Bowel Perforation Research Articles

Rectal foreign bodies. Diagnostic program and emergency care

AIM: to estimate clinical approaches to rectal foreign bodies (RFBs).PATIENTS AND METHODS: the retrospective cohort study included 47 patients (2022-2024) with suspected RFBs. Two clinical cases are presented. Case No. 1. Patient N., a 41-year-old male, was presented with RFB (a glass tumbler), introduced into the rectum without his consent. Because of RFB migration to the upper parts of the colon and risk of the intestinal perforation a laparotomy with removal of the intact foreign body was done. Case No. 2. Patient A, a 26-year-old male, was presented with RFB (a 80.0 × 7.0 cm dildo) that was transanally removed in the emergency room without anesthesia. No post-op complications developed. No any literature data of successful transanal removal of a larger RFB was found [1–5].RESULTS: out of 47 patients, the manual transanal removal of RFBs was successful in 46 (97.9%) cases. One (2.1%) patient required laparotomy due to the high risk of rectal injury and retrograde migration of RFB to the proximal colon. A variety of RFBs (size, shape, and material), an individual, structured approach to the diagnosis and treatment is required.CONCLUSION: clinical approach to RFBs depends on risk of intestinal perforation.

Neoadjuvant Pembrolizumab in Stage I-III Deficient Mismatch Repair Colon Cancer: A Clinical Trial.

This clinical trial investigated the safety and efficacy of single-cycle pembrolizumab in patients with localized deficient mismatch repair (dMMR) colon cancer. Neoadjuvant immunotherapy has induced remarkable rates of pathological complete response in patients with dMMR colon cancer. However, the optimal length and type of treatment are yet to be determined. This was an investigator-initiated, multicenter, single-arm, phase II study (ClinicalTrials.gov: NCT05662527) investigating the safety and efficacy of neoadjuvant pembrolizumab in patients with stage I-III dMMR colon cancer. Patients received a single cycle of pembrolizumab 4mg/kg (maximum 400mg) and underwent surgery three to five weeks later. An interim safety and efficacy analysis after including 42 patients was pre-planned. The primary outcomes were safety and efficacy (pathological complete response in more than 20% of patients). Between February 2023 and September 2023, 42 patients were enrolled at five Danish hospitals. All patients received pembrolizumab and underwent surgery, except one patient who refused to undergo surgery. Surgery was performed a median of 32 days after pembrolizumab treatment. Twenty surgical complications were observed in 16 of 41 patients (39%), three of which were above Clavien-Dindo grade 2. Two were grade 3b, and one was a surgery-related grade 5 gastric ulcer perforation. Three adverse events were grade 3. No grade 4 or 5 adverse events were reported. Of the evaluable patients, 46% (19/41) achieved a pathological complete response, while 61% had a major pathological response. In conclusion, neoadjuvant single-cycle pembrolizumab was well tolerated and effective in patients with localized dMMR colon cancer. Thus, the inclusion of patients was continued until 85 patients.

Angioimmunoblastic T-cell lymphoma harboring a t(8;14)(q24;q11.2)/TCR::MYC translocation that presented with intestinal infiltration.

Although rearrangement of the MYC oncogene (MYC-R) is frequently observed in aggressive B-cell lymphomas, it is extremely rare in T-cell malignancies. A 64-year-old man who had been under observation for several years because of asymptomatic pulmonary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALToma) was admitted to our hospital because of poor general condition and hypotension. Blood tests revealed thrombocytopenia and elevated serum lactate dehydrogenase levels, whereas computed tomography revealed systemic lymphadenopathy and splenomegaly. An inguinal lymph node biopsy precipitated a diagnosis of angioimmunoblastic T-cell lymphoma (AITL). Shortly after admission, the patient experienced spontaneous intestinal perforation and hemorrhage caused by multiple intestinal infiltrations of the AITL. Although chemotherapy was administered, the patient died several weeks after admission. A 46,XY,t(8;14)(q24;q11.2) karyotype was identified, and fluorescence in situ hybridization analyses showed split signals for the MYC and T-cell receptor (TCR) alpha genes, by which a TCR::MYC translocation was confirmed. Pathological autopsy analysis revealed systemic infiltration of the AITL and no MALToma lesions. Only a few cases of mature T-cell lymphoma harboring MYC-R have been reported in the literature thus far. To the best of our knowledge, this is the first reported case of AITL with TCR::MYC rearrangement. This condition could be associated with refractoriness to chemotherapy and aggressive clinical course with systemic infiltration that included the intestine.

Integrated safety analysis of tofacitinib from Phase 2 and 3 trials of patients with ankylosing spondylitis

ObjectivesDescribe tofacitinib safety from an integrated analysis of randomized controlled trials (RCTs) in patients with ankylosing spondylitis (AS).MethodPooled data from Phase 2 (NCT01786668; 04/2013–03/2015)/Phase 3 (NCT03502616; 06/2018–08/2020) RCTs in AS patients were analyzed (3 overlapping cohorts): 16-week placebo-controlled (tofacitinib 5 mg twice daily [BID] [n = 185]; placebo [n = 187]); 48-week only-tofacitinib 5 mg BID (n = 316); 48-week all-tofacitinib (≥ 1 dose of tofacitinib 2, 5, or 10 mg BID; n = 420). Baseline 10-year atherosclerotic cardiovascular disease (ASCVD) risk was determined in patients without history of ASCVD (48-week cohorts). Adverse events (AEs)/AEs of special interest were evaluated/compared with findings from other tofacitinib programs (16 Phase 2/Phase 3 rheumatoid arthritis [RA]; 2 Phase 3 psoriatic arthritis [PsA] RCTs) and a real-world cohort of AS patients initiating biologic disease-modifying antirheumatic drugs (US MarketScan).ResultsMost patients (> 75%; 48-week cohorts) without history of ASCVD had low baseline 10-year ASCVD risk. One patient (tofacitinib 5 mg BID; in all 3 cohorts) had a serious infection (aseptic meningitis). Herpes zoster (non-serious) occurred in the 48-week only-tofacitinib 5 mg BID (n = 5 [1.6%]) and all-tofacitinib (n = 7 [1.7%]; one multi-dermatomal [tofacitinib 10 mg BID]) cohorts. No deaths, opportunistic infections, tuberculosis, malignancies, major adverse cardiovascular events, thromboembolic events, gastrointestinal perforations occurred. Limitations: short RCT durations/low patient numbers within cohorts.ConclusionTofacitinib 5 mg BID was well tolerated to 48 weeks in AS patients; safety profile was consistent with RA/PsA clinical programs and a cohort of AS patients from US routine clinical practice.Clinical trial registration numbersNCT01786668 (2013-02-06); NCT03502616 (2018-04-11).

Unveiling Balantidium coli : A rare protozoan causing a series of cases of dysentery in Rajasthan and review of literature.

Balantidium coli is the largest, uncommon, and only ciliate parasite that infects humans and is more common in tropics and subtropical regions. It is mostly asymptomatic, but can cause diarrhea and abdominal pain and sometimes leads to perforation of the colon. It is harbored in animals, particularly among pigs in hotter environments and monkeys in the jungles. If not treated on time, it may lead to perforation of the large intestine, peritonitis, appendicle involvement, etc. It is more common in immune-compromised individuals, particularly in those living in poor hygienic conditions. Retrieval of rare parasites was possible only because of prompt stool transport and its early processing. There are only few previous reports regarding the pediatric cases of balantidiasis, and there is a little information about its clinical signs and treatment. Here, we report a case series of B. coli infection presenting as an acute diarrheal disease from Rajasthan.

Perforation of the Sigmoid Colon in Vasculitis in COVID-19 Patients

The aim of the study was to investigate the main manifestations and pathological changes in the tissues under the sigmoid colon perforation in patients with COVID-19. Materials. The study involved analysis of medical histories of 40 patients with sigmoid colon perforation associated with COVID-19. All patients showed similar symptoms (increasing respiratory failure, dyspnea, high body temperature), followed by the development of the sigmoid colon perforation due to the violation of intravascular hemostasis. In 25% of patients, perforation developed already on the second or third day from the onset of ARVI symptoms, in 75% - on the fifth or sixth day from the onset of the disease. Results. The analysed case histories and the results of histological examination of biopsy or pathological material demonstrated similarities in the clinical presentation of the disease and morphological changes in the affected area of the sigmoid colon. The main symptoms and syndromes are presented using the example of a clinical case. Conclusion. The patient developed complications at the final stage of COVID-19 disease and this was associated with inflammation of the mesentery arteriole walls and the formation of occlusive blood clots in their lumen, which led to the development of the sigmoid colon perforation.

An autopsy of a patient with polyarteritis nodosa who developed fatal intestinal perforation accompanied by systemic multiple aneurysms and arterial thrombosis.

The patient was a 48-year-old man who had developed acute myocardial infarction 3 years earlier. He started experiencing recurrent attacks of abdominal pain 2 years earlier. One month before the presentation, he developed perforative peritonitis, which was treated with right hemicolectomy. Preoperative computed tomography revealed systemic thrombotic aneurysms and fibrinoid necrotizing vasculitis was detected in the vessels in the serosa of the resected intestinal specimen. These findings led to a diagnosis of polyarteritis nodosa. Despite the start of remission induction therapy with high-dose glucocorticoid and intermittent intravenous cyclophosphamide, the effect of immunosuppressive therapy was limited. Approximately 1 month after treatment initiation, he died from small intestinal perforation. Polyarteritis nodosa often exhibits nonspecific clinical symptoms, which make an early diagnosis difficult in some cases. Although the prognosis depends on the presence of ischemic lesions due to a ruptured aneurysm or intra-aneurysmal thrombi, it is not rare for the diagnosis to be made following acute myocardial infarction or acute abdominal pain. In young patients with ischemic organ dysfunction without any arteriosclerotic lesions at low risk of developing cardiovascular events, early diagnosis can be made by performing a whole-body examination with a differential diagnosis of polyarteritis nodosa.

How I Do It: Management of Upper Gastrointestinal Perforations and Leaks (With Video)

Transmural gastrointestinal (GI) tract defects are defined as a complete interruption of the gastrointestinal lumen, and can be characterized as perforations, leaks, and fistulae. Each arise from distinct mechanisms and must be managed with an approach tailored accordingly. While traditionally managed surgically, the emergence of a variety of tools and techniques have enabled endoscopists to offer a less invasive alternative to effectively manage gastrointestinal leaks and perforations. Herein, in this “How I Do It” overview, we focus on the assessment and endoscopic management of GI perforations and leaks, including device selection, adjunctive techniques, and post-procedural considerations.

Hydrostatic reduction of intussusception: the impact of high enema pressure on success rates.

The aim of this study is to analyze the effect of increasing enema pressure on enema outcomes. We conducted a retrospective study to compare the effect of increasing enema pressure on enema outcomes. The primary outcome was the success rate of reduction, while secondary outcomes included intestinal perforation and recurrence rate. From May 2017 to April 2021, a total of 531 intussusceptions in 499 patients (Group A 247 patients, Group B 252 patients) were collected. The overall success reduction rate was 97.00%. The success reduction rate in Group A was 99.20% (245/247) and 94.8% (239/252) in Group B (P = 0.004). The overall recurrence rate within 48h after the initial enema reduction was 8.02%, and beyond 48h was 6.41%. The recurrence rates within 48h and beyond 48h were 9.39% and 6.53% in group A and 7.11% and 6.69% in group B, respectively (P = 0.526). No complications were associated with the enema reduction procedure. Our study has shown that using a hydrostatic pressure of 130mmHg for enema reduction is both effective and safe, with a higher success rate and no increased risk of complications. Therapeutic study, III.

Basidiobolomycosis: Unusual Cause of Colonic Perforation

Basidiobolomycosis: Unusual Cause of Colonic Perforation

Suspecting the unsuspected: spontaneous colonic perforation in healthy children

Colonic perforation is a notorious entity in surgical domain attributing to high morbidity and mortality. Luckily enough this is a rare and sporadic event in pediatric patients, specifically when it comes to spontaneous idiopathic type. The neonates are known to have colonic perforations due to certain known conditions like Hirschsprung’s disease, necrotizing enterocolitis, anorectal malformation, meconium ileus and atresia. Beyond infancy the incidence of spontaneous colonic perforations has a steep decline owing to diminution of congenital and developmental causes. In this case report we bring forth a case that we encountered as an acute abdomen secondary to idiopathic colonic perforation

Intestinal perforation following allogeneic stem cell transplantation caused by Epstein-Barr virus-positive mucocutaneous ulcer.

Not available.

Striking multiple magnetic foreign bodies in the stomach.

A 32-year-old man with a background of schizophrenia presented to gastroenterology outpatient clinic with upper abdominal discomfort and abnormal behavior for 1 day. The physical examination was characterized by a lack of cooperation. Computed tomography of the abdomen (Figure 1A, B) showed a rectangular-like metallic foreign body in the stomach without gastrointestinal perforation. The patient denied swallowing any foreign bodies. Owing to the large size of the metallic foreign body (13.0 by 4.7 by 3.7 cm), endoscopic removal was not attempted. Laparoscopic removal was attempted; however, conversion to an open procedure was performed, and two strings of magnets, approximately 60 pieces (Figure 1C), were successful retrieved from the stomach, with no residual foreign bodies detected. At 1-month follow-up, he was without any discomfort.

Treatment of blunt splenic injury in children in China.

Nonoperative management (NOM) is recognized as a viable treatment for pediatric closed splenic trauma. However, clinical guidelines are applied inconsistently, resulting in different treatment strategies in different regions. This study aimed to investigate the independent risk factors influencing the length of stay in pediatric closed splenic injuries and to analyze the key determinants in the choice of surgical treatment to optimize inpatient management and patient care and improve outcomes. A retrospective evaluation of medical records of pediatric patients with blunt splenic injury (BSI) admitted to Wuhan Children's Hospital from 2020 to 2024 was conducted. The dataset included demographics, mechanism of injury, injury grade, associated injuries, therapeutic measures, and outcomes, which were subjected to statistical analysis. Factors influencing length of hospital stay and treatment regimen were also analyzed. A total of 88.5% of patients underwent NOM, with 11% requiring splenic embolization due to hemodynamic instability or arterial hemorrhage. Surgery was required in 11.5% of patients, primarily for combined gastrointestinal perforation, or peritonitis. One patient died due to brain injury. Trauma scores and transfusion requirements were higher in the surgical group (37.7 ± 16.1 vs. 17.2 ± 13.1, p < 0.001; 21.7% vs. 100%, p < 0.001). Multivariate logistic regression showed that gastrointestinal complications significantly influenced the decision to operate (p = 0.0087). A generalized additive model showed a corresponding increase in length of stay with increasing injury severity, with the curve flattening in the mid to high ISS range (40-60). NOM remains an effective and preferred treatment strategy for pediatric BSI, particularly in the setting of stable hemodynamic parameters. This approach reduces the need for surgical intervention and associated complications while preserving splenic function. The study highlights that gastrointestinal complications are important determinants of surgical management. Further research into long-term outcomes and advancements in conservative management are needed.

Uncommon Clinical Encounter: Colonic Perforation Due to a Borderline Mucinous Ovarian Tumor

Uncommon Clinical Encounter: Colonic Perforation Due to a Borderline Mucinous Ovarian Tumor

Bowel perforation in neonates with Hirschsprung disease: a case series and literature review.

Bowel perforation is a severe complication of Hirschsprung disease (HD) that necessitates prompt diagnosis and aggressive management to reduce mortality and morbidity. This study aimed to provide insights into the clinical management of neonatal HD cases complicated by bowel perforation. A retrospective review was conducted on neonates diagnosed with HD and bowel perforation at Beijing Children's Hospital from January 2007 to January 2024. Inclusion criteria included neonates ≤ 28days old with confirmed HD diagnosis based on postoperative histology. Data collected included perinatal history, patient characteristics, HD classification, clinical presentations, surgical interventions, and outcomes. Statistical analysis was performed using SPSS 26.0. Among 300 neonates diagnosed with HD, 18 (6.0%) developed preoperative bowel perforation. Most perforations were in the proximal ganglionic bowel, with short-segment HD (7/18, 38.9%) and long-segment HD (9/18, 50.0%) being most common. All patients received timely surgical intervention upon the discovery of bowel perforation, with 94.4% (17/18) requiring stoma creation. Postoperative complications included stoma retraction, Hirschsprung disease-associated enterocolitis, and adhesive bowel obstruction, but no mortality was reported. The incidence of preoperative bowel perforation in neonates with HD was 6.0%, primarily in cases of short-segment and long-segment HD. Perforations were mainly located in the proximal ganglionic segments. Prompt surgical intervention, particularly stoma creation, resulted in favorable outcomes for most patients.

New generation endoscopic closure devices for full-thickness defects: a comparative pre-clinical study (with videos).

Endoscopic closure techniques are effective and safe in the management of transmural gastrointestinal defects. However, there is a paucity of data regarding their comparative effectiveness. This study aimed to compare the efficacy and safety of several new-generation, endoscopic closure devices in a pre-clinical model. We evaluated five commercially available devices: a through-the-scope clip (TTSC), an anchor-pronged TTSC, a suturing device, helical tacking system, and over-the-scope clip. We tested closure strength using an ex-vivo porcine model. Next, live animals underwent 15mm gastric and colonic perforations followed by immediate endoscopic closure with one of the devices. We assessed technical success, 7-day survival, time to complete closure, and National Aeronautical and Space Administration Task Load Index (NASA-TLX) task load index. A total of 60 ex-vivo closures were conducted (12 per device). The suturing device achieved a higher closure strength than all other devices (P < 0.05 for all comparisons). Technical success was achieved in 80% of cases, and 9 of 10 animals (90%) survived to 7days post-closure. The mean procedure time for the suturing device was longer than all other devices (P < 0.05 for all comparisons). The mean procedure time for the anchor-pronged TTSC was also faster than over-the-scope clip (P = 0.04). The total endoscopist NASA-TLX score for the suturing device and helical system were greater than all other devices (P < 0.05 for all comparisons). Each closure device varies significantly in closure strength, closure time, and ease of use. Optimal device selection will depend on defect size, anatomic location, the viability of the surrounding tissue, and endoscopist/technician expertise.

From Harmless to Harmful: A Case Series of Hepatic Abscess Induced by Gut Microbiota Due to Fish Bone.

Accidental ingestion of fish bones can lead to serious complications, such as gastrointestinal perforation and hepatic abscesses. This case series presents three instances where fish bone ingestion led to secondary GI tract perforation and the development of hepatic abscesses. It also emphasizes the importance of prompt diagnosis and intervention to prevent serious consequences.

A Case of Severe Post-Biopsy Bleeding and Perforation in Gastric Amyloidosis.

We herein describe a case of severe post-biopsy bleeding and perforation in gastric amyloidosis. A 70-year-old man who had been on dialysis underwent esophagogastroduodenoscopy and biopsy was performed. Post-biopsy bleeding occurred, and three times of coagulation hemostasis and once clip hemostasis were performed. After the hemostasis, he eventually had a gastric perforation and omental patch surgery was performed, however, he passed away after the surgery. From the pathological finding of biopsy specimen, he was diagnosed with gastric amyloidosis caused by dialysis-related amyloidosis. In patients of amyloidosis, the risk of bleeding and perforation is elevated due to vascular and tissue fragility. Therefore, when performing hemostasis in patients with gastrointestinal amyloidosis, clip hemostasis which minimizes tissue damage is considered preferable to coagulation hemostasis.

Two Cases of Colonic Perforation Following Upper Gastrointestinal Barium Examinations

Two Cases of Colonic Perforation Following Upper Gastrointestinal Barium Examinations