Gastrointestinal Obstruction Research Articles

Congenital heart defects in children with Gastro-intestinal malformations

Background. Congenital malformations of the gastrointestinal (GI) tract are common birth defects detected in the neonatal period and usually present with signs of GI obstruction which at times can be life threatening. Anorectal malformations are among the more frequent congenital anomalies. The co-occurrence of congenital heart defect (CHD) along with GI malformation can significantly affect the natural history of either defect. Purpose - to study the prevalence of GI malformations in children with CHD and study the risk factors. Materials and methods. A total 100 patients of GI malformations were enrolled out of which 66 (66%) were males and 34 (34%) were females. All patients with any GI malformations (anorectal malformation, tracheoesophageal fistulae, anterior abdominal wall defects) presenting to Neonatal Intensive Care Unit (NICU), Paediatric Cardiac unit, Pediatric and Pediatric surgery outpatient department (OPD) as well as In-patient department (IPD) between October 2019 to October 2021 were included in study. A detailed history and examination was done followed by echocardiography and the prevalence of CHD among GI malformation was observed and risk factors were studied. Results. Most common GI anomaly was anorectal malformation (71%) followed by tracheoesophageal fistula (17%), CHD was seen in 14 children. Most common heart defect was ventricular septal defect (VSD) (43%) followed by patent ductus arteriosus (PDA) (36%) and atrial septal defect (ASD) (14%). Among cases with anorectal malformation, CHDs was seen in 10% and the most common defect was VSD (43%). Forty one percent of cases with tracheoesophageal fistula had CHDs with PDA (57%) being the most common underlying defect. Functional heart defects were present in 28 children of GI malformations. Conclusions. The coexistence and severity of CHD in patients with GI malformation can have prognostic implications. Thus, early cardiac evaluation should be performed in every case of GI malformation, preferably with echocardiography. This is likely to help in the risk stratification as well as management of such children. The study was performed in accordance with the principles of the Declaration of Helsinki. Study is approved by Ethical Committee of the Institution. Informed consent of patients was obtained for the study. No conflict of interests was declared by the authors.

Solitary Fibrous Tumor of the Peritoneum: An Unusual Location of A Rare Tumor

Introduction: SFT is an uncommon tumor representing 3, 7% of all soft tissue sarcomas and mesenchymal tumor. The most common location is pleura followed by the abdomen. Case Report: A 68 years old male patient was admitted to our department with abdominal pain and a mobile masse in his abdominal hypogastric area. CT-scan showed a well-defined mass with vividly homogenous enhancing features in both the arterial and venous phases. A complete resection of the tumor was performed thought a median sub-ombilical laparotomy. The histological examination showed a fibroblastic mesenchymal tumor with expression of CD34, CD99 and Bcl2 in the immunohistochemical study that is specific of the solitary fibrous tumor. Discussion: SFT are anatomically ubiquitous mesenchymal tumors developed from fibroblasts. It is an uncommon tumor represents 3, 7% of all soft tissue sarcomas and mesenchymal tumors. The most common location is the pleura followed by the abdomen. Clinically, abdominal SFT is usually manifest as abdominal fullness, gastrointestinal obstruction, weight loss, jaundice, fever, or hypoglycemia. Immunohistochemistry, the cell of the SFT typically express the following markers: CD34, CD99 and Bcl2. Complete surgical removal of the tumor is the gold standard treatment which can be completed by adjuvant radiotherapy. Conclusion: Primary SFTs in the peritoneum are extremely uncommon. Clinical symptoms and imaging manifestations are nonspecific whish make the diagnosis difficult. Treatment includes surgical resection, embolization therapy, radiation therapy, chemotherapy and anti-angiogenic agents.

Clinicopathological and radiographic indicators for orogastric decompression in rabbits presenting with intestinal obstruction at a referral hospital (2015-2018).

Orogastric decompression is regularly recommended as a part of both medical and pre-surgical treatment for small intestinal obstruction in rabbits. However, guidelines as to when orogastric decompression is indicated are sparse. The medical records of 35 rabbits diagnosed with gastrointestinal obstruction over a 3-year period were examined. Differences in presentation, clinicopathological and radiographic examination findings, treatments and outcome were evaluated. Approximately 49% of the cases evaluated were considered to have non-life-threatening disease, while 51% were considered to have life-threatening disease. The severity of gastric obstruction was correlated with the severity of hyperglycaemia (average 25.7mmol/L; 463mg/dl) and corresponding hyponatraemia (Na < 138mmol/L; 138mEq/L). These patients were treated with orogastric decompression and medical management only. This is a retrospective study and there are inherent limitations involving the quality of the data and data collection. Additional studies should be completed that strive for larger sample sizes to compare the differences in outcome between surgical and medical management, as well as investigate the outcomes of rabbits with hyperglycaemia and hyponatraemia that did not have an orogastric decompression performed. Blood glucose and sodium concentrations, in combination with radiographic findings, may aid clinicians in determining if orogastric decompression is indicated to stabilise rabbits with small intestinal obstructive disorders.

Endoscopic transpapillary drainage for walled-off pancreatic necrosis with complete main pancreatic duct disruption by metallic stent placement: A retrospective study.

Walled-off pancreatic necrosis (WOPN) is a serious complication of acute necrotizing pancreatitis (ANP) and may lead to disruption of the main pancreatic duct (MPD). Endoscopic passive transpapillary drainage (PTD) is an effective method for treating MPD disruptions. However, WOPN with complete MPD disruption is usually accompanied by disconnected pancreatic duct syndrome (DPDS), especially with infected necrosis. Endoscopic PTD with a fully covered self-expanding metallic stent (FCSEMS) and a plastic stent placement may have the potential for future application in treating complete MPD disruption in patients with WOPN. Patients with WOPN caused by ANP were classified according to the 2012 Atlanta classification and definition. In all patients, ERCP was performed 2 times. First, 3 patients were diagnosed with complete MPD disruption by ERCP. At the time of diagnosis, a plastic pancreatic stent (7Fr) was placed. Second, they underwent endoscopic PTD for WOPN with complete MPD disruption in which an FCSEMS and plastic stent placement were the only access routes to the necrotic cavity. The etiology of pancreatitis in these patients was of biliary, lipogenic, and alcoholic origin. The WOPN lesion size ranged from 6.5 to 10.2 cm in this study, and the type of WOPN was mixed in two cases and central in one case. The type of MPD disruption was complete in all three patients. The locations of disruption included the pancreatic body and head. The time from occurrence to the first ERCP was 18, 23, and 26 days, respectively. The main symptoms were abdominal pain, abdominal distention, fever, gastrointestinal obstruction, and/or weight loss. The three patients with symptomatic WOPN and MPD disruption underwent endoscopic PTD with FCSEMS and plastic pancreatic stent placement. Technical and therapeutic successes were achieved in 3/3 of patients. The mean time of stenting was 28-93 days. The clinical symptoms connected with WOPN and collection disappeared postoperatively in all three patients. During the follow-up period of 4-18 months, no patient developed collection recurrence or other complications, such as gastrointestinal bleeding or reinfection. All patients recovered uneventfully. In patients with WOPN with complete MPD disruption, endoscopic PTD with FCSEMSs and plastic stent placement may be an effective and safe method of treatment.

Superior Mesenteric Artery Syndrome.

We report a unique case of obstruction of the upper gastrointestinal tract diagnosed in a 15-year boy presenting with a 6-month history of persistent abdominal pain, epigastric fullness, repeated episodes of vomiting, and significant weight loss. The computed tomography (CT) scan of the abdomen with intravenous and oral contrast demonstrated the angle between the aorta and superior mesenteric artery (SMA) to be 15° and revealed the stomach and duodenum to be massively dilated, leading up to a diagnosis of SMA syndrome, which was successfully operated. SMA syndrome is a challenging diagnosis and must always be included in the list of probable diagnoses causing obstruction of the upper gastrointestinal tract. Key Words: Upper gastrointestinal obstruction, Superior mesenteric artery syndrome, Small bowel obstruction, Duodenojejunostomy.

Eating styrofoam balls presented as intestinal obstruction- PICA associated with bezoar: a rare case report and review of literature

Gastrointestinal obstruction secondary to foreign body bezoars (industrial materials, plastic, tissue paper, sponge) have been reported but foreign body bezoar with styrofoam has never been reported in literature. PICA associated bezoars are an unusual complication and reports say that a wide variety of substances are consumed, ranging from socks, newspapers, and sofa pillows to dirt and hair and in this case, it was ingestion of styrofoam balls. Styrofoam being foam plastic does not breakdown or get absorbed in body when ingested, but its persistent ingestion creates bezoar which can fill the whole gastrointestinal tract.

Neonatal Microcolon Occlusion: About A Case and Review of the Literature

Microcolon is a rare radiological feature encountered during neonatal lower gastro intestinal obstruction. It results from a defect in the passage of digestive contents from the small intestines to the colon during fetal life. The etiologies involved are meconium ileus, ileojejunal atresia, and total colonic agonglion. The unprepared abdomen (UAP) and colonic opacification help to orient the diagnosis and the therapeutic attitude. We report the case of a neonate with a micro-colon occlusion by reviewing the data in the literature.

S2542 A Rare Case of Renal Cell Carcinoma Diagnosed on EGD

Introduction: Neoplasms of the duodenum account for a fraction of overall gastrointestinal tumors. Even when a lesion is found in the duodenum, it is more likely to be of secondary neoplastic origin than primary. Here we present a unique case of primary renal cell carcinoma (RCC) diagnosed on EGD. Case Description/Methods: A 55-year-old male with a history of alcohol use disorder presented to the emergency department for lightheadedness, fatigue, and 100-pound unintentional weight loss over 3 months. On exam, the patient was found to be hypotensive, tachycardic, and jaundiced. Laboratory values were pertinent for a Hemoglobin of 4.4 g/dl. After adequate resuscitation, esophagogastroduodenoscopy (EGD) was performed that showed a large partially obstructive, infiltrative, and ulcerated mass with no bleeding in the second part of the duodenum. Histology from the duodenal mass biopsy revealed clear cell carcinoma of renal origin with mucosal ulceration. An abdominal computerized tomography (CT) scan showed a heterogeneous, centrally necrotic right renal mass causing mass effect on the second and third portions of the duodenum, right hemicolon, and hepatic flexure. The scan was also suggestive of duodenal invasion by the mass. Solid pulmonary nodule biopsy was unequivocal for metastasis. The patient was discussed in tumor board and deemed to be a candidate for cytoreductive surgery with partial duodenal resection and systemic immunotherapy if metastasis was confirmed on future biopsies (Figure). Discussion: Duodenal metastasis from RCC is very rare and poses a diagnostic challenge. The most common presentation is with upper gastrointestinal hemorrhage or obstruction, though sometimes it can present with perforation, intussusception, or obstructive jaundice. Duodenal involvement is often from direct infiltration or metastatic spread. Delay in care and large tumor size are the likely reasons for the rare presentation seen in this patient. This case highlights the importance of considering all neoplasms of extraintestinal origin when duodenal lesions are identified endoscopically.Figure 1.: Left: 2nd portion of duodenum. Right: CT Abdomen/Pelvis.

Wilke's Syndrome

Background: Superior mesenteric artery (SMA) syndrome or Wilke's syndrome is a rare, atypical cause of upper gastrointestinal tract obstruction. It occurs due to acute angulation between SMA and aorta causing compression of the third part of the duodenum inbetween them leading to proximal intestinal obstruction. Clinical Description: SMA syndrome occurs mostly in patients who have significant weight loss. It occurs mostly due to the loss of the retroperitoneal fat pad, which serves as a cushion for the duodenum protecting it from compression between the two arteries. Causes include prolonged supine bed rest, spine surgery, an unusual high insertion of ligament of Treitz, other causes leading to weight loss, and congenital anatomical defects. Symptoms include weight loss, bilious vomiting, pain abdomen, postprandial nausea, early satiety, and anorexia. We report a 14-year-old female, a known case of pulmonary tuberculosis, who developed pneumothorax followed by acute gastric dilatation superadded with septicemia and upper gastrointestinal tract obstructive symptoms during the hospital course. Management: Detailed history and radio imaging such as barium studies or contrast-enhanced computerized tomography abdomen are required for diagnosis. Treatment includes conservative management such as gastric decompression, maintenance of electrolytes, nutritional rehabilitation via nasojejunal feeding, orally or parenterally. Treatment aims to restore the mesenteric fat pad to increases the angle between the two arteries. If it fails, surgery needs to be planned wherein duodenojejunostomy can be performed. Conclusion: An increased index of suspicion should be kept for this rare syndrome in children, especially in cases associated with significant weight loss. This may lead to timely diagnosis and saving a precious life.

S352 Presidential Poster Award Light at the End of the Tunnel: Pipeline to the Jejunum

Introduction: Small intestinal strictures that are distal to the duodenum, particularly the jejunum, are uniquely complicated to manage. Adult endoscopes are often too short or too rigid to reach this region of the small bowel. Furthermore, duodenal stents are not flexible enough and are uncovered. In this case, we were able to place several esophageal stents in the proximal jejunum using a pediatric colonoscope that could not be placed previously. Case Description/Methods: A 56 year-old woman with hypertension, obstructive lung disease, and a prior ischemic stroke presented to the hospital for four days of postprandial emesis, abdominal distention, epigastric pain, and constipation. She previously underwent appendectomy and hysterectomy, and had no prior endoscopic studies. Computed tomography (CT) was performed demonstrating mural thickening of the distal duodenum and partial occlusion of the small bowel with regional lymphadenopathy, and a large left adrenal mass. Esophagogastroduodenoscopy (EGD) showed an intrinsic severe stenosis in the distal duodenum. After biopsies were taken, the tissue was found to be a primitive neuroectodermal tumor. Because of the presence of mesenteric adhesion and extensive stenosis, it was decided to correct the stricture endoscopically rather than with surgical intervention. Using a pediatric colonoscope and fluoroscopic guidance, three stents were placed sequentially and telescoping each other from the proximal jejunum to the distal duodenum: a fully covered 20 mm x 120 mm esophageal stent, a partially covered 18 mm x 97 mm esophageal stent, and a fully covered 20 mm x 60 mm esophageal stent (Figure). There were no immediate complications with the procedure and repeat imaging demonstrated luminal patency. Due to the expansion of the stents through a tight stricture, the abdominal pain and pressure was present despite no evidence of perforation on CT. Discussion: This demonstrates the feasibility of utilizing multiple esophageal stents to help relieve more distal gastrointestinal obstructions that were not feasible in the past. The covered esophageal stents are extremely useful when there is discontinuity in the lumen of the small bowel to keep the natural flow of food and help prevent surgical interventions. Watch the video at https://tinyurl.com/ACGAbstractS352Figure 1.: (A) Coronal CT image of a large abdominal mass involving loops of bowel and jejunum. (B) Abdominal x-ray showing interval placement of stents from the distal duodenum to the proximal jejunum.

Atypical presentation of Morgagni hernia: Bowel loops in the neck

IntroductionMorgagni hernia is a rare congenital anomaly caused by the fusion defect between the septum transversum and the sternum. Patients may be asymptomatic or present with respiratory symptoms, abdominal pain, retrosternal pain, abdominal fullness, or gastrointestinal obstruction. Chest X-ray and thoracic computed tomography (CT) are the most commonly used modalities in imaging.AimWe describe an adult case in which the transverse colon was herniated from the retrosternal area to the thyroid gland without a history of trauma or surgery.Case studyA 24-year-old female patient living in the countryside presented to our hospital with the complaints of indigestion and chest pain persisting for 2 years. In the thorax CT examination of the patient, it was observed that the transverse colon had herniated to the retrosternal region and then to the neck.Results and discussionMost acquired anterior diaphragmatic hernias are due to blunt or penetrating traumatic injury. However, there are also case reports describing iatrogenic diaphragmatic hernias following a sternotomy performed during thoracic or cardiac surgery. In Morgagni hernia, the most frequently herniated organs are the greater omentum and transverse colon. There are also reports, albeit rarer, describing the herniation of the stomach, liver and small intestines.ConclusionsMorgagni hernia is a very rare type of hernia, especially in adult patients. The diagnosis of these patients can be easily made based on thoracic CT findings.

Current landscape of therapeutic EUS: Changing paradigms in gastroenterology practice.

Therapeutic EUS has witnessed exponential growth in the last decade, but it has been considered investigational until recently. An increasing body of good-quality evidence is now demonstrating clear advantages over established alternatives, adding therapeutic EUS to management algorithms of complex hepato-pancreato-biliary (HPB) and gastrointestinal (GI) conditions. In this review, the available evidence and clinical role of therapeutic EUS in established and evolving applications will be discussed. A Graphical Summary for each scenario will provide (1) technical steps, (2) anatomical sketch, (3) best-supporting evidence, and (4) role in changing current and future GI practice. Therapeutic EUS has accepted well-established applications such as drainage of symptomatic peripancreatic fluid collections, biliary drainage in failed endoscopic retrograde cholangiopancreatography, and treatment of acute cholecystitis in unfit-for-surgery patients. In addition, good-quality evidence on several emerging indications (e.g., treatment of gastric outlet obstruction, local ablation of pancreatic solid lesions, etc.) is promising. Specific emphasis will be given to how these technical innovations have changed management paradigms and algorithms and expanded the possibilities of gastroenterologists to provide therapeutic solutions to old and emerging clinical needs. Therapeutic EUS is cementing its role in everyday practice, radically changing the treatment of different HPB diseases and other conditions (e.g., GI obstruction). The development of dedicated accessories and increased training opportunities will expand the ability of gastroenterologists to deliver highly effective yet minimally invasive therapies, potentially translating into a better quality of life, especially for oncological and fragile patients.

Effect of modified esophagectomy perioperative technique resection for patients with locally advanced esophageal cancer (tumor length > 8 cm): initial experience in 45 cases

BackgroundPatients with locally advanced esophageal cancer with a lesion length greater than 8 cm (LCWEC) are prone to high mortality in a short time due to esophagotracheal fistula (ETF) and esophagoaortic fistula (EAF). We tried to explore a safe salvage surgical method during the perioperative period to maximize the resection of the tumor on the premise of safety and reconstruction of the alimentary tract to avoid early death due to ETF and EAF.MethodsFrom December 2007 to November 2018, forty-five LCWEC patients were treated using the modified Wu’s esophagectomy. Patient features, surgical techniques, postoperative complications, and pathology outcomes were analyzed.ResultsThe average length of the tumors was 12.5 cm (range 8.1–22.5 cm), and the average transverse tumor diameter was 5.8 cm (range 4.5–7.8 cm). No complications like anastomotic leakage, anastomotic stenosis, chylothorax, delayed gastric emptying, vocal cord paralysis, dumping syndrome, and reflux were detected. The 30-day and in-hospital mortality rates were 0%. Complete (R0) resection was achieved in 38 (84.4%) cases. The resection margin rate of positive anastomosis was 0%. Until the death of the patients, no feeding failure due to gastrointestinal obstruction and early death due to ETF or EAF occurrence. During follow-up, the median time to death was 17.2 months for patients treated with surgery alone and 32 months for patients treated with postoperative multimodal treatment.ConclusionThe modified Wu’s esophagectomy is a safe and feasible salvage surgical method for LCWEC resection.

Gastrointestinal obstruction in the course of incarcerated Richter’s hernia in the peritoneal drainage catheter tunnel – a case report

Gastrointestinal obstruction is a condition in which the passage of contents through the intestine is arrested. Thorough physical examination as well as imaging and laboratory diagnosis are needed for a correct diagnosis. Richter’s hernia is a rare form of abdominal hernia in which a part of the intestinal wall is entrapped in the hernial sac. A female patient reported to the Emergency Department (ED) with symptoms of gastrointestinal obstruction. After performing all necessary investigations, Richter-type hernia was found in the peritoneal drainage catheter tunnel, which was surgically treated. Incarcerated abdominal hernias are one of the most common causes of gastrointestinal obstruction. Richter’s hernia, which poses diagnostic difficulty despite overt clinical symptoms, and may be found even in small defects in the abdominal wall, is one of them.

Gastric pneumatosis in a child with congenital duodenal obstruction

Pneumatosis of the foregut is an extremely rare finding which may indicate a potentially serious condition. In newborn the presence of gastric intramural gas is mainly associated to necrotizing enterocolitis and is considered a condition which correlates with a poor prognosis. In infant and children pneumatosis of foregut may be secondary to several causes such as infection, mucosal ischemia, caustic ingestion, gastrointestinal obstruction or mucosal injury occurred during endoscopic procedure. Intramural gastric gas can be classified as “gastric emphysema” (GE) when a mechanical injury is the main causal factor or as “emphysematous gastritis” (EG) in cases of underlying gastrointestinal infection. Portal venous gas is also a rare condition. Necrotic bowel wall dues to infection or ischemia, associated with increased intraluminal pressure, seems to favor the entry of the air into portal venous system. We report a case of gastric pneumatosis associated to portal venous gas in a child affected by Down's Syndrome with a duodenal web and concomitant bacterial and mycotic gastric colonization.

Ovarian torsion causing bowel obstruction in a premature infant

We report a case of 3-months-old infant with diagnosed complex ovarian cyst admitted to the hospital with acute onset of clinical signs of upper gastrointestinal tract obstruction. Urgent laparotomy was performed. A Treves' field mesenterial defect with herniation of small bowel loops and a complex ovarian cyst with torsion was identified. Unexpectedly, the Fallopian tube as a strangulation band of the herniated bowel loops was discovered within the mesenterial defect. During the operation bowel loops reduction, mesenterial defect closure and left adnexectomy due to presence of necrotic changes was done. Perioperatively, coincidental malrotation with Ladd's bands were found, thus Ladd's procedure was performed. Finally, right small paraovarian simplex cyst was fenestrated. The following postoperative course was uneventful. To the best of our knowledge, it is the first case report described in literature proposing unusual combination of congenital anomalies leading to acute intestinal obstruction.

Intussusception in Five Months Old Infant, A Rare Cause Colocolica without Pathologic Lead Point: A Case Report

Intussusception is a common cause in gastrointestinal obstruction and one of condition in which early treatment is critical. Given the risk of acute bowel ischemia, intussusception represents an abdominal emergency in the pediatric population. The symptoms are generally related to intestinal obstruction, as intussusception accounts for up to 50% of pediatric small bowel obstructions in some series. Colocolica intussusception is an uncommon type of intussusception in children that is usually associated with a pathological lead point. This report depicts a five-months-old female baby with a chief complaint of bloody stool 7 hours before admission, accompanied with non-bilious vomit. Patient exhibited the classic triad of intussusception and upon the radiologic examination, a colocolica was noted. Patient then underwent urgent exploratory laparotomy, and the colocolica was reduced through manual reduction (milking technique).

Clinical, Diagnostic, and Treatment Features of Body Packing in Brazil: Drugs, Cell Phones, and Beyond.

Introduction: Body packing consists of the concealment of substances (drugs and non-narcotics) or products inside the human body with the purpose of smuggling and may represent an emergency due to the fatal risk of narcotic toxicity, intestinal obstruction, and visceral perforation. However, non-narcotic body packing, especially in developing countries, is under-evaluated. Thus, the objective of this study was to evaluate cases of body packers in Brazil as regards narcotic and non-narcotic contents.Methods: This retrospective study analyzes the medical records of body packers admitted from January 2015 to December 2019 at one of the main tertiary hospitals in central Brazil.Results: Ten cases of body packing were observed. We found that five patients carried drugs, while seven carried non-narcotic substances such as cell phones and accessories. All the patients were male, prisoners, and young adults. In six patients, there was gastrointestinal obstruction, and in three, there was acute narcotic intoxication. Abdominal radiography diagnosed eight of the cases. In nine of the cases, emergency laparotomy was required, but all patients successfully recovered.Conclusion: There was a higher prevalence of body packing of non-narcotic content; however, diagnostic and surgical approaches were similar to those of narcotic content. Clinicians must be aware of both non-narcotic and narcotic body packing.

Critical aspiration pneumonia during induction of anesthesia in elective abdominal surgery: a case report

BackgroundWe experienced the critical aspiration pneumonia during induction of anesthesia in elective abdominal surgery which standard fasting period was complied with.Case presentationA 64-year-old male was scheduled for gastrojejunostomy because of gastrointestinal obstruction. He fasted from the night before surgery. General anesthesia was induced, and cricoid pressure was applied during intubation. However, he vomited huge amount of gastric contents. The scheduled surgery was performed without surgical complications, and postoperatively respiratory management, including mechanical ventilation with prone positioning, was performed in high care unit. He was extubated on postoperative day 2. He was discharged from the hospital on POD 25.ConclusionThe standard fasting period can prevent aspiration pneumonia in most cases. However, even in elective cases without abdominal symptoms, we consider that massive-volume gastric residual contents, especially in susceptible cases. We suggest that point-of-care gastric ultrasonography be performed in suspicious cases before induction of anesthesia.

Systemic immune checkpoint blockade and intraperitoneal chemo-immunotherapy in recurrent ovarian cancer: An interim analysis (317)

Systemic immune checkpoint blockade and intraperitoneal chemo-immunotherapy in recurrent ovarian cancer: An interim analysis (317)