Bowel Loss Research Articles

Assessing the Impact of Serum Calcium, 25-Hydroxy Vitamin D, Ferritin, and Uric Acid Levels on Colorectal Cancer Risk.

The aim of this study is to investigate whether vitamin D, calcium, ferritin, and uric acids play a beneficial biomarker role in the prevention of colorectal cancer (CRC) risk. The case-control design was employed, including 650 CRC cases and 650 controls aged 35 to 70 years, comprising both men and women. The study encompasses sociodemographic data, clinical information, radiological diagnoses, and biochemical measurements. Statistically significant differences were observed between CRC and controls in terms of age, diagnostic radiology, tomography, positron emission tomography/computed tomography (PET/CT), colonoscopy, CRC awareness, risk factors, age, genetics, exposure to chemicals, inadequate nutrition, smoking, hookah and alcohol use. Significant differences were also identified in intestinal inflammations, obesity, processed foods (P < 0.001), abdominal pain and cramps, diarrhea, constipation, blood in stool, bloating (gas), irritable bowel, nausea/vomiting, anemia, stress, fatigue, weakness, and weight loss. Regarding biochemical parameters, statistically significant differences were found between CRC and controls in terms of hemoglobin, glycated hemoglobin (HbA1c), fasting blood glucose (FBG), vitamin D, neutrophil level, red blood cell (RBC), white blood cell (WBC), platelet level, platelet count, hematocrit, potassium, sodium (Na), calcium, creatinine, cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), bilirubin, uric acid, iron (Fe), ferritin, C-reactive protein (CRP), total protein, systolic blood pressure (SBP), and diastolic blood pressure (DBP) parameters (P < 0.001). Multivariate stepwise regression analysis was performed to find the best risk factors for the diagnosis of CRC as the dependent variable. As a result of the analysis, intestinal inflammation (P < 0.001), nausea/vomiting (P < 0.001), stomach pain (P = 0.003), hookah-smoking (P = 0.034), uric acid (P < 0.001), bilirubin (P < 0.001), cigarette smoke exposure (P = 0.033), processed food consumption (P = 0.002), calcium levels (P = 0.029), vitamin D deficiency (P < 0.001), and ferritin (P < 0.001) levels were identified as significant determinants for CRC. The current study demonstrated that vitamin D, calcium, ferritin, and uric acids play a beneficial biomarker role in reducing the risk of CRC prevention. The increase in CRC rates may be associated with lifestyle, environmental and hereditary factors, nutrition, alcohol consumption, hookah use, and cigarette smoking.

Neuromyelitis optica in a paediatric patient: a case report

Neuromyelitis optica is a multifocal demyelinating disease of the central nervous system that predominantly affects the spinal cord and optic nerves, with variable clinical features including motor weakness in limbs, bowel and bladder affection and loss of vision. The disease is characterized by poor or no recovery. Magnetic resonance imaging (MRI) of spine with contrast shows hyperintense lesions involving contiguous segments with a normal MRI brain. CSF studies shows anti aquaporin 4 antibodies. Visual evoked potential of eyes shows marked reduction of optic nerve function. We report a case of eight year old girl who presented with diminished vision in eyes (right &gt;left) and weakness in all four limbs. Clinical features and investigations were suggestive of NMO. She was treated with inj. methylprednisolone for 5 days followed by oral prednisolone in tapering dose for 6 weeks. The child improved of hemiparetic gait and power in the left side. Vision in the left eye did not deteriorate further. Repeat MRI showed the resolution of previous spinal lesions. Follow up of the child over seven years has multiple admissions due to relapses. In the third admission child was given again 5 days of inj. methylprednisolone followed by azathioprine for two months. On the seventh admission due to relapse, inj. rituximab 500 mg and inj. methylprednisolone 500 mg was given and repeated every 6 months. In the last follow up in June 2024, the child is clinically stable with improvement in gait and no further deterioration of vision and no bowel or bladder affection.

Bowel Resection Margins in Crohn's Disease: Do They Matter?

AbstractMany patients with Crohn's disease (CD) will ultimately require surgical intervention for refractory disease despite recognizing that surgery does not cure CD. The initial operation, primarily for ileocolic disease, is focused on resecting the offending pathology and ideally providing a reduced likelihood for subsequent operations and additional bowel loss through surgical techniques. The appropriate margin, macro- vs. microscopic, lays in balance to provide an adequate resection that minimizes bowel loss, compared to an extensive resection which ensures a thorough resection but inherently includes the loss of normal bowel in attempts to reduce recurrent symptomatic disease. Ensuring the appropriately timed operation, performed in optimal conditions, with apt mesenteric resections and an ideal anastomotic configuration are all only part of the equation, as bowel margins play an important role in limiting surgical recurrence and maintaining bowel length. A grossly normal margin assessed by the lack of serositis and the mesenteric “pinch test” can result in an appropriate margin without sacrificing normal bowel in this group of patients who are at risk of further bowel loss from CD recurrence.

Ayurvedic Management of Crohn’s Disease - A Single Case Study

Crohn’s disease is a chronic idiopathic inflammatory bowel disease condition characterized by skip lesions and transmural inflammation that can affect the entire gastrointestinal tract from the mouth to the anus. It is having variable presenting symptoms and may include diarrhoea, abdominal pain, weight loss, nausea, vomiting etc. The diagnosis is typically made with endoscopic and/or radiologic findings. A 16-year-old female patient diagnosed with Crohn’s disease having complaints of frequent loose stools, bleeding per rectum after evacuation of bowel, generalised weakness, reduced appetite and weight loss since more than 6 years approached the outpatient department of Kayachikitsa, SDM Ayurveda hospital, Kuthpady, Udupi, Karnataka, India. Patient was intervened with Vilwadi Gulika, Dadimashtaka Churna, Kutajarishta, Takra Kalpana, Parpati Kalpana, Picha Basti etc. strictly following Laja diet with Takra in 4 courses of admissions with a time gap of 2-3 months. There was marked improvement in the frequency of loose stools and rectal bleeding. Improvement in weight was noted by a gain of 12 kg and generalised weakness was completely relieved. The therapy gained confidence in the patient to stop all the steroid and immunosuppressant medications completely and continue with Ayurvedic medication. Thus, it can be concluded that Ayurvedic interventions are effective in the improvement of symptoms in Crohn’s disease.

SP1 transcriptionally activates HTR2B to aggravate traumatic spinal cord injury by shifting microglial M1/M2 polarization.

Spinal cord injury (SCI) can result in structural and functional damage to the spinal cord, which may lead to loss of limb movement and sensation, loss of bowel and bladder control, and other complications. Previous studies have revealed the critical influence of trans-acting transcription factor 1 (SP1) in neurological pathologies, however, its role and mechanism in SCI have not been fully studied. The study was performed using mouse microglia BV2 stimulated using lipopolysaccharide (LPS) and male adult mice subjected to spinal hitting. Western blotting was performed to detect protein expression of SP1, 5-hydroxytryptamine (serotonin) receptor 2B (HTR2B), BCL2-associated x protein (Bax), B-cell lymphoma-2 (Bcl-2), inducible nitric oxide synthase (iNOS), clusters of differentiation 86 (CD86), Arginase 1 (Arg-1) and clusters of differentiation 206 (CD206). Cell viability and apoptosis were analyzed by MTT assay and TUNEL assay. mRNA levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-4 (IL-4) and tumor necrosis factor-β (TNF-β) were quantified by quantitative real-time polymerase chain reaction. The association of SP1 and HTR2B was identified by chromatin immunoprecipitation assay and dual-luciferase reporter assay. HE staining assay was performed to analyze the pathological conditions of spinal cord tissues. LPS treatment induced cell apoptosis and inhibited microglia polarization from M1 to M2 phenotype, accompanied by an increase of Bax protein expression and a decrease of Bcl-2 protein expression, however, these effects were relieved after SP1 silencing. Mechanism assays revealed that SP1 transcriptionally activated HTR2B in BV2 cells, and HTR2B knockdown rescued LPS-induced effects on BV2 cell apoptosis and microglial M1/M2 polarization. Moreover, SP1 absence inhibited BV2 cell apoptosis and promoted microglia polarization from M1 to M2 phenotype by decreasing HTR2B expression. SCI mouse model assay further showed that SP1 downregulation could attenuate spinal hitting-induced promoting effects on cell apoptosis of spinal cord tissues and microglial M1 polarization. SP1 transcriptionally activated HTR2B to aggravate traumatic SCI by shifting microglial M1/M2 polarization.

448 Motor Control of Bladder Function by Nerve Transfer

INTRODUCTION: A normal detrusor muscle is activated by parasympathetic efferents that release acetylcholine to muscarinic receptors to contract and expel urine. Through canine work by our group, the scientific underpinning of a somatic nerve transfer to a visceral target (hybrid synapse) was established. We present the scientific basis of this hybrid nerve transfer and report the first-in-human functional outcome. METHODS: Our patient presented with deteriorating bladder function over 1 year and underwent en bloc resection of a sacral chondrosarcoma in December 2020. The sacral roots from S1 caudally were divided – resulting in loss of bowel and bladder function. Urodynamics demonstrated an acontractile bladder (0 cm H20). In May 2021 bilateral obturator nerve transfers to the vesical branches (to bladder) of the inferior hypogastric plexus (6 months after surgery). Patient bladder function and pelvic visceral sensation were followed with serial urodynamic studies. RESULTS: The patient was asked to adduct the thighs and relax the abdomen to initiate a detrusor (bladder) contraction. This provided definitive activation of the nerve transfer in November 2022 (1.5 years after transfer), which was confirmed in January 2023 (∼20 cm H20). Concomitantly, the filling volume at which “full bladder” was perceived appeared at 6 months and progressed until detected within normal range of bladder volumes. CONCLUSIONS: This is a first-in-human nerve transfer that has clear evidence of visceral sensation recovery (need to void) at normal volumes, and functional detrusor contraction. While bladder pressures produced were not within normal range, we expect transfers earlier after loss of function (e.g. within 6 months instead of 18) will result in greater functional gains.

The psychological burden of NMOSD - a mixed method study of patients and caregivers.

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system with common symptoms of rapid onset of eye pain, loss of vision, neck/back pain, paralysis, bowel and bladder dysfunction and heat sensitivity. The rare, unpredictable, and debilitating nature of NMOSD constitutes a unique psychological burden for patients and their caregivers, the specific nature and extent of which is not yet known. This mixed methods study, informed by both quantitative and qualitative data collected via self-report measures, focus groups, and in-depth interviews, aims to investigate and understand the psychological burden of patients with NMOSD and their caregiver/loved ones, so as to inform a specialized intervention. 31 adults living with NMOSD and 22 caregivers of people with NMOSD in the United States and Canada, recruited from NMOSD patient advocacy groups, social media groups, and through word of mouth from other participants, completed a battery of standardized self-report measures of anxiety, depression, trauma, cognitive fusion, valued living, and coping styles. Semi-structured focus group sessions were conducted via HIPAA-compliant Zoom with 31 patients, and separate focus groups were conducted with 22 caregivers. A subset of these samples, comprised of 16 patients and 11 caregivers, participated in individual semi-structured interviews, prioritizing inclusion of diverse perspectives. Descriptive statistics and bivariate correlations were run on quantitative self-report data using SPSS [Version 28.0.1]; data were stored in REDCap. Reflexive thematic analysis was employed regarding qualitative individual interview data. The majority of patients reported experiencing anxiety, depression, cognitive fusion, over-controlled coping, and lack of values-based living. Caregivers also reported heightened anxiety, cognitive fusion, and over-controlled coping, although they did not endorse clinically significant depression. Patient and caregiver degree of anxiety and of overcontrolled coping were both strongly positively correlated, likely affecting how both parties manage NMOSD-related stressors, both individually and as a dyad. Patients reported more anxiety, depression, psychological inflexibility, and lack of values-based living, compared with caregivers. Patient and caregiver narrative themes included mistrust of medical professionals, lack of support immediately following diagnosis, changes in relationships, deviation from values-based living, internalization of feelings, and avoidant coping strategies to manage the psychological burden of NMOSD. A novel mental health intervention targeting the specific psychological burden of life with NMOSD is proposed.

Factors that may affect the outcome of acute occlusive mesenteric ischemia. A single-center study

BackgroundAcute mesenteric ischemia is a rare but lethal disease. Acute occlusive mesenteric ischemia consists of mesenteric artery embolism, mesenteric artery thrombosis, and mesenteric vein thrombosis. This study aimed to investigate the factors that may affect the outcome of acute occlusive mesenteric ischemia.MethodsData from acute occlusive mesenteric ischemia patients admitted between May 2016 and May 2022 were reviewed retrospectively. Patients were divided into 2 groups according to whether complications(Clavien‒Dindo ≥ 2) occurred within 6 months of the first admission. Demographics, symptoms, signs, laboratory results, computed tomography angiography features, management and outcomes were analyzed.Results59 patients were enrolled in this study. Complications(Clavien‒Dindo ≥ 2) occurred within 6 months of the first admission in 17 patients. Transmural intestinal necrosis, peritonitis, white blood cell count, percentage of neutrophils, percentage of lymphocytes, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, creatine kinase isoenzyme, cardiac troponin I, laparoscopic exploration rate, open embolectomy rate, enterostomy rate, length of necrotic small bowel, length of healthy small bowel, surgical time and intraoperative blood loss differed significantly between groups. Creatine kinase isoenzyme (OR = 1.415, 95% CI: 1.060–1.888) and surgical time (OR = 1.014, 95% CI: 1.001–1.026) were independent risk factors associated with complications(Clavien‒Dindo ≥ 2).ConclusionsOur analysis suggests that acute occlusive mesenteric ischemia patients with a creatine kinase isoenzyme level greater than 2.22 ng/mL or a surgical time longer than 156 min are more likely to experience complications’(Clavien‒Dindo ≥ 2) occurrence within 6 months of the first admission.

Small and large bowel anatomy is associated with enteral autonomy in infants with short bowel syndrome: A retrospective cohort study.

Achievement of enteral autonomy (EA) is the ultimate treatment goal in pediatric intestinal failure (IF). We aimed to assess predictors of EA in pediatric short bowel syndrome (SBS) and explore the impact of residual small bowel (SB) and large bowel (LB) length on EA. A retrospective cohort study was performed on infants aged <12 months (n = 367, six centers) with SBS referred between 2010 and 2015. The cohort was stratified based on the achievement of EA. Statistical testing was completed using t-test, chi-square, Cox proportional hazards regression model, and Kaplan-Meier analysis. EA was achieved in 229 patients. In the multivariable analysis, the percentage of residual LB (hazard ratio [HR] = 1.02; 95% CI = 1.01-1.02) and SB (HR = 1.01; 95% CI = 1.01-1.02) length, presence of the ileocecal valve (HR = 2.02; 95% CI=1.41-2.88), and not coming from a high-volume transplantation center (HR = 2.42; 95% CI = 1.68-3.49) were positively associated with EA, whereas a negative association was seen with the presence of stoma at the time when shortest remnant was documented (HR = 0.72; 95% CI = 0.52-1.00). EA achievement was significantly different between the anatomical subgroups (log-rank test P < 0.001) with an EA rate of 80.4% in infants with ≥50% SB and LB (median time 209 days); 62.5% with ≥50% SB and <50% LB (397 days); 58.3% with <50% SB and ≥50% LB (1192 days), and 25.9% with <50% SB and LB. Necrotizing enterocolitis (NEC) was not associated with a better achievement of EA (NEC vs other etiologies: log-rank test P = 0.33). Overall, 62% of infants with IF secondary to SBS achieved EA over a mean time of follow-up of 2.3 years. A colon length of >50% can compensate for the loss of small bowel (<50%) and account for similar EA rates as those in children with residual SB > 50%.

Characteristics and clinical outcomes of pediatric patients following massive bowel resection: A retrospective cohort study

BackgroundMassive bowel resection (MBR), defined as residual small bowel < 25 % of expected length-for-age based on established norms, is a rare entity. Traditionally, children who have undergone MBR have higher mortality and less probability of achieving enteral autonomy compared to patients with less substantial bowel loss. The primary objective of this study was to determine the characteristics and clinical outcomes of pediatric patients following MBR. Secondary objectives included comparing patients who achieved enteral autonomy to those who remained parenteral nutrition (PN)-dependent to determine characteristics associated with PN independence. MethodsRetrospective cohort study of patients following MBR managed by our multidisciplinary intestinal rehabilitation program between January 1, 2006 and December 31, 2017, with an observation period ending December 31, 2021. Results61 patients with MBR fulfilled study inclusion criteria. 21 patients (34.4 %) achieved enteral autonomy while 40 patients (65.6 %) did not. Patients who achieved enteral autonomy had a greater percentage of residual small bowel (22 % vs 13 %, P < 0.01) and colon (100 % vs 50 %, P < 0.01). They were more likely to have an ICV (73.2 % vs 15 %, P < 0.01) and less likely to undergo STEP procedure (14.3 % vs 37.5 %, P = 0.02). 18 patients in the cohort without enteral autonomy achieved greater than 50 % enteral nutrition. In this cohort, the overall transplant rate was 9.8 % and mortality rate was 11.5 %. ConclusionSeveral important advancements have occurred over the last two decades that have allowed more patients to reach their adaptive potential and mitigate complications of prolonged PN following MBR. Overall outcomes are better than previously reported.

“Meet the patient” session: a strategy to teach medical students about autonomic dysfunction after spinal cord injury

Dysregulation of the autonomic nervous system is an important long-term consequence of spinal cord injury (SCI). Yet, there is a scarcity of teaching resources about this topic for preclinical medical students. Given the association of SCI sequelae with emergency complications and mortality, it is imperative to equip medical students with the ability to recognize them. We designed a “Meet the Patient” (MTP) session with the primary goal to enhance student learning about SCI sequelae by interacting with patients and listening to real-life stories. The session primarily focused on recognizing triggers and symptoms of autonomic dysreflexia (AD) and discussing the loss of bowel and bladder control, while providing opportunities to learn more about living with SCI from patients’ real-life experiences. During the MTP session, patients living with SCI discussed their experience with AD, neurogenic bowel and bladder, and spasticity, among other SCI sequelae. We evaluated the outcomes of the MTP session by assessing numerical performance in questions related to the session (post-session quiz and final exam) and students’ satisfaction (post-session survey) in two subsequent academic years. The numerical performance in SCI-questions was high for both academic years (and higher than national average for the final exam question), indicating adequate acquisition of knowledge. Satisfaction with the session was high, with most students indicating that the session helped them consolidate their knowledge about the topic.

Nontraumatic Spine Emergencies: A Primer for the On-Call Radiologist

Myelopathy is defined as rapidly developing muscle weakness, sensory deficit, and loss of bowel and bladder sphincter control. The differential for atraumatic myelopathy includes both extrinsic and intrinsic causes, with the former including disc herniations with compressive myelopathy, osteomyelitis with epidural abscess, and leptomeningeal spread of disease whereas the latter includes acute inflammatory processes like Guillain-Barre syndrome or demyelinating disease, and spinal cord tumors.

Outcomes by disease onset, sex, and intervention in neonates with SIP and surgical NEC.

Outcomes of infants following surgical necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) categorized by the age of onset, interventions, and sex are not well defined. Retrospective comparison of infants categorized by age of onset (NEC at <10, 10-20, and >20 days) and SIP at <7 versus ≥7 days), sex, and intervention [Penrose Drain (PD) vs. laparotomy]. A total of 114 infants had NEC and 37 had SIP. On multinomial logistic regression, infants with NEC/SIP onset >20 days had significantly lower odds of small bowel involvement (aOR = 0.07, 95% CI: 0.01-0.33, p = 0.001), higher necrosis (aOR = 3.59, 95% CI: 1.34-9.65, p = 0.012) and higher CRP (p = 0.004) than onset <10 days. Initial laparotomy was associated with more bowel loss (24.1 cm [12.3; 40.6] vs.12.1 [8.00; 23.2]; p = 0.001), small and large intestine involvement (47.1% vs 17.2%; p = 0.01), and ileocecal valve resection (42% vs. 19.4%; p = 0.036) than initial PD therapy. Females underwent fewer small bowel resections (52.3% vs 73.6%; p = 0.025) but had higher surgical morbidity (53.7% vs. 24.7%.; p = 0.001) than males. Clinical, radiological, and histopathological presentation and outcomes in preterm infants with surgical NEC/SIP are associated with age of disease onset, sex, and initial intervention. Neonates with surgical NEC onset >20 days had more severe necrosis, inflammation, kidney injury, and bowel loss than those with <10 days. Initial laparotomy was associated with later age onset, more bowel loss, and ileocecal valve resection compared to initial PD treatment, but not with differences in mortality or length of stay. Female sex was associated with lower maturity, more placental malperfusion, less often small bowel involvement, lower pre-NEC hematocrit as well as higher surgical morbidity than males. Whether the management of surgical NEC and SIP should differ by the age of onset requires further investigation.

A Rare Presentation of AKI Due to Retroperitoneal Fibross as A Result of Gastric Linitis Plastica: A Case-Based Review

Short bowel syndrome (SBS) refers to a condition resulting from loss of bowel or loss of small bowel absorptive surface area due to surgical resection or bypass leading to maldigestion, malabsorption and malnutrition.

AYURVEDIC MANAGEMENT OF SCIATICA (GHRIDHRASI) W.S.R. TO LUMBAR DISC HERNIATION - A SINGLE CASE STUDY

Sciatica is a result of the sciatic nerve root pathology. It causes pain and paresthesia in the sciatic nerve distribution area. The most common cause of sciatica is a herniated or bulging lumbar intervertebral disc. Unresolved sciatic nerve compression causes increased pain over time, paresthesia and loss of muscular strength in the affected leg, loss of bowel and bladder function, permanent nerve damage. In Ayurveda it is correlated with Ghridhrasi. Case Report - A 73 yr male having complaints of Low back pain radiating to right lower limb, difficulty and pain while walking and sitting, tingling and numbness in right leg. Aim - To evaluate the effect of Ayurvedic treatment such as Yog Basti, Panchtikta-Ksheerbasti and Shaman Chikitsa for relieving the signs and symptoms of Lumbar disc herniation co-related to Ghridhrasi. Result - Patient got marked relief in SLRT, Femoral Stretch Test, Braggard’s Sign Test, The Roland-Morris low back pain and disability questionnaire. Conclusion-The mentioned Ayurvedic therapy gives symptomatic relief for the management of Sciatica (Gridhrasi).

Case study highlighting cauda equina syndrome and the effects on bladder management.

Cauda equina syndrome (CES) is a rare and severe type of spinal stenosis, where all the nerves in the lower back suddenly become severely compressed. It is a serious medical emergency, and compression of the nerves in the lower portion of the spinal canal can lead to permanent loss of bowel and bladder control, paraesthesia, and paralysis of the legs if left untreated. Causes of CES include: trauma, spinal stenosis, herniated discs, spinal tumour, cancerous tumour, inflammatory and infectious conditions or due to an accidental medical intervention. CES patients typically present with symptoms of: saddle anaesthesia, pain, incontinence and numbness. Any of these are red flag symptoms and require immediate investigation and treatment.

Teaching Neuro Images : Acute neurologic deficits due to surfer's myelopathy

A previously healthy 32-year-old man developed acute onset of lower extremity weakness (American Spinal Injury Association [ASIA]–motor L2-S1, grade 2/5), T8 sensory level, and loss of bowel and bladder control (ASIA Impairment Scale [AIS] C) while surfing. The patient was a novice surfer and recalled a prolonged period in prone hyperextension. MRI spine was consistent with surfer's myelopathy, a rare nontraumatic cause of myelopathy found in novice surfers (figure).1,2 The etiology is postulated to be due to dynamic compression of the artery of Adamkiewicz. The patient recovered full function with conservative management over 3 days. Full recovery is expected in patients with AIS B or better, as opposed to patients with AIS A, who typically do not recover.1

COMPLETE RECTAL PROLAPSE WITH CONCOMITANT RECTO-SIGMOIDOANAL INTUSSUSCEPTION - A RARE CASE REPORT

Intussusception is more common in the pediatric age group and very rare in adults. The presentation, etiology and treatment of adult intussusception is different from that in pediatric age group. Adult colonic Intussusceptions account for only 5% of all cases, out of which only 1% present as obstruction. Often the diagnosis in adults is delayed due to vague, chronic and non-specic symptoms that are either ignored or treated symptomatically. Rectal prolapse is more common in geriatric age group compared to younger population. Colonic intussusception can be associated with a rectal prolapse. In children the symptoms of intussusception include palpable abdominal mass, fresh blood in stools and colicky abdominal pain. However, in adults, symptoms consist of bloody stool, constipation or symptoms suggestive of malignancy such as weight loss, altered bowel habits and loss of appetite. We present a case of a complete rectal prolapse with strangulated rectosigmoid intussusception for which sigmoid resection was done with reduction of rectal prolapse, rectosigmoid anastomosis, mesh rectopexy and diverting transverse colostomy

Persistent Bowel Loop in the Left Upper Quadrant: An Indication for Relaparotomy in Paediatric Adhesive Intestinal Obstruction: A Retrospective Cohort Study

Introduction: Abdominal surgery in children is known to contribute to Adhesive Small Bowel Obstruction (ASBO). No X-ray findings have been validated for predicting management in ASBO. Various imaging modalities often cannot predict complications or if a conservative line of management would be successful. Aim: To determine if a persistent prominently dilated small bowel loop in the Left Upper Quadrant (LUQ) on plain X-rays (Omega loop) would suggest early operative intervention. Materials and Methods: A retrospective cohort study was conducted in the Department of Paediatric Surgery, IMCH, Government Medical College, Kozhikode, Kerala, India from January 2016 to December 2018. Diagnosis was based on history, clinical features, and radiologic findings. Demographic, clinical, radiologic, and operative data were collected. After exclusions, the study population was divided into two groups: Group A - ASBO patients with the characteristic Omega loop, and Group B - patients without the Omega loop. Appropriate statistical methods were used to compare the groups, with significance defined as p&lt;0.05. Results: Among the 72 cases of ASBO that met the inclusion criteria, 40 (55%) were successfully managed conservatively, and 32 (45%) required non urgent relaparotomy. The median age was 6.9 years (range: 2-12 years), and 55% were male. Group A comprised 16 patients (22.2%), and the remaining patients were in Group B 56 (77.8%). Group A showed higher rates of failure of conservative management (n=14, p=0.0002), with higher rates of single-band obstruction, bowel loss, perforation, matting of bowel loops, and difficult dissection. The Omega loop had a low sensitivity (43.7%) but high specificity (95%) and positive predictive value (87.5%) for the need for relaparotomy. Conclusion: The Omega loop suggests the possibility of more complications, and therefore, earlier operative intervention should be considered.

Value of abdominal ultrasonography in predicting intestinal resection for premature infants with necrotizing enterocolitis

BackgroundAbdominal ultrasonography (AUS) has been suggested to be valuable in the early detection of necrotizing enterocolitis (NEC).ObjectiveHere, we intended to assess the efficiency of abdominal ultrasound in terms of predicting bowel resection in infants with NEC.MethodsFrom January 2018 to March 2021, 164 hospitalized children with NEC who underwent surgical management were enrolled. The enrolled infants were separated into two groups according to whether they underwent bowel resection. We reviewed the clinical data, as well as dynamic sonographic and abdominal radiographic (AR) parameters. The potential performance of AUS parameters was identified and compared with that of AR using a logistic regression analysis and receiver operating characteristic (ROC) curve analysis.ResultsSeveral parameters were detected to be statistically significant in predicting the occurrence of bowel resection, including thick to thin transformation [p < 0.001, odds ratios (OR), 4.38; 95% confidence interval (CI) 2.26–8.52], absence of peristalsis certain areas (p = 0.001, OR, 2.99; 95% CI 1.53–5.86), absence of bowel wall perfusion (p < 0.001, OR 10.56; 95% CI 5.09–21.90), and portal venous gas (p = 0.016, OR, 2.21; 95% CI 1.12–4.37). Furthermore, the ROC curve analysis showed significant differences (p = 0.0021) in the area under the receiver operating curve (AUROC) for the logistic models of AUS (AUROC: 0.755, 95% CI 0.660–0.849) and AR (AUROC: 0.693, 95% CI 0.597–0.789) for the prediction of intestinal resection.ConclusionsA dynamic AUS examination play an important role to indicate the potential for bowel loss during the surgery.