Intestinal Distension Research Articles

389 WHEN YOU HAVE A HAMMER, EVERYTHING LOOKS LIKE A NAIL

Abstract Introduction ST-segment elevation myocardial infarction (STEMI) is one of the most lethal manifestations of ischemic cardiomyopathy. Diagnosis is made through clinical signs, symptoms and, most importantly, the surface ECG. Several conditions mimicking the STEMI repolarization pattern have been hitherto recognised and their identification is of utmost importance in order to provide the correct treatment. Case report A 81-years old man affected by multiple sclerosis and dysphagia was admitted to our hospital for continuous vomiting. His anamnesis was relevant for an episode of bowel obstruction; ECG upon admission exhibited ST-elevation in D1, aVL, V5 and V6 with specular ST-depression in the inferior leads. The patient was unconscious, therefore making it impossible to report any kind of symptoms, in addition, bedside echocardiography showed a thoracic fluid collection completely obscuring cardiac chambers. Physical examination displayed tachypnoea and, most importantly, a tender abdomen with no bowel movements; this specific finding added to the anamnesis and the echocardiography called into doubt the possibility of a real myocardial infarction. Preliminary laboratory findings pointed out high levels of C-reactive protein, procalcitonin and both indirect and direct bilirubin. Being hesitant about the next step, we took a second look at the only clue we had so far, the ECG. At a deeper analysis, the aspects of repolarization did not exactly resemble the convex ST-elevation seen in STEMI presentations, rather reminding (in D1 and aVL) of a pattern called “spiked helmet sign”, described as an index of poor prognosis and increased intrathoracic pressure in critically ill patients. Considered a high suspect of bowel obstruction, a nasogastric tube was placed and, soon after, 3 litres of dark fluid were drained from his stomach. In the following minutes, we witnessed the progressive normalization of the ST alterations initially observed, thus excluding the necessity of a cath lab activation. A CT scan was then performed showing a faecaloma extending from the rectum to the descending colon creating a complete obstruction associated with intestinal pneumatosis and gastric distension. As soon as troponin levels came out normal, the patient underwent surgery, but, unfortunately, he died a few days later due to intervention-related complications. Discussion Although current literature reports several cases of STEMI phenocopies, with a minority referring to bowel obstruction, this is one of the rarely reported circumstances with no instrumental findings or patient symptoms available to support the diagnosis. As most physicians know, diagnoses are rarely straightforward and instrumental findings, especially in the context of an emergency, may drive to incorrect deductions if not properly analysed or incoherent with the clinical context. The “old-fashioned” anamnesis and clinical evaluation may be the keys to unlocking the true diagnosis in difficult contexts where pitfalls can mislead the clinician to the most obvious and quickest conclusion.

Cholinergic receptor-Wnt pathway controls immune activation by sensing intestinal dysfunction.

Alterations in the intestinal physiology caused by pathogen colonization result in immune activation. To provide insights into the mechanisms underlying the control of immune activation by changes in intestinal homeostasis, we conducted a forward genetic screen for suppressors of immune activation by intestinal distension in Caenorhabditis elegans. Our results indicate that C. elegans ACC-4, a member of a family of acetylcholine receptors, is required in immune activation by defects in the defecation motor program or by pathogen infection. ACC-4 acts postsynaptically in non-cholinergic RIM neurons to regulate several immune genes and a Wnt-mediated host immune response. These findings uncover a gut-brain-microbial axis that uses neural cholinergic signaling and the Wnt pathway to control immune activation in response to alterations in intestinal homeostasis.

ODP374 Abdominal Distention as a Unique Sign of Congenital Hypothyroidism

Abstract Background Most neonates with congenital hypothyroidism have a normal appearance at birth. Infrequent clinical presentations have been reported, including abdominal distention as the only sign, which remit with the initiation of levothyroxine therapy. Clinical Case Female newborn, full-term, appropriate weight for gestational age, six days old, who presented abdominal distension, without vomiting and with normal meconium elimination. No visceromegaly or abdominal masses were palpated. With the diagnosis of sepsis, treatment was started with ampicillin and amikacin, decompressive nasogastric tube and intravenous fluids. Abdominal X-ray showed intestinal distension. The requested cultures were negative. On the seventh day of life a TSH level of 89 mlU/L was reported; the free T4 value was analyzed and was found to be low. With the diagnosis of congenital hypothyroidism, levothyroxine therapy was indicated, and the abdominal distension remitted one week after initiation of therapy. Conclusion Most cases of congenital hypothyroidism are asymptomatic; abdominal distension, as the only sign of congenital hypothyroidism, is caused by the lower intestinal motility frequently observed in congenital hypothyroidism. Presentation: No date and time listed

A Novel Role for Biomechanical Forces in the Pathogenesis of Idiopathic Constipation

INTRODUCTION: Chronic constipation is a common gastrointestinal disorder, but an anatomic or physiologic cause is identified in only 5% of patients. Surgery to remove chronically dilated segments of intestine is offered as a last resort. Our goal is to understand how the intestinal microenvironment is affected by biomechanical forces such as chronic distention in idiopathic constipation. METHODS: To evaluate the effects of biomechanical force on the colon, we used 3 models: (1) colon from wildtype mice was cultured ex vivo for 24 hours with and without distention and extracellular matrix–related gene expression was assayed using reverse transcriptase-polymerase chain reaction; (2) an in vivo mouse model of enteric distention was assessed at 7 to 14 days by immunohistochemistry; and (3) human specimens from pediatric patients who underwent colon resections for chronic idiopathic constipation (n = 27) were histologically evaluated to clinically validate our findings (Figure).FigureRESULTS: Ex vivo and in vivo colon under tension demonstrated increased fibrosis compared with control. Tension resulted in significantly decreased expression of antifibrotic Gremlin-1 and increased expression of profibrotic interleukin-1β. Collagens and matrix metalloproteinases were downregulated while laminins were upregulated. Seventy-seven percent of patients with chronic idiopathic constipation displayed dilated and/or redundant colon on imaging. In surgical specimens, 26% had interstitial fibrosis, 33% had muscular hypertrophy, and 15% had myocyte vacuolization. These histologic findings were also seen in distended mouse colon. CONCLUSION: Chronic intestinal distention led to a profibrotic phenotype in all 3 models. We conclude that mechanically sensitive cells may be affected by chronic distention and contribute to intestinal dysfunction in idiopathic constipation.

Dissection of a sensorimotor circuit underlying pathogen aversion in C. elegans

BackgroundAltering animal behavior to reduce pathogen exposure is a key line of defense against pathogen attack. In Caenorhabditis elegans, alterations in intestinal physiology caused by pathogen colonization and sensation of microbial metabolites may lead to activation of pathogen aversive behaviors ranging from aversive reflexes to learned avoidance. However, the neural circuitry between chemosensory neurons that sense pathogenic bacterial cues and the motor neurons responsible for avoidance-associated locomotion remains unknown.ResultsUsing C. elegans, we found that backward locomotion was a component of learned pathogen avoidance, as animals pre-exposed to Pseudomonas aeruginosa or Enterococcus faecalis showed reflexive aversion to drops of the bacteria driven by chemosensory neurons, including the olfactory AWB neurons. This response also involved intestinal distention and, for E. faecalis, required expression of TRPM channels in the intestine and excretory system. Additionally, we uncovered a circuit composed of olfactory neurons, interneurons, and motor neurons that controls the backward locomotion crucial for learned reflexive aversion to pathogenic bacteria, learned avoidance, and the repulsive odor 2-nonanone.ConclusionsUsing whole-brain simulation and functional assays, we uncovered a novel sensorimotor circuit governing learned reflexive aversion. The discovery of a complete sensorimotor circuit for reflexive aversion demonstrates the utility of using the C. elegans connectome and computational modeling in uncovering new neuronal regulators of behavior.

Asymmetric Control of Food Intake by Left and Right Vagal Sensory Neurons

Gut‐innervating vagal sensory neurons residing in the nodose ganglia (NG) conveys meal‐borne signals and control food intake, however, the underlying gut‐brain neurocircuit is unclear. The neuropeptide cocaine‐ and amphetamine‐regulated transcript (CART) is expressed in a subpopulation of vagal sensory neurons (~40%) that innervate the whole length of the gut and its release in the NTS is sufficient for meal termination. Thus, it can be an excellent target to understand the role of sensory neurons in feeding. Emerging evidence suggests that right or left NG (LNG or RNG) neurons recruit different downstream central circuits to control feeding, but the mechanisms remain poorly understood. Our hypothesis is that LNGCART and RNGCART neurons sense different meal‐related signals and are necessary and sufficient to modulate feeding.MethodsIn vivo calcium imaging, viral neuronal tracing, and feeding behaviors were assessed in response to chemo‐ and opto‐genetic stimulation of gut‐innervating vagal sensory neurons using CARTcre mice.ResultsAnatomical tracing revealed that LNGCART and RNGCART neurons innervate different regions of the duodenum (n=3). LNGCART innervate the muscular layer, while RNGCART innervate the villi. Importantly, 2‐photon calcium imaging highlighted real time increased activity in LNGCART in response to stretch, while intraduodenal fat infusions preferentially increased RNGCART neuron activity (n=7/group). Mice with LNGCART neurons ablation consumed higher volumes of liquid meal indicative of attenuated response to gastric and intestinal distension (n=6‐7/group). Furthermore, chemogenetic stimulation of LNGCART, but not RNGCART, caused pronounced and sustained hypophagia (n=7/group). Interestingly, mice with chemogenetic activation of RNGCART, but not LNGCART, increased flavor conditioning (n=7/group), while ablation of RNGCART neurons abolished the conditioned flavor preference that was paired with intragastric fat infusion (n=7/group) supporting their role in reward. In addition, optogenetic stimulation of RNGCART promoted self‐stimulation in a nose poke task (n=4). Lastly, dopaminergic neurons of the substantia nigra increased their firing rate in response to intraduodenal fat infusion, but not duodenal distension (n=2/group).ConclusionLeft and right vagus nerves provide different sensory information about a meal to the brain. Both anatomical and behavioral feeding studies support the necessity and sufficiency LNGCART neurons as food quantity detectors and RNGCART neurons as food reward mediators ‐ which has less influence on how much is consumed but rather plays a role in the decision‐making process about which foods to consume. Our findings on asymmetrical vagal innervation of the gut provides new mechanistic insight for how feeding decisions are made in response to vast and complex meal‐related signals.

Computed tomographic findings of the gastrointestinal tract in rabbits

Gastrointestinal (GI) diseases are common in rabbits. Although diagnostic imaging studies can assist clinicians in selecting therapeutic approaches, there are few reports of advanced imaging findings in normal rabbits. Computed tomography (CT) is recognized as a useful tool in dogs and cats, but there are few reports of normal findings on multidetector computed tomography (MDTC) in rabbits. The goals of this study are to describe the CT anatomic imaging appearance of the GI tract and their normal variation in healthy pet rabbits and to obtain the normal wall thickness measurements of normal GI tract structures. Twenty-three rabbits were scanned under general anesthesia and the CT abdominal images were analyzed by two experienced radiologists. Location and size of the major GI organs and structures were determined, and wall thickness of the stomach, small and large intestines were measured, including the interobserver agreement. Statistical analysis of quantitative and qualitative variables was performed. Wall thickness values were established for the different parts of the stomach (cardia: 3.4 ± 0.4mm; fundus: 1.4 ± 0.2mm; body: 1.4 ± 0.1mm; pylorus : 2.9 ± 0.5mm), small intestines (duodenum: 1.4 ± 0.1mm; jejunum : 1.2 ± 0.1mm; ileum: 1.4 ± 0.1mm), and large intestines (cecum: 1.2 ± 0.1mm; colon ascending: 1.4 ± 0.3 mm and descending: 1.3 ± 0.3mm). When distended the stomach did not extend beyond the caudal limits of the L2 vertebra . The cecum occupied the ventral abdominal region from T12/T13 to L7/S1, the sacculus rotundus was identified in 11 of the 23 rabbits. The sacculus rotundus and vermiform cecal appendix were identified only in rabbits with mild large intestinal distension. It was possible to use CT to evaluate the different portions of the GI tract that are not normally readily visible on radiographs and ultrasound (US). Normal wall thickness values of the different portion of the GI tract were stablished. These results provide new and important reference values for CT studies in normal pet rabbits and provide data for further studies in rabbits with GI diseases.

Acute Abdomen and Appendicitis in 1010 Pediatric Patients With COVID-19 or MIS-C: A Multinational Experience from Latin America.

Background:To date, there are only sporadic reports of acute abdomen and appendicitis in children with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C).Methods:Children 17 years of age or younger assessed in 5 Latin American countries with a diagnosis of microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and children fulfilling MIS-C definition were included. For children with acute abdomen, we investigate main radiologic patterns, surgical treatment and intraoperative findings, outcomes.Findings:One-thousand ten children were enrolled. Forty-two children (4.2%) had a clinical diagnosis of acute abdomen. Four (9.5%) were diagnosed with MIS-C and did not undergo surgery. The remaining 38 children (3.8%) underwent abdominal surgery due to suspected appendicitis, 34 of them (89.7%) had an intraoperative diagnosis of acute appendicitis (AA), while 4 of them had nonsurgical findings. Eight children died (0.8%), none of them being diagnosed with appendicitis. Children with AA were significantly older than those without (P < 0.0001). Children with complicated appendicitis had more frequently fever (85.7% vs. 60%), intestinal distension on the abdominal radiograph (7.1% vs. none), leukocytosis (85.7% vs. 40%) and high levels of C-reactive protein (35.7% vs. 5%), although differences were not statistically significant.Conclusions:Our study showed that children may present with acute abdomen during COVID-19 or MIS-C, which is not always associated with intraoperative findings of appendicitis, particularly in case of MIS-C. Further studies are needed to better characterize children with acute abdomen during COVID-19 or MIS-C, to avoid delay in diagnosis of surgical conditions and at the same time, minimize unnecessary surgical approaches.

TRP channels: Intestinal bloating TRiPs up pathogen avoidance

Transient receptor potential (TRP) channels are expressed in many nonneural tissues where their functions are not well known. Using C. elegans as a model, a new study demonstrated that colonization of the Gram-positive pathogenic bacteria E. faecalis in the intestine causes intestinal distention. Two TRPM channels sense such intestinal distension to trigger fast pathogen avoidance behavior, thereby limiting pathogen infection. This work signifies the novel role of TRP channels in gut physiology and pathogen defense.

Optimization of Field Design in the Treatment of Rectal Cancer with Intensity Modulated Proton Beam Radiation Therapy: How Many Fields Are Needed to Account for Rectal Distension Uncertainty?

PurposePreoperative chemoradiation represents the standard of care in patients with locally advanced rectal cancer. Robustness is often compromised in the setting of proton beam therapy owing to the sensitivity of proton particles to tissue heterogeneity, such as with intestinal gas. The ideal beam arrangement to mitigate the anatomic uncertainty caused by intestinal gas is not well defined. Methods and MaterialsWe developed pencil beam scanning plans using (1) 1-beam posteroanterior (PA) plans, (2) 2-beam with right and left posterior oblique (RPO and LPO) plans, (3) 3-beam with PA and opposed lateral plans, and (4) 5-beam with PA, RPO, LPO, and opposed lateral plans. We created 12 plans with robustness optimization and ran a total of 60 plan evaluations for varying degrees of intestinal gas distension to evaluate which plans would maintain clinical goals to the greatest degree. ResultsA single PA beam resulted in considerable loss of target coverage to the clinical target volume prescribed 50 Gy (volume receiving 100% of the prescribed dose [V100%] < 90%) with rectal distension ≥3 cm in diameter in the short axis. In contrast, the other field designs maintained coverage with up to 5 cm of distension. On plans generated based on a 5-cm distended rectum with air medium, the 1-beam, 3-beam, and 5-beam arrangements resulted in loss of target coverage (V100% < 90%) with rectal contraction ≤3 cm, whereas the 2-beam arrangement maintained coverage to as low as 2 cm. On plans generated based on a 3-cm distension of the rectum, both the 2-beam and 3-beam arrangements maintained V100% > 90% even with collapsed rectum to as low as 1 cm, simulating a patient treatment scenario without any rectal gas. ConclusionsA single PA beam should be avoided when using proton beam therapy for rectal cancer. RPO/LPO and PA/opposed lateral arrangements may both be considered; RPO/LPO is favored to reduce integral dose and avoid beams traversing the hips. In patients for whom the plan CT has rectal distension of ≥3 cm, resimulation or strategies to reduce intestinal gas should be strongly considered.

A young man with abdominal pain and intestinal distension

A 20-year old man of Balkan descent presented to the emergency department with abdominal pain and constipation of several days‘ duration. On clinical examination, he was afebrile and normotensive. The abdomen was distended with reduced bowel sounds. Laboratory investigations were significant for hyponatraemia (129 mmol/l) and elevated aminotransferases in the double digits; inflammatory markers were normal. Abdominal ultrasound was unrevealing as to a specific cause but meteorism was noted. Cortisol response to an adrenocorticotrophic hormone stimulation test was normal.

TRPM channels mediate learned pathogen avoidance following intestinal distention.

Upon exposure to harmful microorganisms, hosts engage in protective molecular and behavioral immune responses, both of which are ultimately regulated by the nervous system. Using the nematode Caenorhabditis elegans, we show that ingestion of Enterococcus faecalis leads to a fast pathogen avoidance behavior that results in aversive learning. We have identified multiple sensory mechanisms involved in the regulation of avoidance of E. faecalis. The G-protein coupled receptor NPR-1-dependent oxygen-sensing pathway opposes this avoidance behavior, while an ASE neuron-dependent pathway and an AWB and AWC neuron-dependent pathway are directly required for avoidance. Colonization of the anterior part of the intestine by E. faecalis leads to AWB and AWC mediated olfactory aversive learning. Finally, two transient receptor potential melastatin (TRPM) channels, GON-2 and GTL-2, mediate this newly described rapid pathogen avoidance. These results suggest a mechanism by which TRPM channels may sense the intestinal distension caused by bacterial colonization to elicit pathogen avoidance and aversive learning by detecting changes in host physiology.

Optimising working space for laparoscopic pyeloplasty in infants: Preliminary observations with the SGPGI Protocol.

Aims:This study aimed to test the efficacy of SGPGI protocol to minimise bowel distension and optimise working space for laparoscopic pyeloplasty in infants.Methodology:All infants who underwent laparoscopic pyeloplasty for unilateral pelvi-ureteric junction obstruction (PUJO) between January 2017 and March 2020 were included in the study. The patient cohort was divided into two groups: Group A and B. Group A included patients who underwent routine pre-operative preparation. Group B included patients wherein the SGPGI protocol was used. The key features of the protocol were fasting for 8 h, enemas, inserting a nasogastric tube in the pre-operative period and decompressing the colon on the operation table. Demographic features, pre-operative, intraoperative and post-operative parameters were compared between the two groups.Results:A total of 26 infants with unilateral PUJO underwent laparoscopic pyeloplasty during the study period. Group A included 12 patients and Group B included 14 patients. Both the groups were similar in age, weight and sex distribution. The median surgeon's rating score for suturing conditions was 2 for Group A and 5 for Group B patients (P > 0.05). The operating time was significantly longer in Group A (196 ± 21 min) as compared to Group B (114 ± 18 min) (P < 0.05). In Group A, intra-abdominal pressure (IAP) varied between 9 and 14 mmHg (median 12 mmHg), while in Group B, IAP varied between 6 and 9 mmHg (median 8 mmHg) (P < 0.05). In Group A, in 2/12 cases (16.7%), conversion to an open procedure was necessary because of inadequate working space owing to gross intestinal distension. Two patients in Group A also had intraoperative injuries to adjacent structures due to poor working space.Conclusions:Optimal working space is critical to the performance of advanced laparoscopic surgery like pyeloplasty in infants. SGPGI protocol significantly improves working space, which permits a faster and safer surgery with a lower intra-abdominal working pressure. This protocol is simple, safe and easy to replicate at most centres in our country.

Severe constipation in a pediatric patient causing abdominal compartment syndrome

Abstract Introduction Abdominal compartment syndrome is defined as elevated intra-abdominal pressure, and typically presents following trauma or burns in adults or in neonates with abdominal wall defects1. A definitive cutoff value for intra-abdominal pressure is unknown in pediatric patients. Case presentation 8 year old male with no previous past medical history presented with abdominal compartment syndrome due to constipation and distention of 2 weeks duration, despite multiple laxatives and enemas. The patient was treated with rectal decompression followed by decompressive laparotomy and delayed abdominal closure with end ileostomy creation. Discussion Reperfusion syndrome is a complex inflammatory response and may cause further injury to the tissues. This occurs partially due to microvascular dysfunction, increased permeability of capillaries and arterioles, and release of transcription factors leading to prolonged ileus and further intestinal distention. Reperfusion can cause a secondary/recurrent compartment syndrome, and in order to prevent and control sequela of reperfusion, decompressive laparotomy should be performed with temporary abdominal closure, regardless of the cause of abdominal compartment syndrome. Conclusion Constipation is a rare cause of ACS; regardless of cause of ACS, treatment should be decompressive laparotomy with temporary abdominal closure, and continued resuscitation as appropriate. A higher index of suspicion is needed in pediatric patients without obvious cause for ABS given that the abdominal exam is not always reliable, and due to the potential for life-threatening complications in the event of a missed diagnosis.

Diagnosis and management of segmental volvulus of the jejunoileum in a first lactation Flekvieh heifer

AbstractA three‐year‐old first lactation Flekvieh heifer was presented with sudden milk drop, anorexia and absence of faeces in the rectum after being perceived as fit and healthy the day before. Following medical treatment and close monitoring, an exploratory laparotomy was performed and a segmental volvulus of part of the small intestine was identified. Successful treatment involved relieving the intestinal distension and untwisting the intestine. This case was interesting as the cow showed minimal outward signs of discomfort and cardiovascular compromise with intestinal volvulus.

Microbial colonization induces histone acetylation critical for inherited gut-germline-neural signaling.

The gut-neural axis plays a critical role in the control of several physiological processes, including the communication of signals from the microbiome to the nervous system, which affects learning, memory, and behavior. However, the pathways involved in gut-neural signaling of gut-governed behaviors remain unclear. We found that the intestinal distension caused by the bacterium Pseudomonas aeruginosa induces histone H4 Lys8 acetylation (H4K8ac) in the germline of Caenorhabditis elegans, which is required for both a bacterial aversion behavior and its transmission to the next generation. We show that induction of H4K8ac in the germline is essential for bacterial aversion and that a 14-3-3 chaperone protein family member, PAR-5, is required for H4K8ac. Our findings highlight a role for H4K8ac in the germline not only in the intergenerational transmission of pathogen avoidance but also in the transmission of pathogenic cues that travel through the gut-neural axis to control the aversive behavior.

PERFORATIVE PERITONITIS IN NEWBORNS: INSTRUMENTAL AND MORPHOLOGICAL EXAMINATION FINDINGS

The aim: To study and analyze the results of instrumental diagnostic measures and morphological verification of perforations of abdominal viscera in peritonitis in newborns, their importance in timely diagnosis, as well as to present authors’ experience of examining newborns with PP, taking into account the complexity of diagnosis and treatment of these patients. Materials and methods: The study is based on the results of examining 59 newborns with PP of various etiologies. Instrumental methods that were used in the diagnosis of PP and differential diagnosis of other emergencies involved the following: radiological examination (plain abdominal radiography), abdominal and retroperitoneal ultrasound, neurosonography, echocardiography, diagnostic abdominal paracentesis. Morphological verification of hollow viscus perforations was performed by methods of histologic examination in 54 newborns who underwent surgery. Results: It is emphasized that perforations in NEC and spontaneous gastrointestinal perforations have clinical and morphological differences. The analysis of morphological data showed absence of intestinal musculature or muscular wall defect in spontaneous gastrointestinal perforations. Perforations in NEC had massive gastric or bowel wall necrosis. Morphogenesis of gastrointestinal perforations in newborns is crucial for developing correct treatment strategy and choosing surgical approach. Conclusions: Diagnosis of PP in newborns should be comprehensive and include modern instrumental studies that enable to reliably establish the cause of peritonitis and indications for surgical treatment. Differential diagnosis of PP in newborns with other diseases aims to differentiate PP from a number of similar clinical symptoms of urgent conditions in order to conduct adequate preoperative preparation and appropriate surgery. Diagnostic markers of PP involve the following: pneumoperitoneum, free fluid in the abdomen, sentinel loop (intestinal distention), fixed bowel loop, cloudy brown or greenish intra-abdominal fluid with a large number of leukocytes and bacteria.

Abdominal gastrointestinal imaging findings on computed tomography in patients with COVID-19 and correlation with clinical outcomes

PurposePulmonary imaging finding of Coronavirus disease 2019 (COVID-19) has been widely described, but until now few studies have been published about abdominal radiological presentation. The aim of this study was to provide an overview of abdominal imaging findings in patients with COVID-19 in a multicenter study and correlate them with worse clinical outcomes. Materials and methodsThis retrospective study included adult COVID-positive patients with abdominal CT performed from 4/1/2020 to 5/1/2020 from two institutions. Demographic, laboratory and clinical data were recorded, including clinical outcomes. ResultsOf 81 COVID-positive patients, the average age was 61 years, 42 (52%) women and 45 (55%) had positive abdominopelvic findings. The most common abdominal imaging features were intestinal imaging findings (20/81, 24%), including colorectal (4/81, 5%) and small bowel thickening (10/81, 12%), intestinal distension (15/81, 18%), pneumatosis (1/81, 1%) and intestinal perforation (1/81, 1%). On multivariate analysis, intestinal imaging findings were associated with higher risk of worse outcome (death or invasive mechanical ventilation) (RR = 2.6, p = 0.04) and higher risk of invasive mechanical ventilation alone (RR = 6.2, p = 0.05). ConclusionIntestinal abnormalities were common findings in COVID-19 patients who underwent abdominal CT and were significantly correlated to worse outcomes in the clinical follow-up.

The role of multidetector computed tomography enterography in the evaluation of localized malignant small intestinal lesions: retrospective radiological and pathological experience.

PurposeOur purpose is to present our experience in using multidetector computed tomography (MDCT) enterography in the evaluation of localized malignant small intestinal lesions with pathological correlation.Material and methodsWe retrospectively evaluated 53 patients of pathologically proven malignant localized small intestinal tumours, who underwent multidetector CT enterography.ResultsIn this study, the mean age was 51.39 ± 17.4 years. The most commonly affected age group was from 50 to 59 years. The commonest clinical complaint was abdominal pain. The ileum was the most commonly affected anatomical region, showing 25 lesions (47.16%). Radiologically irregular/asymmetric wall thickening was detected in 42 cases(79.24%). Pathologically the most common malignancy was small intestinal adenocarcinoma, followed by carcinoid tumour, lymphoma, and gastrointestinal stromal tumours (GIST). We found that there was a statistically significant association between the pathological lymphadenopathy (p = 0.005) and absent proximal intestinal dilatation (p = 0.01) with intestinal lymphoma. Also, there was a statistically significant association between the extra-intestinal mesenteric fat changes with carcinoid tumours (p = 0.001). Irregular/asymmetric wall thickening was detected in 14 cases of small intestinal adenocarcinoma with a statistically significant association (p = 0.001) while exophytic pathological mass formation was statistically significant associated (p ≤ 0.001) with small intestinal GIST.ConclusionsMultidetector CT enterography is a non-invasive and accurate method in the evaluation of focal and localized small intestinal malignant lesions. The accurate detection of these lesions depends to some degree on the experience of the radiologist, lesional size, site and pattern of enhancement, as well as adequate intestinal distension.

Outcome and complications following transrectal and transabdominal large intestinal trocarization in equids with colic: 228 cases (2004-2015).

To describe outcome and complications after large intestinal trocarization in equids with colic and identify factors associated with nonsurvival and clinically relevant peritonitis (CRP). 228 (198 horses, 24 ponies, and 6 donkeys and mules) equids with colic that underwent large intestinal trocarization. Medical records from 2004 through 2015 were reviewed for equids with colic that underwent large intestinal trocarization. Factors associated with nonsurvival in all (ie, surgically and medically treated) equids and with CRP in medically only treated equids were identified. Medically only treated equids with a high peritoneal fluid cell count (ie, > 10,000 cells/μL) after large intestinal trocarization were classified as having CRP if they met ≥ 2 of the following clinical criteria: anorexia, fever, lethargy, abnormal oral mucous membrane color, abnormal WBC count, or high blood fibrinogen concentration (> 5 g/L). Transabdominal large intestinal trocarization was performed in 190 (83%) equids, transrectal trocarization in 17 (7%), and both procedures in 21 (9%). Of 228 equids, 167 (73%) survived to hospital discharge. None died or were euthanized because of complications from large intestinal trocarization. Nonsurvival was associated with an increasing number of trocarization procedures and diagnosis of a large intestinal strangulating lesion. A diagnosis of nephrosplenic ligament entrapment of the large colon decreased the odds of nonsurvival. Twelve of 60 (20%) equids that received medical treatment only had CRP following large intestinal trocarization. Large intestinal trocarization could be considered for equids with colic and large intestinal gas distension. More than one trocarization procedure was associated with an increase in nonsurvival, which should be considered for equids for which consent for surgery has been obtained.