Enema Research Articles

Imaging clinical case

Hirschsprung disease is the most common congenital gut motility disorder and usually diagnosed in the neonatal period. It is caused by an aganglionic bowel segment resulting in absence of intestinal peristalsis and functional obstruction. Diagnosis should be considered in all patients with constipation that does not respond to conventional treatment. Radiography and contrast enema are important diagnostic exams, but the definitive diagnosis is established through histochemical analysis of aganglionic segment biopsy. Treatment is surgical and early recognition is important to avoid complications and improve prognosis. Herein is reported the clinical case of a young infant presenting to the Pediatric Emergency Department with nausea, vomiting, constipation, refusal to feed, and important abdominal distension. Abdominal radiograph and contrast enema were compatible with Hirschsprung disease. Biopsy histochemical analysis confirmed the diagnosis and surgical treatment was performed.

Incidence of intussusception in children less than five years of age: a pre-rotavirus vaccine survey from Iran, 2010-2015.

Background: The aim of this study was to determine the baseline statistics of intussusception in the under-five- year age group in Iran to facilitate the monitoring of potential side effects after administration of rotavirus vaccine. Methods: This hospital-based historical cohort study reviewed children under 60 months of age with the final diagnosis of intussusception, ICD-10 code K56.1, using census in all hospitals of Tehran, Iran from March 2010-2015. Demographic (sex, age, hospital stay duration), clinical manifestations (such as currant jelly stool, abdominal pain, vomiting, and fever),diagnostic and treatment methods (contrast enema, ultrasonography, laparotomy, and laparoscopy), and outcome data of patients aged less than 5 years with the diagnosis of intussusception were collected and analyzed using SPSS Version 16.0 (SPSS Inc., Chicago, IL, USA) Results: In this study, 759 patients were diagnosed with intussusception; 309 (40.7%) cases were less than 12 months old. The annual incidence of intussusception was 66.54 cases per 100.000 in children less than one-year-old and 31.61 cases per 100.000 in children less than five years old. The most common symptoms and signs were abdominal pain/irritability (94.2%) and tenderness (24.2%), respectively. The diagnostic method was ultrasound in 75.9% of cases. The most frequent anatomic location was the ileocolic region (87.87%) and the most common treatment method was barium enema. Conclusion: This research has provided a baseline statistic for childhood intussusception in Tehran prior to the administration of the rotavirus vaccine to provide a better comparison with post-introduction data.

Literature review of the research on chronic prostatitis treated by traditional Chinese medicine

This paper reviews the clinical research on the treatment of chronic prostatitis with traditional Chinese medicine in recent years. It is believed that the core of the etiology and pathogenesis of this disease lies in the deficiency of spleen and kidney, dampness heat, phlegm turbid and blood stasis toxin. If the disease lasts for a long time, the spleen and kidney become to the deficiency from excess. The internal treatment of traditional Chinese medicine includes syndrome differentiation, disease differentiation or single prescription, while the external treatment mainly includes herbal bathing, enema, anal administration and acupuncture. Traditional Chinese medicine has advantages in the treatment of this disease. We should continue to study the the mechanism of traditional Chinese medicine for this disease, standardize the syndrome differentiation and treatment and outocmes evaluation, and carry out research on famous prescriptions on prostatitis. Key words: Prostatitis; Traditional Chinese medicine therapy; Research progress; Literature review

Methodology, safety and applications of colonic transendoscopic enteral tubing (with video)

Objective To evaluate the methodology, safety and clinical applications of colonic transendoscopic enteral tubing (TET) as a new method of fecal microbiota transplantation (FMT) and colonic administration. Methods This prospective study included patients who underwent colonic TET for FMT and(or) colonic administration in the Second Affiliated Hospital of Nanjing Medical University from October 2014 to December 2018. The TET procedure time, success rate, retention time of TET tube, factors influencing TET tube retention, adverse events and satisfaction degree were evaluated. Results A total of 257 patients underwent TET, among whom 130 patients (50.6%) for microbiota tronsplantation, 8 patients (3.1%) for colon-drip medication, 118 patients (45.9%) for FMT and colon-drip medication, and 1 patient (0.4%) without treatment after TET. The TET procedure time was 10.0±2.8 min. The number of endoscopic clips used was 3.5±1.0. The success rate of the TET procedure was 100.0% (257/257). The retention time of TET tube for 160 patients maintaining the tube for treatment was 9.3±3.8 days. Multivariate analysis indicated that endoscopic clip type (P=0.001) was an independent influencing factor for the retention time of the tube. A total of 9 patients (3.5%) reported adverse events of mild anus discomfort, 4 patients (1.6%) of mobile inconvenience, 3 (1.2%) of anal pain, 2 (0.8%) of mild abdominal pain, 2 (0.8%) of mild bloating, and 1 (0.4%) of mild anal bleeding. No severe adverse events were observed in this study. The total satisfaction degree on colonic TET was 97.3% (250/257) in all patients. Conclusion The colonic TET, a safe and easy-operating endoscopic interventional technology with a high degree of patients satisfaction, can be used for colonic delivering of FMT and medications for various diseases. Key words: Colonoscopy; Fecal microbiota transplantation; Enema; Transendoscopic enteral tubing

Experimental study of ginsenoside Rg3 in the treatment of acute radiation proctitis in rat models

Objective To evaluate the efficacy of ginsenoside Rg3(GRg3) in the treatment of acute radiation proctitis in rat models. Methods On the 7th day after 21.5 Gy irradiation, 100 rats were divided into the control group (normal saline, n=20), GRg3 group (gavage of 20 mg/kg, 40 mg/kg and 80 mg/kg GRg3, n=20 for each dose) and Smecta mixture enema group (n=20). After 2 weeks, all rats were anesthetized with chloral hydrate (3 ml/kg) and approximately 5 ml of blood sample was collected from the abdominal aorta prior to sacrifice. The rectal tissues were taken and prepared for detection of Bax and NF-κB contents and HE staining to observe the pathological changes of the rectal tissues. After the blood samples were centrifuged, the supernatants were collected for ELISA to detect the serum levels of IL-2, IL-6, TNF-α and MPO in each group. Results In the GRg3 group, the serum inflammatory cytokines, serum MPO concentration and the concentration of Bax and NF-κB in the intestinal tissues of rats were decreased along with the increasing dose of GRg3. These parameters in the high-dose GRg3 group were significantly lower than those in the saline group (all P 0.05), suggesting that GRg3 exerted good therapeutic effect on acute radiation proctitis in rat models. Conclusions GRg3 can significantly reduce the concentration of inflammatory cytokines, Bax and NF-κB in the intestinal tissues of rat models with acute radiation proctitis, which is more efficacious than the normal saline. GRg3 can be used to treat acute radiation proctitis in rat models. Key words: Ginsenoside Rg3; Acute radiation proctitis; Rat

Early diagnosis and surgical intervention untie the Gordian knot in newborns with colonic atresia: report of two cases and review of the literature.

Incidence of colonic atresia in living infants ranges from 1:5,000 to 1:60,000 (average 1:20,000). It constitutes 1.8 to 15% of all cases of atresia of the gastrointestinal tract. In 58.56-75% of all cases is right-sided. We aim, through the presentation of two cases of colonic atresia which we encountered and after systematic research of the current literature, at addressing three major issues: diagnostic approach, operative strategy and management of the prognostic parameters of the colonic atresia. The common parameter in these two cases was the early diagnosis, which played a significant role in the uncomplicated postoperative course. The first case was a type I sigmoid atresia. Contrast's escape during contrast enema examination due to accidental rupture of the distal part of the colon led to diagnosis. Side-to-side anastomosis, restoration of the rupture and a central loop sigmoidostomy were urgently performed. The second case was a type III atresia at the level of the ascending colon, which was early diagnosed via pregenital ultrasonography, in which colonic dilation was depicted. Restoration of the intestinal continuity early after birth was performed at a time. In conclusion, we believe that early diagnosis, selection of the appropriate operative strategy and prompt recognition of potential post-operative complications, especially rupture of the anastomosis, contribute to the optimization of the prognosis in patients with colonic atresia.

Study on the bifidobacterial adhesion to the host tissue in ulcerative colitis and related serum inflammatory factors with Pingkui enema

Objective This study is designed to investigate the effect and mechanism of Pingkui enema in treatment of ulcerative colitis. Methods Sixty SD rats at SPF level were randomly divided into 6 groups which were normal group, model group, and the low, medium and high dose groups of Chinese medicine Pingkui enema, and sulfasalazine (SASP) enema group. The normal group and model group were given an equal volume of saline enema after modeling. After continuous administration for 10 days, the histopathological effects were evaluated after extraction, and the serum interleukin-8 (IL-8), interleukin-13 (IL-13), tumor necrosis factor (TNF-α), rat intestinal mucosal bifidobacteria adhesion and adhesin receptor were measured by enzyme-linked immunosorbent assay (ELISA). The real-time fluorescence quantitative PCR (RT-PCR) were used to detect the intestinal bifidobacterial content. Results Compared with the model group, the content of IL-8 (153.50 ± 8.59 pg/ml, 150.84 ± 5.38 pg/ml vs. 167.13 ± 13.66 pg/ml), TNF-α (330.08 ± 10.02 pg/ml, 287.27 ± 13.89 pg/ml vs. 376.50 ± 19.06 pg/ml) in medium, high dose group of Pingkui enema significantly decreased (P<0.05), while the IL-13 (37.04 ± 3.62 pg/ml, 40.64 ± 5.98 pg/ml vs. 31.57 ± 2.95 pg/ml) significantly increased (P<0.05). The bifidobacteria adhesin (124.84 ± 9.74 ng/L, 149.93 ± 9.57 ng/L, 176.74 ± 11.01 ng/L vs. 101.11 ± 17.18 ng/L) and adhesin receptor (78.44 ± 14.03 ng/L, 99.50 ± 3.63 ng/L, 107.36 ± 5.05 ng/L vs. 60.96 ± 13.89 ng/L) in low-, medium-, high dose group of Pingkui enema significantly increased (P<0.05). The content of bifidobacteria (1 331.4 ± 242.2 copies/μl vs. 490.5 ± 106.0 copies/μl) in the middle dose Pingkui enema group significantly increased (P<0.05). Conclusions The Pingkui enema can promote the colonization of intestinal epithelial cells by promoting bifidobacteria, increase bifidobacterium adhesin and adhesin receptors, up-regulate the expression of IL-13, and down-regulate the expression of IL-8, TNF-α. Key words: Colitis, ulcerative; Pingkui enema; Bifidobacterium; Adhesin; Adhesion receptor; Inflammation; Rats

Efficacy of short-term naturopathy and yoga interventions on palmoplantar psoriasis

Psoriasis is a chronic inflammatory disease, associated with a higher risk of cardiovascular, metabolic, and renal disease, and patients may experience significant impairment of health-related quality of life even with localized disease. According to a study conducted on 3065 patients, plantar lesions were seen in 91.9% of patients and palmar lesions in 55.6% of patients. Our patient is a 47-year-old married man, with a history of erythema, scaling, itching pain often associated with bleeding on the affected area of both palms and soles since 6 months. After obtaining informed consent, he was admitted to our inpatient Department of Government Yoga and Naturopathy Hospital. Since naturopathic interventions aimed to put right the lifestyle improvement, he underwent treatments such as neutral enema, mud therapy, diet therapy, acupuncture, and yoga therapy at our inpatient department (IPD). Considering the basic principle of naturopathy, i.e., accumulation of morbid matter, one of the main causes of disease has been taken into an account for planning the line of treatment. Pre-blood investigations include resting blood pressure, pulse rate, respiratory rate, fasting blood glucose level, and serum cholesterol level. The patient was asked to fill the Psoriatic Area and Severity Index (PASI) was used as a tool to measure the severity of the lesions and the area affected. Pre- and post-assessments were done using PASI. Immediately after 2 days of intervention, the pain and the itching in the affected area was subsided, and after 15 days of intervention, our patient was provided with exclusive juice diet with 6 servings per day. After 20 days of intervention, the PASI Scoring was reduced from 8.8 to 2. A 20-day naturopathic intervention has shown clinically significant change in the severity of psoriatic lesions in our case.

Traditional herbal enema combined with vacuum sealing drainage for perianal abscess

Objective To evaluate the efficacy of traditional herbal enema combined with vacuum sealing drainage in the treatment of perianal abscess. Methods A total of 87 patients who met the inclusion criteria were randomly divided into control group (43 cases) and study group (44 cases) by random number table method. The control group was treated with vacuum sealing drainage. The study group was given traditional herbal enema on the basis of the control group. Both groups were treated for 20 days and followed up for 6 months. The WBC, neutrophil count (NEU) and neutrophil percentage (NEU%) was measured by automatic blood cell analyzer, and the hospitalization and wound healing time was recorded. The recurrence rate of abscess and secondary anal fistula was observed during the follow-up period. Results The total effective rate was 97.7% (43/44) in the study group and 88.4% (38/43) in the control group. There was significant differences between the two groups (χ2=4.010, P=0.045). The hospitalization time (14.2 ± 0.6 d vs. 17.0 ± 1.2 d, t=13.970) and wound healing time (45.6 ± 0.7 d vs. 48.7 ± 1.2 d, t=15.216) in the study group was significantly shorter than those in the control group (P<0.01). After treatment, the WBC, NEU and NEU% level in the study group was significantly lower than those in the control group (t=23.318, 12.827, 46.630, all Ps<0.01). After 6 months of follow-up, the recurrence rate of abscess and the secondary anal fistula rate in the study group was significantly lower than those in the control group(χ2=12.813, 4.225, respectively, P<0.01 or P<0.05). Conclusions Traditional herbal enema combined with vacuum sealing drainage can significantly shorten the hospitalization and wound healing time, reduce the recurrence of abscess and secondary anal fistula, and improve the clinical efficacy. Key words: Anorectal disease; Negative-pressure wound therapy; Drainage; Enema therapy

Significance of fecal occult blood test in colorectal cancer screening

Colorectal cancer is one of the most common malignant tumors of the digestive system. The incidence of colorectal cancer in China is increasing year by year. Screening for adenomas, precancerous lesions and early cancers can effectively reduce the incidence and mortality of colorectal cancer. Therefore, colorectal cancer screening is particularly important. At present, the colorectal cancer examination is mainly divided into fecal examination and colon structural examination. The fecal examination includes fecal occult blood test, fecal exfoliated cell test and fecal genetic analysis. The colon structural examination includes barium enema, colonoscopy and computed tomography colonography. Colonoscopy is considered as the gold standard for the diagnosis of colorectal cancer. It has the advantage of high accuracy, and can be used to find precancerous lesions and remove them at the same time. However, the screening should be greatly restricted because of its invasive examination, the need for intestinal preparation, obvious discomfort and the high cost of medical treatment. Comparatively, fecal occult blood test is simple, easy, non-invasive, saving manpower and material resources, and is suitable for large population screening. Some scholars in China have begun to pay attention to colorectal cancer screening, and fecal occult blood test is widely used in these screenings. Key words: Intestinal neoplasms; Screening; Fecal occult blood test

Unusual Recto-colonic Tubular Duplication in a Female Neonate

Complete tubular colonic duplication is exceedingly rare. A second ectopic opening in the perineum other than a normally cited anus could be an unusual presentation. We report an unusual case of recto-colonic duplication in a 16-day-old girl who presented with fecal discharge from a vestibular opening in addition to a normally situated anus. The diagnosis of total recto-colonic tubular duplication associated with a rectovestibular fistula and a normal anus was confirmed by barium enema and computed tomography scan with double contrast. At operation, we performed a long transanal incision of the common septum to create an anastomosis between the normal and duplicated colon with complete submucosal excision of the rectovestibular fistula. The patient was doing well at 3-year follow-up examination.

Clinical value of Bristol stool form scale for bowel preparation in pediatric patients undergoing colonoscopy

Objective To evaluate the clinical value of Bristol stool form scale(BSFS) for bowel preparation in pediatric patients. Methods Data of 202 pediatric patients undergoing colonoscopy were collected from May 2016 to December 2016 at Children′s Hospital of Fudan University. All patients received polyethylene glycol (PEG)-4000 with clear fluid diet for bowel preparation. BSFS was used to record the stool form, and Boston bowel preparation scale (BBPS) was used to evaluate the quality of bowel cleansing. Differences in BBPS score between the enema group with BSFS 6 and the no enema group with BSFS 7 were studied. Based on the data types, t(or t′) test and chi-square test were used to analyze the influencing factors for colon preparation respectively. Those factors of statistical significance were studied with multivariate logistic regression analysis. Results The mean defecation time of pediatric patients during bowel preparation was 14.4±6.8. One hundred and sixty-five (81.7%) patients were assessed as 7 points in BSFS, 37 (18.3%) were 6 points in BSFS with supplemented enema, and 154(76.2%) patients achieved adequate bowel preparation. No significant differences were observed between the no enema group and enema group in the BBPS scores [75.2%(124/165) VS 81.1%(30/37), χ2=0.587, P=0.526]. Significant factors for inadequate colon preparation were constipation history(χ2=32.588, P=0.000), total time of defecation(t=3.432, P=0.001) and total time of BSFS 7 (t′=2.877, P=0.005). Multivariate logistic regression analysis showed constipation history(P=0.000, OR=12.620, 95%CI: 4.850-32.800) was independent risk factor for inadequate colon preparation. Conclusion Patients of BSFS 6 points could receive warm saline enema as a remedy. Patients with total time of defecation less than 15 and total time of BSFS (7 points) less than 8 are liable for the possibility of inadequate bowel preparation. It is also suggested that for patients with constipation history, the time of bowel preparation should be prolonged for microscopic visual field clarity. Key words: Child; Colonoscopy; Bowel preparation

Acute colonic pseudo-obstruction after cesarean section: a retrospective analysis of 11 cases

Objective To summary the risk factors, clinical characteristics and treatment of acute colonic pseudo-obstruction (ACPO) after cesarean section(CS). Methods The case group enrolled 11 patients who were diagnosed with ACPO after cesarean section in the First Affiliated Hospital of University of Science and Technology of China from January 2006 to January 2018. Another 55 patients without ACPO after CS, performed within two weeks' difference from the case group, were randomly selected as the control group. Clinical data of all subjects were analyzed retrospectively. Potential clinical risk factors were statistically analyzed. T test, Chi-square test and logistic regression analysis were used for statistical analysis. Results In the case group, the abdominal distension presented on 2 d (n=1), 3 d (n=7), 4 d (n=2) and 17 d (n=1) respectively after CS, and all cases experienced abdominal pain and nausea. Vomiting was reported in some cases. Plain abdominal X-ray images revealed pneumocolon with colon pouch. The maximum diameter of cecum was 6 to 12 cm. Air-liquid levels were observed in two patients. All patients underwent fasting, gastrointestinal decompression, intravenous fluid infusion, correction of electrolyte imbalance, hypertonic saline enema and prophylactic antibiotic treatment. The disease condition lasted two to six days in these patients. Conservative treatment was successful in eight patients and failed in the other three who later went for operations. The maximum cecal diameters in the three patients who underwent surgery were all ≥9 cm, among whom one case progressed quickly and laparotomy was tempted to rule out mechanical intestinal obstruction. In this case, the pressure was successfully reduced by placing a thoracic catheter through the anus after the failure of intestinal puncture trying to release the gases. One patient underwent colostomy due to positive signs of peritoneal irritation after a failure of four-day conservative treatment. One patient suffered a relapse after having been treated conservatively for five days, and then underwent surgeries of resection of ileocecum, distal closure of the colon ascendens plus terminal ileostomy due to intestinal perforation. Multivariate logistic regression analysis showed that higher postoperative leukocyte count (OR=1.38, 95%CI: 1.12-1.71, P=0.003) and postoperative body temperature >38 ℃ (OR=6.47, 95%CI: 1.06-39.61, P=0.044) were the risk factors for ACPO after CS. Conclusions Elevated leukocyte count and body temperature >38 ℃ were two high-risk factors for ACPO after CS. ACPO is characterized by acute onset, and the first choice is conservative management. Active surgical treatment would be required if conservative treatment fails, especially when the maximum diameter of the cecum is ≥ 9 cm, which may increase the incidence of intestinal necrosis or perforation. Key words: Cesarean section; Postoperative complications; Colonic pseudo-obstruction; Intestinal perforation

Review of Clinical Studies of Herbal Medicine Retention Enema for Pediatric Diarrhea in Chinese Medicine

Review of Clinical Studies of Herbal Medicine Retention Enema for Pediatric Diarrhea in Chinese Medicine

Megarectosigmoid in anorectal malformations: the role of laparoscopic resection.

Surgical treatment for anorectal malformations may lead to chronic constipation or stool incontinence. The first condition is mostly linked to an abnormal dilation of rectum and sigma and it is primarily managed with medical therapy (laxatives, diet and enemas). When medical therapy fails to improve the symptoms, a surgical resection of the dilated colon is advocated. When performing the procedure it is mandatory to consider all the previous operations the patient undergone. We present a laparoscopic left emicolectomy for an extremely dilated megarectosimoid after posterior sagittal anorectoplasty in childhood for a recto-urethral fistula. (www.actabiomedica.it)

Effects of diet with different vitamin D concentration on visceral sensitivity in rats with irritable bowel syndrome

Objective To explore the mechanism of vitamin D in the genesis of irritable bowel syndrome (IBS). Methods A total of 50 newborn Sprague Dawley (SD) rats were divided into three model groups and two control groups (saline control group and normal control group). The model was induced by dilute acetic acid enema. After rats were weaned, the rats of three IBS model groups were fed with normal diet, vitamin D deficient diet and vitamin D sufficient diet, respectively. The visceral sensitivity of the rats was assessed by the colorectal distention experiment. The intestinal tissues of rats was taken for histological score, and the intestinal mast cell (MC) was also counted. The mRNA level of vitamin D receptor (VDR) in colon tissues of rats was determined by real-time reverse transcription-polymerase chain reaction (RT-PCR). T test or rank sum test was performed for statistical analysis. Results When the water volume of balloon was 0.5 mL and 1.0 mL, the abdominal withdrawal reflex (AWR) scores of male rats of the vitamin D deficient model group were 2.67±0.33 and 3.60±0.28, which were higher than those of normal vitamin D model group (1.93±0.15 and 3.20±0.18), and the differences were statistically significant (t=4.491 and 2.683, both P 0.05). The number of MC in the mucosal tissue of the sigmoid colon of female rats in IBS model group was 41.00±19.80, which was higher than that in normal control group (12.40±5.35), and the difference was statistically significant (t=3.118, P=0.030). The number of MC in the mucosal tissue of ileum of the female rats in vitamin D deficiency model group was 16.00±3.71, which was higher than that in normal vitamin D model group (7.30±2.66), and the difference was statistically significant (t=4.263, P=0.003). The VDR mRNA level in the colon tissues of male model rats of normal vitamin D model group was 1.48±0.33, which was higher than that of saline control group and normal control group (0.97±0.21 and 1.00±0.21; t=2.590 and 2.482, both P<0.05). The VDR mRNA levels in colon tissues of female rats of vitamin D deficient model group was 1.90±0.66, which was higher than that of normal control group (1.00±0.14), and the difference was statistically significant (t=2.649, P=0.038). Conclusions Vitamin D may affect visceral hypersensitivity in IBS, and MC may involve in vitamin D induced visceral hypersensitivity. Key words: Irritable bowel syndrome; Vitamin D; Models, animal; Mast cells; Visceral sensitivity

Clinical analysis of perioperative electrolyte imbalance in 999 patients undergoing gastrointestinal surgery

To investigate the perioperative electrolyte imbalance in patients undergoing gastrointestinal surgery. Retrospective case analysis was used in this study. Patients who underwent gastrointestinal surgery under general anesthesia at the Sixth Affiliated Hospital of Sun Yat-sen University from January to April 2018 were selected through electronic medical records system. Blood gas analysis during surgery must be carried out in the enrolled patients. Patients with excessive fluid infusion, critical conditions or patients who had been enrolled in other clinical trials were excluded. A total of 999 patients were enrolled. The preoperative, intraoperative and postoperative concentrations of serum sodium, potassium and calcium were collected by the last biochemical examination before surgery, arterial blood gas analysis within 1 h after anesthesia and another biochemical examination within 24 hours after surgery respectively. The type and incidence of electrolyte imbalance were then analyzed, and logistic regression analysis was used to investigate the risk factors. In the 999 patients, 683 cases were male (63.9%) and 361 cases were female(36.1%), with an average age of (56.9±14.6) years old. Fifty-eight patients (5.8%) underwent emergency surgery and 941 patients (94.2%) underwent elective surgery; Sixty-two patients were treated with laxatives at least 3 times and 115 patients were treated with enema at least 3 times before operation. The incidence of hypokalemia was 49.6%(496/999) intraoperatively and decreased to 15.2%(152/999) postoperatively. No hyperkalemia cases were found. The incidence of hypocalcemia was 53.8%(537/999) intraoperatively and increased to 79.7% (796/999) postoperatively. The incidence of hypokalemia in ileus patients was 33.3%(17/51) before surgery, which was higher than that in patients with colorectal cancer [12.3%(86/703)], patients with gastric cancer [7.8%(8/104)] and patients with other gastrointestinal diseases[10.6%(15/141)] (all P<0.05). Similarly, the preoperative and intraoperative incidence of hyponatremia in ileus patients were both 15.7%(8/51), which were higher than those in patients with colorectal cancer [3.0% (21/703) and 2.3% (16/703)] and patients with gastric cancer [2.9%(3/104) and 1.9%(2/104)]. The incidence of hypocalcemia in ileus patients was 31.4%(16/51) preoperatively, which were also higher than those in patients with colorectal cancer [7.4%(52/703)] and patients with gastric cancer [8.7%(9/104)] (all P<0.05). Logistic regression analysis showed that ileus and emergency surgery were risk factors for patients with preoperative electrolyte imbalance; preoperative electrolyte imbalance was a risk factor for intraoperative electrolyte imbalance; intraoperative electrolyte imbalance was a risk factor for postoperative electrolyte imbalance; preoperative electrolyte imbalance was a risk factor for postoperative imbalance of sodium and potassium. The incidence of electrolyte imbalance is high in patients undergoing gastrointestinal surgery, especially hypocalcemia and hypokalemia. It is necessary to recognize the electrolyte abnormality timely and give active intervention and correction.

Exclusive enteral nutrition′s moderating effect on Th17 cell of juvenile rat with inflammatory bowel disease

Objective Through the TNBS-induced inflammatory bowel disease model in young rats, to observe the level of Th17 cell related cytokine IL-17A on the intestinal tissue of IBD young rats model after feeding EEN, Peptisorb, and investigate the enteral nutrition’s regulative effects on Th17 cells. Methods Thirty six four-week healthy male Sprague-Dswley rats were selected and divided into 4 groups, blank control group and EEN control group with 8 rats in each group, IBD group and IBD-EEN group with 10 rats in each group: blank control group and EEN control group were given normal saline enema, then fed with normal diet and enteral nutrition separately; IBD group and IBD-EEN group were given 5% TNBS enema, establish the IBD model, then fed with normal diet and enteral nutrition separately.The weights, defecate characters and occult blood situations of all rats were determined.Also, we carried out the activity index score of disease according to the Cooper score method.On the seventh day, all rats were sacrificed and the colon specimens were collected.We observed mucosal injury by HE staining and expression level of Th17 cell related cytokine IL-17A that were detected by immunohistochemical staining. Results Compared with IBD group, IBD-EEN group was improved significantly in terms of defecate character and occult blood situation.Both IBD group and IBD-EEN group gained their body weights than before, (39.95±2.929)g and(38.40±4.545)g respectively after 7 days(P≥0.05). In IBD group, gross tissue and pathological section displayed significant intestinal inflammation change, showing typical inflammatory bowel disease change; under the microscope, intestinal mucosa showed a large amount of inflammatory cell infiltration, a part of section displayed inflammatory granuloma formation, normal glandular structure was damaged.After EEN treatment, DAI scores werr decreased significantly; intestinal inflammation changes were relieved; intestinal mucosa inflammatory cell infiltration were reduced.Immunohistochemical study showed that the expression of IL-17A cytokine in the intestinal mucosa of IBD group was higher than that of IBD-EEN group(P<0.05). Conclusion The exclusive enteral nutrition treatment possessed the effect of reducing IBD young rat′s intestinal mucosal inflammation, the inner mechanism may be related with the changing expression of Th17-cell cytokines, IL-17A. Key words: Exclusive enteral nutrition; Inflammatory bowel disease; Th17 cell; Rat

Retrospective series of side-to-side ileosigmoidostomy shunting surgery for the treatment of slow transit constipation in elderly patients

Objective To evaluate the clinical and functional outcomes of Side-to-Side Ileosigmoidostomy Shunting Surgerys for the treatment of elder STC patients. Methods The clinical data of 67 patients all more than 63 years old with severe idiopathic STC treated with this novel approach between June 2010 and July 2017 were retrospectively analyzed. The perioperative complications and defection conditions were followed up by telephone and outpatient. The Wexner constipation score and gastrointestinal tract were compared before and after the operation. SPSS 19.0 software was used for statistical analysis. Independent sample t test was used for measurement data, t and χ2 test were used for comparison of count data. Results All the patients received their operations successfully without deaths or serious complication. The center follow-up period (from outpatients or phone) was 12 months (6-29 months). only 16 patients developed complications including 2 and 14 total colonic exclusion. 12 of the 14 got better obviously after enema and taken dynamic drugs, Only 2 patients with repeated abdominal pain and distention received jejunostomy. Six months after the operation, only 5 patients needed to take some drugs for defectation. Wexner constipation scores and Gastrointestinal Quality of Life Index (GIQLI) has improved obviously after 6 months and 12 months. Conclusions The novel surgical procedure, side-to-side ileosigmoidostomy Shunting Surgery that practised in our department, is an easy, safe and effective for the treatment of selected elderly patients with STC. Large-sample, randomized, controlled analyses are worth to investigate its clinical effects. Key words: Aged; Constipation; Treatment outcome; Slow-transit constipation; Elderly slow transit constipation patients; Total colonic exclusion and side to side ileorectal anastomosis; Wexner constipation scores; Gastrointestinal quality of life index

Clinical study on TCM enema combined with continuous renal replacement therapy on the treatment of severe acute renal injury

Objective To evaluate the clinical efficacy of TCM enema combined with continuous renal replacement therapy on the treatment of severe acute renal injury. Methods A total of 100 patients of severe AKI patients were divided into 2 groups by random digital table, each of which was 50 cases. The control group was treated with CRRT, and the observation group cooperated with the traditional Chinese medicine enema on the basis of the control group. The 2 groups were treated continuously for 14 d. The renal function and urine volume recovery time were observed; 24 h urinary protein and 24 h urinary albumin excretion rate were determined by automatic biochemical analyzer.The blood urea nitrogen (BUN), serum creatinine (SCr), serum cystatin C (Cys C) were detected. And theclinical efficacy was compared between the two groups. Results The total effective rate of the observation group was 70.0% (35/50) and the control group was 50.0% (25/50). The difference between the 2 groups was statistically significant. After treatment, the levels of serum BUN (6.51 ± 1.07 mol/L vs. 8.22 ± 2.31 mol/L, t=4.750), SCr (91.29 ± 21.05 μmol/L vs. 108.67 ± 19.34 μmol/L, t=4.299) and Cys C (0.85 ± 0.33 mg/L vs. 1.03 ± 0.45 mg/L, t=2.281) in the observation group were significantly lower than those of the control group (P<0.01 or P<0.05). The urinary albumin excretion rate of 24 h urine protein (115.37 ± 26.15 mg/24 h vs. 167.55 ± 38.66 mg/24 h, t=7.905) and 24 h urine (198.41 ± 33.24 μg/min vs. 226.19 ± 38.35 μg/min, t=3.871) was significantly lower than that of the control group (P<0.01). Conclusions TCM enema combined with CRRT can promote the recovery of renal function in patients with severe AKI, can effectively delay the progression of renal injury. Key words: Acute kidney injury; Enema; Compounds (TCD); Hemodiafiltration; Blood urea nitrogen; Serum creatinine; Cys C