Bowel Perforation Research Articles

Dehiscence rate and associated risk factors after gastrotomy for removal of foreign material in dogs and cats.

Identify rate and associated risk factors for dehiscence following gastrotomy for foreign material removal. Medical records from 2 private practice emergency and referral hospitals were reviewed, and history, laboratory values, intraoperative findings, and outcomes were collected on 271 dogs and 31 cats (n = 302). Hospital A performed 222 procedures and Hospital B performed 80 procedures. Three cats (3 of 31 [10%]) and 20 dogs (20 of 271 [7%]) had intraoperative intestinal perforations. Two cats (2 of 31 [6.5%]) and 7 dogs (7 of 271 [2.6%]) were diagnosed with preoperative septic peritonitis. Concurrent surgical procedures in felines included enterotomy (3 of 31 [10%]), multiple enterotomies (3 of 31 [10%]), intestinal resection and anastomosis (IR&A; 2 of 31 [6%]), and other (1 of 31 [3%]). Concurrent surgical procedures in canines included enterotomy (55 of 271 [20%]), multiple enterotomies (11 of 271 [4%]), IR&A (24 of 271 [9%]), IR&A and enterotomy (1 of 271 [0.4%]), splenectomy (11 of 271 [4%]), and other (50 of 271 [18%]). There was no proven gastrotomy dehiscence. Two patients that did not have follow-up surgery or necropsy before euthanasia developed postoperative septic peritonitis, and gastrotomy dehiscence could not be ruled out as a differential diagnosis. Assuming neither patient, 1 patient, or both patients had gastrotomy dehiscence, the gastrotomy dehiscence rate was 0% to 0.66%. However, these patients also had an IR&A. Two cases were presumed to have gastrotomy dehiscence, as the authors would rather overestimate the dehiscence rate. However, it is more likely that the IR&A was the dehiscence site rather than the gastrotomy. Gastrotomy dehiscence rate is low in cats and dogs, and the dehiscence rate reported in this study may be an overestimation.

Rare but important gastrointestinal complications after laparoscopic inguinal hernia repair: a single-center experience

Transabdominal preperitoneal patch plasty (TAPP) versus total extraperitoneal patch plasty (TEP) are surgical techniques commonly used to treat inguinal hernia. However, studies indicate that both procedures may lead to significant complications, particularly gastrointestinal complications, some of which can be life-threatening. We statistically analyzed the complications caused by adult inguinal hernia patients admitted from 2018 to 2022. We focused on gastrointestinal complications and conducted a case-by-case analysis on their causes and treatment processes. A total of 1034 patients were included in the final analysis, with 783 patients receiving TAPP treatment and 251 patients undergoing TEP. The overall complication rate for the TAPP group was slightly higher at 4.72% compared to 3.58% in the TEP group, but the difference was not statistically significant (p = 0.446). The incidence of both common and gastrointestinal complications is similar between the two groups, with no significant difference observed. Five patients (0.48%) suffered gastrointestinal complications, one with gastric perforation after TEP surgery, and four during TAPP surgery. All five cases of gastrointestinal complications were Grade III or higher according to the Clavien-Dindo classification, and all required reoperation. Gastrointestinal complications, though rare in LIHR, often require readmission and reoperation. Attempting non-operative management of such complications may lead to disastrous consequences. The majority of these complications are attributed to improper use of surgical instruments, necessitating vigilance on the part of the surgical team in preventing them.

Assessment of IL-6 Pathway Inhibition in Gastrointestinal Behçet's Disease from Immunological and Clinical Perspectives.

Behçet's disease is an autoinflammatory disorder characterized by relapsing and remitting vasculitis that can manifest in various forms, including gastrointestinal Behçet's disease (GIBD). Its complications (e.g., intestinal perforation) are among the primary causes of morbidity and mortality. GIBD pathogenesis involves the enhanced production of certain cytokines, e.g., tumor necrosis factor α and interleukin-6 (IL-6), which could serve as a target for potential therapies. This review provides an overview of GIBD, including the diagnosis and immunopathogenesis as it is currently understood, and evaluates the emerging role of the inhibition of IL-6 (classic and trans-signaling) as an alternative treatment option for patients with GIBD. Given the current paucity of data, we reflected on the potential of IL-6 inhibitors such as tocilizumab and olamkicept based on immunopathogenic considerations and available clinical data in patients with inflammatory bowel disease (IBD), in whom clinical response or remission was induced. The selective inhibition of IL-6 trans-signaling may bring new impetus to the development of this drug class, particularly regarding safety. Still, the benefits of IL-6 inhibitors for patients with GIBD need to be evaluated in appropriate proof-of-concept studies. The clinical outcomes of IL-6 inhibitors in IBD are promising and may suggest their potential relevance in GIBD.

Anti-nuclear matrix protein 2 antibody-associated juvenile dermatomyositis with gastrointestinal perforations was successfully treated with traditional therapeutic drugs combined with vedolizumab: a case report after a long-term follow-up and a review of the literature

Anti-nuclear matrix protein 2 antibody-associated juvenile dermatomyositis with gastrointestinal perforations was successfully treated with traditional therapeutic drugs combined with vedolizumab: a case report after a long-term follow-up and a review of the literature

Candiduria in Pediatric Patients: Two Case Reports and a Review of Management Strategies.

Introduction: Urinary infections, while common in intensive care and surgical units, present a unique challenge when fungal pathogens are involved. These fungal urinary infections, known as fungiuria, require a more intricate and prolonged treatment plan involving antifungal medications. This complexity underscores the need for specialized knowledge and skills in managing such cases. This study aims to present two cases of operated pediatric patients who developed urinary fungal infections following Catheterization and simultaneous treatment with two antibiotics. Results: Two pediatric patients, aged 12 and 16, underwent surgical procedures in our clinic. The first patient was treated for gangrenous appendicitis complicated by generalized peritonitis. The second patient was treated for a perforation of the small intestine caused by gangrene in a segment of the bowel, resulting from twisting around intestinal adhesions, also complicated by generalized peritonitis. Both patients, aged 12 and 16, developed urinary symptoms four days after surgery. Microbiological analysis confirmed the presence of fungal infections caused by Candida albicans. However, with the administration of antifungal medications, we were able to successfully eradicate Candida albicans from their urinary tracts, as confirmed by follow-up microbiological cultures after several weeks of therapy. This successful outcome should instill a sense of accomplishment in the audience. Conclusion: Candidiasis, a significant complication in patients undergoing prolonged Catheterization and simultaneous antibiotic therapy, requires vigilant monitoring. The challenging treatment often necessitates long-term administration of antifungal medications for successful eradication. This underscores the importance of vigilance in monitoring fungal infections in catheterized patients and adopting preventive strategies to minimize their occurrence.

Medication Blisters: A Rare Cause of Bowel Perforation

Medication Blisters: A Rare Cause of Bowel Perforation

A retrospective Study on Intestinal Injury from Blunt Abdominal Trauma

Introduction: Blunt abdominal trauma is the primary cause of morbidity and mortality. Suppose there are no indications of external trauma or changes in the patient's vital signs; blunt abdominal injuries might be complicated to identify at first. It is possible to lose a significant amount of blood without the abdomen appearing significantly different. A direct blow from blunt trauma can result in visceral damage and solid organ rupture, which can cause hemorrhage, peritonitis, and related pelvic injuries. The liver, small bowel, and spleen are the most frequently injured organs. Objectives: To find out the etiology, manifestation, anatomical distribution, diagnostic method, management, and outcome of intestinal injuries from blunt abdominal trauma. Material and Methods: About 59 individuals who had laparotomies during a 3-year period to treat intestine damage from traumatic abdominal trauma were included in the research. In a retrospective analysis, the patients' causes, presentations, anatomical distributions, diagnostic techniques, related injuries, courses of therapy, and deaths were all examined. Results: About 59 individuals with 60 significant bowel and mesentery lesions from blunt abdominal trauma were conducted. The average age was 36.78 years, and the male-to-female ratio was 5.5: 1. About 60 people sustained severe injuries. Furthermore, there were 50 minor intestinal injuries, which included 48 perforations, 12 major seromuscular injuries, and seven mesenteric, eleven colonic, and one duodenal injury. Thirty-three individuals suffered injuries from automobile incidents. The most frequent damage was a perforation at the small bowel's antimesenteric boundary. For colonic perforations, treatment included protective colostomy after resection, anastomosis, and perforation repair. There were 2 (3.38%) documented fatalities, and 10 (16.9%) individuals experienced significant problems. Conclusion: Due to its enormous infectious potential, early detection of intestinal injuries following severe abdominal trauma is crucial, even if it might be challenging. Severe injuries are frequently linked to intestinal perforations and are likely the deciding factors in survival.

Similarities and differences of clinical manifestations and prognosis between eosinophilic gastroenteritis and eosinophilic granulomatosis with polyangiitis complicating gastrointestinal involvement.

To investigate the similarities and differences of clinical manifestations and long-term prognosis between eosinophilic gastroenteritis (EGE) and eosinophilic granulomatosis with polyangiitis (EGPA) complicating GI involvement (EGPA-GI). Sixty-two EGE and 30 EGPA-GI patients were retrospectively enrolled in PUMCH from 2008 to 2023. Baseline clinical records were collected. Kaplan-Meier curves and log-rank tests were used to analyzed the relapse-free and non-adverse-outcome survival rate. Logistic regression was used to construct a predictive model for diagnosing EGE and EGPA-GI. Both diseases had a middle age onset. EGE had a shorter disease duration (3.5 vs. 11.0 months, p = 0.023), higher prevalence of distension (50.0% vs 20.0%, p = 0.007) and intestinal obstruction (32.3% vs 3.3%, p = 0.001), and lower prevalence of fever (6.5% vs 50.0%, p < 0.001) than EGPA-GI. EGPA-GI had higher prevalence of allergic diseases (86.7% vs 46.8%, p < 0.001) and higher IgE level (445.0 KU/L vs 153.0 KU/L, p = 0.003). Meanwhile, in EGPA-GI, higher ESR (25.0 mm/h vs 4.0 mm/h, p = 0.001) and hsCRP (48.9 mg/L vs 1.8 mg/L, p < 0.001) were observed. Asthma (OR 572.043, 95% CI 21.729-176,210.429, p = 0.0043), fever (OR 25.221, 95% CI 2.334-585.159, p = 0.0157), rash (OR 28.671, 95% CI 1.898-2274.543, p = 0.454), intestinal obstruction (OR 0.015, 95% CI 0.000-0.357, p = 0.0318), higher ESR (OR 1.101, 95% CI 1.035-1.208, p = 0.0099), and hsCRP (OR 1.038, 95% CI 1.010-1.081, p = 0.0208) were found to be independent discriminating factors for EGPA-GI. Both diseases presented recurrent courses. Adverse outcomes including GI perforation, organ failure, and all-cause death occurred in seven EGPA-GI patients while none in EGE (p = 0.00011). Both diseases have chronic and recurrent disease courses. Clinical manifestations and laboratory tests help to discriminate them. EGPA-GI have more unfavorable prognosis compared with EGE during long-term follow-up. Key Points •Baseline characteristics and long-term prognosis of 62 EGE and 30 EGPA patients with GI involvement (EGPA-GI) were compared in this study. •Both diseases had chronic and recurrent disease duration, eosinophilia, and increased IgE level. •EGPA-GI had higher prevalence of asthma, fever, rash, higher IgE, ESR, and CRP compared with EGE. •EGPA-GI had higher risk for severe adverse outcomes.

Unlocking the Potential of Cecostomies: A Valuable Lifesaving Procedure in Emergency Surgery for Colonic Obstructions.

Colonic obstructions present a serious medical emergency that requires prompt surgical intervention to prevent life-threatening complications. Cecostomy, a procedure involving the creation of an opening in the cecum to decompress the colon, serves as one surgical approach for managing these obstructions. The aim of this review is to evaluate the effectiveness and benefits of cecostomies in emergency surgical settings, with a focus on recent clinical studies and case reports. Cecostomy is highlighted as a bridge procedure in cases such as obstructive carcinomas, providing data on success rates, relative survival, and clinical effectiveness. The importance of the patient's condition and surgeon expertise in selecting cecostomy as a procedure is emphasized. Further comparative research is suggested to optimize the selection criteria, providing a strong, clinically oriented conclusion. A comprehensive literature review was conducted to identify studies and case reports focusing on the application of cecostomies in cases of acute colonic obstruction. Articles were selected based on their relevance to emergency surgery, the effectiveness of cecostomies, and patient outcomes in various clinical scenarios, including obstructive carcinomas and colonic pseudo-obstructions. The analysis reveals that cecostomies provide rapid decompression and effective relief from colonic obstruction, particularly when immediate intervention is needed to prevent bowel perforation or ischemia. In several cases, cecostomies act as a bridge to more definitive surgical treatments, such as resection and anastomosis, and are associated with reduced morbidity and mortality. The selection of cecostomy as a preferred procedure depends on the patient's condition, location of the obstruction, and surgeon expertise. Cecostomies play a crucial role in the emergency management of colonic obstructions, offering a viable and sometimes lifesaving alternative for rapid decompression. Understanding the indications and appropriate use of cecostomies can enhance patient outcomes and provide surgeons with effective strategies for managing acute colonic obstructions. Further research is warranted to refine selection criteria and to compare outcomes between cecostomies and other decompressive techniques in emergency settings.

Tenascin-X deficiency causing classical-like Ehlers Danlos syndrome type 1 in humans is a significant risk factor for GI and tracheal ruptures.

Classical-like Ehlers Danlos Syndrome type 1 (clEDS1) is a very rare form of Ehlers Danlos Syndrome (EDS) caused by tenascin-X (TNX) deficiency, with only 56 individuals reported. TNX is an extracellular matrix protein needed for collagen stability. Previous publications propose that individuals with clEDS1 might be at risk for gastrointestinal (GI) tract perforations and/or tracheal ruptures. To characterize complications resulting from perforations of the GI tract and/or tracheal rupture in an international case series of individuals with clEDS1 due to disease-related tissue fragility. This case series includes individuals with confirmed clEDS1 and GI perforations and/or tracheal ruptures from participating centres. Researchers who previously reported such individuals were contacted for additional information. A retrospective assessment of clinical features was performed. Fifteen individuals were included. Ten had spontaneous GI perforations, seven of whom had multiple GI perforations. Almost all had severe diverticulosis. Three individuals experienced iatrogenic tracheal ruptures. Severe GI complications, such as perforation, and tracheal rupture were observed in a substantial number of individuals with clEDS1. As these features seem significantly more common in clEDS1 than in the average population, we advise vigilance during intubation and GI endoscopic interventions of individuals with clEDS1. Routine referrals to clinical geneticists are recommended for patients with symptoms indicative of clEDS1, especially with unexplained GI perforations and connective tissue symptoms. Our findings offer valuable insights for the clinical management of clEDS1 and underscore the importance of specialized care, providing a foundation for improved clinical guidelines and preventive strategies.

JAK inhibitor-related gastrointestinal perforations

JAK inhibitor-related gastrointestinal perforations

Stent stoma: Endoscopic stent insertion for refractory small intestine fistulas.

The therapeutic management of fistulas presents significant challenges, often involving both conservative and surgical approaches. Despite these interventions, recurrence and postoperative mortality rates remain high. Endoscopic stent insertion into the fistula, along with the creation of a stent stoma, may offer a promising alternative for patients who fail surgical or conservative therapies. This study aimed to evaluate the feasibility, effectiveness, and safety of endoscopic stent insertion in the treatment of refractory small intestinal fistulas. Patients with refractory small intestine fistulas who underwent endoscopic stent insertion were included. The primary endpoint was defined as successful fistula treatment, which included an improvement in clinical symptoms related to the fistula, successful bridging to subsequent surgical revision, and the restoration of enteral nutrition. Secondary endpoints comprised the feasibility of the endoscopic procedure, complications, procedure-related complications, and in-hospital mortality. Eight patients were included, with a median follow-up period of 2.7 months. The implantation of a self-expanding metal stent was successfully performed in all patients (technical success rate, 100%; n = 8/8). The clinical success rate was 87.5% (n = 7/8), indicating clinical improvement in fistula-related symptoms, wound care, and enteral nutrition. Procedure-related complications occurred in one patient (12.5%; n = 1/8), involving stent dislocation leading to small intestine perforation, which was managed endoscopically. No procedure-related mortality was observed. Endoscopic stent insertion is a feasible, effective, and safe option for the management of therapy-refractory small intestinal fistulas. The creation of a stent stoma improves patient quality of life.

A real-world drug safety surveillance study from the FAERS database of hepatocellular carcinoma patients receiving pembrolizumab alone and plus lenvatinib

Pembrolizumab plus Lenvatinib is regarded as a significant treatment option for advanced unresectable hepatocellular carcinoma (HCC). This study aims to meticulously monitor and identify adverse events (AEs) related to this combined therapy, enhance patient safety, and offer evidence-based recommendations for the appropriate use of these drugs. We gathered adverse drug reactions (ADRs)-related data from the FAERS database for HCC patients who received Pembrolizumab, both alone and in combination with Lenvatinib from the first quarter of 2014 to the fourth quarter of 2023. ADRs signal detection was performed using the ROR, PRR, BCPNN, MHRA, and MGPS methods. We gathered data on 459 and 358 AEs from patients with HCC treated with pembrolizumab alone and in combination with lenvatinib, respectively. Using four signal quantification techniques, we identified 50 and 38 distinct AEs, which were classified into 15 different System organ class (SOC) categories. Notably, the most common AEs associated with pembrolizumab were gastrointestinal disorders and hepatobiliary disorders. In both patient groups, the most frequently reported AEs were hepatic encephalopathy, blood bilirubin increased and diarrhea. We also observed some unexpected significant AEs, such as dehydration, skin ulcers, and intestinal perforation. The countries reporting the highest number of AEs were the United States, followed by China, France, and Japan. The median onset time for AEs related to pembrolizumab alone and its combination with lenvatinib was 80.5 days (interquartile range 20.0–217.3 days) and 77.5 days (interquartile range 19.7–212.3 days), respectively. This study offers new insights into the monitoring and management of ADRs in HCC patients receiving pembrolizumab alone or in combination with lenvatinib. It is crucial to closely monitor the safety of this treatment regimen in HCC patients to avoid serious AEs.

Gut microbes of the cecum versus the colon drive more severe lethality and multi-organ damage.

Intestinal perforations lead to a high risk of sepsis-associated morbidity and multi-organ dysfunctions. A perforation allows intestinal contents (IC) to enter the peritoneal cavity, causing abdominal infections. Right- and left-sided perforations have different prognoses in humans, but the mechanisms associated with different cecum and colon perforations remain unclear. This study investigates how gut flora influences outcomes from perforations at different sites in mice. Using fecal-induced peritonitis mouse model, isolated IC from the cecum or colon was injected peritoneally at 2mg/kg. Bacterial burden was quantified with quantitative PCR, and microbial communities were analyzed using 16S rRNA gene sequencing. Survival rates were monitored, and blood biochemical indices, histological changes, cytokines expression, immunological signaling and multiple-organ damage were assessed at 16h post-injections. The results showed cecum IC developed more severe sepsis than colon IC, with shorter median survival time and greater multi-organ damage. Mice treated with cecum IC displayed elevated tissue damage markers in the liver, heart, and kidneys, contributing to worsened pathology. This was likely driven by systematic inflammatory cytokines production and lung inflammation. Mechanistically, cecum IC triggered stronger cGAS-STING and TBK1-NF-κB signaling, promoting systemic inflammation compared to the colon IC. Moreover, bacterial analysis demonstrated that cecum IC carry a higher bacterial burden than colon IC and exhibit a different microbial community. A detailed microbiome comparison revealed an increased abundance of potentially pathogenic bacteria in the cecum IC. These findings suggest that the site of intestinal perforation influences sepsis severity, with the cecum being associated with a higher bacterial burden and a relatively increased abundance of potentially pathogenic bacteria compared to the colon. Our findings first compared the lethality associated with the microbial composition of the cecum and colon, indicating the perforation site could help providers predict the severity of sepsis, thereby introducing a novel perspective to microbiology and sepsis research.

Application of Different Surgical Strategies in Helicobacter pylori-Associated Gastric Ulcers with Perforation: A Comparative Study of Short-Term and Long-Term Outcomes and Complication Risks.

This study compared the short- and long-term efficacy of simple suture with omental patch repair (Graham patch) in open surgery versus laparoscopic omental patch repair (LOPR) in treating patients with Helicobacter pylori (H. pylori)-associated gastric ulcers with perforation, and analyzed the incidence of complications. The clinical information of patients who had stomach perforation repair surgery in Deqing People's Hospital between January 2021 and January 2022 was retrospectively analyzed. The patients were divided into a control group (n = 54), whose subjects underwent the Graham patch repair, and an observation group (n = 52), whose subjects underwent laparoscopic gastric perforation repair. The general characteristics, therapeutic outcomes, intraoperative and postoperative surgical indicators, 1-year postoperative recurrence, and incidence of various postoperative complications were recorded and compared between the two groups. A total of 106 patients' clinical data were included in the study, of which 52 (49.1%) underwent LOPR and 54 (50.9%) were treated with Graham patch. The general characteristics of the patients in both groups were comparable. The observation group demonstrated significantly better outcomes in terms of operative time, intraoperative blood loss, and postoperative recovery time compared to the control group (p < 0.05). Moreover, the observation group had lower rates of postoperative complications and recurrence compared to the control group (p < 0.05). LOPR is a potential therapeutic method for patients with H. pylori-associated gastric ulcers with perforations on grounds of its superior efficacy and decreased incidence of comorbidities.

A fatal case of peritonitis due to colonic localization of acute myeloid leukemia.

Myeloid sarcoma (MS) is an extramedullary localization of immature granulocyte cells that can occur in association with acute myeloid leukemia (AML). Gastrointestinal involvement is relatively common in MS, but exclusive colonic localization is a rare occurrence. Here, we report on a 53-year-old male patient affected by AML developing a severe abdominal pain caused by intestinal perforation requiring surgical intervention. The post-mortem examination revealed an infiltrate consistent with MS. Diagnosis of colonic MS can be difficult due to non-specific symptoms and complicated by the challenges associated with exploring this area. Clinical acumen is crucial to promptly establish adequate management due to the potentially life-threatening nature of this condition.

Effect of gestational age on clinical features in necrotizing enterocolitis-associated intestinal perforation.

To investigate the clinical features of necrotizing enterocolitis-associated intestinal perforation (NEC-IP) in neonates with different gestational ages (GAs). Furthermore, we also want to identify the risk factors of poor prognosis for these patients. The retrospective study of patients with NEC-IP was conducted with basic information, comorbidity, intraoperative findings, related treatment, and prognosis. According to the GA, patients were divided into three groups: early (GA: 28-<32 weeks, Group 1), mid-term (GA: 32-<34 weeks, Group 2), and late (GA: 34-<37 weeks, Group 3). The clinical features of the three groups were analyzed, and risk factors for poor prognosis were identified. Of the 113 cases, the number of cases in Groups 1 to 3 was 36 (31.9%), 44 (38.9%), and 33 (29.2%), respectively; and the overall proportion of poor prognosis was 19.4% (22/113). For basic information, the birth weight of Group 1 was lower than that of Group 2 and Group 3, while the postnatal day at the time of surgery of NEC and the onset age were higher than that of Group 2 (onset age: G1 12.0[7.00;20.5], G2 9.00[4.00;13.0]; postnatal day at the time of surgery: G1 22.0[13.8;27.2], G2 13.0[8.00;21.0]) (P < 0.016). For comorbidity, the incidence of sepsis, coagulopathy, type of (congenital heart disease) CHD, and hypoproteinemia in Group 1 was higher than that in Group 2 (all P < 0.016), and the incidence of respiratory failure, hypoproteinemia in Group 1 was higher than that in Group 3 (all P < 0.016). For related treatment, the usage rate of vasoactive substances and mechanical ventilation in Group 1 was higher than that of Group 2 and Group 3 (all P < 0.016). By Lasso and Logistic regression analysis, we found that GA (OR: 0.274, 95%CI: 0.078-0.796), sepsis (OR: 7.955, 95%CI: 1.424-65.21), coagulopathy (OR: 19.51, 95%CI: 3.393-179.1), CHD (OR: 6.99, 95%CI: 1.418-54.83) and diseased bowel segment (OR: 2.804, 95%CI: 1.301-7.316) were the independent factors for poor prognosis (all P < 0.05). The clinical features of NEC-IP patients differ based on GA, particularly in terms of CHD type, postnatal day at the time of surgery, utilization of vasoactive substances, and prognosis. Furthermore, GA, sepsis, coagulopathy, CHD, and diseased bowel segment are independent factors for poor prognosis of patients with NEC-IP.

A Simple Nomogram for Predicting the Development of ARDS in Postoperative Patients with Gastrointestinal Perforation: A Single-Center Retrospective Study.

Acute respiratory distress syndrome (ARDS) is a severe form of organ dysfunction and a common postoperative complication. This study aims to develop a predictive model for ARDS in postoperative patients with gastrointestinal perforation to facilitate early detection and effective prevention. In this single-center retrospective study, clinical data were collected from postoperative patients with gastrointestinal perforation admitted to the ICU in Hebei Provincial People's Hospital from October 2017 to May 2024. Univariate analysis and multifactorial logistic regression analysis were used to determine the independent risk factors for developing ARDS. Nomograms were developed to show predictive models, and the discrimination, calibration, and clinical usefulness of the models were assessed using the C-index, calibration plots, and decision curve analysis (DCA). Two hundred patients were ultimately included for analysis. In the development cohort, 38 (27.1%) of 140 patients developed ARDS, and in the internal validation cohort, 13 (21.7%) of 60 patients developed ARDS. The multivariate logistic regression analysis revealed the site of perforation (OR = 0.164, P = 0.006), the duration of surgery (OR = 0.986, P = 0.008), BMI (OR = 1.197, P = 0.015), SOFA (OR = 1.443, P = 0.001), lactate (OR = 1.500, P = 0.017), and albumin (OR = 0.889, P = 0.007) as the independent risk factors for ARDS development. The area under the curve (AUC) was 0.921 (95% CI: 0.869, 0.973) for the development cohort and 0.894 (95% CI: 0.809, 0.978) for the validation cohort. The calibration curve and decision curve analysis (DCA) demonstrate that the nomogram possesses good predictive value and clinical practicability. Our research introduced a nomogram that integrates six independent risk factors, facilitating the precise prediction of ARDS risk in postoperative patients following gastrointestinal perforation.

Bevacizumab combined with chemotherapy could be superior to chemotherapy alone in relapsed ovarian cancer after PARPi: evidence from a multi-center propensity score-matched analysis.

A retrospective, multi-center propensity score-matched (PMS) analysis was conducted to investigate the efficacy and safety of the treatment strategy that combines bevacizumab and chemotherapy for patients with relapsed epithelial ovarian cancer (EOC) who previously received poly ADP-ribose polymerase inhibitors (PARPis). A total of 250 ovarian cancer (OC) patients relapsed after PARPi received chemotherapy with or without bevacizumab at 4 medical centers were enrolled in the study. For both treatments, Kaplan-Meier analysis and Cox regression were used to compare PFS. In the multivariable analysis of 250 patients, the incorporation of bevacizumab into chemotherapy demonstrated a significant enhancement in PFS (hazard ratio [HR]=0.49; 95% confidence interval [CI]=0.34-0.72; p<0.001). Fifty-five patients were enrolled in Group A (bevacizumab combined with chemotherapy) and 55 were enrolled in Group B (chemotherapy alone regime) after PSM analysis. A statistically significant difference in PFS was observed between the 2 regimens (HR=0.62; 95% CI=0.40-0.97; p=0.036), suggesting that the bevacizumab combined with chemotherapy regimen confers superior clinical benefits. The median PFS was 11 months in Group A and 9 months in Group B. A significant variation was noted in PFS between patients without RCRS (HR=0.50; 95% CI=0.30-0.82) and the platinum-resistant subgroup (HR=0.31; 95% CI=0.14-0.68). Adverse effects of Grade 3-4 were more prevalent in Group A than in Group B. Additionally, instances of severe hypertension and bowel perforation were reported solely within Group A. In patients diagnosed with EOC relapsed after PARPi, the regime of chemotherapy combined with bevacizumab is associated with better PFS.

A Case Report of a Pregnancy Complicated by Sigmoid Volvulus in the Extreme Preterm Gestational Age.

Intestinal obstruction is a rare but life-threatening incidence in pregnancy. Diagnosis can be challenging for clinicians as the symptoms might be approached as other common obstetric complications. Performing radiological and abdominal surgery are also areas of great concern in this field; since radiologic studies inevitably expose the fetus to radiation and the treatment options mostly involve surgery that is worrisome during gestation. The maternal and fetal outcomes are dependent on timely diagnosis and management; as intestinal perforation, necrosis and peritonitis can happen and lead to fetal or maternal mortality or morbidity. In this study, we present a challenging case of a 36-year-old pregnant woman with severe abdominal pain and distension that emergently underwent surgery after the diagnosis of sigmoid volvulus without the gestation being discontinued. To our knowledge, our study presents one of the rarest cases of intestinal obstruction during pregnancy that was managed surgically without pregnancy termination. Further we will discuss intestinal obstruction in pregnancy based the current literature.