Gastrointestinal Tract Surgery Research Articles

Entero-Cutaneous and Entero-Atmospheric Fistulas: Insights into Management Using Negative Pressure Wound Therapy.

Enteric fistulas are a common problem in gastrointestinal tract surgery and remain associated with significant mortality rates, due to complications such as sepsis, malnutrition, and electrolyte imbalance. The increasingly widespread use of open abdomen techniques for the initial treatment of abdominal sepsis and trauma has led to the observation of so-called entero-atmospheric fistulas. Because of their clinical complexity, the proper management of enteric fistula requires a multidisciplinary team. The main goal of the treatment is the closure of enteric fistula, but also mortality reduction and improvement of patients' quality of life are fundamental. Successful management of patients with enteric fistula requires the establishment of controlled drainage, management of sepsis, prevention of fluid and electrolyte depletion, protection of the skin, and provision of adequate nutrition. Many of these fistulas will heal spontaneously within 4 to 6 weeks of conservative management. If closure is not accomplished after this time point, surgery is indicated. Despite advances in perioperative care and nutritional support, the mortality remains in the range of 15 to 30%. In more recent years, the use of negative pressure wound therapy for the resolution of enteric fistulas improved the outcomes, so patients can be successfully treated with a non-operative approach. In this review, our intent is to highlight the most important aspects of negative pressure wound therapy in the treatment of patients with enterocutaneous or entero-atmospheric fistulas.

Influence of various positive airway pressure levels on catheterization of the right internal jugular vein

Background: Central venous catheterization is a commonly used method of administering drugs and measuring central venous pressure during major surgery. Chronic obstructive pulmonary disease, acute respiratory distress syndrome, and obstructive sleep apnea are among the respiratory disorders that can be treated with positive airway pressure (PAP). While PAP therapy benefits patients with respiratory disorders, its impact on central venous catheterization must be more adequately studied, particularly in the right internal jugular vein (RTIJV). Aims and Objectives: The study aimed to predict the most applicable PAP for RTIJV catheterization and to evaluate the complications with different airway pressures. Materials and Methods: This study was conducted using a comparative prospective randomized control trial study design in a tertiary care hospital. One hundred participants were selected from subjects who came for gastrointestinal tract surgery and urological surgery, and they were randomized through a computer-generated random number table. Results: Participants were divided into four different groups (A, B, C, and D), and they were subjected to four pressures 0 cmH2O, 10 cmH2O, 15 cmH2O, and 20 cmH2O, respectively. The cross-sectional area of RTIJV is significantly increased in Groups C and D compared to Groups A and B. The number of completed catheterizations was higher in Groups C and D. The number of first-pass punctures was also higher in Groups C and D. Depth of needle insertion is significantly reduced with increased pressure. Conclusion: Moderate-to-high PAPs, specifically around 15 cmH2O to 20 cmH2O, boost catheterization success. This is achieved through improved vein dilation, enhanced accuracy, and decreased needle insertion depth.

Added value of positive intraluminal contrast CT over fluoroscopic examination for detecting gastrointestinal leakage after gastrointestinal surgery

We aimed to evaluate the added value of positive intraluminal contrast computed tomography (CT) over fluoroscopy in detecting anastomotic leakage after gastrointestinal (GI) surgery. A total of 141 GI surgery patients who underwent fluoroscopic examination and CT were included. Two radiologists reviewed the fluoroscopic images with and without CT to determine anastomotic leakage on a 5-point confidence scale and graded the leakage on a 4-point grading system. The hospital stay duration and treatment type were recorded. The radiologists’ diagnostic performance in determining leakage was compared using the receiver operating characteristics analysis, and interobserver agreement was analyzed. Fifty-three patients developed GI leakage. When CT was added to the fluoroscopic images, the area under the curve (AUC) values significantly increased for both reviewers. The interobserver agreement for leakage between the two reviewers was excellent and improved with the addition of CT (weighted kappa value, 0.869 versus 0.805). Postoperative intervention was more frequently performed (P < 0.001), and patients with leakage had a significantly longer mean postoperative hospital stay (45 days vs. 27 days) (P = 0.003). Thus, positive intraluminal contrast CT provides added value over fluoroscopic examination for detecting GI leakage in patients undergoing GI tract surgery, increasing AUC values, and improving interobserver agreement.

Conventional versus enhanced recovery after surgery protocols in emergency gastrointestinal tract surgery: a randomized clinical trial

Background Compared with elective operations, emergency abdominal surgery is more likely to result in perioperative morbidity and mortality. Implementation of care programs could be beneficial for such patients to decrease complication rates. Enhanced recovery after surgery (ERAS) is a complex perioperative approach that has proven its efficacy in multiple elective procedures. Nonetheless, its efficacy in emergency abdominal surgery has been questioned. Herein, we compared the ERAS and conventional approaches in the management of such patients. Patients and methods Sixty adult patients were enrolled in our randomized prospective trial, and they were assigned to two groups; the conventional and ERAS groups. The duration of hospitalization was the main outcome. Results Preoperative characteristics, presentation, and surgical operations were comparable between the two study groups. A perforated duodenal ulcer was the most common diagnosis and was treated by through and through suture with the omental patch (36%) followed by resection anastomosis (36%) in patients with ischemic loop or patients with severely injured loops, and primary repair in simple injury (28%). The hospitalization period decreased significantly in ERAS patients (5.9 vs. 10.5 days in the conventional group P&lt;0.001). The ERAS protocol had a significant beneficial impact on postoperative recovery, which manifested in earlier nasogastric tube removal, drain removal, bowel sounds, bowel motion, and oral intake compared with the conventional group. The incidence of postoperative complications especially surgical site infection increased significantly with the conventional perioperative regimen (36.7% vs. 13.3% after ERAS P=0.034). Conclusion ERAS has multiple advantages over the conventional approach when implemented in emergency surgery patients and is recommended in emergency surgical practice.

Identification of Risk Factors for Intra-Abdominal Candidiasis.

Background: Intra-abdominal candidiasis (IAC) is associated with substantial morbidity and mortality in hospitalized patients. Identifying high-risk populations may facilitate early and selective directed therapy in appropriate patients and avoid unwarranted treatment and any associated adverse effects in those who are low risk. Patients and Methods: This retrospective, case-control study included patients >18 years of age admitted from July 1, 2010 to July 1, 2021 who had a microbiologically confirmed intra-abdominal infection (gastrointestinal culture positive for either a Candida spp. [cases] or bacterial isolate [controls] collected intra-operatively or from a drain placed within 24 hours). Patients receiving peritoneal dialysis treatment or with a peritoneal dialysis catheter in place or treated at an outside hospital were excluded. Multivariable regression was utilized to identify independent risk factors for the development of IAC. Results: Five hundred twenty-three patients were screened, and 250 met inclusion criteria (125 per cohort). Multivariable analysis identified exposure to corticosteroids (odds ratio [OR], 5.79; 95% confidence interval [CI], 2.52-13.32; p < 0.0001), upper gastrointestinal tract surgery (OR, 3.51; 95% CI, 1.25-9.87; p = 0.017), and mechanical ventilation (OR, 3.09; 95% CI 1.5-6.37; p = 0.002) were independently associated with IAC. The area under the receiver operating characteristic (AUROC) and goodness of fit were 0.7813 and p = 0.5024, respectively. Conclusions: Exposure to corticosteroids, upper gastrointestinal tract surgery, and mechanical ventilation are independent risk factors for the development of microbiologically confirmed IAC suggesting these factors may help identify high-risk individuals requiring antifungal therapy.

A PROSPECTIVE STUDY OF ELECTROLYTE IMBALANCE AND ITS MANAGEMENT IN GASTROINTESTINAL SURGERY

Objective: The objective is to study electrolyte imbalance and its management in gastrointestinal (GI) surgery. Methods: The present study was carried out in the Department of Surgery, S.P. Medical College and P.B.M Hospital, Bikaner. This is a prospective descriptive study and was carried out between December 2021 and November 2022 including 100 cases operated for GI tract surgeries (both elective and emergency). Results: Out of 100 patients, 54% patient had electrolyte imbalance and required correction for same. 46% of patients had normal serum electrolytes post-operatively. The most common electrolyte imbalance observed is hyponatremia (30%) followed by both hypokalemia and hyponatremia (14%). We observed that the most common surgical interventions which had electrolyte imbalance were ileostomy patients (84%) followed by resection and anastomosis of bowel (70%). Conclusion: Patients who had electrolyte imbalance were found to have more post-operative complications, longer hospital stay, and probably had an association with mortality. Early diagnosis, aggressive resuscitation, and timely definitive surgical treatment along with correction of electrolyte imbalance are essential to decrease the incidence of morbidity and mortality associated with electrolyte imbalance.

Effect of oral function and postoperative eating patterns on salivary bacterial counts in gastrointestinal tract surgery patients: A preliminary study

Background/purposePerioperative oral care is widely provided to prevent postoperative pneumonia and surgical site infections in patients undergoing surgery under general anesthesia. However, there is a lack of clarity regarding the kind of oral care that should be provided for different patients. The purpose of this study was to clarify the factors that influence the increase in salivary bacterial counts before and after gastrointestinal surgery to identify patients with a particular need for oral care. Materials and methodsTwenty patients undergoing gastrointestinal surgery were examined before surgery for denture use, number of remaining teeth, regular dental care, Oral Hygiene Index-Simplfied tongue coating, tongue pressure, bite pressure, masticatory efficiency, and dry mouth. Saliva samples were collected before surgery, in the fasting period after surgery, and in the oral feeding period. Total bacterial counts were determined by real-time PCR, and factors associated with bacterial counts were investigated. ResultsPatients with decreased oral functions, such as tongue pressure, bite pressure, and masticatory efficiency, tended to have higher salivary bacterial counts in the preoperative, fasting, and oral feeding periods. Regarding the pre- and postoperative changes, salivary bacterial counts increased in the fasting period compared to the pre-operative period and returned to preoperative values in the oral feeding period. ConclusionPerioperative oral care is important for patients with reduced oral function because the number of bacteria in saliva tends to be higher in such patients. As the number of bacteria in saliva increases during the fasting period, oral care is important, and oral feeding should be restarted as soon as possible.

Comparison of ultrasound-guided versus conventional technique for caudal block in paediatric patients

Caudal blocks have been recommended for surgical procedures mainly below umbilicus. Their use has increased in paediatric cases as they are easy to perform with low complication rates. There have been reports of this technique being performed as a sole anaesthetic in children who may not be a suitable candidate for general anaesthesia. This study was conducted with an aim to compare the traditionally used landmark guided technique of caudal block with ultrasound-guided technique in terms of intra-operative analgesia, haemodynamic parameters, time required to perform block and demand for rescue analgesia.This prospective randomized comparative study was carried out in 68 paediatric patients divided in two study groups (Group C and Group U) undergoing elective lower gastrointestinal and genito-urinary tract surgeries over a period of two years in a tertiary care hospital.The intra-operative haemodynamic parameters were comparable in both the groups. There was a significant increase in time taken to perform the block in Group U as compared to Group C (6.5 minutes v/s 15 minutes) (p-value &amp;#60;0.001). The success rate at first puncture was 52.2% in Group C and 47.8% in Group U. The majority of patients were relaxed and comfortable in the 1st hour post-operatively. The requirement of rescue analgesia in the post-operative period was comparable in both the groups. The conventional technique is easier and less time consuming as compared to the ultrasound-guided technique, which is newer and the practitioner needs expertise. The quality of analgesia provided by both the techniques is comparable. The frequency of complications associated with the block are fewer with the ultrasound-guided approach. Ultrasonography is the modality of choice specially in cases where detection of sacral anatomy and landmarks is difficult. However, further studies are needed to establish the role of ultrasonography in performing caudal block.

188 Incidence and Root Causes of Surgical Site Infections After Gastrointestinal Surgery at a Public Teaching Hospital in Sudan

Abstract Aim Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays and additional financial burden. Patients undergoing gastrointestinal tract procedures carry a high risk of SSIs. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing gastrointestinal tract surgeries. Method A hospital based, cross-sectional study conducted at Soba University Hospital in Khartoum, Sudan. We included all patients from all age groups attending the gastrointestinal tract surgical unit between September-December 2017. A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p &amp;lt; .05. Results 80 participants were included in the study. (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) underwent large bowel surgery. 27.5% developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p &amp;gt; .001), malignant nature of the disease (p &amp;gt; .001), intra-operative blood loss (p &amp;gt; .001), and intra-operative hypotension (p = .013). The most prevalent microorganism isolated was E coli (47.8%), followed by Enterococcus faecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%). Conclusions The results showed a high prevalence of SSIs among patients attending the gastrointestinal tract surgical unit and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.

Pneumopericardium: A Rare Complication of Antireflux Surgery

Pneumopericardium is a rare clinical entity, occurring in the setting of thoracic trauma, malignancies, or mechanical ventilation. Very few cases report pneumopericardium as a complication of gastrointestinal tract surgery. Signs and symptoms may be frustrating, ranging from asymptomatic to chest pain, sepsis, hemodynamic instability, pericarditis, or even cardiac tamponade. Clinical pathognomonic signs of pneumopericardium include pericardial metallic tinkling friction rub and mill wheel murmur. Diagnostic work-up includes electrocardiogram, chest radiography, and, computed tomography imaging. A gastro pericardial fistula should be considered a rare differential diagnosis for acute chest pain in patients with a history of gastroesophageal surgery. Rapid recognition and treatment avoid life-threatening complications. The successful outcome of gastro pericardial fistula treatment depends on both emergency and definitive surgical management. The survival rate with conservative management is poor. We present the case of a 78-year-old patient suffering from pneumopericardium and pericardial infusion, due to a fibrotic fistula between the Nissen’s valve, occurring 10 years after redo antireflux surgery. Treatment included broad-spectrum antibiotics, and emergency surgery for pericardial drainage, biopsy of the valve’s defect, suture, and omentoplasty.

FTP5.12 Incidence and Root Causes of Surgical Site Infections After Gastrointestinal Surgery at a Public Teaching Hospital in Sudan

Abstract Aim Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays and additional financial burden. Patients undergoing gastrointestinal tract procedures carry a high risk of SSIs. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing gastrointestinal tract surgeries. Methods Hospital based, cross-sectional study conducted at Soba University Hospital in Khartoum, Sudan. We included all patients from all age groups attending the gastrointestinal tract surgical unit between September-December 2017. A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p &amp;lt; .05. Results 80 participants were included in the study. (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) underwent large bowel surgery. 27.5% developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p &amp;gt; .001), malignant nature of the disease (p &amp;gt; .001), intra-operative blood loss (p &amp;gt; .001), and intra-operative hypotension (p = .013). The most prevalent microorganism isolated was E coli (47.8%), followed by Enterococcus faecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%). Conclusions The results showed a high prevalence of SSIs among patients attending the gastrointestinal tract surgical unit and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.

Wound healing responses of urinary extravasation after urethral injury

The post-surgical fluid leakage from the tubular tissues is a critical symptom after gastrointestinal or urinary tract surgeries. Elucidating the mechanism for such abnormalities is vital in surgical and medical science. The exposure of the fluid such as peritonitis due to urinary or gastrointestinal perforation has been reported to induce severe inflammation to the surrounding tissue. However, there have been no reports for the tissue responses by fluid extravasation and assessment of post-surgical and injury complication processes is therefore vital. The current model mouse study aims to investigate the effect of the urinary extravasation of the urethral injuries. Analyses on the urinary extravasation affecting both urethral mesenchyme and epithelium and the resultant spongio-fibrosis/urethral stricture were performed. The urine was injected from the lumen of urethra exposing the surrounding mesenchyme after the injury. The wound healing responses with urinary extravasation were shown as severe edematous mesenchymal lesions with the narrow urethral lumen. The epithelial cell proliferation was significantly increased in the wide layers. The mesenchymal spongio-fibrosis was induced by urethral injury with subsequent extravasation. The current report thus offers a novel research tool for surgical sciences on the urinary tract.

Presentación tardía de una encefalopatía de Wernicke tras gastrectomía por adenocarcinoma gástrico: a propósito de un caso

La encefalopatía de Wernicke es una emergencia neurológica caracterizada por la tríada clínica clásica de oftalmoplejia, ataxia y alteración del estado mental, que conlleva alta morbimortalidad. Se debe a un déficit de la vitamina B1 (tiamina), que en su forma activa desempeña un papel esencial en el metabolismo de neuronas de áreas específicas del cerebro. Aunque el alcoholismo es la causa más frecuente de este déficit, se han descrito numerosos agentes que pueden alterar la biodisponibilidad o el metabolismo de la tiamina (1), entre las que cabe destacar la cirugía del tracto gastrointestinal, sobre todo tras cirugía bariátrica. Por lo general el cuadro se produce entre las semanas cuatro y doce tras la resección, pero excepcionalmente se han descrito casos que ocurren de forma tardía (años). Presentamos el caso de un paciente intervenido de gastrectomía por un adenocarcinoma antropilórico que desarrolló una encefalopatía de Wernicke a los ocho años de la resección quirúrgica.

Absence of an association between gastrointestinal tract surgery and newly diagnosed psoriasis: A nationwide, population-based, nested, case-control study.

Gastrointestinal tract surgeries could disrupt the microbiome and simultaneously cause trauma, which may result in psoriasis. To examine associations between gastrointestinal tract surgeries and newly diagnosed psoriasis. This nested case-control study included patients with newly diagnosed psoriasis from 2005 to 2013, retrieved from the Taiwan National Health Insurance Research Database. We retrospectively (5 years from the index date) determined whether the patients had undergone gastrointestinal tract surgery. We identified 16 655 patients with newly diagnosed psoriasis and matched 33 310 individuals as the control group. The population was stratified by age and sex. There was no association between age and psoriasis (<20 years: adjusted odds ratio [aOR] 0.80, 95% confidence interval [CI] 0.52-1.24; 20-39 years: aOR 1.09, 95% CI 0.79-1.51; 40-59 years: aOR 0.89, 95% CI 0.57-1.39; ≥60 years: aOR 0.82, 95% CI 0.54-1.26). Similar findings were obtained by sex, with no differences among men (aOR 0.90, 95% CI 0.69-1.17) and women (aOR 0.96, 95% CI 0.71-1.29). Our study indicates that gastrointestinal surgeries have limited age- and sex-related effects on psoriasis. These findings provide new insights into the risk of developing psoriasis.

CT characterization of retractor related liver injuries after pancreaticoduodenectomy: Retrospective analysis of a single institution experience

PurposeRetractor related liver injuries (RRLI) are reported after upper gastrointestinal tract surgeries; most commonly laparoscopic cholecystectomy and gastric surgeries. The aim of this study was to characterize the incidence, identification, type, severity, clinical features and risk factors for RRLI after open and robotic pancreaticoduodenectomy. MethodsA 6-year retrospective study of 230 patients was performed. Clinical data was extracted from the electronic medical record. Post-operative imaging was reviewed and graded using the American Association for the Surgery of Trauma (AAST) liver injury scale. Results109 patients met eligibility criteria. RRLI occurred in 23/109 (21.1%), with a higher incidence in the robotic/combinedapproach (4/9) compared with open (19/100). Most common injury was an intraparenchymal hematoma (56.5%), grade II (78.3%), located in segments II/III (77%). 39.1% of injuries were not reported on the CT interpretation. There was a statistically significant elevation of postoperative AST/ALT in the RRLI group [median AST 219.5 vs. 72.0 (p < 0.001), ALT 203.0 vs. 69.0 (p < 0.001)]. Trends toward lower preoperative platelet counts and longer operations were observed in the RRLI group. No significant difference in hospital length of stay or post-operative pain scores were noted. ConclusionRRLI occurred frequently after pancreaticoduodenectomy, however most injuries were low grade and the only clinical significance was a transient increase in transaminases. A trend toward higher injury rates was observed in robotic cases. In this population, RRLI was often unrecognized on postoperative imaging.

Advances in Hydrogel Adhesives for Gastrointestinal Wound Closure and Repair.

Millions of individuals undergo gastrointestinal (GI) tract surgeries each year with common postoperative complications including bleeding, perforation, anastomotic leakage, and infection. Today, techniques such as suturing and stapling seal internal wounds, and electrocoagulation stops bleeding. These methods induce secondary damage to the tissue and can be technically difficult to perform depending on the wound site location. To overcome these challenges and to further advance wound closure, hydrogel adhesives are being investigated to specifically target GI tract wounds because of their atraumatic nature, fluid-tight sealing capability, favorable wound healing properties, and facile application. However, challenges remain that limit their use, such as weak underwater adhesive strength, slow gelation, and/or acidic degradation. In this review, we summarize recent advances in hydrogel adhesives to treat various GI tract wounds, with a focus on novel material designs and compositions to combat the environment-specific challenges of GI injury. We conclude with a discussion of potential opportunities from both research and clinical perspectives.

Risk factor analysis and construction of prediction models for short-term postoperative complications in patients undergoing gastrointestinal tract surgery.

To identify risk factors associated with short-term postoperative complications in patients with gastrointestinal cancer and develop and validate prediction models to predict the probability of complications. A total of 335 patients enrolled in the primary cohort of this study were divided into training and validation sets in a chronological order. Using univariate and multivariate logistic regression analyses, the risk factors for postoperative complications were determined, and nomogram prediction models were constructed. The performance of the nomogram was assessed with respect to the receiver operator characteristic and calibration curves. Patients with complications had a stronger postoperative stress response and a longer duration of daily fluid intake/output ratio >1 after surgery. Logistic analysis revealed that body mass index (BMI), body temperature on POD4 (T.POD4), neutrophil percentage on POD4 (N.POD4), fasting blood glucose on POD4 (FBG.POD4), and the presence of fluid intake/output ratio <1 within POD4 were risk factors for POD7 complications, and that BMI, T.POD7, N.POD7, FBG.POD4, FBG.POD7, and the duration of daily fluid intake/output ratio >1 were risk factors for POD30 complications. The areas under the curve of Nomogram-A for POD7 complications were 0.867 and 0.833 and those of Nomogram-B for POD30 complications were 0.920 and 0.918 in the primary and validation cohorts, respectively. The calibration curves showed good consistency in both cohorts. This study presented two nomogram models to predict short-term postoperative complications in patients with gastrointestinal cancer. The results could help clinicians identify patients at high risk of complications within POD7 or POD30.

S3531 A Rare Cause of Obstructive Jaundice: Afferent Limb Syndrome

Introduction: Afferent limb syndrome (ALS) is a rare but potentially life-threatening complication of upper gastrointestinal (GI) surgery and reconstruction causing distal obstruction of the biliopancreatic limb with subsequent accumulation of bile, pancreatic fluid, and other small bowel secretions upstream afferent limb dilation. It is imperative to recognize this complication postoperatively as buildup in the small bowel can result in bowel perforation requiring emergency surgery. We present a patient who developed ALS after upper gastrointestinal reconstruction with esophagojejunostomy for the treatment of gastric adenocarcinoma. Case Description/Methods: An 84 year-old female with a past medical history of gastric adenocarcinoma with total gastrectomy and esophagojejunostomy presented to the emergency department with a subacute history of upper abdominal pain and new-onset jaundice. Initial labs were notable for elevated liver chemistries including alkaline phosphate level of 435 U/L (normal 39-117 U/L), alanine transaminase of 62 U/L (normal 6-45 U/L), and aspartate transaminase of 36 U/L (normal 10-25 U/L). Abdominal ultrasound demonstrated markedly dilated common bile and intrahepatic ducts and gallbladder distention without stones. CT scan of the abdomen confirmed the ultrasound findings, but also identified a dilated duodenum with an abrupt transition point in the proximal jejunum suggestive of ALS shown in Figure A. The patient underwent open laparotomy which demonstrated multiple tumor implants. A large implant at the site of the previous jejunojejunostomy was identified as the cause of afferent limb obstruction. A palliative bypass was performed. The patient had a complicated post-operative course. Ultimately, due to the extensive disease burden and ongoing patient discomfort, the patient and their family decided to pursue hospice care. Discussion: ALS is a post-operative complication of upper GI tract surgery that involves mechanical obstruction of the biliopancreatic limb. Patients often present with jaundice. CT scan is the preferred diagnostic modality. First-line treatment involves surgery to relieve the obstruction with revision of the prior anastomosis. Although rare, this diagnosis should be considered in appropriate patients.Figure 1.: A: CT scan with markedly dilated intrahepatic and extrahepatic biliary ductal dilation, distended gallbladder, and markedly dilated duodenum with abrupt transition point in proximal jejunum.

Risk Factors for Candidiasis as an Intra-Abdominal Infection after Gastrectomy in Patients with Gastric Cancer.

Intra-abdominal infections (IAIs) develop in 2.4%-26.6% of patients who underwent gastrectomy for gastric cancer and are occasionally serious. However, there are few reports on the causative organisms of IAI following upper gastrointestinal tract surgery and subsequent risk factors for Candida infections. This study aimed to identify the microorganisms that cause IAIs after gastrectomy and risk factors for Candida-related IAI. The records of patients who underwent gastrectomy for gastric cancer between January 2009 and December 2019 at Shizuoka General Hospital were retrospectively collected. Patients with IAIs of grade II or higher, as measured by the Clavien-Dindo classification, were included in the analysis. The selected patients were divided into the Candida and non-Candida groups according to the presence or absence of Candida as the causative organism. Of 1,379 patients, 56 (4.1%) were diagnosed with IAIs after gastrectomy. Fifty-two patients were included in the study based on culture analyses. A total of 111 strains and 28 bacterial species were isolated during the initial culture test. Candida constituted 7.2% of all identified pathogens. Regarding the risk factors for Candida-related IAI, a history of antimicrobial use and ≥ 4 postoperative days of IAI development were independent risk factors for Candida-related IAI.

The Prevalence and Etiology of Surgical Site Infections Following Gastrointestinal Tract Surgery: A Cross-Sectional Study From a Tertiary Care Hospital.

BackgroundSurgical site infection (SSI) is the most commonly occurring infection in postoperative patients. This study is conducted to evaluate the prevalence of SSI in patients following gastrointestinal tract surgery and identify the risk factors.MethodA cross-sectional study was conducted at the Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan, between December 2021 and May 2022. A total of 132 patients participated in the study who were at least 18 years older and had undergone the gastrointestinal surgical procedure. Patients who refused to give consent, died after the procedure, and were diagnosed with SSI after they were discharged were excluded from the study. We performed a chi-squared test.ResultA total of 132 patients were included in the study, of which 63 (47.7%) were males, while 69 (52.3%) were females. SSI was more commonly found among the age group of 41-70 years with 29 (38.7%) patients. Presurgical features including hemoglobin of >11 mg/dL, albumin of >3.5 g/dL, blood glucose of <80 mg/dL, and emergency surgery were found to be associated with the SSI having a significant p-value. Similarly, the surgical and postsurgical features significantly associated with the SSI having a significant p-value were the presence of surgical trauma, wound irrigation with normal saline, malignancy, bowel preparation, longer duration of the surgery, intraoperative hypotension, operative site, drain insertion, and the absence of a second antibiotic.ConclusionThe early identification and management of the demographical, presurgical, surgical, and postsurgical risk factors can help reduce the incidence of SSIs. Bowel preparation should be encouraged, and unnecessary delays during the surgical process leading to increased procedure time should be avoided. Extra precaution needs to be provided for the patients highly susceptible to SSIs.