Bowel Loss Research Articles

Early Mobility for Antepartum Post VA-ECMO Patient with Non-Traumatic Spinal Cord Injury: A Case Report

<h3>Research Objectives</h3> To describe mobility progression of a post VA-ECMO non-traumatic spinal cord injured patient immediately antepartum with prolonged hospitalization. <h3>Design</h3> Cardiac arrest represents approximately 56.6% of complications in the immediate antepartum period where extracorporeal membrane oxygenation (ECMO)is indicated. ECMO cannulations include veno-arterial (VA), veno-venous (VV), and venous-arterial-venous (VAV), where large-bore catheters are placed into large vessels and connected to a circuit. A membrane oxygenator pumps blood to exchange oxygen and carbon dioxide. Spinal cord tumors develop inside the spinal canal and are intramedullary or extramedullary. They can impact motor and sensory neurons, triggering pain, loss of movement, sensory changes, and bowel and bladder dysfunction. Dichorionic diamniotic gestation occurs when each fetus has a separate placenta and amniotic sac. Mothers remain at increased risk of premature labor and delivery. <h3>Setting</h3> 746 bed university affiliated tertiary hospital. <h3>Participants</h3> 31-year-old Dominican obese female with spinal cord tumor at 25 weeks 5 days gestation with dichorionic diamniotic pregnancy. Placed on VA-ECMO following cardiac arrest secondary to massive pulmonary embolism. <h3>Interventions</h3> Physical therapy (PT) initiated in the intensive care unit (ICU) following VA-ECMO decannulation. Interventions included cognitive stimulation, positioning, bed mobility, strengthening, cycle ergometry, and out of bed tolerance. Sessions were 15-60 minutes and progressed following standard safety measures. <h3>Main Outcome Measures</h3> FSS-ICU, AM-PAC, and RASS scores; manual muscle strength; number of therapy sessions; and mechanical ventilation (MV) days. <h3>Results</h3> PTs collected data in the hospital-based setting. Patient demonstrated improvement on outcome measures, although statistical significance was not calculated. FSS-ICU from un-scorable to 8/35, AM-PAC from 6/24 to 7/24, RASS score from -5 to 0, manual muscle strength from 0/5 throughout to 3+/5 to 4-/5 in the upper extremities and 0/5 in the lower extremities by discharge. 15 total PT sessions, including 13 in the ICU. 5 mobility sessions while on MV. <h3>Conclusions</h3> PT was deemed safe, and patient demonstrated improved functional mobility . Additional research is warranted for this population, although this case may serve as a framework given lack of complex patients to compare protocols to. <h3>Author(s) Disclosures</h3> No disclosures.

Case Report: Hemophagocytic lymphohistiocytosis associated with acute polymyositis

Hemophagocytic lymphohistiocytosis (HLH) is a rare condition marked by uncontrolled histiocyte proliferation and activation, and phagocytosis of normal hematopoietic cells. This disease is rare, and a concurrent presentation with acute polymyositis is rare. A 14-year-old male was admitted to Chattogram Medical College Hospital with a high-grade fever for 25 days, generalized severe body aches, and multiple large joint pain in the lower limb for the same duration. On examination, the patient was found to have splenomegaly, tenderness in both knee joints, symmetrical proximal weakness of both lower limbs, several sensory losses, and loss of bowel and bladder control. The laboratory data showed that he had anemia, thrombocytopenia, hyperferritinemia, hypertriglyceridemia, hypofibrinogenemia, hypoalbuminemia, raised D-dimer, and serum creatine phosphokinase (S. CPK). Along with these, a bone marrow biopsy revealed hemophagocytic cells, and he was diagnosed with HLH with acute polymyositis (PM). The patient was treated with intravenous (IV) hydrocortisone and dexamethasone. Clinical stability was achieved with gradual improvement of initial symptoms and biochemical markers. The patient was discharged with oral steroids at a tapering dose and was advised to regularly follow-up.

Personal experience in intramedullary lesions, in adults

Background: Intramedullary spinal cord lesions (IMSCL) although they are rare, it generates invasion and destruction of the spinal cord. Such lesions must be diagnosed as early as possible, some have histological and genetic aggressiveness, generating severe functional neurological damage.&#x0D; Objective: To identify the optimal strategy for diagnosis and treatment in IMSC, to improve prognosis.&#x0D; Methods: A retrospective clinical study from 2001 to 2021, was performed on 33 adult patients (18 women, 15 men), diagnosed with magnetic resonance imaging with IMSCT. The most common topography was: thoracic 27 cases disposed between T2-T12, cervical 6 cases disposed between C2-C6, lumbar 2 cases at L1-L2. The most frequent symptoms in my cases were: unilateral radicular pain related to the tumour topography or bilateral diffuse burning pain, especially during the night; back and neck stiffness; paresthesia, motor disturbances with an ASIA score of 2-4, and severe atrophy especially in cervical topography, ataxia, initial retention, impotence and later loss of bowel and bladder function with incontinence. All patients were operated by the same senior neurosurgeon with at least 6 months of follow-up postoperatively. For functional outcome, the most important predictors are the preoperative neurological grade, and the high-grade IMSCT generating recurrence and reoperations.&#x0D; Results: The patients addressed the clinic for pain and neurological deficits; the topography of the intramedullary lesion was confirmed by MRI native / with contrast, ultrasonography, and spinal arteriography. Several histologic entities were recorded: ependymomas - 12 cases, astrocytomas - 8 cases, hemangioblastomas - 3 cases, cavernomas - 6 cases, metastases - 2 cases, germ cell tumour - 1 case, malignant peripheral nerve sheath tumour - 1 case. Gross total excision was performed in 25 cases, with no mortality. In eight cases recurrences were recorded requiring the resumption of surgical treatment. In all cases physiotherapy-rehabilitation approach was used, and the outcome was correlated with pre-operatory motor deficits severity, 3 patients with thoracic high-grade astrocytoma underwent stereotactic spine radiosurgery (SSR) with Cyberknife abroad, stopping tumour growth one year after.&#x0D; Conclusions: Intramedullary spinal cord lesions (IMSCL) are rare conditions, and MRI development allows an early diagnosis of these tumours. To adequately counselled patients, with minor preoperative deficits, real expectations concerning the functional outcomes, in benign tumours, and even anatomical healing should be based still on refinements of radical surgical excision. Actual radiotherapy techniques should be used in aggressive tumours.

Risk factors and a simple scoring system for predicting bowel resection in infants with NEC

Background and aimsWe intended to investigate the predictors for bowel resection in infants with necrotizing enterocolitis (NEC). We further developed a scoring system for better predicting bowel resection. MethodsA total of 207 infants who underwent surgical management at Children's Hospital, Chongqing Medical University between April 2008 and December 2020 were identified for the following investigation. Bowel resection was reviewed among the infants who underwent the procedure. Potential parameters related to bowel resection were explored using a multiple logistic regression method, and then a scoring system was developed. ResultsAmong the 207 patients who underwent operative intervention that were reviewed, 109 infants underwent bowel resection. Multivariate logistic regression analysis showed that birth weight, hypotension, neutropenia, pneumoperitoneum, acidosis, and intestinal wall thickness were predictors related to the occurrence of bowel resection. A 6-point scoring system was further developed based on the obtained total coefficient, and the infants could be divided into low-, moderate- and high-risk groups according to cut values of 7 and 13. ConclusionThe results of this study demonstrated that severe NEC features and low birth weight were associated with bowel resection. The risk scoring system could accurately separate infants that were suspected to have bowel loss during surgery.

Chronic mesenteric ischemia: Diagnosis & management

BackgroundWith rising rates of atherosclerotic disease and obesity worldwide, the prevalence of chronic mesenteric ischemia (CMI) has been progressively rising. Prompt diagnosis and early intervention are crucial to avoid bowel loss and mortality in optimising long-term outcomes for patients and achieving symptom relief. ObjectivesThis article aims to summarise relevant literature on CMI, enabling primary care physicians to make a timely diagnosis and intervention, improving outcomes of patients with CMI. DiscussionCMI is often mistaken for more common pathologies due to its non-specific history and physical examination findings. A missed diagnosis can end up in acute mesenteric infarction and bowel perforation which can cause severe morbidity and mortality. Thus, a thorough gastrointestinal disease work-up ruling out other conditions may be required. CT angiogram is the gold standard non-invasive investigation for confirming a CMI diagnosis. Referral to vascular surgery with early surgical intervention through angioplasty and stenting is crucial for improving patient outcomes. Long-term follow-up of patients through routine consultations and serial non-invasive imaging can monitor for recurrence and disease progression.

Lipid absorption and overall intestinal lymphatic transport are impaired following partial small bowel resection in mice

Short bowel syndrome (SBS) is associated with diminished levels of serum fats caused by unknown mechanisms. We have shown that mesenteric lymphatics remodel to a more primitive state one week after small bowel resection (SBR); therefore, this study focuses on the effect of chronic lymphatic remodeling and magnitude of resection on intestinal lipid uptake and transport. C57BL6 and Prox1 creER-Rosa26LSLTdTomato (lymphatic reporter) mice underwent 50% or 75% proximal SBR or sham operations. Functional transport of lipids and fecal fat content was measured and lymphatic vasculature was compared via imaging. There was a significant reduction in functional transport of cholesterol and triglyceride after SBR with increasing loss of bowel, mirrored by a progressive increase in fecal fat content. We also describe significant morphological changes in the lymphatic vasculature in both the lamina propria and mesentery. Intestinal lymphatic drainage assay in vivo demonstrated a marked reduction of systemic absorption after resection. Intestinal lymphatic vessels significantly remodel in the setting of chronic SBS. This remodeling may account at least in part for impaired intestinal uptake and transport of fat via the compromised lymphatic architecture. We believe that these changes may contribute to the development of intestinal failure associated liver disease (IFALD), a major morbidity in patients with SBS.

P.156 Spinal subdural hematoma from a type I spinal arteriovenous malformation: case report and literature review

Background: Type 1 spinal arteriovenous malformations (AVM) are dural fistulas which classically present due to progressive congestive myelopathy. Acute hemorrhage resulting in a spinal subdural hematoma is exceedingly rare with only three reported cases. Methods: This 46-year-old female experienced rapidly progressive paraplegia over several hours. There was no history of anti-coagulant use, trauma, fever, or infection. On examination, she had 0/5 in the lower extremities bilaterally and decreased sensation to pinprick below the T6 level on both sides. She also had loss of bowel and bladder control. MRI demonstrated evidence of an intra-dural extramedullary lesion located anteriorly causing significant compression on the spinal cord from T4 down to T7 level. Results: She underwent thoracic laminectomy from T4 – T7. After dural opening, a well organized sub-dural hematoma with significant mass effect on a distorted spinal cord was evacuated. Subsequently, a large abnormal artery leading into a dilated serpiginous vein on the dorsal aspect of spinal cord at the T7 level was visualized. Indocyanine green angiography confirmed our suspicion of a dural arteriovenous fistula which was disconnected. Conclusions: Type I spinal AVM in rare cases can present acutely as subdural hematoma and should be kept in the differential diagnosis for acute paraplegia.

Spontaneous spinal intradural hemorrhage in dengue fever: a case report

BackgroundSpontaneous spinal cord hemorrhage is extremely rare in dengue fever. We report a case of spontaneous spinal intradural hemorrhage in dengue fever associated with severe thrombocytopenia.Case presentationA 48-year-old Indian woman presented with fever and body aches followed by acute onset of paraplegia with bladder and bowel dysfunction and loss of sensations below the level of the umbilicus. She had severe thrombocytopenia and positive dengue serology. Magnetic resonance imaging of the spine showed compression of the spinal cord due to intradural hematoma at the D7–D8 vertebral level. The patient received symptomatic treatment for dengue fever and steroids. Emergency D7–D8 laminectomy with excision of the clot and dural repair was done after stabilizing the platelet count with multiple platelet transfusions. The constitutional symptoms responded well to the treatment. There was good improvement in sensory symptoms but negligible improvement in paraplegia with a change in muscle power from grade 0/5 to grade 1/5 in the postoperative period. The patient was discharged from the hospital in a stable condition, but paraplegia showed little improvement during follow-up of 1 year.ConclusionsSpontaneous spinal cord hemorrhage can present as acute paraplegia in dengue fever. Failure to recognize this complication can delay initiating appropriate treatment with permanent loss of neurologic function.

Case Report: Jejunoileal Atresia With Persistent Poor Bowel Function Can Occur After Surgical Correction for Hirschsprung Disease

Jejunoileal atresia (JIA) is one of the common etiologies of intestinal obtrusion in neonates. However, cases of concomitant ileal atresia and Hirschsprung disease (HD) rarely occur. We report the case of a male infant who had JIA concomitantly with HD that was re-anastomosed. The patient underwent an exploratory laparotomy to resect the dilated terminal ileum. Subsequently, owing to a significantly dilated proximal bowel, he underwent a second exploratory laparotomy. However, he continued to have feeding intolerance postoperatively. He had colonic aganglionosis and was diagnosed with HD. A third laparotomy was then performed. Additionally, he had recurrent episodes of gram-negative bacteremia, especially candida parapsilosis fungemia, despite receiving antibiotics and antifungal, and there were no identifiable underlying genetic or immunological causes. Finally, the patient had recurrent episodes of hypoglycemia, central hypothyroidism, and multiple organ failure and died at the age of 7 months. The concomitant ileal atresia and HD was thought to be due to a common intrauterine vascular accident, together with loss of bowel, thereby acting as a barrier for the caudal migration of neuromeric cells and leading to colonic aganglionosis. In this case, ileal atresia was associated with colonic aganglionosis, central hypothyroidism, and persistent bacteremia, which is a unique finding. In cases of JIA, persistent poor bowel function after surgical correction of concomitant HD should be considered.

Interpretable prediction of necrotizing enterocolitis from machine learning analysis of premature infant stool microbiota

BackgroundNecrotizing enterocolitis (NEC) is a common, potentially catastrophic intestinal disease among very low birthweight premature infants. Affecting up to 15% of neonates born weighing less than 1500 g, NEC causes sudden-onset, progressive intestinal inflammation and necrosis, which can lead to significant bowel loss, multi-organ injury, or death. No unifying cause of NEC has been identified, nor is there any reliable biomarker that indicates an individual patient’s risk of the disease. Without a way to predict NEC in advance, the current medical strategy involves close clinical monitoring in an effort to treat babies with NEC as quickly as possible before irrecoverable intestinal damage occurs. In this report, we describe a novel machine learning application for generating dynamic, individualized NEC risk scores based on intestinal microbiota data, which can be determined from sequencing bacterial DNA from otherwise discarded infant stool. A central insight that differentiates our work from past efforts was the recognition that disease prediction from stool microbiota represents a specific subtype of machine learning problem known as multiple instance learning (MIL).ResultsWe used a neural network-based MIL architecture, which we tested on independent datasets from two cohorts encompassing 3595 stool samples from 261 at-risk infants. Our report also introduces a new concept called the “growing bag” analysis, which applies MIL over time, allowing incorporation of past data into each new risk calculation. This approach allowed early, accurate NEC prediction, with a mean sensitivity of 86% and specificity of 90%. True-positive NEC predictions occurred an average of 8 days before disease onset. We also demonstrate that an attention-gated mechanism incorporated into our MIL algorithm permits interpretation of NEC risk, identifying several bacterial taxa that past work has associated with NEC, and potentially pointing the way toward new hypotheses about NEC pathogenesis. Our system is flexible, accepting microbiota data generated from targeted 16S or “shotgun” whole-genome DNA sequencing. It performs well in the setting of common, potentially confounding preterm neonatal clinical events such as perinatal cardiopulmonary depression, antibiotic administration, feeding disruptions, or transitions between breast feeding and formula.ConclusionsWe have developed and validated a robust MIL-based system for NEC prediction from harmlessly collected premature infant stool. While this system was developed for NEC prediction, our MIL approach may also be applicable to other diseases characterized by changes in the human microbiota.

Review on Radiation Therapy on Cancer

At high doses, radiation therapy kills cancer cells or slows their growth by damaging their DNA. Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the damaged cells die, they are broken down and removed by the body.Radiation therapy does not kill cancer cells right away. It takes days or weeks of treatment before DNA is damaged enough for cancer cells to die. Then, cancer cells keep dying for weeks or months after radiation therapy ends. Radiation therapy is used to treat cancer and ease cancer symptoms. When used to treat cancer, radiation therapy can cure cancer, prevent it from returning, or stop or slow its growth.When treatments are used to ease symptoms, they are known as palliative treatments. External beam radiation may shrink tumors to treat pain and other problems caused by the tumor, such as trouble breathing or loss of bowel and bladder control. Pain from cancer that has spread to the bone can be treated with systemic radiation therapy drugs called radiopharmaceuticals.

Conversion of ileo-pouch anal anastomosis to continent ileostomy: strategic surgical considerations and outcome.

The aim was to evaluate surgical strategies for conversion of failed ileo-pouch anal anastomosis (IPAA) to continent ileostomy (CI), taking morbidity and overall outcome into account. The hypothesis was that complex conversions are equivalent to the primary construction of a CI at the time of proctocolectomy. This was a retrospective analysis of IPAA conversions acknowledging the underlying disease (inflammatory bowel disease [IBD] and non-IBD) and extent of pouch reconstruction (PR): type 1 (without PR), type 2 (partial PR), and type 3 (complete PR). Twenty-six patients (IBD, n=16; non-IBD, n=10) were converted (type 1, n=13; type 2, n=7; and type 3, n=6).12/26 patients (46.2%) presented postoperative complications directly related to the conversion with scarification of two pouches. In a mean follow-up time of 7.5±6.6years, 5/24 patients required revisional surgery. Of these, three required pouch excision. The cumulative probability of reoperation at the end of the second year increased to 21.7% and remained constant thereafter until the maximum follow-up time of 26years. The total pouch loss rate was 19.2% (5/26), of which all occurred in the first 3years. No statistically significant differences were found between the conversion types, complications or pouch survival. For all parameters, IBD patients performed slightly unfavourably. Due to the overall small number of respective patients, a differentiated investigation of IBD was not performed. Complex conversion procedures (types 1 and 2) deliver comparable long-term results to new constructions (type 3), thereby limiting the loss of small bowel. IBD compromises outcome versus non-IBD.

Neurological paradox during treatment in a non-HIV patient with pulmonary tuberculosis: A case report

Rationale: To report neurological paradox in a non-HIV patient with pulmonary tuberculosis.Patient concerns: A 26-year-old non-human immunodeficiency virus immunosuppressed female patient presented with diffused headache, diplopia, ascending paraparesis with loss of bowel and bladder control.Diagnosis: Disseminated neurological paradoxical reaction developed during tuberculosis treatment in a non-human immunodeficiency virus patient.Intervention: High-dose intravenous corticosteroid was added to the anti-tuberculous drugs, followed by tapered dose of oral prednisolone in 3 months.Outcome: A favorable neurological outcome was obtained 6 months later.Lessons: Neurological paradoxical reaction cannot be overlooked among the tuberculosis-treated cases who present with newly emerged neurological disorders.

Nerve Root Sparing En Bloc Resection of Sacral Chondrosarcoma: Technical Note and Review of the Literature.

Total en bloc sacrectomy provides the best long-term local control for large primary bony sacral tumors, but often requires lumbosacral nerve root sacrifice leading to loss of ambulation and/or bowel, bladder, and/or sexual dysfunction. Nerve-sparing techniques may be an option for some patients that avoid these outcomes and accordingly improve postoperative quality of life. To describe the technique for a posterior-only en bloc hemisacrectomy with maximal nerve root preservation and to summarize the available literature. A 38-yr-old woman with a 7.7×5.4×4.5 cm biopsy-proven grade 2 chondrosarcoma involving the left L5-S2 posterior elements underwent a posterior-only left hemisacrectomy tri-rod L3-pelvis fusion. A systematic review of the English literature was also conducted to identify other descriptions of high sacrectomy with distal sacral nerve root preservation. Computer-aided navigation facilitated an extracapsular resection that allowed preservation of the left-sided L5 and S3-Co roots. Negative margins were achieved and postoperatively the patient retained ambulation and good bowel/bladder function. Imaging at 9-mo follow-up showed no evidence of recurrence. The systematic review identified 4 prior publications describing 6 total patients who underwent nerve-sparing sacral resection. Enneking-appropriate resection was only obtained in 1 case though. Here we describe a technique for distal sacral nerve root preservation during en bloc hemisacrectomy for a primary sacral tumor. Few prior descriptions exist, and the present technique may help to reduce the neurological morbidity of sacral tumor surgery.

How should the neonatal retrieval team respond to the neonate referred with bilious vomiting?

Bilious vomiting (BV) in the neonatal period may herald malrotation with life-threatening volvulus. In New South Wales, contrast fluoroscopy is not available in non-tertiary paediatric centres; therefore, transfer is required. An infant with BV referred to Newborn and Paediatric Emergency Transport Service is prioritised for urgent retrieval to a surgical centre for contrast fluoroscopy and paediatric surgical review. This study analysed how many neonates with BV needed retrieval to prevent bowel loss or to save one life and to identify predictors of malrotation and/or volvulus. All neonatal referrals (<29 days) to Newborn and Paediatric Emergency Transport Service between 31 July 2014 and 31 July 2020 with BV or aspirates were examined. Data on time of onset of BV, time of call for retrieval, vital signs, lactate level and blood glucose at referral, time of arrival at the surgical centre and outcome were analysed. Of 391 neonates referred with BV, 113 (28.9%) had a surgical cause and 31 (7.9%) had a time-critical malrotation and/or volvulus. All 31 neonates were well at referral with normal vital signs including three neonates who subsequently died. Lactate levels at referral (1-7.5 mmol/L) were not predictive of outcome. The odds of a time-critical diagnosis increased with every day of age (odds ratio=1.097), heart rate >140 (P=0.04) and decreased for each kilogram of birthweight (odds ratio 0.475; confidence interval 0.294-0.768). Neonates with BV require urgent referral to paediatric surgery and contrast fluoroscopy. Thirteen urgent transfers are required to preserve the bowel integrity and life in one baby.

INFECTIVE ENDOCARDITIS WITH SPINAL CORD INFARCTION

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Infective endocarditis can present with disseminated septic emboli phenomenon. Neurological complications of disseminated infective endocarditis include spinal epidural abscess. Spinal cord infarction is a very rare complication of infective endocarditis with only two cases previously reported. We present a case with fulminant infective endocarditis with widespread septic emboli and spinal cord infarction. CASE PRESENTATION: 34-year-old male, intravenous drug abuser with recent incarceration presented with five-day history of progressive lower extremity weakness and pain associated with inability to walk, lower back pain, loss of bowel and bladder control, and pleuritic chest pain. Past medical history was significant for recurrent infective endocarditis of tricuspid valve and prosthetic tricuspid valve with recent tricuspid valve repair 6 months ago. Laboratory analysis was remarkable for leukocytosis, microcytic anemia, severe thrombocytopenia, lactic acidosis, and oliguric acute kidney injury requiring emergent hemodialysis. The patient was subsequently intubated for acute respiratory failure with worsening septic shock requiring pressor support. Transthoracic echocardiogram revealed a normal left ventricular ejection fraction. A large 4.1 x 1.6 cm mobile vegetation was noted involving the bioprosthetic tricuspid valve extending into the right ventricle associated with moderate stenosis. Blood cultures were positive for Serratia marcescens. CT chest was significant for bilateral ground-glass opacities, multiple nodular infiltrates, and cystic cavitary lesions representing septic emboli. CT abdomen was significant for splenomegaly with multiple splenic infarcts and bilateral multiple renal cortical infarcts. CT scan of spine ruled out epidural abscess. MRI could not be performed due to presence of epicardial leads. Based on above findings, patient was diagnosed with infective endocarditis with systemic shower of septic emboli to lungs, spleen, and kidneys with high suspicion of spinal cord infarction. Patient was started on empiric antibiotics on admission later adjusted to culture sensitivities. He continued to deteriorate clinically and underwent cardiac arrest within 72 hours of admission and expired. DISCUSSION: Infective endocarditis with septic emboli phenomenon can present with a myriad of clinical features. In the presence of neurological deficits, spinal cord infarction should be high in the differential and managed emergently due to its time-sensitive salvage. However, the probability of complete recovery after spinal infarction is very low; overall mortality in the first month is 25%, with long-term disability in 40-50% requiring wheelchair or chronic bladder catheterization. CONCLUSIONS: Spinal cord infarction is a rare complication of infective endocarditis with disseminated septic emboli phenomenon that requires emergent time-sensitive management with overall high mortality. REFERENCE #1: Kfoury B, Sharma D, Mansour W, Suen P, Abou Yassine A, Chalhoub M. Endocarditis to the Spine: A Rare Cause of Spinal Cord Infarction. Chest. 2017 Oct 1;152(4):A366. REFERENCE #2: Robertson, C.E., et al., Recovery after spinal cord infarcts: long-term outcome in 115 patients. Neurology, 2012. 78(2): p. 114-21 DISCLOSURES: No relevant relationships by Huda Asif, source=Web Response No relevant relationships by Adam Friedlander, source=Web Response No relevant relationships by Katherine Hodgin, source=Web Response No relevant relationships by Stanislav Ivanov, source=Web Response No relevant relationships by Arsalan Wappi, source=Web Response No relevant relationships by Christopher Wood, source=Web Response

Perioperative major neurologic deficits as a complication of spine surgery.

Retrospective review of spine surgery patients with new major neurologic complication. To define the causes and severity of new neurologic damage to the spinal cord or cauda equina caused by spinal surgery. Consult records were reviewed for all postoperative spine surgery patients referred to a tertiary spinal cord injury rehabilitation center over a 12-year period. Any patients with a new perioperative surgery-related decrement in American Spinal Injury Association (ASIA) Impairment Scale (AIS), loss of bowel or bladder function, or loss of ability to ambulate were examined and final 1-year gaps for neurologic loss reported. 64 patients had a new perioperative major neurologic event with: 41% thoracic, 39% cervical, and 20% lumbar; 61% intraoperative, 31% in the immediate 2-week postoperative period, 8% unknown. Chronic myelopathy (44%) was the most common indication. The causes of neurologic injury were postoperative fluid collection (25%), malposition of instrumentation (14%), traumatic decompression (14%), cord infarct (11%), deformity correction (2%), and unknown (34%). Overall, 87% lost the ability to ambulate and 66% lost volitional bowel-bladder control. AIS decrement and loss of ambulation and bowel-bladder function did not differ statistically significantly by surgical indication. However, among the main root causes, traumatic decompressions and cord infarcts had significantly worse neurologic deterioration than fluid collections or malposition of instrumentation. The relative rate of major neurologic injury in spine surgery is higher in thoracic and cervical cases at spinal cord levels, especially when done for myelopathy, even though lumbar surgeries are most common. The most common causes of neurologic injury were potentially avoidable postoperative fluid collections, malposition of instrumentation, and traumatic decompression.

Sentinel bowel loop as a marker for primary segmental intestinal volvulus in extreme low birth weight neonates.

Primary segmental intestinal volvulus is a rare condition that may affect neonates. This condition occurs when a loop of bowel torses around the axis of its mesentery without any other abnormality or malrotation. In the earlier stages, the diagnosis can be challenging due to the lack of specific clinical and radiographic signs. Prompt surgical management is critical as a delay in diagnosis may result in bowel loss or death. We present a series of three cases of extremely low birth weight infants with primary segmental volvulus. A sentinel bowel loop was critical in guiding each patient's surgical management as there were no other clinical markers concerning a pending intra-abdominal catastrophe. This case series suggests that a sentinel bowel loop may be a radiographic marker for primary segmental intestinal volvulus in extremely low birth weight infants.

A case report of Hirschsprung\u2019s disease presenting as sigmoid volvulus and literature review, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

BackgroundSigmoid volvulus is an uncommon problem in children and adolescents, and is rarely considered a diagnosis in this group. A high index of suspicion is necessary to reach a diagnosis and avoid morbidity and mortality. Sigmoid volvulus is a rare complication of Hirschsprung’s disease, which has been reported in neonates, children, and adults. Here we report a case of sigmoid volvulus accompanied by undiagnosed Hirschsprung's disease.Case presentationA 9 years old boy who presented with sudden onset of colicky abdominal pain of 4 h duration associated with gross abdominal distension and 2 episodes of non-bilious vomiting. A plain abdominal radiographs showed single hugely dilated bowel loops in the left lower quadrant with single air fluid level. Sigmoid volvulus was considered and rectal tube deflation was done and it was successful. Full thickness rectal biopsy was done and it was consistent with aganglionic megacolon. A primary trans-anal Soave endo-rectal pull through was done 3 weeks later, after biopsy result arrived, which yielded loss of symptoms and regular bowel movement.ConclusionsSigmoid volvulus should be considered in the differential for children presenting with acute onset of abdominal obstruction. It should be known that when its’s diagnosed in children, it is often associated with Hirschsprung's disease. Therefore, a proper diagnostic and treatment algorithm should be followed in order not to miss associated HD and to give optimum care to such patients.

Nutritional and pharmacological strategy in children with short bowel syndrome.

Short bowel syndrome in neonates is a severe and life-threatening disease after a major loss of small bowel with or without large bowel. Intestinal adaptation, by which the organism tries to restore digestive and absorptive capacities, is entirely dependent on stimulation of the active enterocytes by enteral nutrition. This review summarizes recent knowledge about the pathophysiologic consequences after the loss of different intestinal parts and outlines the options for enteral nutrition and pharmacological therapies to support the adaptation process.