Intestinal Necrosis Research Articles

A case of successful treatment of a neuroendocrine tumor of the small intestine complicated by partial intestinal obstruction

The incidence of neoplasms of the small intestine does not exceed 3% in the structure of all tumors of the gastrointestinal tract. Among them, the frequency of neuroendocrine tumors is about 30%. Due to the absence of pathognomonic symptoms, such tumors are usually detected at the stage of surgical complications such as intestinal obstruction or intestinal necrosis. In such a situation, the oncological process is already either locally widespread or generalized. Therefore, timely diagnosis of tumors should be based not only on the complaints and anamnesis, allowing to suspect the development of complications, but also on the use of modern imaging methods.
 A clinical case demonstrating the difficulties of timely diagnosis of a neuroendocrine tumor of the small intestine is presented.

A clinical analysis of intestinal mucosal necrosis and exfoliation induced by superior mesenteric vein thrombosis: A case report.

Superior mesenteric vein (SMV) thrombosis is a rare intestinal ischemic disease. The clinical manifestations of patients differ, and most experience gastrointestinal symptoms. A 45-year-old female patient presented with persistent abdominal pain and abnormal vaginal bleeding for 7 days. A physical examination revealed significant abdominal tenderness with positive rebound tenderness. A laboratory examination revealed a white blood cell count of 27 × 109/l, hemoglobin level of 52 g/L, and D-dimer of 4.54 mg/l. Enhanced computed tomography revealed a thickening and swelling of the jejunum and ileum in the left upper quadrant and portal vein. Filling defects in the main lumen and branch lumen suggested the possibility of portal vein and superior mesenteric vein thrombosis. Symptoms improved after treatment with low-molecular-weight heparin and warfarin. One month later, the patient developed occasional dull pain in the left lower quadrant, with long strips of discharge. An electronic colonoscopy revealed avascular necrosis and tissue exfoliation of the intestinal mucosa. After the continuation of warfarin therapy, the abdominal pain resolved. Five months later, the patient experienced recurrent abdominal pain and vomiting. A physical examination revealed a blood pressure of 75/49 mm Hg. An incomplete ileus with the portal and superior mesenteric vein thrombosis was diagnosed, partial jejunectomy and gastrointestinal bypass anastomosis were performed, and warfarin was continued postoperatively. The intestinal mucosal shedding observed, in this case, was caused by SMV thrombosis, which enriched the clinical manifestations of the disease and provided a new basis for the clinical diagnosis of SMV thrombosis.

A new model for prediction of bowel gangrene in sigmoid volvulus.

Sigmoid volvulus is a pathology that can be mortal because it is frequently encountered in elderly patients. In case of bowel gangrene, mortality and morbidity increase further. We planned a retrospective study, in which the effectiveness of the model was evaluated by creating a model that aims to predict whether intestinal gangrene is present in patients with sigmoid volvulus only by blood tests and thus to quickly guide treatment methods. In addition to demographic data such as age and gender, laboratory values such as white blood cell, C-reactive protein (CRP), lactate dehydrogenase (LDH), potassium, and colonoscopic findings and whether there was gangrene in the colon during the operation were evaluated retrospectively. In the analysis of the data, independent risk factors were determined by univariate and multivariate logistic regression analyzes as well as Mann-Whitney U and Chi-square tests. Receiver operating characteristic (ROC) analysis was performed for statistically significant continuous numerical data, and cutoff values were determined and Malatya Volvulus Gangrene Model (MVGM) was created. The effectiveness of the created model was again evaluated by ROC analysis. Of the 74 patients included in the study, 59 (79.7%) were male. The median age of the population was 74 (19-88), and gangrene was detected in 21 (28.37%) patients at surgery. In univariate analyzes, leukocytes <4000/mm3 and >12000/mm3 (OR: 10.737; CI 95%: 2.797-41.211, p=0.001), CRP ≥0.71 mg/dl (OR: 8.107 CI 95%: 2.520-26.082, p<0.0001), potassium ≥3.85 mmoL/L (OR: 3.889; 95% CI): 1.333-11.345, p=0.013), and LDH ≥288 U/L (OR: 3.889; CI 95%: 1.333-11.345, p=0.013), whereas, in multivariate analyzes, only CRP ≥0.71 mg/dL (OR: 3.965; CI 95%: 1.071-15.462, p=0.047) was found to be an independent risk factor for bowel gangrene. The strength of MVGM was AUC 0.836 (0.737-0.936). In addition, it was observed that the probability of bowel gangrene increased approximately 10 times if MVGM was ≥7 (OR: 9.846; 95% CI: 3.016-32.145, p<0.0001). Besides being non-invasive compared to the colonoscopic procedure, MVGM is a useful method for detecting bowel gangrene. In addition, it will guide the clinician in taking the patients with intestinal loop gangrene to emergency surgery without wasting time in the treatment steps, as well as avoiding complications that may occur during colonoscopy. In this way, we think that morbidity and mortality rates can be reduced.

Traumatic intestinal ischemic necrosis.

A 71-year-old male patient presented to our emergency department with a 1-day history of abdominal pain after an accidental fall. Laboratory test results were as follows: a white blood cell count of 2.32 × 109/L, blood lactate of 3.0 mmol/L, pH 7.30, calcitonin precursor level of 71.09 ng/ml, and creatinine of 115 umol/L. The abdominal CT revealed: portal vein gas accumulation (PVGA) accompanied by a fluid-air level; pneumatosis cystoides intestinalis (PCI) manifested as multiple gas collections within the wall of the lower small intestine. Based on lowered blood pH and elevated lactate levels, there was a high suspicion of small intestinal ischemic necrosis. Subsequent emergency laparotomy and pathological examination confirmed necrosis of the small intestine.

Ileoileal intussusception due to Meckel's diverticulum in a pre-term neonate

Presented is a case of ileoileal intussusception in a pre-term male born at 24 weeks gestation caused by a Meckel's diverticulum, which likely occurred in utero. Neonatal intussusception accounts for less than 1.3% of all intussusception cases and is exceedingly rare in premature infants [2]. Around 90% of pediatric intussusceptions involve the ileum telescoping into the cecum or ascending colon (ileocolic), however, ileoileal intussusception due to Meckel's diverticulum is less common [6]. The diagnosis of intussusception in the neonatal period requires a high index of suspicion and does not have any specific radiological findings or signs, in contrast to older children. Misdiagnosis leads to delay in treatment, which leads to intestinal perforation and necrosis [3]. Radiologic studies to help differentiate intussusception from other disease entities, including necrotizing enterocolitis (NEC). These studies include ultrasound, plain abdominal films, and air or contrast enema. Treatment of neonatal intussusception is primarily operative versus necrotizing enterocolitis(NEC) in which medical treatment can be considered initially. This case presentation reports an exceedingly rare cause of intestinal obstruction in a neonate and reminds clinicians to expand the differential diagnosis when consulted by the NICU.

Enterocolite necrosante neonatal: relato de caso e revisão de literatura

Neonatal necrotizing enterocolitis (NEC) is a syndrome characterized by inflammation and ischemic necrosis of the gastrointestinal tract that can course with variable clinical manifestations: such as abdominal distension, bilious vomiting, hematoquezia, frequent gastric waste, decreased hydro-air noises, fecal changes. The condition is usually associated with systemic signs (pallor, apnea, hypoactivity, dysthermias). NEC can manifest with partial intestinal necrosis and have complete recovery, requiring only clinical treatment. Case report: newborn (NB) of T.A.A., female, premature (33 weeks and 5 days), extremely low weight (888g), APGAR 8/9, referred to the Neonatal Intensive Care Unit (ICU NEO). On the 1st day of life, he presented significant abdominal distension and bilious debt by the orogastric tube (SOG). It eliminated meconium after rectal stimulation, with 43 hours of life. He maintained abdominal distension until the 10th day of life, progressing, with progressive improvement (reduction of abdominal distension, change in the aspect of the debt by SOG), after the institution of adequate therapy. On the 11th day of life, he started a minimal enteral diet, progressing gradually, achieving success in diet progression. Enterocolitis is one of the most frequent gastrointestinal emergencies in neonates, most frequently affecting premature newborns, especially those born with very low birth weight. Studies indicate the recent increase in the incidence of NEC in NEO ICUs, in several countries, due to the increased survival of premature newborns. Therefore, there is a need for a greater dissemination of knowledge about the pathology; mainly among health professionals who work in these units.

Enterocolite Necrotizante Grave em Recém-Nascido A Termo: Relato de Caso

Necrotizing enterocolitis (NEC) is an important cause of mortality in the neonatal intensive care unit, and a rare finding in term neonates. We report a case of NEC in a 15 day old term neonate who presented to urgency care with fever and abdominal distension. He had a severe course of illness with pneumoperitoneum and hemodynamic instability and required surgical intervention with extensive intestinal resection. This case is particular due to the absence of classical risk factors for NEC (congenital cardiopathy, perinatal hypoxia, cow milk protein allergy) and to the more severe clinical presentation than most cases of NEC in term patients. Furthermore, the late start of symptoms and small intestine necrosis rather than colonic were unusual. NEC diagnosis is a challenge in term neonates due to the unspecific signs and symptoms it can present and its low prevalence in this group.

Volvulus of the Small Intestine in adults with intestinal malrotation: case report

Introduction: The volvulus of the small intestine with intestinal malrotation is a rare disease when occuring in adults, though, a surgeon’s ignorance of this diagnosis can result in potentially fatal extensive small intestinal necrosis. Presentation of case: Here, we present the case of a 57years old woman admitted and operated for a volvulus of the small intestine with intestinal malrotation after radiographic and pre-operative confirmation, whom follow up was unmarked. Discussion: The usual mechanism of obstruction in the volvulus of the small intestine with intestinal malrotation is adhesive compression of the duodenum and volvulus of the small intestine, this condition is the result of an arrest in the normal counterclockwise rotation of the cecum from the left lower quadrant to the right upper quadrant. Pre-operative diagnosis not always an easy task but the abdominal CT-scan is with a great help mainly by identifying the "WHIRL-WIND" sign. The Ladd procedure, consisting of division of Ladd’s bands, widening of the mesentery, and incidental appendectomy, is considered the worldwide standard up til now. Conclusion: This condition is rare and can be diagnosed mainly by CT-scan, however,the surgical management worldwide standard is the Ladd's procedure which can be led by laparotomy or laparoscopy and results in great outcome.

An autopsy case of polyarteritis nodosa accompanied with multiple immune-specific autoantibodies and rhabdomyolysis

A 72-year-old male complained of fever lasting 1 month and developed muscle weakness and paresthesia in the legs. He presented with muscle weakness, grasping pain, decreased deep tendon reflexes in the extremities, and reduction of tactile sensation in the distal parts of the left leg muscles. Blood tests revealed leukocytosis and inflammatory reactions. Collagen-disease-specific autoantibodies including anti-double-stranded DNA and anti-Scl-70 antibodies were positive, but antineutrophil cytoplastic antibodies were negative. Nerve conduction studies revealed asymmetric axonal degeneration, indicating multiple mononeuropathy. We started intravenous methylprednisolone pulse and plasma exchange therapies. However, the patient developed intestinal necrosis and perforation, and he died 44 days after the onset of fever. An autopsy revealed vasculitis in small- to medium-sized vessels in multiple organs as well as myoglobin casts in the renal tubules, which were suggestive polyarteritis nodosa (PAN) accompanied with rhabdomyolysis. Positivity for collagen-disease-specific autoantibodies and accompanying rhabdomyolysis are atypical findings with PAN. This patient was not clinically diagnosed as PAN, and so promptly starting immunotherapies should be considered when a case presents with evidence of vasculitis.

Enterocolite necrotizante grave em recém-nascido a termo: relato de caso

Necrotizing enterocolitis (NEC) is an important cause of mortality in the neonatal intensive care unit, and a rare finding in term neonates. We report a case of NEC in a 15 day old term neonate who presented to urgency care with fever and abdominal distension. He had a severe course of illness with pneumoperitoneum and hemodynamic instability and required surgical intervention with extensive intestinal resection. This case is particular due to the absence of classical risk factors for NEC (congenital cardiopathy, perinatal hypoxia, cow milk protein allergy) and to the more severe clinical presentation than most cases of NEC in term patients. Furthermore, the late start of symptoms and small intestine necrosis rather than colonic were unusual. NEC diagnosis is a challenge in term neonates due to the unspecific signs and symptoms it can present and its low prevalence in this group.

Can whole blood viscosity predict the development of acute mesenteric arterial thrombosis?

Acute mesenteric ischemia is a serious condition with high mortality rate, resulting internal organ damage and intestinal necrosis due to sudden occlusion in the arteries feeding the abdominal solid organs and intestines. The most common causes of acute mesenteric artery ischemia are embolic processes and thrombosis that develops on the basis of primary mesenteric artery atherosclerosis. Whole blood viscosity (WBV) was defined by De Simon and could be calculated with a formula that consists of total plasma protein and hematocrit (HCT). In our study, we aimed to investigate the predictive value of WBV for acute mesenteric ischemia caused by primary mesenteric artery occlusion. Between January 2015 and February 2021, a total of 55 patients with a retrospective diagnosis of acute mesenteric ischemia (AMI) and 50 healthy volunteers as a control group were included in the study. WBV was calculated with the De Simon for-mula using the HCT and plasma protein levels from the blood tests of healthy volunteers and patients at the time of admission with acute abdomen. No significant differences between the two groups in terms of baseline demographic characteristics except the preva-lence of age (72.1±12.4 vs. 65.7±6.4; p<0.001) and hypertension (40% vs. 23% p=0.002). AMI patients had significantly higher WBV values both at low shear rate (LSR) ([46.3±21.7 vs. 33.4±±13.1, p<0.001] and high shear rate [HSR] [16.5±11 vs. 15.8±0.7, p<0.001]). The univariate analysis identified several variables for predicting AMI including age (odds ratio [OR]: 1.066 confidence interval [CI]: 1.023-1.111, p=0.003), hypertension (OR: 3.612 CI: 1.564-8.343, p=0.003), WBV at HSR (OR: 2.074 CI: 1.193-3.278, p=0.002), and WBV at LSR (OR: 2.156 CI: 1.331-3.492, p=0.002). However, after multivariate analysis, only hypertension (OR: 3.537 CI: 1.298-9.639, p=0.014) and age (OR: 1.085 CI: 1.026-1.147, p=0.004) showed significance. In receiver operating characteristic analysis, a cut-off value of 43.5 WBV for LSR had a 72% sensitivity and a 70% specificity for prediction of mesenteric ischemia patients (area under curve [AUC]: 0.743, p<0.001) and a cut-off value of 16.29 WBV for HSR had a 78% sensitivity and 76% specificity for prediction of mesen-teric ischemia patients (AUC: 0.773, p<0.001). In our study, we determined that the WBV value obtained with the De Simon formula is a valuable parameter in predicting the development of acute mesenteric artery ischemia caused by primary mesenteric artery occlusion.

Enterocolite necrosante neonatal: relato de caso e revisão de literatura

Neonatal necrotizing enterocolitis (NEC) is a syndrome characterized by inflammation and ischemic necrosis of the gastrointestinal tract that can course with variable clinical manifestations: such as abdominal distension, bilious vomiting, hematoquezia, frequent gastric waste, decreased hydro-air noises, fecal changes. The condition is usually associated with systemic signs (pallor, apnea, hypoactivity, dysthermias). NEC can manifest with partial intestinal necrosis and have complete recovery, requiring only clinical treatment. Case report: newborn (NB) of T.A.A., female, premature (33 weeks and 5 days), extremely low weight (888g), APGAR 8/9, referred to the Neonatal Intensive Care Unit (ICU NEO). On the 1st day of life, he presented significant abdominal Residência Pediátrica; 2023: Ahead of Print. DOI: 10.25060/residpediatr-2023-567 distension and bilious debt by the orogastric tube (SOG). It eliminated meconium after rectal stimulation, with 43 hours of life. He maintained abdominal distension until the 10th day of life, progressing, with progressive improvement (reduction of abdominal distension, change in the aspect of the debt by SOG), after the institution of adequate therapy. On the 11th day of life, he started a minimal enteral diet, progressing gradually, achieving success in diet progression. Enterocolitis is one of the most frequent gastrointestinal emergencies in neonates, most frequently affecting premature newborns, especially those born with very low birth weight. Studies indicate the recent increase in the incidence of NEC in NEO ICUs, in several countries, due to the increased survival of premature newborns. Therefore, there is a need for a greater dissemination of knowledge about the pathology; mainly among health professionals who work in these units.

LEUKEMOID REACTION AS A MARKER OF ACUTE SURGICAL PATHOLOGY (A CLINICAL CASE)

The most accessible method for diagnosing various pathological processes is a complete blood cell count. It can reveal, in particular, such changes in the white hematopoietic lineage as leukocytosis and leukopenia. the causes of leukocytosis are very diverse. the most dangerous among them are leukemias and leukemoid reactions. in doubtful cases, additional methods of clinical examination are counting the differential white blood cell count and determining inflammation markers. Leukemoid reactions can develop against the background of sepsis, peritonitis, oncological diseases and severe infectious processes. This article presents a clinical case of leukemoid reaction in acute surgical pathology. the high point of the event was intestinal necrosis, which was manifested by corresponding symptoms and signs and a change in the complete blood cell count. the correctness of the diagnosis was proved by rapid normalization of the patient's white blood parameters after the surgical intervention.

A multicentric prospective observational study of diagnosis and prognosis features in ICU mesenteric ischemia: the DIAGOMI study

BackgroundNon-occlusive mesenteric ischemia (NOMI) is a challenging diagnosis and is associated with extremely high mortality in critically ill patients, particularly due to delayed diagnosis and when complicated by intestinal necrosis. Plasma citrulline and intestinal-fatty acid binding protein (I-FABP) have been proposed as potential biomarkers, but have never been studied prospectively in this setting. We aimed to investigate diagnostic features, the accuracy of plasma citrulline and I-FABP to diagnose NOMI and intestinal necrosis as well as prognosis.MethodsWe conducted a prospective observational study in 3 tertiary ICU centers in consecutive patients with NOMI suspicion defined by at least two inclusion criteria among: new-onset or worsening circulatory failure, gastrointestinal dysfunction, biological signs and CT-scan signs of mesenteric ischemia. Diagnosis features and outcomes were compared according to NOMI, intestinal necrosis or ruled out diagnosis using stringent classification criteria.ResultsDiagnosis of NOMI was suspected in 61 patients and confirmed for 33 patients, with intestinal necrosis occurring in 27 patients. Clinical digestive signs, routine laboratory results and CT signs of mesenteric ischemia did not discriminate intestinal necrosis from ischemia without necrosis. Plasma I-FABP was significantly increased in presence of intestinal necrosis (AUC 0.83 [0.70–0.96]). A threshold of 3114 pg/mL showed a sensitivity of 70% [50–86], specificity of 85% [55–98], a negative predictive value of 58% [36–93] and a positive predictive value 90% [67–96] for intestinal necrosis diagnosis. When intestinal necrosis was present, surgical resection was significantly associated with ICU survival (38.5%), whereas no patient survived without necrosis resection (HR = 0.31 [0.12–0.75], p = 0.01).ConclusionIn critically ill patients with NOMI, intestinal necrosis was associated with extremely high mortality, and increased survival when necrosis resection was performed. Elevated plasma I-FABP was associated with the diagnosis of intestinal necrosis. Further studies are needed to investigate plasma I-FABP and citrulline performance in less severe forms of NOMI.

Quercetin alleviates intestinal inflammation and improves intestinal functions via modulating gut microbiota composition in LPS-challenged laying hens

Quercetin, a well-known flavonoid, has been demonstrated to exert beneficial effects on intestinal functions and gut microbiota in birds. In this study, we investigated the effects of quercetin supplementation on inflammatory responses, intestinal barrier functions and gut microbial community in LPS-challenged laying hens. A total of two hundred eighty-eight 32-wk-old Jingfen No.6 laying hens were randomly assigned to 3 groups, the CON group, the LC group and the LQ group. LQ group was fed with 0.4 mg/kg quercetin and at the end of 12 wk, LC and LQ groups were challenged intraperitoneally with lipopolysaccharide (LPS). After LPS challenge, 8 birds of each group were randomly selected and sampled. LPS challenge induced an obvious intestinal mucosal injury, necrosis and shedding, while quercetin intervention maintained its structure. Quercetin significantly decreased the elevated malondialdehyde contents (P < 0.05), and increased the activity of total antioxidant capacity and glutathione peroxidase (P < 0.05) in intestinal mucosa of LPS-challenged laying hens. Quercetin rescued the LPS-induced decreases in goblet cell density and mucin2 expression levels (P < 0.05). There was a significant decline (P < 0.05) in the mRNA expression of Claudin1 and Occludin in intestinal mucosa of LPS-challenged layers, which could be alleviated (P < 0.05) by dietary quercetin. LPS challenge induced the increased expression levels (P < 0.05) of IL-1β and TLR-4 in intestinal mucosa, while these rises could be reversed (P < 0.05) following dietary quercetin supplementation. LPS challenge induced a shift in gut microenvironment, and quercetin addition could elevate the relative abundance of some short chain fatty acids (SCFA)-producing or health-promoting bacteria such as Phascolarctobacterium, Negativicutes, Selenomonadales, Megamonas, Prevotellaceae, and Bacteroides_salanitronis. In conclusion, dietary quercetin addition ameliorated the LPS challenge-induced intestinal inflammation and improved intestinal functions, possibly associated with its modulation on gut microbiota, particularly the increased population of SCFA-producing bacteria.

Identification and pathogenetic study of tilapia lake virus (TiLV) isolated from naturally diseased tilapia

As an emerging pathogen, tilapia lake virus (TiLV) has caused severe socio-economic impacts and remains a devastating factor in wild and farmed tilapia. Early diagnosis and timely reporting of TiLV are very important and necessary. In the study, a TiLV infection event in a tilapia farm is studied and reported. Naturally diseased tilapia with clinical signs such as anorexia, exophthalmia, skin abrasion and hemorrhage are collected. Multiple tissue lesions of liver, spleen and kidney are observed by histopathological analysis, such as syncytial formation, intracytoplasmic inclusion body and necrosis. No bacterial pathogens are identified from liver, spleen and kidney of the diseased tilapia, while all of them show TiLV-positive. E-11 cells are employed for TiLV isolation, and cytopathic effects are developed following incubation with supernatants of the homogenized tissues collected from the diseased tilapia. Electron micrographs of the infected cells and purified TiLV show that nearly round-shaped, enveloped viral particles (60–80 nm) can be identified. Segment 1 of the isolated TiLV has a high sequence similarity to other isolates, but phylogenetic analysis shows that it is placed in a unique cluster. Experimental infection with the isolated TiLV can cause high mortality (> 90%) in healthy Nile tilapia, with the similar clinical signs and tissue lesions to those found in naturally infected tilapia. Moreover, vacuolation and necrosis in brain, inclusion body and necrosis in heart, megalocytes and necrosis in intestine are observed in experimentally infected tilapia. Muscle, spleen, liver, intestine, brain, heart, kidney and gill of the re-infected tilapia show TiLV-positive, and liver, spleen and brain are the main target tissues. The data so far confirm a TiLV-associated disease outbreak in China, enriching the relevant information of TiLV.

PECULIARITIES OF CYSTIC FIBROSIS IN NEWBORN ON THE EXAMPLE OF A CLINICAL CASE

Cystic fibrosis is a severe genetic disease, which is inherited in an autosomal recessive manner and is characterized by a polyorganic clinical presentation with predominantly exocrine, respiratory and digestive gland involvement. Every year more than 45 000 children are born worldwide with this genetic disease. According to official statistics, 674 children with cystic fibrosis are registered in Ukraine, 25 of them in the Vinnytsia region. The disease is caused by a mutation in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR). The F508del mutation is most common in the paediatric population (19-34%). The most common clinical manifestations of cystic fibrosis in newborns are disorders of the gastrointestinal tract, pancreas, hepatobiliary system and respiratory system. In 20% of newborns, one of the earliest manifestations of cystic fibrosis is meconial ileus, which may pose a risk of complications such as meconium peritonitis, sputum, gangrene or intestinal necrosis. Early diagnosis with neonatal screening, improved care for the neonatal manifestations of meconial ileus and adequate medical follow-up by a multidisciplinary team of specialists, and improved lifelong replacement fermentation therapy have a significant impact on the life expectancy of patients with cystic fibrosis.This article presents a clinical case of early diagnosis of cystic fibrosis in a newborn. When meconial ileus is present and cysticfibrosis is suspected in a newborn, early genetic diagnosis is mandatory, in addition to timely and correctly performed neonatal screening. Comprehensive and timely treatment leads to improvement in cystic fibrosis patients and slows down the development of pathological changes in the bronchopulmonary and hepatobiliary systems.Conclusions. Prevention of a severe course of cystic fibrosis is in early detection of the disease during neonatal screening, indiagnosis at the first signs of the disease and early start of pathogenetic treatment, which improves the quality of life of patients.

Lupus Enteritis: An Unusual Manifestation of Systemic Lupus Erythematosus

ABSTRACT Though gastrointestinal symptoms are common in Systemic Lupus Erythematosus (SLE), lupus enteritis remains a rare manifestation of the disease. The clinical picture may be non-specific but should be considered in patients with abdominal pain, as this disease entity can progress to intestinal necrosis and perforation if left untreated. This is a case report of a 37-year-old female who had multiple hospital admissions for abdominal pain, was diagnosed with lupus enteritis and showed excellent response to methylprednisolone.

Succoring the challenging acute mesenteric ischemia: Feasibility of lactate dehydrogenase for evaluation of intestinal necrosis extension and mortality.

Acute mesenteric ischemia is a lethal challenging pathology for surgeons in the emergency department due to its ambiguous clinical presentation and lack of early diagnostic markers. Serum lactate is considered a relevant biomarker in terms of bowel necrosis length and mortality prediction. Nevertheless, its association has been poorly studied. Hence, we evaluated the relation between serum lactate admission levels, bowel necrosis extension, and mortality in patients with acute mesenteric ischemia. A Retrospective cross-sectional study with a prospective database was conducted, including patients over 18 years old with mesenteric ischemia that required surgical management between January 2012 and December 2018. We describe the association between serum lactate admission levels with bowel necrosis length and mortality in patients with acute mesenteric ischemia. 74 patients presented with acute mesenteric ischemia, 44 males and 30 females. Mean age was 73.5±10.7 years old. Significant association between serum lactate admission levels and mortality was found (ROC cut-value of 3.8mmol/l, 81.0% sensibility and 76% specificity, LR+3.41 (95%CI 1.57, 7.40), LR- 0.25 (95%CI 0.13-0.45))(P.001). Nonetheless no statistically significant association was found between serum lactate admission levels and bowel necrosis length (ρ=0.195,95%CI -0.046, -0.436, P>.99). As post hoc analysis, a classification and regression tree on mortality was fitted. Early diagnosis, prognosis and management of mesenteric ischemia is vital given its high morbidity and mortality. Serum lactate admission levels can be considered as a useful prognostic tool in terms of mortality in patients with acute mesenteric ischemia.

Radiological predictive factors of transmural intestinal necrosis in acute mesenteric ischemia: systematic review and meta-analysis.

Transmural intestinal necrosis (TIN) is related to high mortality in patients with acute mesenteric ischemia (AMI). Radiological predictive factors of TIN in AMI remains controversial. This study aimed to identify the CT-based predictive factors of TIN in AMI. EMBASE and PUBMED were searched for publications predicting TIN using radiological features. Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the methodological quality of individual studies. Data were presented in terms of diagnostic odds ratio (DOR), sensitivity, specificity, and 95% confidence interval (CI). The random-effects models were used for the meta-analysis. Eleven studies including 1037 cases with AMI were considered. The meta-analysis showed that bowel wall thinning (DOR = 13.10; 95% CI: 3.71, 46.25), decreased or absent bowel wall enhancement (DOR = 5.77; 95% CI: 2.95, 11.30), bowel dilation (DOR = 3.23; 95% CI: 2.03, 5.15), pneumatosis intestinalis (DOR = 5.78; 95% CI: 2.24, 14.95), porto-mesenteric venous gas (DOR = 5.36; 95% CI: 2.14, 13.40), and arterial occlusive AMI (DOR = 2.66; 95% CI: 1.53, 4.63) were risk factors for predicting TIN. Bowel wall thinning and porto-mesenteric venous gas displayed high specificity to diagnose TIN (98%, 95%, respectively). The subgroup analysis showed that decreased or absent bowel wall enhancement (DOR = 8.23; 95% CI: 4.67, 14.51) and bowel dilation (DOR = 3.14; 95% CI: 1.55, 6.39) were predictors of TIN in venous occlusive AMI, which were not related to TIN in arterial-origin AMI. For predicting TIN, there are specific radiological features. The radiological predictors of TIN may differ according to the various causes of AMI. Future primary studies should further evaluate the relationships between radiological signs and TIN based on different etiologies. • Bowel wall thinning, decreased or absent bowel wall enhancement, bowel dilation, pneumatosis intestinalis, porto-mesenteric venous gas, and arterial occlusive AMI were risk factors for predicting TIN. • Decreased or absent bowel wall enhancement and bowel dilation were predictors of TIN in venous occlusive AMI, which were not related to TIN in arterial-origin AMI.