub-clinical hypothyroidism. Potential complications following near-total/total thyroidectomy include the risk of permanent hypoparathyroidism (&amp;lt; 2.0%) or recurrent laryngeal nerve injury (RLN) (&amp;lt; 2.0%). A small risk of permanent RLN injury exists with surgery for TA. Following RAI therapy, there have been reports of new-onset Graves Disease (up to 4% prevalence) as well as concern for thyroid malignancy and a very minimal increase in late non thyroid malignancy. Radiofrequency ablation (RFA) has been a precise and effective alternative for the treatment of many benign thyroid nodules over the past ten years, including hot nodules. RFA could preserves normal thyroid function compared to surgery or RAI. Clinical case: We evaluated the effectiveness of a single session of RFA in 32 patients with TA, through hormonal status, achieving normalization of thyroid and volumetric reduction of the nodule. Among the 32 patients included in this study, aged between 25 and 88 years, of these, 31 were women and 1 was a man, all of whom underwent a single RFA procedure (“moving shot” technique associated with hydrodissection). We had a single case of a reversible complication: a patient who had transient vocal cord paralysis, with total reversal. There was a reduction in the volume of all nodules as well as all patients progressed to a state of euthyroidism within 60 days of follow-up. Conclusion: A single session of RFA was effective in treating autonomous nodules, restoring euthyroidism in all patients. Presentation: 6/3/2024

7876 Complex Complications of Thionamide Therapy in One Patient: Methimazole-Induced Agranulocytosis and PTU-Induced ANCA-Vasculitis

Abstract Disclosure: E. Zweibach: None. A. Chang: None. Introduction: Thionamides, including methimazole and propylthiouracil (PTU), are essential for treating Graves' disease but can cause serious side effects such as agranulocytosis and ANCA-vasculitis. Although agranulocytosis itself is quite uncommon, the incidence of ANCA vasculitis is even more infrequent, making combination of conditions particularly exceptional. We present a unique case of a Graves' disease patient who suffered both complications: agranulocytosis due to methimazole and ANCA vasculitis from PTU, with successful resolution of both the clinical signs and laboratory findings following drug discontinuation. Case: 61-year-old female with a history of Graves' disease previously managed with methimazole but discontinued due to agranulocytosis, presented with lower extremity swelling, atrial fibrillation with RVR, and high output cardiac failure. Laboratory tests showed hyperthyroidism (TSH 0.008, Free T4 3.07), leading to a diagnosis of thyroid storm. Patient was started on PTU inpatient and discharged with this medication to home. Eight months later, the patient developed alarming signs including gross hematuria, oral ulcers, widespread muscle pain, found to have AKI with Cr of 2.79 and hospitalized for further eval. While hospitalized, the patient was found to have a range of complications including leukopenia with normal granulocyte count, anemia, AKI, proteinuria, and microscopic hematuria. Rheumatological evaluation showed +ANA and a high ANCA titer &amp;gt;1:1280, along with elevated levels of MPO and PR-3, and reduced complement levels. These symptoms and laboratory findings led to a diagnosis of ANCA vasculitis induced by PTU, resulting in the cessation of this medication. Following the discontinuation of PTU there was a notable improvement with normalization of serum Cr and resolution of proteinuria within 1.5 months. Concurrently, MPO and PR-3 levels began to decrease, and her hematological abnormalities resolved. During this period, her Free T4 levels gradually increased, leading to the administration of radioactive iodine for the treatment of her Graves' disease. Discussion: This case underscores the complexities in treating a patient with Graves' disease highlighting the unpredictable and severe side effects of antithyroid drugs like agranulocytosis and ANCA vasculitis. We report the first documented case of sequential thionamide-induced complications: agranulocytosis with methimazole, followed by ANCA vasculitis with propylthiouracil. Although both can arise from immune responses to these medications, they are distinct in their pathophysiology and are not associated with one another. The unpredictable nature of these side effects complicates prevention. Educating patients to promptly report any unusual symptoms and immediate medical intervention with drug discontinuation are key to managing these adverse reactions effectively. Presentation: 6/1/2024

6616 Copeptin Use To Reduce Hospital Stay In A Complicated DI Case

Abstract Disclosure: S.S. Kowsika: None. H. Moran: None. Introduction: While there is literature describing the use of copeptin for the diagnosis of polyuria-polydipsia syndrome, its utilization remains very limited in many hospitals. We present a case where the patient, initially misdiagnosed with central diabetes insipidus (DI), was appropriately diagnosed with partial nephrogenic DI through the use of copeptin. Case: A 48-year old female with a history of cardiac arrest, anoxic brain injury and diabetes insidious (DI) presented to the emergency department with hypernatremia (Na 154 mmol/L). The patient had been initiated on desmopresin (DDAVP) at an outside facility prior to her current admission. Despite receiving high doses of DDAVP, her sodium levels remained elevated, prompting further investigation. DDAVP administration was discontinued. A water deprivation test was subsequently performed, followed by IV administration of 2 mcg of DDAVP, which resulted in an increase in urine osmolality from 191 to 331 mosm/kg, which was less than the expected 50% increase observed in central DI. Additionally, a baseline copeptin level was obtained and noted to be 31 pmol/L, confirming the diagnosis of partial nephrogenic DI. The patient was started on Amiloride, leading to normalization of sodium levels. Discussion: Many patients with polyuria-polydipsia syndrome are frequently misdiagnosed and receive incorrect treatment, potentially worsening their clinical condition. Copeptin (Carboxy-Terminal-Pro-vasopressin) is the C-terminal peptide of pro-vasopressin, co-secreted with arginine vasopressin (AVP). It has been proposed as a direct test for diagnosing polyuria-polydipsia syndrome. Baseline Copeptin testing without stimulation can accurately diagnose nephrogenic DI if elevated (&amp;gt;21.4, pmol/L). To differentiate between central DI and chronic polyuria, prior thirsting with hypertonic saline or glucagon stimulation is necessary, with stimulated copeptin &amp;lt;4.9 pmol/L diagnosing central DI. Despite its diagnostic potential, Copeptin is underutilized in many settings. In this case, using Copeptin to accurately diagnose our patient led to appropriate treatment and the resolution of hypernatremia. Presentation: 6/1/2024

Appendicitis in children: correlation between the surgical and histological diagnosis

PurposeStudy was designed in order to evaluate the discrepancies between surgical and histological diagnosis in pediatric acute appendicitis (AA) and to compare the outcomes of laparoscopic (LA) and open appendectomies (OA).MethodsIn a retrospective observational cohort, AA patients were included under 18 years of age, operated between 2011 and 2020. Surgical diagnosis was defined by the operating surgeon. The histological findings were classified as uncomplicated and complicated AA. The LOS and complications were also statistically analyzed.ResultsAltogether, 1444 patients were included. Significant strong correlation and a moderate to substantial agreement were found between the surgeon’s and the histopathological findings in all appendectomy cases (weighted kappa value in OA: 0.633, LA: 0.639, total sample: 0.637). If the surgeon’s diagnosis was less severe than the pathologist’s, the LOS was 4 (3;7) days, whereas if the surgical diagnosis was correct, the LOS was 3 (3;5) days (p < 0.0001).ConclusionsIn contrary to the literature, our study revealed a strong correlation and moderate agreement between the intraoperative and histopathological findings regarding the severity of AA. Complicated cases are distinctly recognizable during the surgery. In case the surgeon underestimates the severity of AA, the chance of complications is higher.Level of evidence: II

Fusing Transformer and diffusion for high-resolution prediction of daylight illuminance and glare based on sparse ceiling-mounted input

Accurate prediction of workplane daylight illuminance and eye-height glare is crucial for lighting control. Existing studies used machine learning to predict illuminance at predetermined locations based on indoor sensors, but they may encounter challenges in scenarios 1) with flexible seating arrangements, 2) with dynamic shading devices, and 3) requiring the prediction of glare. To address these challenges, we proposed a novel method fusing Transformer and Diffusion models, with the input being data collected from sparse ceiling-mounted illuminance sensors, and the outputs being high-resolution workplane illuminance and glare. The model works well for rooms without and with dynamic roller shades. For the former, the mean absolute errors for illuminance below 3000 lx and Daylight Glare Index (DGI) are only 20.77 lx and 0.20, and the error rates in detecting illuminance <500 lx and DGI>22 are only 0.85 % and 5.55 %. For the more complicated latter case, the aforementioned four numbers are 34.78 lx, 0.59, 2.47 % and 23.13 %. The model significantly outperforms the linear and the ANN models, particularly in glare prediction. The influence of sensor number and placement strategy on model performance was also revealed. The model can potentially enhance lighting control, especially in cases with dynamic shading, with flexible seating arrangements, and where glare is of interest.

A high-fidelity personalised 3d printed simulator for the left atrial appendage occlusion procedure

Purpose This study aims to develop a realistic 3D printing-based simulator for the training and planning of the left atrial appendage occlusion (LAAO) to be used in the cath lab. Design/methodology/approach Starting from a pre-operative computed tomography dataset of a patient already treated with LAAO, the model was obtained, consisting in the right and left heart, opportunely assembled to replicate the position and orientation of the patient's anatomy while lying on the cath lab table. Different 3D printing techniques and materials were used to mimic the interaction between the cardiac tissue and the clinical instrumentation. The simulator was tested in the cath lab under proper image guidance by three LAAO expert operators. The clinicians were required to assign a score in terms of realism to each material used to fabricate the fossa ovalis and the LAA. Findings The simulated interventions were successfully performed by the operators, who were able to navigate in the system and release the occluder device as during a real procedure. The intraoperative images acquired during the simulations were highly comparable with data from a real intervention, with a mean percentage difference below 10%. Originality/value This study demonstrated the feasibility of the proposed simulator to faithfully replicate the LAAO procedure and its potentiality to be used for multiple purposes, including the training of the young clinicians, the evaluation of the most complicated cases and the design of novel occluder devices, in a fully realistic setting.

Analyzing the dynamics of complicated and uncomplicated appendicitis during the COVID-19 pandemic in Seoul: a multifaceted time series approach.

This study investigated the impact of the COVID-19 pandemic and associated control strategies on the incidence of appendicitis in Seoul, using data from 2018 to 2020 from South Korea's National Health Insurance. We analyzed records of total, complicated, and uncomplicated appendicitis cases, as well as the ratio of complicated to uncomplicated appendicitis, using natural spline and piecewise regression models to identify trends and breakpoints. Bayesian structural time-series (BSTS) models were used to evaluate the causal impact of social distancing on appendicitis incidences. The spline regression analysis indicated decreasing trends in both total and uncomplicated appendicitis cases. Conversely, the incidence of complicated appendicitis and the ratio of complicated to uncomplicated cases increased. Breakpoints for a decline in uncomplicated appendicitis and a rise in the ratio occurred at 31 weeks in 2020 (95% confidence interval [CI], 23.2 to 38.8) and at 33.9 weeks (95% CI, 28.3 to 39.6), respectively. The BSTS model demonstrated a 7.8% reduction in total appendicitis cases (95% credible interval [CrI], -12.0% to -3.3%). It also showed a 17% decrease in uncomplicated cases (95% CrI, -22% to -12%) and increases of 13% (95% CrI, 4.9% to 22.0%) in complicated cases and 39% (95% CrI, 27.0% to 53.0%) in the ratio of complicated to uncomplicated appendicitis. The COVID-19 pandemic resulted in a decrease in both total and uncomplicated appendicitis cases, while the number of complicated cases increased. Reduced medical visits likely accounted for these changes. Strategies are needed to manage changes in disease pathophysiology resulting from altered healthcare utilization during health crises.

Laparoscopic adrenalectomy performed with the Endo GIA™ Stapler as an easy and safe approach.

The purpose of this study was to determine whether the application of the Endo GIA™ Stapler (Medtronic, Dublin, Ireland) could be helpful in the dissection of adrenal tumors in complicated cases. We retrospectively reviewed the records of patients who underwent laparoscopic adrenalectomy between 2012 and 2022 at the College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea (Seoul, Republic of Korea). We adopted the Endo GIA™ Stapler (Medtronic) to seal vessels around adrenal gland and separate adrenal gland completely when it was difficult to perform meticulous dissection and isolation with laparoscopic instruments. Thirteen patients who underwent laparoscopic adrenalectomy with Endo GIA™ staplers were reviewed and compared with 45 other patients who underwent laparoscopic adrenalectomy without Endo GIA™ staplers. There were no statistical differences between the two groups in demographic, tumor-related, and diagnostic variables. Surgical outcomes such as margin involvement, bleeding, operation duration, rate of conversion to open surgery, blood transfusion, complications, and recurrence were not different between the two groups. In our experience, applying of the Endo GIA™ Stapler (Medtronic) in laparoscopic adrenalectomy is a feasible and acceptable approach.

Atypical Mumps; are We Heading Towards an Outbreak?

Mumps, caused by the mumps virus, is a contagious disease primarily affecting children and young adults. While typically presenting with salivary gland swelling and systemic symptoms, mumps can lead to various complications including SNHL, orchitis/ oophoritis, aseptic meningitis. Recent observations suggest atypical features in mumps cases, raising concerns of a potential outbreak in India. To discuss the etiopathogenesis and clinical presentation in cases of atypical mumps with increasing number of cases, a prospective multicentric study was conducted across five major centers - SMS Medical College Jaipur, RDBP Jaipuria Hospital, Jaipur, Shri Ashwini Saxena ENT Hospital Rewari, AIIMS Bhubaneswar and SP Medical College Bikaner, in India to evaluate patients with acute salivary gland swellings. Clinical and laboratory data were collected, including demographics, presenting symptoms, history of vaccination, imaging findings, and treatment outcomes. Patients were followed for four weeks post-treatment to monitor for delayed complications. Among 53 patients, a bimodal age distribution was observed, with peaks in early adolescents and middle-aged individuals. Vaccination status was recorded based on recall. Fever and salivary gland swelling were predominant symptoms, with a significant proportion experiencing submandibular gland involvement. Elevated serum amylase and CRP levels correlated with disease severity and prolonged symptomatic resolution. Notably, cases of sensorineural hearing loss (SNHL) and airway complications emerged as significant concerns. The study highlights a shift in mumps demographics, with higher age groups affected and increased incidence of complications like SNHL and airway compromise. International trends also suggest periodic outbreaks and evolving clinical manifestations post-COVID-19 pandemic. Factors contributing to mumps resurgence include lack of vaccination or vaccine efficacy, population immunity, and seasonal variations. India appears to be facing a potential mumps outbreak, characterized by atypical features and increased risk of complications like SNHL and airway compromise. Serum amylase and CRP serve as valuable markers for disease severity. Early recognition and management of complications are crucial, emphasizing the importance of mumps immunization to mitigate the impact of the disease. ENT specialists should remain vigilant for emerging complications, particularly SNHL, advocating for comprehensive immunization strategies.

Total laparoscopic segmental resection with transanal natural orifice specimen extraction for treatment of colorectal endometriosis: Descriptive analysis from the TrEnd study database

ObjectiveTo report our 3-year institutional experience of total laparoscopic (TL) segmental sigmoid colon/rectal resection for treatment of bowel endometriosis (BE). DesignThe TrEnd trial is a single-institutional retrospective/prospective study conducted with the aim of systematically collecting data from consecutive patients undergoing segmental colorectal resection for BE. This paper reports the outcomes of patients undergoing intracorporeal anastomosis and transanal natural orifice specimen extraction (NOSE) from this database. Primary endpoints were to evaluate the safety and efficacy of this approach in terms of: complications, conversion to conventional technique/open surgery, endometriosis-free bowel resection margins, recurrence. Secondary endpoints were to assess: intraoperative blood loss, operating time, gastrointestinal function recovery, duration of hospital stay, reproductive outcomes. SettingMalzoni Research Hospital, Avellino, Italy. ParticipantsOnly patients undergoing TL colorectal resection with transanal NOSE were included in the present analysis. Patients were considered non-eligible if they had received concomitant hysterectomy and/or transvaginal NOSE. InterventionsResults presented here are descriptive. ResultsEighty-one patients were included in the present analysis. Post-operative severe complications occurred in 3.7%. No cases of intraoperative complications or conversion to conventional technique/open surgery occurred. Final pathology showed endometriosis-free resection margins in all colorectal specimens. After a median follow-up of 21 months, all patients were free from BE. Median blood loss was 20 mL. Median length of surgery was 160 minutes. Median hospital length of stay was 3 days. All patients achieved the first passage of flatus on post-operative day 1. Median time to first defecation was 4 days. Twenty-six patients attempted to conceive. Nine of them achieved a pregnancy and 2 gave birth to a healthy child. ConclusionThis study represents the main experience on TL segmental colorectal resection for BE treatment. The observed optimal outcomes seem to recommend further studies to assess safety and efficacy of said surgical technique in women with BE.Clinical trial registry name: ClinicalTrials.gov

S3910 Complicated Case of Diverticulitis Turned Crohn’s

S3910 Complicated Case of Diverticulitis Turned Crohn’s

A Complicated Case of Severe Cytomegalovirus (CMV) Retinitis after 2 Decades of Kidney Transplant

A Complicated Case of Severe Cytomegalovirus (CMV) Retinitis after 2 Decades of Kidney Transplant

Clinical outcomes and pathologic results following identification of appendicitis

Aims: Acute appendicitis (AA) is one of the most frequent clinical pathologies for urgent surgery in children We aimed to investigate the occurrence and distribution of pathological findings in appendectomy specimens from patients initially diagnosed with AA. Methods: The demographic information and histopathological findings of patients who underwent appendectomy at our center between 2011 and 2021 were retrospectively analyzed. Results: A total of 259 patients were included in the study. The patients were aged 38-212 months (mean 143±39), with 180 (69.5%) male patients. Based on the histopathological results, 63 (24.3%) patienst had lymphoid hyperplasia (LH), 109 (42.1%) AA, 11 (4.2%) suppurative appendicitis (SA), 46 (17.8%) phlegmonous appendicitis (PA), and 30 (11.6%) gangrenous/necrotizing appendicitis (GA). Twenty (31.7%) patients with LH and 16 patients (53.3%) with GA had an invisible appendix on ultrasound. The leucocyte count and appendix diameter were significantly lower in LH than in the other groups (for all comparisons, p&lt;0.001). CRP level was significantly higher in the complicated groups (GA, PA,SA) than the LH and AA groups. The appendix diameter was significantly higher in the GA group than in the PA group (p=0.049). We found a positive correlation between AD and preopertaive leucocyte count, and the duration of hospitalization in days (r=0.265, p=&lt;0.001;r=0243, p=0.001). On the other hand, there was no correlation between appendix diameter and CRP. The binary logistic regression analyses showed that high appendix diameter was a risk factor fo CA (OR:0.206, CI: 95%, 1.061-1.422, p= 0.006). Conclusion: The high rate of complicated cases (33.5%) we found in our study shows that appendicitis can still be complicated. Additionally, the conclusion has been drawn that even in serious cases such as GA, US may overlook appendicitis at a high rate. Finally new diagnostic methods should be developed for cases that do not require surgical intervention, such as LH and eosinophilic gastrointestinal pathologies (colitis).

Endoscopy and endoscopic ultrasound for embedded or migratory digestive foreign body.

Embedded or migratory ingested foreign bodies (FBs) may be a disaster when not found intraluminally and can be seriously life-threatening. Endoscopic ultrasound (EUS) has advantages of transmural, close range and real-time imaging. Under its guidance, minimally invasive endoscopic removal of FBs and abscess drainage become available and safe to avoid unnecessary surgery. However, relatively few diagnostic applications of EUS have been reported. Endoscopic removal and abscess drainage with or without EUS-guidance were even scarce. We found 21 cases of migratory FBs reported in which EUS was used to diagnose and/or treat including our case. We further summarized clinical characteristics and EUS manifestations of embedded or migratory FBs for future differentiation, and treatment strategies by endoscopy and EUS. EUS is a valuable tool in recognizing and differentiating embedded or migratory FBs. EUS-guided endoscopic removal is a minimally invasive, safe and innovative solution. EUS with novel device also assists in sufficient and secure drainage for FBs related abscess collections. A multidisciplinary team consult is sometimes mandatory for complicated cases. This would break a conceptual barrier in therapeutic endoscopy.

Two complicated cases of severe scrub typhus, eschar- a non-negligible sign: Case reports and literature review.

Scrub typhus is a mite-borne, acute febrile disease caused by Orientia tsutsugamushi. The endemic areas of scrub typhus are expanding, both globally and in China. Patients who are not treated promptly, are likely to die of multiple organ dysfunction syndrome. Case I A 61-year-old female patient complained of sudden chest tightness and shortness of breath accompanied by fever for 6 days. Case II A 54-year-old male patient complained of fever and cough for 4 days and renal insufficiency for 2 days. Scrub typhus, multiple organ dysfunction syndrome. After the definite diagnosis, both patients were treated with doxycycline and various organ supports. The patient in case I was ultimately not salvageable. The patient in case II was successfully cured by the prompt administration of doxycycline along with continuous renal replacement therapy. With early diagnosis and treatment, patients can completely recover. Eschar, a characteristic sign of scrub typhus, is often overlooked, leading to delayed diagnosis and regrettable outcomes.