Site Of Perforation Research Articles

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.

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.

Bilateral Orocutaneous Fistula Secondary to Pericoronal Infection of Mandibular Third Molars: A Rare Case Report.

Odontogenic cutaneous fistulas are abnormal connections between the oral cavity and skin, often mistaken for skin infections. They typically result from dental infections but may also arise from salivary gland issues, tumors, or congenital anomalies. Accurate diagnosis is essential to prevent complications like infection, osteomyelitis, and discomfort. A 26-year-old woman presented with bilateral facial lesions and itching for the past year. Her symptoms began 5 years earlier with cheek pain and swelling, initially treated with antibiotics. Examination revealed pericoronitis of the mandibular third molars, leading to bilateral orocutaneous fistulas. Surgical removal of the affected teeth and fistulas was performed. Orocutaneous fistulas commonly result from long-standing dental infections. Their location depends on the perforation site of the cortical plate. Early diagnosis through clinical examination and imaging is vital to prevent severe complications like osteomyelitis. Treatment involves addressing the underlying cause, typically through root canal therapy or tooth extraction. This case highlights the importance of early, interdisciplinary management of orocutaneous fistulas to prevent misdiagnosis, reduce discomfort, and avoid complications. Timely treatment ensures better outcomes and minimizes cosmetic concerns.

Management of a Corneal Perforation Due to Resistant Peripheral Ulcerative Keratitis by Repeated Tectonic Patch Grafting Combined with Conjunctival Resection

Tectonic graft patching and conjunctival resection is one of the effective treatment modalities in especially resistant PUK patients with corneal perforation additional to topical and systemic immunosuppressive treatment. A 44-year-old female patient with a 10-year history of rheumatoid arthritis, was referred to our clinic with peripheric corneal perforation. Her visual acuity was at the level of hand movement perception in the left eye. Slit-lamp examination revealed medial PUK with corneal perforation. Tectonic patch grafting was performed. Two weeks later, because of small melting area at the inferior part of the graft with iris incarceration, an additional cornea-scleral graft transplantation was performed. Due to the immune nature of the PUK, limbal conjunctiva at the perforation site was also resected. Three months after the re-grafting, there was no recurrence. Best corrected visual acuity was 5/10 log MAR in the left eye.

Etiology and therapy of pharyngeal perforations.

The primary aim of this study is to evaluate the impact of diagnostic procedures and treatment interventions performed at our medical institution on the final outcomes and survival rates of patients with iatrogenic and traumatic pharyngeal perforation (PP). We reviewed the medical records of 36 patients with iatrogenic and trauma-induced PP who were treated at the Quaternary Medical Center of Otorhinolaryngology between 2010 and 2020. Comorbidities were classified according to the Age-adjusted Charlson Comorbidity Index (ACCI) scoring system, and postoperative complications were classified according to the Clavien and Dindo scoring system. Of the 36 patients, 15 (41.7%) were male and 21 (58.3%) were female. The median age was 73 years, and PP was typically diagnosed within one day. Notably, the perforation site was identified in the hypopharynx in 29 (80.5%) patients. The median ACCI score was 4, with the most frequent ACCI score observed being 5. During the treatment course, 17 patients (47.2%) experienced complications, with 9 of these patients experiencing grade IV complications according to the Clavien and Dindo classification. Our study showed that patients with hypopharyngeal perforations have an almost 42-fold higher risk of mortality during hospitalization compared to those with epipharyngeal or oropharyngeal perforations, though results are limited by the small sample size and the variable dates. Additionally, neurosurgery of the cervical spine, transesophageal echocardiography, and diverticular surgery emerged as procedures carrying the highest risk for pharyngeal perforations. Within our patient cohort, 4 patients (11.11%, all female) died during the treatment course.

EGS SO29 - Therapeutic Endoluminal Vacuum Therapy (EVT) as first line management for oesophageal and selected gastric and duodenal perforations

Abstract Background Upper gastro-intestinal (GI) perforations and leaks affect roughly 2,800 patients annually in the UK. They can occur spontaneously, as a complication of medical intervention, or be due to trauma. Mortality rates are around 20%, rising to 50% if diagnosis and treatment is delayed. Around a third of cases fall into the delayed category. Traditionally, management of this group of patients involved surgery with long hospital stays and poor outcomes. Our Unit has adopted EVT as first line management for these cases, using an ad-hoc Endoluminal Vacuum Device (EVD), which has significantly improved patient outcomes compared to traditional treatment strategies. Method The primary aim of this study was to assess the successful perforation/ leak healing rate, the overall mortality rate, and the complication rate of EVT. A retrospective analysis of a prospectively collated database for all patients who received EVT between May 2011 to November 2023 was performed. Patients who had oesophageal, gastric or duodenal perforations were included. The ad-hoc EVD was constructed using an open pore sponge (granufoam, KCI) sutured to the end of a nasogastric (NG) tube. This was inserted endoscopically into the site of perforation and with negative pressure (125mmHg) applied using a negative pressure vacuum pump. Results 104 patients received EVT, with a median age of 65years (range 23-92years), and median ASA of 3 (range 1-5) at presentation. Eighty-five cases were oesophageal, 15 gastric and 4 duodenal. Post-operative leaks accounted for 42 cases, 26 were iatrogenic, 30 spontaneous, and 6 traumatic. Leak resolution was achieved in 94 patients (90.4%). Twelve (11.5%) patients died; 7 (6.7%) deaths were due to treatment failure. Seven (6.7%) patients had a significant bleeding event during EVT of which 4 (3.8%) were directly related to the leak because of undrained sepsis. One patient had an oesophageal mucosal injury during EVD removal. Conclusion EVT is a safe and effective treatment for upper GI tract leaks regardless of their cause. It achieves a significant reduction in mortality compared to traditional treatments, especially in patients with delayed presentation. Adequate drainage of surrounding sepsis is essential to ensure therapy success and avoid bleeding complications. Given the improvement in patient outcomes that EVT delivers, it should be considered for first line management in patients with delayed diagnosis and presentation of oesophageal perforation, following anastomotic leak after resectional surgery, as well as in select patients with gastric and duodenal perforations.

EGS SO33 - Management Strategies and Outcomes of Non-Malignant Oesophageal Perforation at a Tertiary Care Hospital

Abstract Background Oesophageal perforation is a life-threatening emergency that requires prompt and effective management. This study aims to evaluate the outcomes of different management strategies—conservative, surgical, and endoscopic washout with stent insertion—for non-malignant oesophageal perforations at a specialist Upper GI unit in a tertiary care hospital. Method This is a retrospective study conducted over a 10-year period from 2012 at a specialist Upper GI Unit in a tertiary care hospital. All patients aged 18 and above who were referred to or admitted with oesophageal perforation were included, with exclusion of those with underlying oesophageal cancer. Data were collected from hospital records. Variables studied included age, gender, Charlson Comorbidity Index (CCI), WHO performance status, site and size of oesophageal perforation, treatment modality (Conservative, Surgery, or Stent), type and size of stent used, length of hospital stay, and mortality. Data analysis was performed using SPSS v.25. Results Over 10 years, 72 cases of non-malignant oesophageal perforation were managed (M:F, 37:35, median age 62.5 years (range 20-86), median CCI 3). The causes of perforation were spontaneous (n=45, 62.5%), iatrogenic (n=22,30.6%), foreign body (n=4,5.6%), and post-corrosive intake (n=1,1.4%). Most perforations occurred in the distal oesophagus (n=52, 72.2%) with an average size of perforation of 3 ± 1.38cm. Management included surgery (n=43,59.7%), conservative treatment (n=22,30.6%), and stent insertion (n=7,9.7%). Overall, in-hospital mortality was 20.8% (n=15). Survival rates varied: 90.9% for conservative treatment, 79.1% for surgical management, and 57.1% for stenting; however, the differences were not statistically significant (p=0.134). Conclusion Oesophageal perforation is a life-threatening condition. This 10-year observational study assessing conservative, surgical, and stent treatments for non-malignant perforations confirms that survival rates varied among the different treatment groups. However, there was no statistically significant survival advantage observed. This underscores the importance of developing individualized management plans based on patient factors to improve outcomes.

Abstract 4117690: Cardiac Rupture as a Life-Threatening Outcome of Takotsubo Syndrome: A Systematic Review.

Background: Takotsubo syndrome is a reversible cause of heart failure; however, a low percentage of patients can develop serious complications, including cardiac rupture. Aims: Analyze case reports or case series of cardiac rupture in patients with Takotsubo syndrome, detailing patient characteristics to uncover risk factors and prognosis for this severe complication. Methods: We conducted a systematic search of MEDLINE and Embase databases to identify case reports or case series of patients with Takotsubo syndrome complicated by cardiac rupture, from inception to October 2023. Results: We identified 39 reported cases, including 44 subjects (40 females; 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity. An emotional trigger was present in 15 (34%) subjects and common admission symptoms were chest pain (35 [80%]) and dyspnea (14 [32%]). ST-segment elevation was present in 39 (93%) of 42 cases, with the anterior myocardial segments (37 [88%]) being the most compromised, followed by lateral (26 [62%]) and inferior (14 [33%]) segments. The mean left ventricular ejection fraction was 40±13% and an apical ballooning pattern was observed in all (100%) ventriculographies. The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery treatment was attempted in 16 (36%) cases, and 28 (64%) patients did not survive (Figure). Conclusions: Cardiac rupture as a complication of Takotsubo syndrome is a rare clinical condition associated with high mortality. Elderly females, especially from White/Caucasian or East Asian/Japanese descent, presenting with ST-segment elevation in the anterior or lateral leads, and an apical ballooning pattern, are disproportionally affected. Additional studies with prospective collection of patient-level data are needed to better identify those at increased risk for cardiac rupture associated with Takotsubo syndrome and to address ways to improve mortality rates in this population.

Evaluation of Morbidity and Mortality in Iatrogenic Colonic Perforation During Colonoscopy: A Comprehensive Systematic Review and Meta-Analysis.

This systematic review and meta-analysis explores the clinical and patient-specific factors contributing to increased morbidity and mortality following iatrogenic colonic perforation (ICP) during routine colonoscopy. A comprehensive search of Scopus, PubMed (Medline), Embase, and Google Scholar was conducted, reviewing studies published between 2010 and 2024. Data were synthesized through thematic analysis for qualitative data and meta-analysis for quantitative outcomes. This study found the overall perforation rate during colonoscopy to be between 0.019% and 0.66%. The average age of patients was 68.91 years. The mortality rate was approximately 11%. Older patients had a higher risk of perforation and an increased mortality rate. Therapeutic colonoscopy carries a significantly higher risk of perforation compared to diagnostic colonoscopy. Diagnostic colonoscopies were more likely to cause larger perforations, which, in turn, carry greater morbidity than smaller perforations. The most common sites of perforation are the sigmoid colon and the rectosigmoid junction. The leading causes of perforation include diverticulitis, malignancy, abnormal sigmoid anatomy, and inflammatory bowel disease. About half of the perforations were discovered during or immediately after the procedure. The most common surgical interventions were resection with primary anastomosis and Hartmann's procedure. Operators with limited experience were more likely to cause perforations and experience delayed recognition of the issue. The results suggest that both clinical and patient-specific factors play critical roles in determining outcomes for patients experiencing ICP during routine colonoscopy. Early detection, timely intervention, and operator experience are key to improving patient survival and reducing complications. Furthermore, the study highlights the need for ongoing research to refine patient selection criteria and enhance postoperative care protocols, particularly for high-risk populations such as the elderly and those with significant comorbidities. This review underscores the importance of heightened vigilance in colonoscopy procedures, especially among vulnerable populations. Future research should focus on improving diagnostic protocols and treatment strategies to minimize the risks associated with ICP and enhance patient safety in routine colonoscopy practices.

Management of iatrogenic atrial perforation caused by pacemaker electrodes: a case report

BackgroundThe complications associated with cardiac device implants ranges between 5.3% and 14.3%. Cardiac perforation due to “leads” represent a very rare complication of cardiac device implantation, ranging between 0.3% and 0.7%. Clinically, they can manifest different, nonspecific symptoms; hence, the diagnosis may not be immediate.Case presentationOur clinical case describes the successful treatment of cardiac tamponade occurring in a Caucasian 79-year-old man following a pacemaker implantation. Two days after the procedure, the patient reported an episode of nonspecific chest pain associated with syncope. The echocardiogram performed revealed a pericardial effusion in the apical area, along the right chambers, with a thickness of 7 mm, not hemodynamically significant. A chest computed tomography scan with contrast showed hemopericardium (maximum thickness of 11 mm), caused by an atrial perforation. A few hours later, the patient experienced hemodynamic instability. For this reason, an urgent sternotomy was performed with drainage of a significant hemopericardial effusion, revealing a perforation of the upper free wall of the right atrium with pericardial injury caused by the retractable screw lead. The perforation site was sutured and the sternal wound was closed. The patient was discharged after 4 days without further complications. At the control visit, scheduled 30 days after the hospital discharge, the patient was in good conditions.ConclusionsAlthough the atrial perforations from leads are very rare complications of pacemaker implantation procedures, they are potentially lethal. In conclusion, this clinical case highlights the need, before hospital discharge, of an accurate screening for evaluation the pericardial effusion in patients that undergo to the cardiac implantable electronic devices.

070. Total Bowel Obstruction and Secondary Renal Impairment Following Bajakah Root Ingestion: Case Report

Background: Total bowel obstruction is a critical condition often caused by malignancies and adhesions or rare caused by foreign bodies. The bajakah root is a herbal medicine in Dayak community (Central Kalimantan), traditionally used to treat any diseases. This report presents a unique case of bowel obstruction due to bajakah root, and renal impairment as a complication. Case: A 62 years old female without any psychiatric disorders with history bajakah root consumtion complaint difficult defecation and green vomiting. Physical examination showed abdominal distention with collapsed rectal ampulla. Laboratory results revealed renal impairment. Imaging studies confirmed total bowel obstruction. Exploratory laparotomy identified ileoileal and ileo-omental adhesions with 0.5x0,5 cm ileum perforation 120 cm distal to the ligament of Treitz and a 2x2 cm wooden foreign body 10 cm distal from the perforation site. Surgical management included adhesiolysis, wedge excision of the ileum, foreign body extraction and anastomosis. Conclusion: Total bowel obstruction, renal impairment, bajakah, foreign body, foreign body extraction.

067. Report in Delayed Peritonitis Due to Ileal Perforation Due to Abdominal Blunt Trauma in Sardjito Hospital

Background: Abdominal blunt trauma is a difficult situation, leading to considerable illness and death, particularly in developing nations. The later appearance of symptoms and indicators in these individuals significantly adds to the heightened illness and death rates experienced by the patients. Small bowel perforation following blunt abdominal trauma is an uncommon occurrence, and typically, such cases manifest right after the trauma. Case: We present one case of elderly patient with ileum perforation with Boey Score 2 who showed symptoms on the second day after the injury. We performed ileostomy on the perforation site. We found duodenal perforation 1.5 cm in diameter and 20 cm from ileocecal junction. We refreshed the perforation edge. Patient was in hospital for 5 days and before being discharged. Conclusion: Small bowel perforation is rare, leading to a delay in definitive treatment. Gathering a detailed injury mechanism, observing the patient, conducting thorough investigations using CT and/or FAST, and remaining aware of the potential for small bowel perforation are crucial for successful management of patients with blunt abdominal trauma.

Can ultrasonography be used to detect root perforation? An invitro study.

This study assessed the usability of ultrasonography in detecting root canal perforations. The buccal side of incisor root were perforated. The actual lengths up to the perforation site were measured by visualisation of the tip of a file. Specimens were embedded in gypsum, and it was scraped to simulate bone resorption. Resorption cavities were filled with ultrasound gel. Measurements were taken by advancing a file through the canal until the tip became visible in the ultrasound image. 3D scans were obtained using cone-beam computed tomography (CBCT) and the distance between the coronal point of the resorption cavity and the reference point was measured. The actual distance of the resorption cavity from the reference point varied 6-10.6 mm. The same distances were measured via ultrasound as 5.7-10.9 mm, while measured using CBCT 6-10.5 mm. No significant differences were found. Ultrasonography shows promise for detecting root perforations, however further research is needed.

Distribution of bone fragments in angled shots: an experimental study conducted on composite models containing artificial bone plates.

In conventional gunshot injuries to targets containing bone the resulting osseous fragments do not precede but follow the bullet on its further way through adjacent soft tissues. The term "secondary projectiles" for the particles does not appear to be appropriate since they are not believed to have enough energy necessary for creating their own wound channels away from the temporary cavity. Former studies have shown that in angled shots to glass panes the bulk of splinters does not follow the bullet's trajectory: The majority of the glass fragments, especially the larger ones, move at right angles to the pane shot through. The aim of the presented study was to examine whether osseous fragments behave like glass splinters in angled shots to flat synthetic bone. In this context, it should also be assessed, whether the bone fragments might act as secondary projectiles in rare cases. To answer these questions, test shots were fired to composite models consisting of flat synthetic bone and ballistic gelatin. Pistol cartridges 9mm Luger were used to fire the shots which were video-documented with a high-speed camera. Afterwards, the composite models underwent CT examination and macroscopic inspection. Video-documentation revealed that the larger bone particles from the perforation site move at a roughly right angle from the osseous sheet into the gelatin, causing an eccentric bulge of the temporary cavity. The smaller bone fragments were also lodged along the bullet's path, predominantly in the cracks radiating from the permanent wound channel.

IDENTIFICATION OF THE AETIOLOGY OF GASTROINTESTINAL PERFORATION: CLINICAL AND MDCT CLUES

A common medical emergency that has a high fatality rate between 30 and 50 % is perforation of the gastrointestinal tract (GIT). Oesophageal perforations can cause rapid chest pain, odynophagia, and vomiting gastroduodenal perforations can cause acute, severe abdominal pain and colonic perforations typically advance more slowly, resulting in localized abscesses or secondary bacterial peritonitis. Sepsis, an abscess that resembles an abdominal mass, or delayed symptoms are among the subsets of people who may present. Ancillary findings may indicate underlying problems that require more examination after initial closure of the ruptured bowel, while direct multidetector computed tomography (MDCT) findings confirm the diagnosis and localize the perforation site. Findings from MDCT scans include extraluminal gas, gut wall thickening, apparent discontinuity in the intestinal wall, extraluminal contrast, aberrant mural enhancement, localized fat stranding and/or free fluid, and localized abscess or phlegmon in confined perforations. In order to highlight the MDCT and clinical signs suggestive of the underlying aetiology and localization of the perforated site, this paper will examine the range of MDCT results found in GIT perforation. I. KEY POINTS Extraluminal gas, wall discontinuity or thickness, and fat stranding are signs of a GIT perforation. There is a spectrum of abundance to absence in pneumoperitoneum and extraluminal oral contrast. Additional observations include masses, faecal impaction, ischemia, foreign substances, and excessive wall thickening. The presence of a ruptured peptic ulcer suggests supramesocolic pneumoperitoneum and hyperenhancing gastric wall. Iatrogenic perforation is indicated by ascites and/or persistent or growing free air after surgery.

Clinico-pathologic characteristics of gastrointestinal perforations from a tertiary care hospital in Pakistan

Background: Hollow viscus perforation is one of Pakistan’s most commonly encountered surgical emergencies. Gastroduodenal perforations account for the most common site of perforations worldwide. However, the Pakistani population has a different pattern. Objective: The aim of this study was to determine the clinico-pathologic features of patients and the effectiveness of surgical options in the emergency management of bowel perforation. Materials and Methods: This retrospective, observational study was conducted at the Department of General Surgery, Unit-III, Lahore General Hospital, Lahore from January 1, 2021 to December 31, 2021. Data on demographic profiles, clinical presentation, risk factors, site of perforation, and surgical details of 73 patients with gastrointestinal perforation admitted via emergency were collected and analyzed using the Microsoft Excel (Microsoft Corp., Redmond, WA) spreadsheet. Results: There were 74% females out of the 73 included cases. Perforation was most common among the age group of 21–25 years. Abdominal pain was present in all patients, followed by vomiting in 46.6% of cases. Guarding was observed as the most common sign in 78.1% of patients. The ileum was the most common site of perforation in 41.1% of cases, while typhoid was the most common cause of bowel perforation in 20.5% of patients. In 42.5% of cases, stoma was made, followed by primary closure in 16.4% of patients. Conclusion: This study shows an increased incidence of perforation in the ileum in the Pakistani population, different from the rest of the world and common in youth. An increased incidence of perforation due to typhoid highlights the prevalence and inadequate treatment of this disease.

Togetherness Reminded by the Earthquake: Relationship Between Stress and Peptic Ulcer Perforation

Background: Severe stress is one of the leading causes of peptic ulcer perforations. Peptic ulcer perfora-tion is a clinical condition that can be fatal if not treated urgently. This study aimed to investigate the effects of social stress caused by the earthquakes in Kahramanmaraş on peptic ulcer perforation. Materials and Methods: A retrospective evaluation was conducted on 66 peptic ulcer perforation cases operated on in three major centers in Şanlıurfa, considering two large earthquakes that occurred on February 6, 2023, and by comparing the 6-month periods before and after the earthquakes. Patients were assessed in terms of age, gender, diagnostic method, perforation site, surgical technique, operation time, length of hospital stay, and mortality. Our study also evaluated laboratory parameters such as white blood cell (WBC) count, hemoglobin, urea, creatinine, and albumin levels. Results: In the 6 months prior to the earthquakes, 21 patients underwent surgery for peptic ulcer perfo-ration, whereas 45 patients were operated on for the same reason in the 6 months following the earthquakes; there were two deaths in each group. The number of patients operated on after the earthquakes was significantly higher than the number of patients operated on before the earthquakes. Furthermore, the two groups were also compared in terms of demographic data and laboratory findings; no significant differences between the two groups were observed regarding these parameters. Conclusions: Stress plays a remarkable role in the development of peptic ulcer perforation. In stressful situations that affect the general population, such as earthquakes, it is essential to assess stress tenden-cies and dyspeptic complaints in patients presenting to the hospital. Patients with positive findings should undergo endoscopy if necessary, followed by appropriate gastric treatment.

Less Is (Sometimes) More: Laparoscopic Peritoneal Lavage and Drainage for Diverticulitis.

Introduction: Laparoscopic lavage and drainage (LLD) emerged as an alternative to Hartmann's procedure (HP) for patients with diverticulitis and uncontained perforation. Although initially popular as a less invasive approach, its use in modern practice is in question. This summary will review the available literature to show techniques, outcomes, and indications. Methods: The literature was reviewed for relevant case studies, randomized trials, prospective series, retrospective analyses, and meta-analyses to define peritoneal lavage and determine the clinical outcomes of peritoneal lavage. Results: LLD can be considered on an individual basis for Hinchey III diverticulitis (purulent peritonitis), but there are several contraindications. The extent of adhesionolysis (limited versus extensive) as well as the management of sites of perforation found during surgery are debated. Most surgeons continue lavage with warm saline until water runs clear and place drains in the operation. Three randomized controlled trials (RCTs), the LADIES, SCANDIV, and DILALA trials compared LLD with either resection and anastomosis or Hartmann's procedure. One other RCT (the LapLAND trial) is still with results pending. The LADIES trial studied LLD versus primary anastomosis and resection in Hinchey III diverticulitis and was terminated early secondary to higher 30-day morbidity in the LLD arm; however, 3-year data showed no significant difference in morbidity and mortality. The SCANDIV trial compared LLD with resection in acute diverticulitis (Hinchey I-III) and saw no difference in 90-day morbidity or mortality; however, it noted higher rates of reoperation in the LLD group. The DILALA trial compared Hinchey III diverticulitis patients undergoing LLD with open HP and found that the LLD group had a lower rate of reoperation at 2 years, but no difference in rates of readmission or mortality. Conclusions: Debate still remains over the technique of LLD and specific indications, as well as outcomes compared with resection and primary anastomosis or HP.

Effectiveness of surgical approach in the management of non-traumatic corneal perforations

ABSTRACT Clinical relevance Non-traumatic aetiologies are one of the leading causes of corneal perforations. The management of corneal perforation is quite challenging and complex for anterior segment surgeons. The appropriate surgical approach for each case is usually determined on the basis of a combination of many different parameters. Background The study aimed to evaluate surgical approach options and outcomes in the treatment of non-traumatic corneal perforations. Methods Patient data who underwent surgery for non-traumatic corneal perforation between 2016 and 2023 were retrospectively evaluated. Medical records were assessed in terms of age, gender, perforation aetiology, the first and last examination notes, surgical approach, follow-up time, and additional surgeries and outcomes according to anatomical, therapeutic and functional success. Anterior segment photographs were investigated for thorough explanation of the examinations. Results Forty-five eyes of 45 patients were included (mean age 61.2 ± 22.4 (90-2), female/male ratio 20/25). Surgical approaches applied according to the size and location of the perforation site included fibrin glue application (6), amniotic membrane transplantation (AMT) (9), corneal patch graft application(15), and tectonic keratoplasty (15). The ratio of inflammatory and infectious causes as the two main indications was 29/16. Globe integrity was ensured with the first surgery in 27 eyes. However, 17 eyes required secondary surgical attempts due to failure of the first approach and 1 eye underwent evisceration. AMT was the least successful method among other methods in anatomical, therapeutic, and functional assessment. Conclusion There are various surgical approaches for repairing non-traumatic corneal perforations, each with its own advantages and disadvantages. These include high tissue resistance, the ability to remove necrotic tissue, ease of access, and anti-inflammatory activity. It is possible to successfully repair corneal perforations with single and combined methods, considering the above-mentioned features, especially depending on the size and location of the defect. While AMT is a viable and time-saving choice − especially in the lack of donor tissues − further interventions are necessary in most circumstances.

Treatment outcomes of root perforations repaired by calcium silicate-based cements with or without an accelerator: A randomized controlled trial

ABSTRACT Aim: To compare the clinical outcomes of root perforations repaired using two calcium silicate-based cements (CSC) with or without accelerator in a randomized controlled trial. Methods: The study was designed as a noninferiority, double-blind, randomized controlled trial. Forty-six teeth with root perforations were recruited following the inclusion and exclusion criteria. Teeth were randomly allocated and treated according to the root-repair material into CSC with accelerator (Bio-MA) and CSC without accelerator (ProRoot® MTA) groups. Treatment outcomes of the perforation site and periradicular area were evaluated from clinical and radiographic examination as healed, healing, or disease, where healed and healing were combined and defined as success. Chi-square, Fisher’s exact, and noninferiority analyses were used to analyze the outcomes. Results: The recall rate was 100% with a median period of 23.5 months. At the perforation site, healed and healing were 90.5% (19/21) and 9.5% (2/21) in the Bio-MA group and 95.7% (22/23) and 4.3% (1/23) in the ProRoot® MTA group; no disease was found in either group. At the periradicular area, the Bio-MA group had 85.7% (18/21) healed and 14.3% (3/21) healing while ProRoot® MTA group had 82.6% (19/23) healed, 13.0% (3/23) healing, and 4.4% (1/23) disease. No significant difference in treatment outcome, either at the perforation site or periradicular area, was found between the groups (P > 0.05). Bio-MA tended to be noninferior in root-perforation repair compared with ProRoot® MTA. Conclusion: Treatment outcomes of root perforation repair using CSC with or without accelerator demonstrated similarly high success rates (P > 0.05).