Gastrointestinal Obstruction Research Articles

Why is surgery not popular among medical students and young doctors? - Review of literature

Introduction: Contemporary medicine is witnessing significant advancements in conservative treatment modalities. However, surgery remains paramount for radical cancer treatment and emergent conditions such as trauma, peritonitis, gastrointestinal obstruction, and cholecystitis. Despite the essential role of surgeons, there is a global trend indicating waning interest among medical students in pursuing surgical specialties. Concurrently, practicing surgeons report heightened levels of professional burnout, and many regions face a looming shortage of surgical professionals, posing a threat to healthcare quality. Brief Overview of Current Knowledge: Research conducted across Poland, Germany, Argentina, the United Kingdom, and Japan highlights the declining inclination towards surgery among medical students. Students cite unattractive working conditions, poor work-life balance, elevated stress levels, and limited avenues for scholarly growth as deterrents. Gender plays a role, with females expressing heightened concerns regarding work-life balance and family aspirations. Furthermore, the surgical work environment, inadequate preparatory training in medical schools, and prolonged working hours are identified as factors exacerbating burnout risk among surgeons. Summary: Professional burnout represents a significant concern among surgeons, impacting both their work satisfaction and patient safety. Despite the strides made in conservative medical therapies, surgery remains indispensable, yet its allure as a specialty is diminishing among medical students. Understanding and addressing the discouraging factors, along with promoting healthy work practices, may mitigate burnout and encourage young physicians to consider surgical careers.

Clinical Analysis of Feeding Jejunostomy and Optimal Selection of Enteral Nutrients (Report of 238 Cases)

The objectives of this study is to summarize and analyze the clinical and pathological data of patients with feeding jejunostomy, evaluate its clinical application value and risk, and study the optimal selection of enteral nutrients. The clinical data of 238 patients who underwent feeding jejunostomy in Beijing Shijitan Hospital, Capital Medical University, from September 1, 2017 to July 31, 2021 were retrospectively studied. The serious complications and treatment of patients were summarized and analyzed. Serious complications included anastomotic fistula, postoperative bleeding, and so on. Complications related to jejunal feeding stoma included: tube folded, intestinal stenosis at the stoma, and others. The symptoms of some enteral nutrition patients with abdominal pain, abdominal distension and diarrhea were improved by changing the type of enteral nutrients and increasing dietary fiber. Feeding jejunostomy can effectively solve the enteral nutrition problems of upper gastrointestinal anastomotic leakage, perforation, obstruction and functional eating disorder, can also be used as a separate means of enhance enteral nutrition support, but also can cause severe complications, and even death. Compliance with surgical indications is as important as mastery of surgical technical details. Reasonable use of enteral nutrients can achieve better nutritional support effect.

Recurrent Brunneroma: A Rare Cause of Duodenal Obstruction

Abstract Brunneroma, also known as Bruner’s gland adenoma or hamartoma, is a rare benign tumor of the duodenum. It is usually asymptomatic and sometimes presents with an upper gastrointestinal (UGI) bleed or obstruction. The majority of the cases are detected incidentally during endoscopy for UGI bleeding and may require endoscopic excision. Here, we attempt to highlight a case of recurrent large Brunneroma in a 52-year-old male and reassess the representative features that surgeons need to be aware of. We had to go for a major surgical intervention to relieve the duodenal obstruction.

Amelioration of gastric ulcer using a hydro-alcoholic extract of Mangifera indica in Sprague Dawley rats by prevention of muco-oxidative stress

BackgroundGastric ulcer is a significant global public health concern that can result in severe complications such as gastro-intestinal bleeding, perforations, gastro-intestinal obstruction and cancer. Mangifera indica seed kernel, a traditional Chinese medicine, is widely available and used in China. The current study was aimed to determine gastro-protective effect of Mangifera indica kernel extract in preventing gastric ulcer in rats. MethodsSD rats were divided into six groups. Each group consisted of five rats. Group-I received 1 ml/kg/day p.o. of 1 % carboxy methylcellulose. Group-II received indomethacin (20 mg/kg/day, p.o.). Group-III received Mangifera indica kernel extract (500 mg/kg/day, p.o.). Group-IV received the extract (1000 mg/kg/day, p.o.). Group-V received 50 mg/kg/day ranitidine. Group-VI (per se) received the extract (1000 mg/kg/day, p.o.). The ulcer index, mucus barrier, and histopathology were calculated. After homogenization of gastric tissue in buffer, anti-oxidant enzyme potency was also evaluated. ResultsMangifera indica kernel extract significantly (p < 0.01) and dose-dependently increased mucus, superoxide dismutase, and catalase levels while lowered ulcer index and thiobarbituric acid reactive substances in comparison to ulcer control group-II. According to histopathological data, indomethacin medication led to gastric ulcers whereas Mangifera indica kernel extract protected from gastric ulcer by prevention of indomethacin-induced muco-oxidative stress. Mangifera indica 1000 mg/kg/day in group-IV had ulcer prevention potency comparable to ranitidine 50 mg/kg/day in group-V. DiscussionThus, Mangifera indica extract possesses promising effect on amelioration of gastric ulcer and protects from gastric ulcer by prevention of indomethacin-induced muco-oxidative stress, re-inforcing the gastric mucosa, and reducing the secretion of gastric acid.

COQ7 defect causes prenatal onset of mitochondrial CoQ10 deficiency with cardiomyopathy and gastrointestinal obstruction

COQ7 pathogenetic variants cause primary CoQ10 deficiency and a clinical phenotype of encephalopathy, peripheral neuropathy, or multisystemic disorder. Early diagnosis is essential for promptly starting CoQ10 supplementation. Here, we report novel compound heterozygous variants in the COQ7 gene responsible for a prenatal onset (20 weeks of gestation) of hypertrophic cardiomyopathy and intestinal dysmotility in a Bangladesh consanguineous family with two affected siblings. The main clinical findings were dysmorphisms, recurrent intestinal occlusions that required ileostomy, left ventricular non-compaction cardiomyopathy, ascending aorta dilation, arterial hypertension, renal dysfunction, diffuse skin desquamation, axial hypotonia, neurodevelopmental delay, and growth retardation. Exome sequencing revealed compound heterozygous rare variants in the COQ7 gene, c.613_617delGCCGGinsCAT (p.Ala205HisfsTer48) and c.403A>G (p.Met135Val). In silico analysis and functional in vitro studies confirmed the pathogenicity of the variants responsible for abolished activities of complexes I + III and II + III in muscle homogenate, severe decrease of CoQ10 levels, and reduced basal and maximal respiration in patients’ fibroblasts. The first proband deceased at 14 months of age, whereas supplementation with a high dose of CoQ10 (30 mg/kg/day) since the first days of life modified the clinical course in the second child, showing a recovery of milestones acquirement at the last follow-up (18 months of age). Our study expands the clinical spectrum of primary CoQ10 deficiency due to COQ7 gene defects and highlights the essential role of multidisciplinary and combined approaches for a timely diagnosis.

Colonic lymphomatous polyposis mantle cell lymphoma: a case report and review of literature

IntroductionMantle cell lymphoma is a rare lymphoma of the gastrointestinal tract that may present as multiple lymphomatous polyposis. We report a case of lymphomatous polyposis with a review of the literature.Case reportA 56-year-old man of Black ethnicity and Ivorian nationality with no relevant past medical history, consulted for a sudden onset symptoms of gastrointestinal obstruction, which evolved over 2 days. Macroscopic examination revealed the presence of multiple polyploid formations of the colonic mucosa. Histology showed diffuse lymphomatous proliferation of submucosa consisting off small lymphoid cells with a hyperchromatic crenelated nucleus, suggesting lymphomatous polyposis. Immunohistochemical examination showed expression by the tumor cells of antibodies to CD20, CD5, Bcl2, and cyclin D1. They did not express antibodies to CD10 and CD23. The Ki67 proliferation index was 25%. We have thus retained the diagnosis of mantle cell lymphomatous polyposis.ConclusionMultiple lymphomatous polyposis is a rare entity characterized by the presence of numerous gastrointestinal polyploid lesions sometimes involving several segments of the gastrointestinal tract. Typical lymphoma presenting as lymphomatous polyposis is mantle cell lymphoma; although, other tumors may have this aspect.

The association of the perioperative fluid balance and cardiopulmonary complications in emergency gastrointestinal surgery: exploration of a randomized trial

BackgroundThe association between perioperative fluid administration and risk of complications following emergency surgery is poorly studied. We tested the association between the perioperative fluid balance and postoperative complications following emergency surgery for gastrointestinal obstruction or perforation.MethodsWe performed a re-assessment of data from the Goal-directed Fluid Therapy in Urgent Gastrointestinal Surgery Trial (GAS-ART) studying intra-operative stroke volume optimization and postoperative zero-balance fluid therapy versus standard fluid therapy. The cohort was divided into three groups at a perioperative fluid balance (FB) of low < 0 L, moderate 0–2 L, or high > 2 L. We used a propensity adjusted logistic regression to analyse the association with cardiopulmonary (primary outcome), renal, infectious, and wound healing complications. Further, the risk of complications was explored on a continuous scale of the FB.ResultsWe included 303 patients: 44 patients belonged to the low-FB group, 108 to the moderate-FB group, and 151 to the high-FB group. The median [interquartile range] perioperative FB was –0.9 L [–1.4, –0.6], 0.9 L [0.5, 1.3], and 3.8 L [2.7, 5.3]. The risk of cardiopulmonary complications was significantly higher in the High-FB group 3.4 (1.5–7.6), p = 0.002 (odds ratio (95% confidence interval). On a continuous scale of the fluid balance, the risk of cardiopulmonary complications was minimal at –1 L to 1 L.ConclusionFollowing emergency surgery for gastrointestinal obstruction or perforation, a fluid balance < 2.0 L was associated with decreased risk of cardiopulmonary complications without increasing renal complications.

Obstruction of Small Bowel due to Strangulated Obturator Hernia: Case Report

Introduction: Obturator hernia is one of the rare types of hernia and the important cause of small intestine obstruction. It mostly occurs in elderly people and women. This disease is challenging to diagnose and has a high mortality rate. Cese Presentation: In this study, two patients are introduced. The first patient was a 95-year-old woman who came with symptoms of gastrointestinal obstruction, nausea, bilious vomiting, as well as lack of gas and stool excretion. There was no suspicious pathological examination. The computed tomography (CT) scan was performed for the patient with the report of the left Obturator hernia. The second case is an 88-year-old woman with a history of neurological problems and symptoms of gastrointestinal obstruction, who had tenderness and rebound tenderness of the right lower quadrant of the abdomen during the examination. Since imaging findings were normal, the CT scan was performed for the patient, and the report was in favor of the right obturator hernia. Both patients underwent surgery with a midline incision of the abdomen. The small intestine was gangrenous at the hernia site and did not have proper peristalsis. Therefore, she underwent resection and anastomosis of the small intestine and repair of the obturator hernia. Conclusion: Obturator hernia is a rare but significant cause of intestinal obstruction, especially in emaciated elderly women. The diagnosis of this disease is challenging for doctors. One of the appropriate methods for diagnosing this disease is a CT scan of the abdomen and pelvis, and the only treatment method is surgery.

Neonatal Gastrointestinal Emergencies

Background: Neonatal gastrointestinal emergencies refer to a set of life-threatening conditions affecting the digestive system of a newborn within the first 28 days of life and often associated with high morbidity and mortality. As such, these conditions require immediate and accurate diagnosis as well as proper treatment to optimize the outcomes of these patients. This condition has the potential to obstruct the flow of gastric content leading to vomiting, failure to thrive, and electrolyte imbalances. Discussion: Gastrointestinal obstruction is one of the most common conditions causing emergency condition in neonates. This condition may occur anywhere between the upper part of gastrointestinal tract to the lower gastrointestinal tract. In most cases of neonatal gastrointestinal emergencies, patients almost always present with vomiting that may be bilious or non-bilious. Furthermore, persistent vomiting may also lead to a more severe consequences such as hypovolemic shock and electrolyte imbalances. Therefore, clinicians are expected to address this problem early while also working to find the underlying etiologies of neonatal vomiting. On the other hand, gastrointestinal bleeding is often an alarming sign that indicates a possible emergency condition in neonates. However, some non-emergency condition such as swallowed maternal blood and cow's milk allergy can also result in gastrointestinal bleeding in neonates. Conclusion: Given the critical time window and the vulnerability of the neonate population, the proper identification and prompt treatment of neonatal gastrointestinal emergencies is crucial to minimize morbidity and mortality. Multidisciplinary management with neonatologists, pediatric surgeons, radiologists, and nursing staff working closely together can provide the best possible outcomes.

A99 HIGHER HOSPITAL INPATIENT RACIAL DIVERSITY IS ASSOCIATED WITH BETTER OUTCOMES AMONG HISPANIC AND INDIGENOUS AMERICAN PATIENTS FOR FIVE COMMON GASTROINTESTINAL DIAGNOSES

Abstract Background There is evidence that gastrointestinal disease (GI) outcomes are poorer among patients from underrepresented backgrounds. However, the impact of hospital patient racial diversity on GI outcomes is understudied. Aims We aimed to investigate the impact of hospital patient racial diversity on GI outcomes Methods Using the 2019 National Inpatient Sample (NIS), racial diversity was defined by the percentage of Hispanic or Indigenous American patients discharged from each hospital. GI discharge diagnoses were defined by diagnostic related group. We included GI bleeding, inflammatory bowel diseases, GI obstruction, cirrhosis, and alcoholic hepatitis. Logistic regression was used to predict major complication rates or comorbidity (MCC), long length of stay (LOS), and high total charges. Control variables included age, gender, payer type, patient location, area-associated income quartile, hospital characteristics including size, urban vs. rural, teaching vs. nonteaching, region, and the interaction of the percentage of Hispanic and Indigenous Americans with patient race. Results were validated with the 2018 NIS dataset. Results Our analysis cohort of 537,830 hospitalizations included 252,225 GI bleeding discharges, 59,310 gastrointestinal obstruction discharges, 106,820 cirrhosis and alcoholic hepatitis discharges, and 119,475 inflammatory bowel diseases discharges. In the unadjusted analyses, MCC rates were higher among Hispanic (24.8%) and Indigenous American patients (30.4%), compared to Whites (18.3%). In adjusted analyses, compared to white patients, Hispanic patients had higher MCC rates [adjusted odds ratio (OR) 1.21, 95% Confidence Interval (CI) 1.15-1.28]. The same trend was seen among Indigenous American patients [OR 1.25, (95% CI) 1.09-1.43]. However, as hospital Hispanic diversity increased, inpatient MCC outcomes for Hispanics improved [OR 0.93, (95% CI) 0.87-1.14], and were even better among Indigenous American patients as hospital inpatient Indigenous American diversity increased [OR 0.83, (95% CI) 0.73-0.94] (Table 1). A similar improvement in MCC with increasing Hispanic and Indigenous American diversity was observed in the 2018 validation cohort. Table 1 highlights impact of increasing diversity on LOS and total charges. Conclusions Increasing hospital inpatient Hispanic and Indigenous American diversity is associated with better outcomes for these underrepresented minority groups. More research is needed on the impact of cultural competence and linguistic concordance on patient outcomes. Funding Agencies None

Role of opioid use in gastrointestinal obstruction and perforation: A retrospective review.

Pain is one of the most common complaints that brings a patient to a hospital. For this, usually, the patient might have already consumed various types of pain killer combinations, either prescribed or over-the-counter. In some of these cases, a patient consumes these medicines unmonitored for a long time and then comes with complications, among which gastrointestinal tract obstruction and perforation are the most life threatening. Case files from the Department of Surgery were retrieved and studied. Patients were contacted telephonically for details of drug abuse history. These were then further studied in detail. Forty-eight (68 percent) patients out of a total of 78 had a history of drug abuse. The most commonly abused pain killer was a combination of anti-inflammatory and other salts, which was found in 22 (46 percent) patients, followed by tramadol, NSAIDs, opium, and alcohol (23, 17, 10, and 4 percent, respectively). These groups were comparable in socio-demographic details except in the mean age, occupation, and gender distribution, and the difference was significant (p < 0.01). The most common cause for starting to use any of the above-mentioned pain killer was persistent pain. The most common site of obstruction in drug abusers was the stomach (60 percent), followed by the small intestine (38 percent) and the large intestine (2 percent). (1) This is an observational retrospective record review. (2) Records were studied in hospital settings, so results should be generalized cautiously. (3) Risk of recall bias is present. Pain killers should always be prescribed with caution and for a short duration. Alternative options for pain relief should be made available, and doctors should be trained. Drug abusers tend to have a gastrointestinal complication at an early age, which means they are prone to further complications and recurrence if the problem is not addressed on time.

Prognostic impact of ectopic fat deposition within psoas muscle in patients undergoing systemic chemotherapy for stage IV gastric cancer.

285 Background: Sarcopenia is a progressive condition characterized by loss of skeletal muscle mass, muscle strength, and physical function, and is identified as an important prognostic factor in malignant tumors. The patients of gastrointestinal (GI) malignancies are often poor nutrition, weight loss, and loss of skeletal muscle mass due to pathophysiology such as the dysfunction of nutritional absorption and GI obstruction. The prevalence of sarcopenia is high in GI malignancies, especially in advanced gastric cancer (GC), which is reported to be 30%. Recently, in assessing sarcopenia, muscle quality as well as skeletal muscle mass has been considered important and some studies suggest that intramuscular adipose tissue is useful in assessing muscle quality. In this study, we focused on the fat ratio within psoas muscle (FRPM) and sought to clarify the impact of FRPM on overall survival (OS) in GC patients undergoing systemic chemotherapy. Methods: We retrospectively analyzed the patients with histologically confirmed stage IV GC receiving at least one systemic chemotherapy between February 2017 and March 2021 in our hospital. We measured PMI (Psoas Muscle Index: bilateral muscle mass (cm2)/height squared(m2)) and FRPM both at the lumber three level on the CT images before chemotherapy. PMI and FRPM values were classified into two groups, High and Low, according to whether they were higher or lower than the median, and differences in OS were analyzed for each group. Results: The analysis included 79patients (median age: 69 years, 59 males). The median FRPM was 1.67%. The FRPM-high group and the FRPM-low group were 40/39patients, respectively. The median PMI in male and female patients was 4.35 cm2/m2 and 2.88 cm2/m2. Thirty male patients and ten female patients were defined as the PMI-high group, and the remaining 39 patients were in the PMI-low group. The 1, 2 and 3year cumulative OS rate in patients with FRPM-high and FRPM-low was 67.3%, 14.3% and 7.6% in the FRPM-high group and 74.8%, 40.5% and 32.4% in the FRPM-low group ( P = 0.0341). The 1, 2 and 3year cumulative OS rate in patients with PMI-high and PMI-low was 86.7%, 40.4% and 30.0% in the PMI-high group and 55.8%, 12.8% and 6.4% in the PMI-low group ( P &lt; 0.0001). In the multivariate analysis of factors associated with OS, PMI ( P = 0.0047) and FRPM ( P = 0.0019) were independent predictors for the OS. Conclusions: High-FRPM may be associated with declined physical activity, suggesting that skeletal muscle function may be an important prognostic factor in patients with GC receiving systemic chemotherapy.

Gastrojejunostomy as an Evolving Therapeutic Paradigm in the Management of Metastatic Pancreatic Tumors: A Comprehensive Case Review Illuminating the Strategic Role of Gastrointestinal Anastomosis

In the intricate landscape of metastatic pancreatic tumors, the therapeutic approach continues to evolve, with a burgeoning emphasis on innovative strategies to enhance patient outcomes. This comprehensive case review delves into the nuanced realm of gastrojejunostomy as a pivotal intervention in the management of metastatic pancreatic tumors. The case under scrutiny presents a compelling narrative of a patient grappling with the formidable challenge of pancreatic malignancy, wherein the judicious application of gastrojejunostomy emerged as a strategic maneuver to navigate the complexities of gastrointestinal obstruction. Our analysis unfolds the intricate details of the patient's clinical journey, exploring the diagnostic intricacies, treatment modalities, and the ultimate decision-making process leading to the implementation of gastrojejunostomy. The discussion encapsulates the anatomical and physiological considerations inherent to this procedure, delineating its role in mitigating symptoms, improving nutritional status, and fostering an enhanced quality of life for the afflicted individual. Furthermore, we illuminate the broader implications of gastrojejunostomy within the context of multidisciplinary care, underscoring its integration into the evolving landscape of therapeutic options for metastatic pancreatic tumors. This case review endeavors to contribute valuable insights into the clinical decision-making matrix, providing clinicians with a nuanced understanding of the role and potential benefits of gastrojejunostomy in the comprehensive management of patients with metastatic pancreatic malignancies. As the medical community continues to unravel the intricacies of gastrointestinal anastomosis, this exploration serves as a testament to the evolving armamentarium available to confront the challenges posed by metastatic pancreatic tumors, ultimately fostering a more informed and effective approach to patient care.

Endoscopic gastrointestinal bypass anastomosis using deformable self-assembled magnetic anastomosis rings (DSAMARs) in a pig model

BackgroundTo investigate the feasibility of a deformable self-assembled magnetic anastomosis ring (DSAMAR), designed and developed by us, for endoscopic gastrointestinal bypass anastomosis.MethodsTen experimental pigs were used as model animals. The DSAMAR comprises 10 trapezoidal magnetic units, arranged in a straight line under the constraint of a guide wire. When the desired anastomosis site is reached under the guidance of an endoscope, the catheter pushes the magnetic unit along the guide wire. The linear DSAMAR can be assembled into a circular DSAMAR. Two DSAMARs were inserted, one at the end of the duodenum and the other into the stomach successively. They attracted each other and compressed the wall of the stomach and duodenum to establish gastrointestinal bypass anastomosis. The experimental pigs were euthanized 4 weeks after the operation, and the gastrointestinal bypass anastomosis specimens were obtained. The anastomosis formation was evaluated by the naked eye and histology.ResultsGastrointestinal bypass anastomosis with DSAMARs was successfully performed. The average operation time under an endoscope was 70.30 ± 19.05 min (range: 43–95 min). The DSAMARs were discharged through the anus 10–17 days after surgery. There were no complications such as gastrointestinal bleeding, perforation, anastomotic fistula, and gastrointestinal obstruction during and after the operation. Gastroscopy and gross specimen of the anastomosis showed a well-formed magnetic anastomosis. Histological observation showed good continuity of the serous membrane and the mucosa of magnetic anastomosis.ConclusionThe DSAMAR is a safe and feasible device for fashioning gastrointestinal bypass anastomosis in this animal model.

Comparative Analysis of Enteral and Parenteral Nutrition Impact on Outcomes in Esophageal Cancer Patients: A Paradigm for Nutritional Optimization in Oncology

Background: Individuals diagnosed with esophageal cancer face a pronounced risk of malnutrition, primarily attributed to the early onset of gastrointestinal obstruction. This risk persists and may even intensify following therapeutic interventions and the subsequent reconstruction of gastrointestinal passages. The current study focuses on elucidating the differential impact of enteral vs. parenteral nutrition on outcomes in patients hospitalized with esophageal cancer. Methods: The study analyzed adult discharges related to esophageal cancer from 2019 and 2020 using data from the National Inpatient Sample. Exclusion criteria included discharges involving minors and mixed nutritional regimens. Enteral nutrition and parenteral nutrition subgroups were identified using International Classification of Diseases, 10th revision codes. Outcome variables were determined through ICD-10 codes in the NIS dataset. Multivariable regression analyses were used to investigate associations between mode of nutrition and specified outcomes. Results: In this study involving 28,015 hospitalizations for esophageal cancer, 756(2.7%) received enteral nutrition, and 1064(3.8%) received parenteral nutrition. After adjusting for confounding variables, parenteral nutrition emerged as an independent predictor of mortality (OR 1.75, P=0.023), while enteral nutrition showed no association with higher mortality (OR 0.56, P=0.162). Both nutrition modes were associated with increased length of stay, with patients on parenteral nutrition having significantly longer stays (+9.07 days, P&lt;0.001 vs 3.07 days, P=0.001). While both nutrition modes were linked to high total hospitalization charges, patients with parenteral nutrition experienced a significantly more significant increase in total treatment cost compared to those on enteral nutrition (112,093 USD, P&lt;0.001 vs 54,953 USD, P=0.01) patients on enteral nutrition had lower odds of pneumonia compared to the parenteral nutrition group. The parenteral nutrition group had higher odds of various complications, including esophageal perforation, constipation, diarrhea, acute kidney injury, ICU admission, and acute respiratory failure, than those on enteral nutrition. Both forms of nutrition were associated with increased odds of malnutrition, fluid and electrolyte disorders, and septic shock. Conclusion: Parenteral nutrition has a higher risk of mortality compared to enteral nutrition. Both types are linked to longer hospital stays, increased treatment costs, and other adverse outcomes, with parenteral nutrition leading to more complications than enteral nutrition.

Accidental ingestion of multiple magnetic beads by children and their impact on the gastrointestinal tract: a single-center study

ObjectiveIn this study, we aimed to enhance the treatment protocols and help understand the harm caused by the accidental ingestion of magnetic beads by children.MethodsData were collected from 72 children with multiple gastrointestinal perforations or gastrointestinal obstructions. The 72 pediatric patients were divided into a perforation and a non-perforation group. The data collected for the analysis included the gender, age, medical history, place of residence (rural or urban), and symptoms along with the educational background of the caregiver, the location and quantity of any foreign bodies discovered during the procedure, whether perforation was confirmed during the procedure, and the number of times magnetic beads had been accidentally ingested.ResultsThe accuracy rate of preoperative gastrointestinal perforation diagnosis via ultrasound was 71%, while that of the upright abdominal X-ray method was only 46%. In terms of symptoms, the risk of perforation was 13.844 and 12.703 times greater in pediatric patients who experienced vomiting and abdominal pain with vomiting and abdominal distension, respectively, compared to patients in an asymptomatic state. There were no statistical differences between the perforation and the non-perforation groups in terms of age, gender, medical history, and the number of magnetic beads ingested (P > 0.05); however, there were statistical differences in terms of white blood cell count (P = 0.048) and c-reactive protein levels (P = 0.033). A total of 56% of cases underwent a laparotomy along with perforation repair and 19% underwent gastroscopy along with laparotomy. All pediatric patients recovered without complications following surgery.ConclusionAbdominal ultrasonography and/or upright abdominal X-ray analyses should be carried out as soon as possible in case of suspicion of accidental ingestion of magnetic beads by children. In most cases, immediate surgical intervention is required. Given the serious consequences of ingesting this type of foreign body, it is essential to inform parents and/or caregivers about the importance of preventing young children from using such products.

Capecitabine-associated gastrointestinal ulceration, haemorrhage, and obstruction: a pharmacovigilance analysis based on the FAERS.

Capecitabine has been reported to be associated with severe gastrointestinal (GI) adverse drug reactions (gastrointestinal ulceration, haemorrhage, and obstruction). However, statistical correlations have not been demonstrated, and specific GI adverse drug reactions, such as GI obstruction, are not listed on its label. We aimed to determine the associations between capecitabine and GI ulceration, haemorrhage, or obstruction among patients with breast cancer by examining data from the United States Food and Drug Administration Adverse Event Reporting System (FAERS). We performed disproportionality analysis of GI ulceration, haemorrhage, and obstruction by evaluating the reporting odds ratio (ROR) and the information component (IC) with their 95% confidence intervals (CIs). We identified 279 patients with capecitabine-associated GI ulceration, haemorrhage, or obstruction reported between 1 January 2004 and 31 December 2020. One-fourth of the cases of GI ulceration, haemorrhage, or obstruction resulted in death. Capecitabine as a drug class had disproportionately high reporting rates for GI ulceration [ROR 1.94 (1.71-2.21); IC 0.80 (0.60-0.99)], haemorrhage [ROR 2.27 (1.86-2.76); IC 0.99 (0.69-1.28)], and obstruction [ROR 2.19 (1.63-2.95); IC 0.96 (0.51-1.40)]. Pharmacovigilance research on the FAERS has revealed a slight increase in reports of GI ulceration, haemorrhage, and obstruction in capecitabine users, which may cause serious or deadly consequences. In addition to the adverse reactions described in the package insert, close attention should be paid to GI obstruction to avoid discontinuation or life-threatening outcomes.

Lidocaine constant rate infusion improves the probability of survival in rabbits with gastrointestinal obstructions: 64 cases (2012-2021).

To determine the survival to discharge rate of rabbits with gastrointestinal obstructions treated with lidocaine constant rate infusion (CRI) and other factors associated with survival. Cases of gastrointestinal obstruction in rabbits (n = 56, including 64 events) that had presented to a veterinary teaching hospital from 2012 to 2021. This was a retrospective study in which data on rabbits with evidence of gastrointestinal obstruction were extracted from veterinary teaching hospital medical records over a 9-year period. Systemic lidocaine treatment, breed, sex, age, temperature at presentation, blood glucose at presentation, and time to discharge or death were evaluated with univariate and multivariate logistic regression to identify factors significantly associated with survival to hospital discharge in rabbits with gastrointestinal obstruction. Comparatively, 89.7% of rabbits treated with lidocaine CRI (n = 39) survived to hospital discharge, while only 56% of rabbits that were not treated with lidocaine CRI (25) survived. In the final multivariate analysis, 2 factors were associated with survival to discharge: rabbits treated with systemic lidocaine and male rabbits had increased odds of survival compared to those not treated with systemic lidocaine and female rabbits, respectively. Results demonstrated that rabbits with gastrointestinal obstruction and treated with a lidocaine CRI were more likely to survive compared to rabbits not treated with lidocaine CRI.

Clinicopathological Factors and Nomogram Construction for Lymph Node Metastasis in Locally Advanced Gastric Cancer.

The research on lymph node metastasis (LNM) in locally advanced gastric cancer (LAGC) infiltrating the subserous tissue and serous membrane (T3-4a) is significantly inadequate. This study aims to explore the clinicopathological factors related to LNM in stages T3 and T4a LAGC, while also developing predictive nomograms. After systematic searching and rigorous screening, 1995 T3 and 1244 T4a LAGC cases who underwent surgery without neoadjuvant or perioperative chemotherapy were selected. The risk factors associated with LNM were identified using both univariate and multivariate logistic regression analyses. Subsequently, the independent variables identified through the multivariate analyses were utilized to construct a nomogram. The incidence of LNM in T3 and T4a LAGC was 77.1% (1539/1995) and 83.8% (1043/1244), respectively. The following factors were found to be independently associated with LNM in T3 LAGC: preoperative serum albumin <41g/L (P=0.007), gastrointestinal obstruction (P<0.001), tumor location (P=0.040), tumor size >4cm (P=0.002), mixed (P=0.001) and undifferentiated histological types (P=0.002), presence of lymphovascular invasion (LVI) (P<0.001) and nerve invasion (P<0.001). Additionally, in T4a LAGC cases, serum albumin < 39g/L (P=0.004), tumor size >6cm (P=0.020), mixed (P<0.001) and undifferentiated histological types (P<0.001), presence of gastrointestinal hemorrhage (P=0.016), neuroendocrine differentiation (P=0.024), and LVI (P<0.001) independently influenced the occurrence of LNM. This study identified the risk factors associated with LNM in T3-4a LAGC cases and constructed nomograms, thereby providing valuable guidance for formulating and implementing a multidisciplinary perioperative treatment program.

Surgical and endoscopic approach to gastrointestinal obstruction caused by a foreign body in dogs: Case report

Surgical and endoscopic approach to gastrointestinal obstruction caused by a foreign body in dogs: Case report