Gastrointestinal Tract Complications Research Articles

Associations between Celiac Disease, Extra-Gastrointestinal Manifestations, and Gluten-Free Diet: A Narrative Overview.

Millions of children and adults worldwide suffer from undiagnosed and untreated celiac disease (CeD). The clinical picture of CeD is highly heterogeneous and comprises manifestations that can affect almost the whole body. This narrative overview is aimed at characterizing diseases and complaints that are associated with unrecognized CeD and that frequently involve sites other than the gastrointestinal (G.I.) tract, i.e., dental, otorhinolaryngological, and ocular complications; skin and hair abnormalities; afflictions of the bones, joints, and muscles; cardiovascular affectations; kidney diseases; neuro-psychiatric disorders; and gynecological-obstetrical manifestations. The association between CeD and extra-GI manifestations is frequently overlooked, which leads to a delay in diagnosis. Most CeD-mediated disorders can be treated with a strict gluten-free diet (GFD), but some of them are irreversible unless CeD is diagnosed in time. Some manifestations can be classified as risk factors for CeD, and CeD screening tests for affected patients should be selectively considered. Apart from gastroenterologists, specialists in other medical disciplines can play an important role in identifying people with unrecognized CeD and may help prevent its progress and long-term complications. Further comprehensive investigations are necessary to clarify the pathogenesis of extra-GI manifestations and the effect of a GFD.

Double Intussusceptions in Peutz-Jeghers Syndrome Patient: A Case Report

Background: Peutz-Jeghers Syndrome is one of the hereditary gastro-intestinal cancer syndrome with characteristic mucocutaneous pigmentation and histologically distinctive hamartomatous polyps in gastro-intestinal tract. Although it is characteristically benign hamartomatous polyp, majority of affected individuals develop symptoms starting from their second decades. We reported a known Peutz-Jeghers Syndrome case developed recurrent polyps leading to double intussusceptions required bowel resection. Multidisciplinary management and patient compliance to surveillance regime are important in managing PJS patients with potential gastro-intestinal tract complications and relative high risk of developing syndrome specific cancers.

Defining the association between the prolonged operative time and 90-day complications in patients undergoing radical cystectomy

ObjectiveRadical cystectomy is a complex lengthy procedure associated with postoperative morbidity. We aimed to assess the operative time (OT) in patients undergoing radical cystectomy and its impact on 90-day postoperative complications and readmission rates. MethodsThe retrospective cohort study included 296 patients undergoing radical cystectomy and urinary diversion from May 2010 to December 2018 in our institution. The OT of 369 min was set as a cutoff value between short and long OT groups. The primary outcome was 90-day postoperative complication rates. Secondary outcomes were gastrointestinal recovery time, length of hospital stay, and 90-day readmission rates. ResultsThe overall incidence of 90-day postoperative complications was 79.7% where 43.2% representing low-grade complications according to the Clavien–Dindo classification (Grade 1 and Grade 2), and 36.5% representing high-grade complications (Grade≥3). Gastrointestinal tract and infectious complications are the most common complications in our data set (45.9% and 45.6%, respectively). On multivariable analysis, prolonged OT was significantly associated with odds of high-grade complications (odds ratio 2.340, 95% confidence interval 1.288–4.250, p=0.005). After propensity score-matched analysis, a higher incidence of major complications was identified in the long OT group 55 (51.4%) compared to 35 (32.7%) in the short OT group (p=0.006). A shorter gastrointestinal tract recovery time was noticed in the short OT group (p=0.009). Prolonged OT was associated with a higher 90-day readmission rate on univariate and multivariate analyses (p<0.001, p=0.001, respectively). ConclusionProlonged OT (>369 min) is associated with an increased risk of postoperative complications and readmission rates. The perception of potential postoperative complications requires careful monitoring of these patients which could translate into better operative outcomes.

An Update on the Generation of the Gastrointestinal Tract in Neonates with Specific Emphasis on the Hurdles Encountered in Feeding Preterm Infants with Associated Complications like Gut, Brain &amp;G-B Axis Generation: A Narrative Review

The 2nd as well as 3rd trimester of pregnancy is key regarding the anatomical along with functional generation of the GIT as well as the correlated digestive functions. Subsequent to premature birth, there is the presence of immaturity of both digestive along with absorptive events as well as that of the GI motility poses considerable hurdles. Information regarding the major generational stages of the events implicated in the digestion along with absorption of protein, carbohydrate as well as lipids and modes of the maturation phases beneath the generation of the gastrointestinal tract (GIT), might help clinical paediatricians regarding maximization of the nutritional management of preterm infants. The immaturity of these GIT systems along with function might possess a negative impact on the designs of gut colonization that biases towards the generation of aberrant microbiome. Hence in turn further aids in the alteration of functional, immune along with neural generation of the gastrointestinal tract (GIT), as well as in particular in preterm infants has been correlated with an escalated risk of GIT complications like Necrotizing enterocolitis(NEC).A greater insight regarding the physiological colonization designs in case of term along with preterm infants might aid in the facilitation of these designs as well as prevention of the microbial disturbances correlated with the generation of the various diseases all through life. Here we have tried to provide full detail over the generational characteristics associated with the maturational properties of the major GIT functions along with their impact subsequent to preterm birth. We have concentrated on the generational variations in case of intestinal digestive along with absorptive events, motility, gut-brain axis(G-B-A) besides gut microbes in preterm besides term infants. Further we have highlighted the pathogenesis of Hirschsprung disease.

Hepatic and gastrointestinal complications after adult cardiac surgery

Background: Gastrointestinal tract (GIT) complications are associated with increased morbidity and mortality after cardiac surgery. Therefore, The goal of this research was to estimate the frequency of GIT and hepatic complications after cardiac surgery and to determine the risk factors for these complications. Additionally, we studied the effect of these complications on the outcomes of surgery.&#x0D; Methods: This longitudinal study included 139 consecutive patients who underwent elective cardiac surgery. Patients were grouped according to the GIT and hepatic complications into two groups. Postoperative outcomes were compared between the two groups. &#x0D; Results The mean age was 59.43 years, and 106 patients were males (76%). The GIT and hepatic complications rate was 15.8% (n= 22). Hepatic dysfunction occurred in 8.6% of cases, GIT bleeding in 2.9%, paralytic ileus in 2.2%, fulminant hepatic failure in 2.2%, and GIT bleeding combined with paralytic ileus in 0.7%. The overall mortality was 7.2 % (n= 10). The mortality rate in patients who developed GIT and hepatic complications was 45.5% (n= 10 out of 22 patients). There was statistically significantly higher mortality (10 (45.5%) vs. 0; P= 0.001), cardiac arrest (10 (45.5%) vs. 3 (2.6%); P= 0.001), and reoperation rate (5 (22.7%) vs. 6 (5.1%); P= 0.005) among patients with GIT or hepatic complications.&#x0D; Conclusion: Patients with hepatic and GIT complications could have higher mortality, morbidity, and longer hospital stay than the non-complicated group.

Characterization of feeding skills and clinical markers of preterm newborns with gastroschisis in a neonatal therapy unit.

To describe the clinical and feeding findings of premature infants with gastroschisis (GTQ) in a neonatal intensive care unit and compare them to preterm infants (NBs) without congenital anomalies. A retrospective case-control study was conducted with 50 premature NBs (25 with GTQ and 25 without comorbidities - control group). The NBs were compared regarding demographic and clinical data: risk of mortality and speech-language assessment (nonnutritive and nutritive sucking). Subsequently, a multiple logistic regression model was applied to determine the variables associated with the negative speech therapy outcome (speech therapy discharge after more than 7 days considering the first speech therapy evaluation). The results of the first analysis indicated that there was a difference between the GTQ and the CG for the following variables: total time in days of hospitalization; use of mechanical ventilation (invasive x noninvasive); days of life on the date of the first speech-language assessment; use of alternative feeding route; and the GTQ group had worse results. The results of the multiple logistic regression indicated that the diagnosis of GTQ, the use of invasive mechanical ventilation, and the absence of adequate intraoral pressure during the first speech-language evaluation were risk factors for a negative speech-language outcome. The feeding skills of preterm infants with QTG are related to the severity of the condition (gastrointestinal tract complications), requiring longer hospitalization, use of invasive mechanical ventilation, prolonged use of alternative feeding route and requiring more speech therapy to start oral feeding.

Catastrophic Upper Gastrointestinal Tract Complications Following Corrosive Ingestion

Ingestion of caustic substances, either acidic or alkali, is a well-known cause of significant mortality and morbidity in the pediatric and adult populations. According to the pH, physical form, amount, and rate of ingestion of these substances, a wide range of immediate as well as possible subsequent chronic complications can result. Some patients may have minimal to mild symptoms. However, others can present with moderate or even serious symptoms, in the form of dysphagia, odynophagia, hoarseness, and epigastric pain. Herein we present a case of a 26-year-old male patient with a history of Nitric acid ingestion. He initially complained of severe chest and abdominal pain, associated with hematemesis, dysphagia, odynophagia, hypersalivation, and inability to tolerate oral intake. Initial Esophagogastroduodenoscopy (EGD) showed diffuse mucosal ulceration reaching the second part of the duodenum. Multiple subsequent EGDs revealed more extensive damage and subsequent esophageal stricture and pyloric stenosis for which multiple dilatation attempts were done. The patient received extensive supportive management during his hospitalization course, but the damage was severe enough that he was referred for surgical management. Such catastrophic sequels of caustic ingestion are still encountered, especially in developing countries. We present this case looking forward to raising awareness about this dangerous phenomenon and highlighting the significance of immediate identification and grading of the injury.

Surgical implications of HIV infection

According to the joint United Nations Programme on HIV/AIDS (UNAIDS), 37.7 million adults and children worldwide were estimated to be living with HIV or acquired immune deficiency syndrome (AIDS) at the end of 2020 [UNAIDS. (2022). http://www.unaids.org . Accessed 30 May 2022]. Most reside in low- and middle-income countries, with approximately 67% in sub-Saharan Africa (SSA). At the end of 2020, the total number of children less than 15years of age living with HIV infection was 2.6 million, of whom 2.3 million (88%) were living in SSA. Aggressive interventions have reduced the annual number of incident (new) HIV infections among children to around 150,000 [UNAIDS. (2022). http://www.unaids.org . Accessed 30 May 2022]. However, paediatric HIV infection remains a pandemic affecting children predominantly in SSA but is also seen in Asia and sporadically elsewhere particularly in areas of civil strife such as is currently the case in Ukraine [War in Ukraine. (2022). https://www.unaids.org/en/War-Ukraine-special . Accessed Apr 2022]. New HIV infections among children declined by more than half (54%) from 2010 to 2020, due mainly to the increased provision of antiretroviral therapy to pregnant and breastfeeding women living with HIV [UNAIDS. (2022). http://www.unaids.org . Accessed 30 May 2022]. These programmes include early identification of HIV infection in pregnant or breastfeeding women through routine HIV testing, provision of antiretroviral therapy (ART) to all HIV-infected women who are pregnant or breastfeeding, provision of antiretroviral prophylaxis to their newborn infants during the first 6-12weeks of life, delivery by elective Caesarean section when indicated, promotion of exclusive breastfeeding, early infancy screening for HIV infection, and initiation of ART in infants with HIV infection. HIV-infected children may require surgery either as an emergency to deal with a life-threatening incidental condition unrelated to HIV infection or for a complication of the disease such as tuberculosis or an aggressive soft tissue infection like necrotising fasciitis. Non-emergency surgical procedures may be required to assist in the diagnosis of an HIV-related condition or to correct a routine surgical problem electively. Surgical conditions associated with HIV infection are described under categories of soft tissue or organ-specific infections requiring drainage or debridement; gastrointestinal tract disease and complications; infections in the perineal area; malignancies and HIV-associated vasculitis. Although surgical outcomes are less favourable in HIV-infected children, pre-operative treatment of coinfections, administration of cotrimoxazole prophylaxis, nutritional support and antiretroviral therapy, together with peri-operative antibiotic prophylaxis have resulted in excellent short-term outcomes [World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach, June 201 http://www.apps.who.int/iris/bitstream/10665/85321/1/9789241505727_eng.pdf?ua=1 ; World Health Organization Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV, September 2015. http://www.apps.who.int/iris/bitstream/10665/186275/1/9789241509565_eng.pdf?ua=1;Eley et al. in BMC Infect Dis 2:3, 2002;Karpelowsky et al. in Pediatr Surg Int 28:1007-1014, 2012;].

Formulation and Evaluation of Flurbiprofen Topical Emulgels

Topical drug delivery has been used for centuries for the treatment of local skin disorders. Emulgel have emerged as one of the most interesting topical delivery system as it has dual control release system i.e. gel and emulsion. One side the topical applications of the drug offers the potential advantages of delivering the drug directly to the site of action and secondly delivering the drug for extended period of time at the effected site. Topical non-steroidal anti-inflammatory drug (NSIAD) formulations are designed to deliver therapeutic levels of the active ingredients to the inflamed tissue without elevating serum levels after application on the skin. This route is an attractive alternative to the oral administration of NSAIDS which is associated with high incidence of gastrointestinal tract (GIT) complications and other systemic toxic effects. Flurbiprofen is a potent non-steroidal anti-inflammatory agent usually well tolerated as compared to other NSAIDS product. It has analgesic and antipyretic properties. It is used in the treatment of rheumatic disorders such as ankylosing spondilities, oesteoarthritis and intraoperative miosis. It suffers from major GIT disturbances. The aim of the present study was to develop an emulgel formulation of flurbiprofen using water soluble polymer of hydroxy propyl methyl cellulose (HPMC K100M), carbopol 940, carbopol 941 and xanthan gum. Oleic acid and propylene glycol were used as permeation enhancers. The influence of the type of the gelling agent on the drug release from the prepared emulgel was investigated. The prepared emulgels were evaluated for their physical appearance, pH determination, viscosity, spreadability, extrudability, in-vitro drug release, ex-vivo drug release and stability. All the prepared emulgels showed acceptable physical properties, homogeneity, consistency, spreadability, viscosity and pH value. The emulgels were found to be stable with respect to physical appearance, pH, and rheological properties and drug content at all temperature and conditions for one month. Keywords: Emulgel, Topical drug delivery, Flurbiprofen, Carbopol, Hydroxy propyl methyl cellulose

Ischemic stroke and concomitant gastrointestinal complications- a fatal combination for patient recovery.

Stroke is primarily a neurodegenerative disease but can also severely impact the functions of other vital organs and deteriorate disease outcomes. A malfunction of the gastrointestinal tract (GIT), commonly observed in stroke patients, is often characterized by severe bowel obstruction, intestinal microbiota changes and inflammation. Over-activated immune cells after stroke are the major contributors to endorse intestinal inflammation and may induce damage to single-layer epithelial cell barriers. The post-stroke leakage of intestinal barriers may allow the translocation and dissemination of resident microflora to systemic organs and cause sepsis. This overshooting systemic immune reaction fuels ongoing inflammation in the degenerating brain and slows recovery. Currently, the therapeutic options to treat these GIT-associated anomalies are very limited and further research is required to develop novel treatments. In this mini-review, we first discuss the current knowledge from clinical studies and experimental stroke models that provide strong evidence of the existence of post-stroke GIT complications. Then, we review the literature regarding novel therapeutic approaches that might help to maintain GIT homeostasis and improve neurological outcomes in stroke patients.

Predictors of relapse in granulomatosis with polyangiitis: a multi-center study

BackgroundGranulomatosis with polyangiitis (GPA) is a rare systemic vasculitis. Its severity ranges from indolent disease to fulminant that may cause death. With treatment, remission is seen in more than 80% of cases, although relapse is still common. There have been studies showing that there may be factors to predict relapse in GPA. Based on relapses, the decision to start treatment and/or to monitor the patients more closely is made. Therefore, predicting the relapse of GPA can be effective in controlling the disease. Our aim was to investigate possible factors for relapse in GPA.We recruited 254 patients diagnosed with GPA who were under treatment at Alzahra hospital affiliated to Isfahan University of Medical Sciences (from 2013 to 2020) and Amir Alam Hospital affiliated to Tehran University of Medical Sciences (from 2020 to 2022) to plan a retrospective study. Chi-squared or Fisher’s exact tests were performed to compare categorical variables, while the Mann–Whitney U test was used to compare continuous variables.ResultsAnalysis of our patients (aged 20–80,122 females) showed that 147 patients (57.9%) experienced relapse. Mean age in relapse group was 43.8 ± 16.6 and in no-relapse group was 45.6 ± 15.1 (P > 0.05). Among many potential predictors, we observed in multivariate analysis that positive PR3-ANCA (proteinase 3-antineutrophilic cytoplasmic antibodies) (P = 0.007, OR:2.62,CI:1.29–5.31),nose manifestations (P = 0.004, OR 3.00, CI 1.43–6.26), mucosal membranes involvement (P = 0.009, OR 4.21, CI 1.43–12.38), and gastrointestinal tract (GI) complications (P = 0.03, OR 5.64, CI 1.14–27.90) were significant predictors of GPA relapse.ConclusionAmong clinical and laboratory features we studied, positive PR3-ANCA, nose manifestations, mucosal membranes involvement, and GI complications were independent predictors of relapse in patients with GPA.

Life threatening gastrointestinal tract complications in a patient of rheumatoid arthritis. Is it drug or disease related?

Introduction: Gastrointestinal (GI) complications are very frequent and sometimes fatal in patients with Rheumatoid Arthritis (RA). Gastrointestinal perforation is a rare but serious event, most frequently involving the lower GIT, which has been observed in patients with RA.&#x0D; Case Presentation: We present here an Adverse Drug Reaction (ADR) which is small bowel ischemia with perforation in a 61-year-old RA patient, who was taking a tablet of Prednisolone and tablet Hydroxychloroquine.&#x0D; Discussion: Several studies indicated that RA patients may be at a higher risk of GI perforation. This could be attributed to the disease pathophysiology or the use of drugs for treatment like Glucocorticoids and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Rheumatologists must be vigilant for GI complications while prescribing anti-rheumatoid drugs.&#x0D; Conclusion: GI perforations are rare events in RA patients, but cause significant morbidity and mortality. Increasing age and other comorbid conditions also increase the risk of adverse GI events.

Gastrointestinal Complications Associated With Non-steroidal Anti-inflammatory Drug Use Among Adults: A Retrospective, Single-Center Study.

BackgroundTraditional non-steroidal anti-inflammatory drugs (NSAIDs) are recognized to injure the upper gastrointestinal tract (GIT) mucosa. For example, gastric mucosal hemorrhages can be caused by a single dose of 650 mg of aspirin. Nearly 30% to 50% of NSAID users showed endoscopic lesions including subepithelial hemorrhages, erosions, and ulcerations. These lesions are often asymptomatic and are mostly found in the gastric antrum. With the chronic exposure, the mucosa adapts to the aggression of the NSAIDs, whereby these lesions slowly lessen or fade.AimThe aim of this study is to detect the association between NSAIDs and gastrointestinal complications among the general population in the Aseer region, Saudi Arabia.MethodologyA record-based retrospective study was conducted targeting people with GIT complications who were 20 years old and above. We reviewed patients' records from the GIT clinic in the Aseer region of Saudi Arabia. We reviewed specifically patients who had GIT complications like gastritis, abdominal pain, GIT bleeding, heartburn, nausea, vomiting, peptic ulcer, and diarrhea. Then we contacted those patients individually to fill out a questionnaire. Participants less than 18 years, those who refused to complete the questionnaire, or any patients with no history of GIT complications were excluded. An online questionnaire was sent to the patients with GIT complications. The questionnaire included participant's personal data, NSAID use, and associated GIT complications. The questionnaire was uploaded online using social media platforms by the researchers and their relatives and friends during the period from March 2012 to May 2022.ResultsA total of 211 participants with GIT complications completed the study questionnaire. Participant ages ranged from 20-59 years with a mean age of 31.2 ± 12.9 years old. A total of 140 (66.4%) were males and 175 (82.9%) were from urban areas. A total of 156 (73.9%) were non-smokers. A total of 103 (48.8%) participants used NSAIDs. As for complications, the most reported were peptic ulcer (37.9%), GIT bleeding (5.8%), GIT erosions (4.9%), and intestinal obstruction (3.9%) while 59.2% had no complications.ConclusionsThe current study revealed that nearly one out of every two participants in the Aseer region mainly used NSAIDs as tablets for pain. Regarding high utilization rates, less than half of them developed GIT complications, mainly peptic ulcers.

Atrophic papulosis (Köhlmeier–Degos disease) revisited: a cross‐sectional study on 105 patients

Atrophic papulosis is a very rare vascular disease of unknown pathogenesis, mostly described by case reports. To assess demographic data and prognosis in patients with atrophic papulosis. A single-centre study was performed on a series of 105 patients with atrophic papulosis, diagnosed 2000-2021. Patients were referred and diagnosed at the evaluation centre and patients' clinical data were provided by the Degos Support Network and evaluated by the authors for confirming the diagnosis of skin lesions and fulfilling the diagnostic criteria for a malignant subset. A unique set of variables were collected from all patients. The mean age of disease onset was 33.3 ± 18.3 years and the male-to-female ratio was 1:1.6. The family history rate was 8.1%. The classification into a benign, merely cutaneous disease (benign atrophic papulosis), and malignant atrophic papulosis, associating cutaneous and visceral lesions was confirmed due to their striking prognostic difference. Benign atrophic papulosis was detected in 41% of the patients with no deaths occurring throughout the follow-up period (median 3.00 years; range 0.13-23). Malignant atrophic papulosis was reported in 59% of patients with 47.5% multisystemic involvement and a median skin lesion onset to systemic symptoms duration of 0.54 years (-6 to 20). The gastrointestinal tract and central nervous system were equally involved; however, the neurological involvement-caused death rate was slightly higher. The disease-specific mortality rate of malignant atrophic papulosis was 22.6%. Atrophic papulosis presents with a striking prognostic difference of benign - merely cutaneous - involvement or quickly developing - into less than 1 year - malignant subset, associating cutaneous and visceral lesions and multiorgan involvement in 1/2 of the patients, which leads to premature, disease-specific mortality in 1/4 of the cases. Central nervous system and gastrointestinal tract complications are the major reasons for disease-specific death. Over the years, the diagnosis of severe nervous system involvement has become more common.

Gastrointestinal Tract Complication Following Accidental Ingestion of Multiple Neodymium Magnets Requiring Surgical Intervention in an 8-year-old Boy

Gastrointestinal Tract Complication Following Accidental Ingestion of Multiple Neodymium Magnets Requiring Surgical Intervention in an 8-year-old Boy

Evaluation of serum total sialic acid in moderate COVID-19 patients with and without gastrointestinal tract manifestations

BackgroundIt is known that SARS-CoV-2 mostly infects the respiratory system causing pneumonia; although it can also affect the gastrointestinal tract (GIT), which covered with a bi-layer of mucus rich in glycosylated proteins that terminated by sialic acid. Therefore; this study aimed to evaluate serum total sialic acid (TSA) in moderate COVID-19 patients with and without GIT manifestations. MethodsA total of 161 moderate COVID-19 patients without and with GIT manifestations and 50 controls were enrolled into our study. Serum electrolytes levels were measured by using colorimetric or turbidmetric commercial assay kits, while the level of serum TSA was measured by using a commercial ELISA kit. ResultsOur results showed that serum TSA level was highly significantly increased in moderate COVID-19 patients with GIT manifestations (81.43 ± 8.91) when compared with controls (61.24 ± 6.41) or even moderate COVID-19 patients without GIT manifestations (69.46 ± 7.03). ROC curve analysis showed that AUC for TSA is 0.84 with 76.2 % sensitivity and 73.7 % specificity in discrimination between moderate COVID-19 patients with and without GIT manifestations. Serum potassium and sodium levels were highly significantly decreased in moderate COVID-19 patients with GIT manifestations when compared with controls or even moderate COVID-19 patients without GIT manifestations; while serum calcium level was found to be significantly decreased in moderate COVID-19 patients with GIT manifestations when compared with controls. ConclusionFinally, we can conclude that SA plays a crucial role in the pathogenesis of GIT complications associated with COVID-19 and could be a potential biomarker for the COVID-19 gastrointestinal complications.

Laparoscopic-assisted removal of multiple ingested magnets: An unusual and unique operative finding

Ingestion of two or more than two magnets is, almost never an innocent occurrence, because these are almost always associated with health morbidity, related to gastrointestinal tract complications. Children are more prone to this potentially life threatening hazard. Herein, we are presenting a unique case of three year old boy who ingested three magnetic beads one month back and presented with complaint of abdominal pain only with no other signs and symptoms. The magnetic objects were retrieved by laparoscopic assistance from gastro-colic ligament.

Early cytomegalovirus reactivation after heart transplantation: A case report and literature review

Reactivation of cytomegalovirus is one of the most significant morbidities in solid organ transplant recipients. Reports describing the risk factors for cytomegalovirus reactivation in heart transplantation are scarce. We present a case in which viral reactivation 9 days after heart transplantation resulted in cytomegalovirus enterocolitis. Before transplantation, the patient received extracorporeal membrane oxygenation. Cytomegalovirus reactivation occurred under prophylactic medication with valganciclovir and progressed to cytomegalovirus enterocolitis, complicated by ischemia and a small bowel perforation. The patient died of repeated septic shock, severe gastrointestinal tract complications, and cytomegalovirus hepatitis. A review of 70 heart transplant recipients at our hospital from 2005 to 2020 revealed that cytomegalovirus reactivation occurred more frequently in those who received pretransplantation extracorporeal membrane oxygenation than in those who did not (36.4% vs. 6.8%, P = 0.018). This finding suggests that early diagnosis and prompt management of cytomegalovirus reactivation in patients receiving extracorporeal membrane oxygenation as a bridge to heart transplantation is crucial.

Surgical treatment of children with complications of foreign bodies of the gastrointestinal tract

Introduction. At the present time the expansion of the spectrum of urgent diseases of the abdominal cavity organs is registered due to the patients with complications of foreign bodies of the gastrointestinal tract. Development of rational treatment-diag nostic algorithm will promote to improve the results of surgical treatment of children with complications of foreign bodies of gastrointestinal tract.Aim. To determine the efficacy of laparoscopic techniques in children with complications of foreign bodies of the gastrointestinal tract..Materials and methods. 38 children with foreign bodies of the gastrointestinal tract of different characteristics, which required surgical treatment, were included in the study.Results and discussion. On the basis of analysis of clinical and medical history data, results of instrumental methods of preoperative diagnostics and laparoscopy three clinical stages of the disease were distinguished. Statistically reliable differences of the presented indicators in different terms of the disease were proved. Surgical intervention involved laparoscopy, during which the volume of surgical intervention was specified. Laparoscopic techniques were effective in the groups of patients with I, II and III stages of the disease in 100, 46 and 20% of observations, respectively.Conclusions. Clinical manifestations in complications of foreign bodies of the gastrointestinal tract are determined by the characteristics of the latter and the clinical stage of the disease. Laparoscopic techniques can be effective at initial stages of the disease. At a complicated course of the disease the required volume of surgical intervention can be performed during laparotomy. The variety of clinical manifestations of foreign bodies of the gastrointestinal tract complications is determined by the characteristics of the damaging agents and the clinical stage of the disease. Laparoscopic techniques of surgical treatment may be a priority in the absence of a complicated course of the disease; in late stages of the disease laparotomy is the operation of choice.Conclusion. Analysis of treatment results of children with complications of FBs of GIT revealed statistically significant differences in some clinical and anamnestic data, results of instrumental methods of preoperative diagnosis and intraoperative manifestations, which allowed us to define three clinical stages of the disease.

Imaging spectrum of abdominal manifestations of COVID-19.

Coronavirus disease 2019 (COVID-19) has posed a serious threat to global public health with its rapid spread, high fatality, and severe burden on health care providers all over the world. Although COVID-19 has been established as a respiratory tract infection, it can manifest with gastrointestinal symptoms as a consequence of direct infection by the virus or due to inflammation-mediated cytotoxicity. It has been observed that COVID-19 patients presenting with gastrointestinal symptoms tend to progress to a severe form of disease with increased morbidity and mortality, thus indicating the need for timely management. COVID-19 manifests with a wide spectrum of radiologic findings on gastrointestinal tract imaging, encompassing bowel abnormalities, hepato-biliary and pancreatic involvement, vascular occlusion, and solid organ infarction. Early recognition of these imaging features can facilitate timely treatment of COVID-19 associated gastrointestinal tract complications and may prompt the diagnosis of COVID-19 in patients with atypical disease manifestations. The aim of this article is to provide an overview of the various gastrointestinal imaging manifestations that can be encountered in patients with COVID-19, with an emphasis on early diagnosis of the disease as well as treatment related complications.