Incidence Of Perforation Research Articles

Clinico-pathologic characteristics of gastrointestinal perforations from a tertiary care hospital in Pakistan

Background: Hollow viscus perforation is one of Pakistan’s most commonly encountered surgical emergencies. Gastroduodenal perforations account for the most common site of perforations worldwide. However, the Pakistani population has a different pattern. Objective: The aim of this study was to determine the clinico-pathologic features of patients and the effectiveness of surgical options in the emergency management of bowel perforation. Materials and Methods: This retrospective, observational study was conducted at the Department of General Surgery, Unit-III, Lahore General Hospital, Lahore from January 1, 2021 to December 31, 2021. Data on demographic profiles, clinical presentation, risk factors, site of perforation, and surgical details of 73 patients with gastrointestinal perforation admitted via emergency were collected and analyzed using the Microsoft Excel (Microsoft Corp., Redmond, WA) spreadsheet. Results: There were 74% females out of the 73 included cases. Perforation was most common among the age group of 21–25 years. Abdominal pain was present in all patients, followed by vomiting in 46.6% of cases. Guarding was observed as the most common sign in 78.1% of patients. The ileum was the most common site of perforation in 41.1% of cases, while typhoid was the most common cause of bowel perforation in 20.5% of patients. In 42.5% of cases, stoma was made, followed by primary closure in 16.4% of patients. Conclusion: This study shows an increased incidence of perforation in the ileum in the Pakistani population, different from the rest of the world and common in youth. An increased incidence of perforation due to typhoid highlights the prevalence and inadequate treatment of this disease.

Endoscopic "calabash" ligation and resection for small gastric mesenchymal tumors.

Gastric mesenchymal tumors (GMT) are identified as soft tissue neoplasms that arise from mesenchymal stem cells within the gastrointestinal tract. GMT primarily encompass gastric stromal tumors (GST), gastric leiomyomas, and gastric schwannomas. Although most GMT are benign, there are still potential malignant changes, especially GST. Thus, early surgical intervention is the primary treatment for GMT. We have designed a simple endoscopic "calabash" ligation and resection (ECLR) procedure to treat GMT. Its efficacy and safety need to be compared with those of traditional endoscopic techniques, such as endoscopic submucosal excavation (ESE). To assess the safety and effectiveness of ECLR in managing small GMT (sGMT) with a maximum diameter ≤ 20 mm by comparing to ESE. This retrospective analysis involved patients who were hospitalized in our institution between November 2021 and March 2023, underwent endoscopic resection, and received a pathological diagnosis of GMT. Cases with a tumor diameter ≤ 20 mm were chosen and categorized into two cohorts: Study and control groups. The study group was composed of patients treated with ECLR, whereas the control group was composed of those treated with ESE. Data on general clinical characteristics (gender, age, tumor diameter, tumor growth direction, tumor pathological type, and risk grade), surgery-related information (complete tumor resection rate, operation duration, hospitalization duration, hospitalization cost, and surgical complications), and postoperative follow-up were collected for both groups. The aforementioned data were subsequently analyzed and compared. Five hundred and eighty-nine individuals were included, with 297 cases in the control group and 292 in the study group. After propensity score matching, the final analysis incorporated 260 subjects in each cohort. The findings indicated that the study group exhibited shorter operation duration and lowered medical expenses relative to the control group. Furthermore, the study group reported less postoperative abdominal pain and had a lower incidence of intraoperative perforation and postoperative electrocoagulation syndrome than the control group. There were no substantial variations observed in other parameters among the two cohorts. ECLR is a viable and effective approach for managing sGMT.

A comparison of procedure-related adverse events between two right ventricular leadless pacemakers.

The Medtronic Micra VR and Abbott AVEIR VR are the leadless pacemakers (LPM) currently available in the United States (US). Micra VR employs fixation tines and the AVEIR VR uses an active fixation helix. Micra VR requires fixation before electrical measurements are obtained, while R-waves may be mapped by AVEIR VR without fixation. Little comparative data is available for these LPMs. Accordingly, we compared the incidences of procedure-related major adverse clinical events (MACE) and device problems in the US for Micra VR and AVEIR VR during 2022-2024. We searched the FDA's Manufacturer and User Facility Device Experience (MAUDE) database for US reports of MACE and device problems that were filed from April 2022 to December 2023 for AVEIR VR, and from June 2022 to April 2024 for Micra VR. Totals for US-registered LPM implants were obtained from the manufacturers' product performance reports. During the study period, 5990 AVEIR VR and 10 940 Micra VR implants were registered in the US. We found 305 MAUDE reports for AVEIR VR (5.1%), versus 541 MAUDE reports for Micra VR (4.9%) (p = .702). The incidence of MACE was 0.72% (43/5990) for AVEIR VR versus 0.59% (65/10 940) for Micra VR, (p = .387). The incidences of procedure-related death, cardiac perforation. cardiac arrest, emergency pericardial drainage or reparative surgery were similar for both LPMs (p > .05). Micra VR had more unacceptable thresholds requiring LPM replacement compared to AVEIR VR (95;0.9% vs. 24;0.4%; p = .001). AVEIR VR had a statistically higher incidence of device dislodgement during (32) and after (21) implant compared to Micra VR (53 (0.9%) vs. 46 (0.4%), p < .001). Micra VR and AVEIR VR have similar procedural safety profiles, including the incidences of death and perforation. However, device problems differed significantly, possibly related to their design differences. Compared to Micra VR, AVEIR VR appears to have an advantageous threshold measurement capability but is more prone to device dislodgement.

Sinonasal Complications of Combined Transseptal–Transnasal and Bilateral Transnasal Approaches for Endoscopic Endonasal Transsphenoidal Pituitary Surgery

BackgroundThe endoscopic combined transseptal–transnasal technique for pituitary adenoma excision is notable for enhanced postoperative functional outcomes. Our study compared the incidence of anterior nasal septal perforation and the resulting sinonasal complications between this method and the bilateral transnasal approach. MethodsUtilizing a retrospective cohort from a preeminent tertiary referral center, we analyzed 141 cases of endoscopic endonasal transsphenoidal surgery performed between March 2018 and May 2023. Outcomes for the transseptal–transnasal group (n = 71) and the conventional bilateral transnasal group (n = 70) were compared. Nasal endoscopy and computed tomography were used to assess anterior nasal septal perforation. Functional outcomes were assessed preoperatively and at 6 months postoperatively using the Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), Sino-Nasal Outcome Test-22 (SNOT-22), and nasal obstruction symptom evaluation (NOSE) ResultsThe transseptal–transnasal approach exhibited reduced rates of postoperative ear fullness (p < 0.001), along with fewer subjective complaints of smell/taste loss (p = 0.022) and thick nasal discharge (p = 0.008), compared to the conventional approach. However, objective smell test results were not significantly different between the two approaches (p = 0.243 and p = 0.454 for CCCRC and CCSIT, respectively). Additionally, although statistically insignificant, a higher incidence of anterior septal perforation was observed with the transseptal–transnasal approach (p = 0.067). ConclusionFor the surgical treatment of pituitary adenomas, the transseptal–transnasal approach offers several advantages over the bilateral transnasal method, particularly in reducing postoperative complications. However, this technique requires careful attention for preventing the occurrence of anterior septal perforation.

Omental incarceration secondary to uterine perforation after dilatation curettage: Conservative approach in sub-saharan Africa.

Complications of uterine perforation and herniation of intra-abdominal organs into the perforated area may occur after gynecological operations. They can be treated with a conservative approach, especially in cases whose vital signs are stable, laboratory values are within normal limits and their general condition is suitable. We aim to present the conservative treatment without using surgical and medical methods as it is the first case in the literature. Uterine perforation is a rare but potentially serious complication of curettage for gynecologic or obstetric reasons especially during and after operative procedures and the application of intrauterine contraceptive devices. The incidence of uterine perforation during gynecological operations is between 0.002-1.7. A 30-year-old multiparous case with a 7-week 4-day pregnancy was diagnosed with incomplete abortion at an external center due to vaginal bleeding. The case underwent suction curettage. After 24 h, revision suction curettage was performed due to the finding of rest in the endometrium during the ultrasonographic control, and the case was diagnosed with uterine perforation and omental herniation due to this. We highlighted the importance of a thorough gynecological assessment following a dilated suction curettage (D&C) procedure that includes a careful clinical examination and a detailed ultrasound evaluation.

Assessment of acute radial artery injury after distal transradial access for coronary intervention: an optical coherence tomography study.

There is a paucity of data on acute radial artery (RA) injuries using optical coherence tomography (OCT) in patients undergoing coronary intervention via distal transradial coronary access (dTRA). To evaluate the incidence of acute RA injury following dTRA for coronary intervention using OCT. We retrospectively analyzed 200 consecutive patients with acute coronary syndrome (ACS) who underwent coronary intervention guided by OCT and RA-OCT after dTRA at our center between June 2021 and November 2022. Total length of RA was divided into three segments based on the sheath location during dTRA: no sheath protection portion (proximal RA segment) and sheath protection portion (divided into mid- and distal segments). Acute RA injuries, including tears, dissections, perforations, thrombi, and spasms, were analyzed. Radial artery occlusion (RAO) was assessed using ultrasonography 24h after dTRA. Acute RA injury was observed in 45.5% of patients after dTRA. The incidence of tear, dissection, perforation, thrombi, and spasm in all the patients was 11.5%, 16.5%, 1.5%, 17.5%, and 17.5%, respectively. In segment-level analysis, dissection and spasm were significantly more frequent in the proximal segment, followed by the mid and distal segments (11.0% vs. 5.5% vs. 4.5%, P = 0.015; 13.0% vs. 4.0% vs. 4.5%, P = 0.002). The rate of RAO at 24-h follow-up was 3.0%. Acute RA injuries were observed in nearly half of the patients using OCT via dTRA; dissection and spasm occurred more frequently in the proximal segment. Hydrophilic-coated sheaths have the potential advantage of preventing radial artery spasm and dissection.

Optimizing Outcomes: Bevacizumab with Carboplatin and Paclitaxel in 5110 Ovarian Cancer Patients-A Systematic Review and Meta-Analysis.

The study aimed to evaluate the efficacy and safety of incorporating bevacizumab into the combination therapy of carboplatin and paclitaxel for epithelial ovarian cancer and other clinical applications. A systematic review was conducted following PRISMA guidelines using keyword searches in PubMed, Embase, Cochrane Library, CINAHL, ClinicalTrials.gov, and ICTRP until February 2024. Randomized controlled trials (RCTs) comparing carboplatin and paclitaxel with and without bevacizumab in ovarian cancer patients were included. Efficacy outcomes were overall survival (OS) and progression-free survival (PFS), as described by hazard ratios (HRs). Safety outcomes were analyzed with risk ratios (RRs) for 16 adverse events. Seven RCTs (n = 5110) were included. The combination with bevacizumab significantly improved PFS (HR: 0.73; 95% confidence interval: 0.58, 0.92; p = 0.008). The chemotherapy group receiving bevacizumab with carboplatin and paclitaxel showed a significantly higher incidence of hypertension, non-CNS bleeding, thromboembolic events, GI perforation, pain, and proteinuria. The combination of carboplatin, paclitaxel, and bevacizumab improves PFS compared to the regimen without bevacizumab, but it raises significant safety concerns. Clinical management should consider adverse event prevention by vigilantly monitoring blood pressure, signs and symptoms of bleeding, thromboembolism, GI perforation, and pain to balance the therapeutic benefits with the potential risks of this combination therapy.

A novel laser resection approach: efficacy of rotatable bi-channel en bloc resection of bladder tumor in a pilot in-vivo study.

En bloc resection of bladder tumor (ERBT) involves removing bladder tumors and their base. Laser resection has been used to reduce complications including bleeding and obturator nerve reflex (ONR). We developed a novel approach (rotatable bi-channel en bloc resection of bladder tumor (RBC-ERBT)) and assessed its efficacy in a pilot in-vivo study to enhance laser ERBT's applicability in challenging bladder regions. In the laser RBC-ERBT procedure, lesions were excised by inserting a holmium laser through the rotating external working channel, while forceps were inserted through the internal working channel provided traction on the tissue. Fifteen laser RBC-ERBT procedures were performed in five different bladder areas of three live pigs. The technical success rate (TSR), procedure time, lesion size, occurrence of complications (bleeding, perforation, ONR), and detrusor muscle (DM) presence rate and DM thickness were evaluated. All 15 procedures were performed with a 100% TSR. The resections were successful in all bladder regions (posterior, left, right and anterior walls and dome). Median procedure time was 20min. The resected specimen size was 10mm × 7mm to 17mm × 13mm. Mild bleeding occurred in two procedures (13.3%) but was effectively managed. No incidents of ONR or perforation were observed. Histological examination confirmed presence of DM in all specimens with a median DM thickness of 1.26mm. Our pilot in-vivo study suggested the feasibility and effectiveness of laser RBC-ERBT for bladder tumors in various locations. This technique offers effective traction, improved visualization, and enhanced laser accessibility. Further studies are required to validate its effectiveness in humans.

Effect of proton pump inhibitors compared to histamine-2 receptor antagonists on bleeding management and wound healing after endoscopic mucosal resection or endoscopic submucosal dissection: A meta-analysis of randomized clinical trials.

Proton pump inhibitors (PPIs) and histamine type-2 receptor antagonists (H2RAs) are generally effective in preventing delayed bleeding and healing artificial wounds after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). This study aimed to review the therapeutic effects of PPIs and H2RAs on damage caused by EMR and ESD. Thirteen articles were collected between 2002 and 2022 by searching Medlib, ScienceDirect, PubMed, International Scientific Indexing (ISI), Embase, and Scopus databases using valid keywords. The main inclusion criteria were delayed wound healing, bleeding, epigastric pain, intraoperative bleeding, and perforation. The odds ratio (OR) and 95% confidence interval (95% CI) were evaluated using a random or fixed effects model. Data analysis was performed using Stata v. 14.2. A total of 13 articles including 1,483 patients were analyzed. The results showed that delayed bleeding was significantly less frequent in the PPI group than in the H2RA group (OR = 0.6; 95% CI: 0.39-0.92). Subgroup analysis showed that PPI was more effective in preventing delayed bleeding than H2RA for ESD wounds (OR = 0.65; 95% CI: 0.44-1.08). There was no statistically significant difference between both groups regarding the incidence of epigastric pain, intraoperative bleeding, wound healing, and perforation after endoscopic treatments. The meta-analysis results reveal that PPI is more effective than H2RA in preventing delayed bleeding after endoscopic treatment, particularly in patients treated with ESD. However, there was no significant difference between PPI and H2RA in terms of intraoperative bleeding, epigastric pain, wound healing, and perforation from endoscopic therapy.

Reducing Lung Injury from Blind Insertion of Small-Bore Feeding Tubes.

Using a blind insertion technique to insert small-bore feeding tubes can result in inadvertent placement in the lungs, leading to lung perforation and even mortality. In a Magnet-designated, 500-bed, level 2 trauma center, two serious patient safety events occurred in a four-week period due to nurses blindly inserting a small-bore feeding tube. A patient safety event review team convened and conducted an assessment of reported small-bore feeding tube insertion events that occurred between March 2019 and July 2021. The review revealed six lung perforations over this two-year period. These events prompted the creation of a multidisciplinary team to evaluate alternative small-bore feeding tube insertion practices. The team reviewed the literature and evaluated several evidence-based small-bore feeding tube placement methods, including placement with fluoroscopy, a two-step X-ray, electromagnetic visualization, and capnography. After the evaluation, capnography was selected as the most effective method to mitigate the complications of blind insertion. In this article, the authors describe a quality improvement project involving the implementation of capnography-guided small-bore feeding tube placement to reduce complications and the incidence of lung perforation. Since the completion of the project, which took place from December 13, 2021, through April 18, 2022, no lung injuries or perforations have been reported. Capnography is a relatively simple, noninvasive, and cost-effective technology that provides nurses with a means to safely and effectively insert small-bore feeding tubes, decrease the incidence of adverse events, and improve patient care.

Meta-analysis of clinical efficacy and safety of transanal endoscopic microsurgery and endoscopic submucosal dissection in the treatment of rectal tumors.

The aim of the article was to systematically evaluate the clinical efficacy and safety of transanal endoscopic microsurgery (TEM) and endoscopic submucosal dissection (ESD) in the treatment of rectal tumors. Control studies were conducted on cases included in the electronic databases Medline, Embase, Cochrane Library, and CNKI. Patients with colorectal tumors were included in the TEM and ESD groups for treatment, with the main indicators being R0 resection rate, postoperative perforation and bleeding incidence, and tumor recurrence rate. The meta-analysis was carried out using RevMan 5.3 software. A total of 10 studies were included, with 736 patients. The analysis showed that for the recurrence rate in the TEM group compared to ESD, OR = 1.23, 95% CI = 0.56-2.72, p = 0.60; for the R0 resection rate between the TEM group and ESD group, OR = 1.35, 95% CI = 0.82-2.22, p = 0.24; for the incidence of perforation in the TEM and ESD groups, OR = 0.59, 95% CI = 0.25-1.40, p = 0.23. The inter-group comparison of these three items was statistically significant. Compared with the ESD group, the hospitalization time and the incidence of bleeding of the TEM group were both lower, with SD = 0.48, 95% CI = 0.26-0.69, p < 0.001 and OR = 0.35, 95% CI = 0.13-0.92, p = 0.03. The differences were statistically significant. Both TEM and ESD endoscopic treatment techniques can achieve a higher R0 resection rate and lower risk of tumor recurrence in the treatment of colorectal tumors. However, TEM may have higher surgical safety than ESD technology, and can shorten postoperative hospitalization time and lower postoperative bleeding rate.

Incidence and prognosis of subclinical cardiac perforation after leadless pacemaker implantation

Abstract Introduction Subclinical cardiac perforation, a known complication of cardiac implantable electronic device leads, occurs in 6–20% of cases. While leadless pacemakers are advised to be placed in the septum to mitigate perforation risk, limited studies exist on lead positioning and perforation incidence. Objectives This retrospective observational study aimed to assess leadless pacemaker lead positions, determine the incidence of subclinical cardiac perforation, and evaluate associated prognoses through computed tomography (CT) in post-implantation patients. Methods Thirty-one patients underwent CT after leadless pacemaker implantation. Two cardiologists and a radiologist analyzed CT scans to categorize lead positions (septum, free wall, or septum-free wall junction) and identify subclinical perforation (defined as tine transversal beyond the outer myocardial contour without symptoms, hemodynamic instability, or pacemaker issues). Results Mean age at implantation was 70.5 ± 12.7 years; 35.5% were male, and 41.9% had atrial fibrillation. Twenty patients (64.5%) were on anticoagulants or antiplatelet agents. Twenty-four patients (77.4%) were positioned at the septum-free wall junction. Subclinical perforation occurred in 12 patients (38.7%), with a higher proportion in patients on non-vitamin K antagonist oral anticoagulants. Two patients had moderate amount of pericardial effusion; the remaining ten with subclinical perforation were stable during follow-up. Conclusions The most common leadless pacemaker implantation site was the septum-free wall junction with 38.7% of subclinical perforation.

Impact of age on the management and prognosis of oesophageal fistula after atrial fibrillation ablation - a subanalysis of the worldwide POTTER-AF study

Abstract Background Oesophageal fistula (OF) is a rare but devastating complication following atrial fibrillation (AF) ablation. The data regarding the impact of age on the management and prognosis of OF are scarce. Methods The POTTER-AF study is a worldwide, multi-centre registry conducted under the auspices of the Working Group of Cardiac Electrophysiology of the German Cardiac Society (AGEP, DGK) which evaluated the incidence, management and outcome of post-procedural OF following catheter ablation of AF. A total of 553 729 patients underwent ablation procedures for AF or atrial tachycardia (AT) in 214 electrophysiological centres from 35 countries between 1996 and 2022. Of them, 138 (0.025%) patients experienced postprocedural OF and data regarding the management and prognosis were available in 113 patients. The median age was 63 years. Results A total of 54 (47.8%) patients experiencing OF were younger than 63 years old (Group 1), while 59 (52.2%) patients were at least 63 years old (Group 2). No difference was noted between the groups regarding the incidence of atrioesophageal fistula, oesophageal perforation, and oesophageal-pericardial fistula. Almost half of the patients in each group were females (44.4% vs. 48.3%; p=0.813). As expected, a CHA2DS2-VASc score higher than 3 was more frequent in the older population (61% vs. 17.3%; p&amp;lt;0.001). Regarding the comorbidities, the patients in Group 2 were more likely to suffer from coronary artery disease (25% vs. 9.8%; p=0.046) and hypertension (72.9% vs. 42.6%; p=0.001). The two populations were similar in terms of sedation type, energy source and ablation techniques used, as well as in terms of oesophageal temperature probe utilization. Interestingly, the older population had a shorter median time to symptoms onset (15 (6, 21) vs. 21 (10, 25.3) days; p=0.031). Fever, chest pain and neurological signs as first manifestations of OF showed similar incidences between the groups. When analysing the diagnostic method, the patients from Group 2 were less likely to receive a cranial computed tomography (cCT) or cranial magnetic resonance imaging (cMRI) (25.9% vs. 45.3%; p=0.046). The older population was more likely to receive a direct endoscopic treatment, without surgery (27.6% vs. 11.3%; p=0.035), while there was no difference regarding the rate of surgical treatment. The conservative treatment was used in similar proportions (37.7% in Group 1 vs. 29.3% in Group 2; p=0.421). A clear trend towards a higher mortality was noted in the older population (72.9% vs. 56.6%; p=0.078). The incidence of major and minor sequalae was similar for both groups. Conclusion The median age of the OF population was 63 years. The older population had a shorter time to symptoms onset, was less likely to receive cCT/cMRI as diagnostic method and more likely to be treated by direct endoscopic treatment. The patients older than 63 years showed a trend towards a higher mortality.Time to symptoms onsetOutcome

Full-Moon Coronary Calcification as Detected With Computed Tomography Angiography in Chronic Total Occlusion Percutaneous Coronary Intervention

"Full moon" is a central calcification that occludes the entire vessel on coronary computed tomography angiography (CCTA). We examined the association of “full moon” calcification as identified by CCTA, on clinical and procedural outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We studied patients who underwent elective CTO PCI in two European centers and had pre-procedural CCTA. The primary endpoint was the inability to cross the lesion and/or the need for extensive debulking techniques. Secondary endpoints were procedural success, in-hospital cardiac mortality, the need for extensive debulking techniques, myocardial infarction (MI), major adverse cardiac events (MACE, defined as in hospital death, MI and clinically driven target vessel revascularization) and stent thrombosis. Secondary procedural endpoints included procedural time, fluoroscopy time, number of guidewires and balloons, stent length, number and diameter and contrast volume. Multivariable logistic regression analysis was performed identifying potential covariates related to the primary outcome according to knowledge and prior studies. Subsequently, a stepwise selection approach was performed to select factors with the greatest predictive value. Among 140 patients included, 28 (20%) had a “full moon” calcified CTO-plaque. Patients in the full moon group were older and had more cardiovascular risk factors. There was not significant difference in the need for retrograde approach and antegrade dissection and re-entry (ADR) techniques in the “full moon” group vs the other groups (32.1% vs 37.5%, p=0.59 and 0% vs 1.7%, p=0.47 respectively). Compared with patients who did not have full moon morphology, full moon patients had higher incidence of the primary outcome (53.5% vs 12.5%;p<0.001). On multivariable analysis that included chronic kidney failure and prior coronary artery bypass surgery, full moon calcification was associated with higher incidence of the primary endpoint; OR 6.5;95% CI 2.1-20.5;p=0.001). Moreover, lower procedural success (71.4% vs 87.5%;p=0.03), higher incidence of coronary perforations (14.2% vs 3.5%;p<0.02) and higher procedural [172.5 (118.0-237.5) vs 144.0 (108.50-174.75); p=0.02] and fluoroscopic time [62.6 (38.1-83.0) vs 42.8 (29.5-65.7); p=0.03] were observed in the “full moon” group. Overall MACE did not differ between the two groups (1 patient in the “full moon” group vs 1 patient in the no “full moon” group; 3.5% vs 0.8%, p=0.29). In conclusion, “full moon” calcification on CCTA was independently associated with procedural complexity and adverse outcomes in CTO-PCI.

Systematic review and meta-analysis: the efficacy and safety of radiofrequency ablation for early superficial esophageal squamous cell neoplasia

Background and AimEsophageal squamous cell neoplasia (ESCN) is predominant in Asia. Endoscopic mucosal resection and endoscopic submucosal dissection (ESD) have both been recommended worldwide, however the application of endoscopic radiofrequency ablation (RFA) for treatment of early superficial ESCN remains inconclusive. We conducted a meta-analysis to study the effectiveness of RFA for early superficial ESCN.MethodsThree major bibliographic databases were reviewed for the enrollment of case series and cohort trials prior to August 23, 2023. We included adults diagnosed with early superficial ESCN who had been receiving endoscopic RFA or ESD if the treatments were available. Our focus was on the 12-month histological complete response rate (CR) and 3-month histological CR, as well as the acute and late postoperative adverse events (AEs) rate during the at follow-up periods.ResultsNine studies were enrolled for qualitative synthesis of narrative review, with eight trials involving a total of 447 participants for analysis. The pooled 12-month and 3-month histological CR were 0.83 (95% CI, 0.59–0.94, I2 = 80%) and 0.74 (95% CI, 0.67–0.80, I2 = 0%), respectively. As for safety, the acute and late postoperative AEs were 0.11 (95% CI, 0.05–0.26, I2 = 68%) and 0.19 (95% CI, 0.14–0.26, I2 = 0%), respectively. In subgroup analysis, the incidence of bleeding, laceration and perforation after endoscopic RFA showed 0.06, 0.06 and 0.02, respectively. When compared with ESD, RFA showed lower acute AEs and late AEs without any obvious significance.ConclusionsFor early superficial ESCN, endoscopic RFA achieved both higher 12-month complete remission and late complication postoperatively when compared to 3-month histological CR and acute AEs separately, while the stricture was encountered most commonly. The choice between endoscopic RFA and ESD remains inconclusive.

Otological manifestations of temporal bone fractures

Background: Temporal bone fractures are caused by high intensity trauma and can result in various facial and cochleovestibular sequelae, which can affect the quality of life. The aim was to study about the various otological manifestations of temporal bone fractures in head trauma patients. Methods: Descriptive study of 82 patients was conducted in the Department of Otorhinolaryngology, Government T D Medical College, Alappuzha from April 2019 to March 2021. All patients with radiological evidence of temporal bone fractures were taken for study and their symptoms and signs were compared among otic capsule sparing (OCS) and otic capsule violating (OCV) type fractures. Data was analysed statistically using SPSS version 22 and p value calculated using chi-square test. Results: Majority of the patients were in the 20–40-year age group. Male to female ratio was 8.1:1. The most common aetiology was road traffic accidents (RTAs) n=74 (90.24%). The incidence of tinnitus (p value=0.02), vertigo (p value=0.007), facial palsy (p value=0.0004), CSFO (p value=0.0002), nystagmus (p value=0.0065) and sensorineural hearing loss (SNHL) (p value=0.00001) were found to be more in OCV type fractures and their association was found to be statistically significant. The incidence of TM perforation (p value=0.01), conductive hearing loss (CHL) (p value=0.0008) and EAC laceration (p value=0.04) was more in OCS type fractures and was statistically significant. Conclusion: Rapid diagnosis of temporal bone fractures is crucial as it enables effective initial management aimed at avoiding the facial and cochleovestibular sequelae that can adversely affect the quality of life. Keywords: temporal bone; fracture; facial palsy; tinnitus; otological manifestation; sensorineural hearing loss

Mucormycosis-Associated Colon Perforation in the Early Postrenal Transplant Period

The incidence of colon perforation in the posttransplant period is 1.3% based on various single-center studies. We report the case of a 32-year-old male, a known case of chronic kidney disease and end-stage renal disease who received a live-related ABO-compatible transplant. The patient was started on tacrolimus, mycophenolate mofetil, and steroids; no induction was given. The patient had a delayed graft function, and his creatinine was persistently high. Hence, a biopsy was done on postoperative day 4, which revealed an acute tubular injury with features of calcineurin inhibitor toxicity. His tacrolimus dose was reduced and his output improved until day 13, after which his renal function worsened. The repeat tacrolimus level was low. Hence, the patient was started on pulse steroids and discharged after the patient improved symptomatically (discharge creatinine: 2.1). The patient was readmitted 3 days after discharge with severe abdominal pain. The patient’s blood pressure was 90/30 mmHg; he was drowsy and tachypneic. His abdomen was distended. Computed tomography of the abdomen revealed pneumoperitoneum, and the patient was subjected to an explorative laparotomy. There was colonic perforation. The peritoneum and colon revealed multiple punched-out lesions and a right hemicolectomy was done. A biopsy revealed suppurative inflammation involving all three layers with multiple giant cells, and tissue staining revealed ribbon-like aseptate hyphae with 90° angulation suggestive of mucormycosis. The patient expired in the immediate postoperative period. The final diagnosis of mucormycosis-associated colon perforation was made. Only one such case has been reported previously.

Air enema reduction versus hydrostatic enema reduction for intussusceptions in children: A systematic review and meta-analysis.

We conducted a comprehensive meta-analysis to compare the effectiveness and safety of fluoroscopy-guided air enema reduction (FGAR) and ultrasound-guided hydrostatic enema reduction (UGHR) for the treatment of intussusception in pediatric patients. A systematic review and meta-analysis were conducted on retrospective studies obtained from various databases, including PUBMED, MEDLINE, Cochrane, Google Scholar, China National Knowledge Infrastructure (CNKI), WanFang, and VIP Database. The search included publications from January 1, 2003, to March 31, 2023, with the last search done on Jan 15, 2023. We included 49 randomized controlled studies and retrospective cohort studies involving a total of 9,391 patients, with 4,841 in the UGHR and 4,550 in the FGAR. Specifically, UGHR exhibited a significantly shorter time to reduction (WMD = -4.183, 95% CI = (-5.402, -2.964), P < 0.001), a higher rate of successful reduction (RR = 1.128, 95% CI = (1.099, 1.157), P < 0.001), and a reduced length of hospital stay (WMD = -1.215, 95% CI = (-1.58, -0.85), P < 0.001). Furthermore, UGHR repositioning was associated with a diminished overall complication rate (RR = 0.296, 95% CI = (0.225, 0.389), P < 0.001) and a lowered incidence of perforation (RR = 0.405, 95% CI = (0.244, 0.670), P < 0.001). UGHR offers the benefits of being non-radioactive, achieving a shorter reduction time, demonstrating a higher success rate in repositioning in particular, resulting in a reduced length of postoperative hospital stay, and yielding a lower overall incidence of postoperative complications, including a reduced risk of associated perforations.

Intestinal incarceration following aspiration evacuation: A case report

Uterine perforation is a frequently overlooked complication of operative procedures. The incidence of perforation is estimated to range from 1 to 4 per 1000 during curettages for pregnancy termination. Reported complications include uterine, digestive, and vesical perforations, hemorrhage, endometritis, and secondary infertility. However, intestinal incarceration after uterine perforation remains extremely rare. We present a case of uterine perforation occurring after an aspiration curettage, complicated by digestive incarceration.

Secondary iatrogenic duedonum perforation: a rare complication

The incidence of perforations resulting from Endoscopic Retrograde Cholangiography (ERCP) is observed to be less than 1%. In this case report, we aim to present our unique experience as a mechanism, which is even more uncommon. A 68-year-old male with an ASA score of 2 was prediagnosed with a distal common bile duct tumor. ERCP was performed for therapeutic and diagnostic purposes and a 9F 10 cm plastic stent was placed to relieve obstruction. The patient, who had the sudden onset of abdominal pain within the initial 24-hour period following the procedure, underwent surgical intervention subsequent to a computed tomography assessment. In the third portion of the duodenum, an approximately 4 mm perforation originating from the stent was observed during the examination. It was repaired with a 3.0 prolene suture, followed by omentopexy. He was discharged uneventfully on the eighth day. Although duodenal perforation due to the placement of a plastic biliary stent with ERCP is a very uncommon complication, the patient's clinical and imaging findings are essential for treatment planning.