Intestinal Occlusion Research Articles

ROS Plays a Role in the Neonatal Rat Intestinal Barrier Damages Induced by Hyperoxia.

Background Hyperoxia treats a subset of critical neonatal illnesses but induces intestinal damage in neonatal pups. In this process, the intestinal flora and mucosal epithelium might be altered by hyperoxia. So the changes of the intestinal flora and mucosal epithelium were studied. Methods Neonatal rats were randomized into the model group that was exposed to hyperoxia and the control group that was maintained under normoxic conditions; then, intestinal lavage fluid and intestinal tissues were harvested. ELISA was used to detect D-lactic acid (D-LA), endotoxin (ET), diamine oxidase (DAO), intestinal fatty acid binding protein (i-FABP), liver-type fatty acid binding protein (L-FABP) and cytokines in the intestinal lavage of neonatal rats during hyperoxia. The intestinal zonula occluden-1 (ZO-1), occlusion protein (Occludin), and closure protein-4 (Claudin-4) of neonatal pups were detected by immunohistochemistry, western blotting, and real-time Polymerase chain reaction (RT-PCR) during hyperoxia. NCM460 cell survival rates were assayed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) during hyperoxia and administration of N-acetyl-L-cysteine (NAC). The expression levels of ZO-1, Occludin, and Claudin-4 in NCM460 cells were detected by immunohistochemistry, western blotting, and RT-PCR during hyperoxia and NAC. Results D-LA, ET, L-FABP, i-FABP, DAO, TNF-α, IL-10, and IFN-γ were significantly increased by hyperoxia, while ZO-1, Occludin, and Claudin-4 were clearly decreased in the hyperoxia group compared with the control group. NAC promoted cell survival, which was inhibited by hyperoxia. The cellular expression levels of ZO-1, Occludin, and Claudin-4, which were lowered by hyperoxia, were increased by NAC. Conclusion Hyperoxia causes injury of the intestinal mucosa, and ROS plays a role in this intestinal damage during hyperoxia.

Effects of Warmed and Humidified CO2 Surgical Site Insufflation in a Novel Experimental Model of Magnetic Compression Colonic Anastomosis.

Background. Pneumoperitoneum insufflation with warmed and humidified carbon dioxide (WH-CO2) can prevent heat loss and increase tissue oxygenation. We evaluated the impact of localized WH-CO2 insufflation on the anastomotic healing process. Methods. Sixty male Wistar rats were randomized: Group 1 (control, n = 12), Group 2 (cold and dry CO2, CD-CO2, n = 24), and Group 3 (WH-CO2, n = 24). A magnetic compression side-to-side colonic anastomosis was performed under 60-minute local abdominal CO2 flow insufflation. Animal temperature was recorded. IL-1, IL-6, and CRP levels were assessed before and after insufflation and on postoperative day (POD) 7 and POD 10. Endoscopic follow-up was performed on POD 7 and POD 10. A burst pressure (BP) test of the specimen was performed on POD 10, and histopathological analysis was then performed. Metabolomics of the anastomotic site was determined. Results. Seven rats (5 CD-CO2 group, 1 WH-CO2 group, and 1 control group) died during the survival period. Necropsies revealed intestinal occlusions (n = 2). One additional rat from the CD-CO2 group was sacrificed on POD 7 due to intestinal perforation. The postoperative course was uneventful in the remaining cases. There was no difference in BP among the groups. Thermal monitoring confirmed that WH-CO2 insufflation was effective to reduce heat loss. IL-1 levels were statistically and significantly lower on POD 10 in the WH-CO2 group than the CD-CO2 group but not lower than the control group. CRP levels, histopathology, and metabolomics did not show any difference between the 3 groups. Conclusions. WH-CO2 was effective to preserve core temperature. However, it did not improve anastomotic healing.

Caracterización clínica, endoscópica e histológica del cáncer colorrectal en un grupo de pacientes cubanos

Introducción: el cáncer colorrectal representa el tercero en incidencia en ambos sexos a nivel mundial, por ellos es importante realizar estudios epidemiológicos del mismo.
 Objetivo: caracterizar clínica, endoscópica e histológicamente el cáncer colorrectal en pacientes atendidos en el Centro de Investigaciones Médico Quirúrgicas, Cuba.
 Métodos: estudio observacional, descriptivo y retrospectivo a 52 pacientes (31 hombres y 21 mujeres) con cáncer colorrectal diagnosticados entre 2012 y 2014. Se recolectaron los datos de historias clínicas y estudios endoscópicos, imagenológicos y anatomopatológicos. La media de edad fue 66,73 años.
 Resultados: el antecedente y/o presencia de pólipos en el colon predominó con 55.8 %. La enterorragia se presentó en 38.5 %, la oclusión intestinal y el dolor abdominal en 17.3 %. Durante la colonoscopia, se encontró el 47.7 % con lesión ulcerada y el lugar más comprometido fue el colon descendente. El adenocarcinoma se encontró en 90.4 % de los pacientes.
 Conclusiones: los antecedentes personales de pólipos colorrectales, el hábito de fumar, la diabetes mellitus tipo 2 y la obesidad fueron los factores de riesgo más encontrados. La forma de presentación más frecuente fue la enterorragia, seguida por la oclusión intestinal y las regiones del colon más afectadas fueron la descendente y la ascendente, respectivamente. El diagnóstico histológico fue en el mayor de los casos un adenocarcinoma. Existe una mayor frecuencia del diagnóstico en etapas avanzadas de la enfermedad.

Oclusión intestinal por proceso neoproliferativo estenosante en yeyuno

Oclusión intestinal por proceso neoproliferativo estenosante en yeyuno

Instrumental diagnosis and laparoscopic treatment of the giant sigmoid diverticulum: technical notes. Internal hernia and abdominal abscess after one month

The giant colon diverticulum is a rare disease. Symptomatology is non-specific but can cause acute abdomen in 30% of cases. Diagnosis is often accidental and is mainly based on CT. The treatment is surgical but there are still few cases treated laparoscopically. We present the case of a patient treated laparoscopically who returns to the ward after a month with intra-abdominal abscess and internal hernia without intestinal occlusion.

Tríada de Rigler


 Paciente de 68 años, sin antecedentes quirúrgicos.
 Ingresó a Emergencia con cuadro clínico de oclusión intestinal. Se solicitó radiografía simple de abdomen (solamente se obtuvo en decúbito), observándose la presencia de la tríada radiológica de Rigler, patognomónica del ileo biliar.
 Se señalan los 3 elementos: asas de delgado dilatadas (flecha negra), aerobilia (flecha blanca) y el cálculo calcificado ectópico en la fosa ilíaca derecha (flecha amarilla).
 El íleo biliar es la oclusión intestinal como consecuencia de la migración de un cálculo biliar a través de una fístula bilio-digestiva y su impactación, frecuentemente a nivel de la válvula ileo-cecal. Habitualmente se trata de una fístula colecisto-duodenal, aunque también puede tratarse de una fístula colecisto-colónica.
 El cuadro clínico clásicamente descrito es el de una oclusión intermitente, siendo más frecuente en pacientes añosos, con larga historia de litiasis biliar sintomática.

The colonoscopic leakage model: a new model to study the intestinal wound healing at molecular level

We describe a novel, fast-track, innovative intestinal wound healing model developed in mice called the ‘colonoscopic leakage model’. This model uses a colonoscopic biopsy grasper to make a controlled transmural...

Phytobezoar induced small bowel obstruction: an uncommon cause of intestinal occlusion

A case of a 42-year-old female patient with a two-days diffuse colicky abdominal pain, nausea and three episodes of vomiting is presented. Furthermore, patient complained for inability to eat for almost a week. In addition, patient had a history of subtotal gastrectomy Billroth II-type, due to gastric ulcer six years ago. There were no other known co-morbidities. Except for a distended, somewhat painful abdomen and sluggish bowel sounds, the rest clinical examination was unremarkable. Plain abdominal X-ray and ultrasound findings agreed with the clinical suspicion of sub-acute small bowel obstruction probably due to post-operative adhesions. A conservative management was decided. However, the patient after an initial clinical improvement, had a relapse of symptoms with the first feeding attempt. A followed computed tomography of the abdomen revealed a well define, oval, mass-like containing mostly air bubbles lesion, occupying for approximately six centimeters long the jejunum lumen. The diagnosis of jejunal phytobezoar was set. In accordance of computed tomography diagnosis were the intra-operative findings and the post-operative histopathology.

Invaginación intestinal en el adulto. Reporte de caso

La invaginación intestinal constituye una causa poco frecuente de oclusión intestinal en el adulto. Se presenta el caso clínico de este cuadro en un adulto mayor. En este caso, la tomografía computarizada (TC) identificó la intususcepción y el tratamiento fue una resección intestinal. La anatomía patológica proporcionó el diagnóstico definitivo. La etiología más frecuente de la obstrucción se corresponde con lesiones orgánicas malignas a nivel de colon, y benignas en intestino delgado. El diagnóstico preoperatorio se ha incrementado actualmente, gracias al avance de las pruebas de imagen. La resección intestinal sigue siendo el tratamiento en la mayoría de los casos, debido al alto porcentaje de patología maligna como causa subyacente.

The Elderly Patient – Clinical-Pathological Particularities of Left Colon Cancer

Abstract Almost half of the patients with colorectal cancer are over 70 years old. The aim of the study is to analyse the main clinical and paraclinical characteristics of elderly patients with left colon cancer. 171 patients with left colon cancer were included in a retrospective study, analysing the differences between the patients under and those over 70 years from the point of view of the symptomatology, laboratory investigations, treatment of anemia, postoperative complications. Secondary anemia is seen in a quarter of the patients, and the indication of intraoperative transfusion was most frequent in the elderly (p=0.007). The incidence of intestinal occlusion increases with age, so that one third of the patients over 80 years are admitted with intestinal occlusion. The management of the elderly patient with left colon cancer should benefit from a pluridisciplinary approach, in the context of the numerous associated disorders and the particularities of the geriatric patient.

Metabolic effects and outcomes of sleeve gastrectomy and gastric bypass: a cohort study.

The outcomes of bariatric surgery should not be evaluated only for weight loss purposes but from a wider point of view that is closer to the reality of morbidly obese patients. The study of the influence of bariatric surgery over obesity-related diseases in bariatric patients is worthwhile. We present a cohort study of 329 patients who underwent either laparoscopic sleeve gastrectomy (LSG: 165 patients) or laparoscopic gastric bypass (LRYGBP: 164). We analyzed complication rate, comorbidities and weight loss evolution. Both groups were comparable in demographic characteristics at baseline. Significant statistical differences were found in length of hospital stay and operative time (both were lower in the LSG group). Bleeding and wound infection were higher in the LRYGBP group, as it happened with intestinal occlusion as a late complication (p < 0.05). After a 5-year follow-up, the percentage of excess weight loss (%EWL) was higher in gastric bypass than sleeve gastrectomy (p = 0.01) but there was no statistical difference in percentage of total weight loss (%TWL) (p = 0.2). The resolution of comorbidities was similar in both groups except for dyslipidemia, which resolution was significantly higher in the gastric bypass group (p = 0.005). Metabolic syndrome (MeTS) resolution was similar in both groups. Sleeve gastrectomy and gastric bypass achieve similar outcomes in hypertension, type 2 diabetes, obstructive sleep apnea and MeTS resolution even when there is weight regain. Although gastric bypass achieves higher weight loss in morbid obese patients, complication rates are also higher compared to those of sleeve gastrectomy. Thus, the appropriate procedure should be tailored based on patient factors and comorbidities, but also on surgeon comfort level and experience.

The Influence of the Type of Surgery on the Immediate Postoperative Results in Patients with Colorectal Cancer Operated in Emergency.

The emergency surgery for colorectal cancer is associated with high rates of morbidity and mortality due to factors related to the characteristics of the patients but also the therapeutic attitude. This study aims to identify the surgical interventions associated with the postoperative complications, with the main causes of morbidity, with the reinterventions and with the postoperative deaths. We included in this retrospective study 431 patients hospitalized and operated in an emergency for complicated colorectal malignant tumors in the Surgery II Clinic of the Clinical Emergency County Hospital "Sf. Ap. Andrei from Galati, in the period 2008-2017. The patients data were collected from observation sheets, operative protocols, pathological, imaging and laboratory bulletins, at the time of the emergency intervention, as well as from those of subsequent admissions in patients who benefited from serial interventions. The postoperative morbidity was 10.44%. The resections with anastomosis were associated with the presence of postoperative complications (p 0.01): pseudomembranous colitis, (p 0.01) and postoperative intestinal occlusion (p 0.01). The practice of lymph node dissection was associated with postoperative complications (p 0.01): pseudomembranous colitis (p 0.01) and intestinal occlusion (p 0.01). The reinterventions were associated with resections with anastomosis (p 0.01), lymph node dissection (p 0.01) or patients with open /semi-open abdomen (p 0.04). The postoperative mortality was 9.28%. It was associated with the practice of lymph node dissection (p 0.01), of the ileostomy (p 0.01), with the open /semi-open abdomen (p 0.04). Patients with colostomy had the lowest number of hospitalization days (p 0.01). The resections with anastomosis per primam and the lymph node dissection were associated with morbidity. The type of main surgery did not influence the postoperative mortality, this being associated with the concomitant surgery: the lymph node dissection, the ileostomy, and the abdomen closure type. The reinterventions were associated with resections with anastomosis per primam, with lymph node dissection and with the open /semi-open abdomen. The duration of hospitalization was significantly shorter in patients with a colostomy.

Volvulus of Sigmoid Colon at Sikasso Hospital

The sigmoid volvulus is an acute strangulation of the colon by the twisting of the sigmoid loop around its mesenteric axis resulting in partial or complete obstruction of the colonic lumen. It is the most common intestinal volvulus and is an absolute medical and surgical emergency. Objectives: Determine the frequency of sigmoid colon volvulus, describe clinical and para-clinical signs, describe treatment, and determine morbidity and mortality. Methodology: This was a retrospective and prospective study performed in the General Surgery Department of Sikasso. This study concerned patients admitted and operated for sigmoid volvulus from January 1, 2014 to December 31, 2017. Retrospective Phase: We have created survey cards to study the following parameters: 1) The age and the sex; 2) The clinical signs and associated defects; 3) The radiological examinations, endoscopic; 4) The established treatment whether medical, or surgical; 5) The evolution and the postoperative consequences; 6) The admission period. Prospective Phase: At the admission each patient to benefit: a complete interrogation, a complete physical examination, additional examinations including radio of the abdomen without preparation, the rate of hemoglobin and hematocrit, grouping/rhesus. Support: Our data were collected from medical records and operating records of patients in the department. Results: We collected 54 cases of sigmoid volvulus (the annual frequency was 13.5 cases for year), which accounted for 58.1% of colonic occlusions 19.6% of intestinal occlusions and 5.9% of operative operations in emergency. The average age was 47.13 with extremes of 18 and 102 years, The sex ratio is 4.40% in favor of men. Abdominal pain, vomiting, stopping of materials and gases were present in 32 (59.3%) patients. Von Wahl’s triad was present in 36 patients (66.7%), the rectal ampoule empty in 92.6%. On the X-ray of the abdomen without preparation, 70.37% of the image was recorded as a double leg. The sigmoid was necrotic in 37% of cases, and a sigmoid volvulus and necrotic hail in 7.4% of cases. We found a simple sigmoid volvulus in 61% of cases. We performed an immediate anastomosis resection in 63%, a Hartmann resection in 29.6%, an immediate anastomosis resection plus an ileostomy in 7.4%. Operative follow-up was simple in 85.2%, with a morbidity of 11.1%, and a mortality of 14.8%. Conclusion: Sigmoid volvulus is a serious surgical emergency requiring early diagnosis and management to improve prognosis. Pre-, postoperative and postoperative resuscitation associated with immediate anastomosis resection, or resection plus Hartmann, would reduce morbidity and mortality.

Anorectal Malformations Operated at University Hospital Brazzaville

Aim: To appreciate the care of children operated for an anorectal malformation. Materials and methods: It was a retrospective study carried out from January 2014 to December 2018 (5 years) in the department of pediatric surgery of university hospital of Brazzaville. Results: We retained 35 files including 20 boys and 15 girls. The mean age of discovery of the malformation was 1.7 days (range 0 and 4 days). On physical examination, we found intestinal occlusion in 22 patients (62.9%): the absence of an anal opening (62.9%), abdominal bloating with tympanism were the most represented signs. (57.1%). There were 13 cases (37.1%) of anorectal malformations high, 12 cases (34.3%) of low and 10 cases (28.6%) of intermediate. There were 20 cases (57.1%) of anorectal malformations without fistula and 15 cases (42.9%) with fistula. The mean age at the time of the anal plasty was 12.7 months (range 2 days and 14 years). We performed the anorectoplasty according to the Peňa and De Vries technique in 26 cases (74.3%), perineal anoplasty in 5 cases (14.3%) and a transposition of the fistula in 4 cases (11.4%). Twenty-seven patients (77.1%) were reviewed with an average follow-up of 2.7 years (1 year and 5 years extremes). The anus had a normal aspect in 20 cases (74.1%). We evaluated anal continence according to the Krickenbeck criteria in 10 patients aged over 3 years, and six had good results.

Contained Rupture in Non-aneurysmal Aorta: 10 Years' Experience of Endovascular Repair of Penetrating Aortic Ulcers in Urgent and Elective Setting

Introduction: Penetrating Aortic Ulcers (PAU) are atherosclerotic lesions leading to rupture of the arterial wall even in non-aneurysmal vessels. The incidence of PAU has increased due to a wider use of diagnostic tools, however presentation, natural history, and technical treatment details are not clearly defined. Aim of the study is to analyze a monocentric 10 years' experience of urgent and elective PAU treatment. Methods: Pre, intra and post-operative data of all consecutive patients treated for PAU from 2009 to 2019 were retrospectively analyzed. Pre-discharge, 30-day and follow-up outcomes of patients treated electively and urgently were evaluated and compared. PAU, intended as ulcer-like projection into the medial lining of an artery with aspect of rupture, is characterized by a “neck” (length of intimal defect at the ulcer site), “depth” (its extension outside the aortic wall) and “maximum aortic diameter” at that level (DIAM). PAU with “depth” >20mm or DIAM >40mm were treated and included in the study. Fisher's exact test and T-student test were used for statistical evaluation. Results: Seventy-one patients (age:78±8 years; M 60-85%; F 11-15%; DIAM 51.2±19.2mm, neck 23.3±11.23mm, depth 29.6±17.58mm) were included in the study. Fifty-three patients (M 85%) were treated electively; 18 patients (M 83%) had symptoms (10-56% back/abdominal pain, 2 intestinal occlusions, 2 rectorrhagia, 2 hemorrhagic shock, 1 thoracic pain, 1 unspecified pain) and were treated urgently. Elective and urgent patients had similar characteristic except for Age (Elective:76±7 vs Urgent:81±7 years; p=.03) and ASA score (Elective:3.3±0.5 vs Urgent:3.7±0.5; p=.04). PAU were located in the infrarenal (39 cases-55%), para-visceral (7-10%), and thoracic aorta (10-14%) and in the iliac arteries (15 -21%). No differences among the aortic level presentation was found in the two groups, however there was a significant difference in “depth”(Elective:25.1±17.54mm vs Urgent:42.89±17.67mm; p=.0001) and DIAM (Elective:46.77±19.20mm vs Urgent:64.44±20.17mm; p=.0001) of PAU. All patients were treated by endovascular repair: urgent procedures required more General Anesthesia (Elective:51% vs 78%;p=.003) and more Intensive Care Unit (Elective:49% vs 78%;p=.003). Thirty-day complications occurred in 6 (8%) cases, with one surgical conversion, one iliac occlusion and femoral-femoral crossover bypass, one post-operative nephrectomy and one post-operative dialysis; 30-days mortality occurred in 2 (3%) cases, all in the urgent group (Elective 0% vs Urgent 11%; p=.01). The mean follow-up was 21±20.73 months: 10 cases (14%) had an Endoleak (8 type II, 1 type Ia, 1 very low type III), 2 patients (3%) needed a late Redo (1 Chimney for visceral vessels for proximal aortic rupture, 1 surgical for late anastomotic disruption). There was no difference in the long-term analysis between elective vs urgent treated patients. Conclusion: Endovascular treatment is an effective treatment for PAU; when it is performed electively, perioperative mortality/morbidity is very low with good long term results. Urgent cases have higher mortality rates and need more extensive anesthesiology support, with long-term results similar to non-urgent cases. According to these results, endovascular repair can be proposed as a safe and durable option in patients with PAU and elective repair should be encouraged. Disclosure: Nothing to disclose

Renal resistive index: a new reversible tool for the early diagnosis and evaluation of organ perfusion in critically ill patients: a case report

BackgroundWe reported a case of early detection of peripheral hypoperfusion trough the evaluation of a new index in intensive care: Renal Doppler Resistive Index (RRI).Case presentationWe admitted a 76-year-old man who underwent ileostomy and hernioplasty because of an intestinal occlusion due to obstructive strangulated right inguinal hernia. The post-operative period was characterised by hemodynamic instability and he needed an invasive hemodynamic monitoring, administration of vasopressors and continuous renal replacement therapy (CRRT). Then, hemodynamic stability was obtained and vasopressors interrupted. RRI was lower than 0.7. In the eleventh post-operative day, despite stable macrocirculatory parameters, we found increased values of RRI. An abdomen ultrasound first and then a CT scan revealed the presence of bleeding from the previous ileostomy. Hence, the patient immediately underwent another surgical operation.ConclusionsRRI modification appears to be more precocious than any other hemodynamic, microcirculatory and metabolic parameter routinely used. RRI has been widely used to assess renal function in critically ill patients; now, we presume that RRI could represent a common and useful tool to manage target therapy in critical condition.

Risk factors for adverse outcome in infancy in meconium ileus cystic fibrosis infants: A multicentre Italian study

BackgroundMeconium ileus (MI) is a risk factor for poor outcomes in cystic fibrosis (CF) patients. The aim of this study was to identify the risk factors for poor 12-month clinical outcomes in MI-CF newborns. MethodsThis retrospective, multicentre, observational study of MI-CF infants born 2009–2015 recorded their pre- and neonatal histories, intestinal occlusion treatments, post-surgical history, nutrition, CF diagnosis, and compared the patients with 12-month faltering growth or chronic Pseudomonas aeruginosa respiratory infection (cases) with the others (controls). ResultsAbout 25% of the 85 patients enrolled by 13 Italian CF centres (24% premature, 18% of low birth weight) had prenatally diagnosed bowel obstruction, and 39% had complex MI. Seventy-one required surgery (the 33 with complex MI and 38 with simple MI), of whom 58 (82%) required post-surgical intensive care, including 25 (35%) needing ventilatory support. Forty-six (54%) were breastfed; exclusively parenteral nutrition was started in 52 (61%). Cholestasis was diagnosed in 21%.Thirty-one (37%) experienced negative outcomes: the only risk factors were prenatally diagnosed intestinal obstruction and a need for intensive care and oxygen therapy. The cases had significantly higher first blood immunoreactive trypsinogen (b-IRT) levels (P = .008).Logistic regression showed that the probability of having negative outcome is decreased in the absence of cholestasis (Odds Ratio = 0.125) and a need for intensive therapy (OR = 0.141), and increased by not having been breastfed (OR = 2.921). ConclusionsHigh b-IRT levels, prenatally diagnosed intestinal obstruction, a severe post-surgical clinical picture and early liver disease are risk factors for negative outcomes. Breastfeeding may be protective.

Complete intestinal occlusion due to flanges andadhesions: case report

Background: Intestinal occlusion is the persistent arrest of intestinal transit, hinders movement towards distal sections. Adherence secondary to surgeries, the most frequent cause, collaborates in internal hernia formation in 4%. Need for surgical intervention is 6.4-10%. Case Report: Woman, 76 years old, 24 hours of evolution of generalized abdominal pain, due to crisis. Stopping 4-day and gas leak, 24 hours. Sigmoidostomy by CA of Sigmoid Colon. Physical examination: soft abdomen, depressant, diffuse pain, defense and pain in sudden decompression; RHA present. Increased soundness It presents neutrophilia, lymphopenia, thrombocytopenia. Urea, creatinine, BD, AST, TP, INR, high fibrinogen. Rx. of abdomen: hydroaryan levels. Ultrasound: Meteor. Simple TAC: obstruction of thin wings with multiple joints; in the transition zone. Diagnosis: Complete Intestinal Oclusion. Exploratory laparotomy consists of thin, violet coloration, multiple flanges and adhesions to the wall, epiplonic and interasas. They provide internal hernias with a 150-230 cm fitting of the fixed handle. Freezes and dissect adhesions and flanges with release of layered. Slim thin wings respond with better coloration and peristaltism. Discussion: 20% of cases of bowel occlusion caused by hernia, 1% of the total for internal hernia. Abdominal adhesions caused by 93% in postoperative cases, such as the picture. 95% of cases of flanges and adhesions are located in the small intestine, such as the presentation. Crisis type pain coincides as a symptomatology of the case. With compatible clinic, simple x-ray of abdomen and simple TAC (Gold Standard). Early surgery prevents intestinal strangulation, resulting in the restoration of the circulation and peristaltism of the wings.

Efficacy and safety results from GEICO 1205, a randomized phase II trial of neoadjuvant chemotherapy with or without bevacizumab for advanced epithelial ovarian cancer

BackgroundBevacizumab is an approved treatment after primary debulking surgery for ovarian cancer. However, there is limited information on bevacizumab added to neoadjuvant chemotherapy before interval debulking surgery.ObjectiveTo evaluate neoadjuvant bevacizumab...

DOZ047.75: Ectopic pancreas in children with esophageal atresia: not an incidental association

Abstract Aim of the Study Ectopic pancreas (EP) is pancreatic tissue lacking vascular or anatomic connection with the main body of the pancreas. Incidence in the general population ranges between 0.15% and 5.2%, and it is most commonly located in the stomach. It is usually asymptomatic, but it can lead to intestinal occlusion, bleeding, or malignant degeneration. After a patient with esophageal atresia (EA) debuted with a symptomatic EP, we aimed to determine EP incidence in our series of EA patients. Method Prospective single center review (2016–2018) was performed of children with upper gastrointestinal diseases who underwent diagnostic or therapeutic esophagogastroduodenoscopy (EGD). Patients were divided according to main diagnosis and gastric EP was actively searched for in every case. Results EGD was performed in 192 patients and the main diagnoses were EA in 53 (27.60%), eosinophilic esophagitis in 37 (19.27%), celiac disease in 23 (11.97%), and other upper gastrointestinal disorders in 79 (41.14%). EP was found in 7 cases (4 ♂/3 ♀), all of them in the EA group (7/53, 13.2%). Out of the 7, 4 had type III EA and in every case the EP was found at a prepyloric location. One patient debuted with hematemesis, so surgical excision was performed. Since the remaining 6 are asymptomatic, conservative treatment has been proposed. PE was not found in any of the other groups (P &lt; 0.05). Conclusion In this series, the incidence of EP in children with EA was higher (13.2%) than the one found in other groups (0%) or in the general population (0.15%–5.2%). These findings suggest that there is an association between EP and EA. Ectopic pancreas should be ruled out in every patient with esophageal atresia due to its potential morbidity, and when found, long-term follow-up is advisable.