Bowel Perforation Research Articles

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

Not available.

Striking multiple magnetic foreign bodies in the stomach.

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

Treatment of blunt splenic injury in children in China

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

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

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

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

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

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

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

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

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

Two Cases of Colonic Perforation Following Upper Gastrointestinal Barium Examinations

Two Cases of Colonic Perforation Following Upper Gastrointestinal Barium Examinations

SMALL BOWEL OBSTRUCTION DUE TO MECKELS DIVERTICULUM IN ADULTS: CASE REPORT

Meckels diverticulum is the partial persistence of the omphalomesenteric duct during the seventh week of gestation [1]. It is the most common congenital anomaly of the gastrointestinal tract with a slight male predominance [1]. It is rare and is encountered in 2 to 4% of the population [2]. Meckels diverticulum is usually, but it can be revealed by complications such as: intestinal obstruction, perforation, fistula and tumor degeneration [3].We report in this work the clinical case and management of small bowel volvulus on Meckels diverticulum, observed in theUniversity Hospital center of Marrakech in a 19-year-old adult in March 2023, this is a patient without medical history admitted to the emergency with acute abdomen made up of abdominal pain, vomiting and fever. The physical examination aimed abdominal bloating and generalized defense. Biology shows an inflammatory syndrome.Abdominal Computed tomography scan in the emergency shows a distension of the small bowel measuring 36mm, with hydroaeric levels, no disparity in caliber, associated with moderate peritoneal effusion.The patient was operated by median laparotomy. Surgical exploration revealed distension of the bowel upstream of a flange taking up an inflamed Meckels diverticulum, 6cm long and 2cm in diameter, situated on the anti-mesenteric edge, 2.30 meters from the Treitz angle and 70cm from the ileo-caecal junction, adhering to the root of the mesentery. It was around this diverticulum that the small intestine had volvulated but was viable. The appendix was normal size. The surgical procedure consisted of a losangicdiverticulectomy preserving the supporting loop of bowel and transverse suture of the loop of bowel using separate stitches.Postoperative recovery was straightforward. Discharge was authorized on the 6th day.Histo-pathological examination showed fibrous tissue with a dense, diffuse inflammatory infiltrate, compatible with a lesion of non-specific gastric diverticulitis.It is important to be aware of the complications of Meckels diverticulum in the presence of acute abdominal pain, to guide surgical management as effectively as possible.

Diaphragmatic morgagni in adult: a case report

A 70-year-old male patient with a history of systemic hypertension, gouty arthritis, and possible chronic kidney disease presented with right flank pain, nausea, and decreased appetite. Examinations revealed a right-sided incarcerated diaphragmatic hernia in the anterior region, with protrusion of adipose tissue and loops of small intestine. A laparoscopic surgery was performed, during which the herniated contents were reduced, and a hernia defect approximately 4 cm in size was found and repaired. Post-surgery, he developed complications including pulmonary thromboembolism, intestinal perforation, and fistula, which required reoperation, and progressive clinical deterioration, ultimately leading to death. This case report presents a rare instance of congenital hernia diagnosed through imaging after the onset of nonspecific clinical symptoms. It emphasizes the importance of considering this pathology among differential diagnoses of acute abdomen for prompt diagnosis and appropriate management through surgical intervention.

Emergency pancreaticoduodenectomy for pancreatitis-associated necrotic perforation of the distal stomach and full-length duodenum: A case report

BACKGROUND Non-ulcerative necrosis of the stomach and duodenum is rare because of the abundant blood supply in the gastrointestinal tract. Duodenal necrosis is a rare complication of severe acute pancreatitis. Emergency pancreaticoduodenectomy (EPD) is a rare procedure, with extensive duodenal necrosis being one of its indications. CASE SUMMARY We here report the case of a 57-year-old man who survived EPD for pancreatitis, which resulted in the necrosis of the distal stomach, full-length duodenum, and part of the jejunum. CONCLUSION Despite significant surgical risks, an EPD could be a life-saving procedure in severe cases of pancreatitis.

Hour of Life at Enteral Feeding Initiation and Associated Clinical Morbidity in Extremely Low-Birth-Weight Infants

Background/Objectives: Identifying nutritional interventions in extremely low-birth-weight (ELBW) infants (&lt;1000 g) that are associated with favorable clinical outcomes is important. Delayed enteral feeding initiation (&gt;3 days) has been associated with increased odds of developing morbidity. Therefore, the aim of this study is to evaluate the relationship between hour of life at enteral feeding initiation and associated clinical outcomes. Methods: An IRB-approved retrospective chart review evaluated ELBW infants. Birth acuity was evaluated using CRIB II scoring and incidence of various morbidities (bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and spontaneous intestinal perforation (SIP)) and mortality was assessed after adjustment. p &lt; 0.05 was statistically significant. Results: A total of 27/61 (44.3%) initiated enteral feeding &lt;12 h of life. CRIB II scores were lower in infants with earlier enteral feeding initiation. There were no statistical differences in NEC, SIP, or death between categories of hour of life at enteral feeding initiation. After adjusting for CRIB II scores, enteral feeding initiation ≥12 h of life was associated with more days receiving oxygen &gt;21% inspired air (β = 32.7; p = 0.040), approximately 7-fold higher odds of developing moderate/severe BPD (95% CI 1.2.8–38.28; p = 0.025), and 9-fold higher odds of being discharged home while receiving oxygen therapy (95% CI 1.03–79.81; p = 0.047). Conclusions: Timing of enteral feeding initiation may be delayed in ELBW infants with higher clinical acuity, yet later initiation by hour of life is associated with worsened clinical respiratory outcomes. Early initiation within the first 12 h of life is feasible and was not associated with gastrointestinal morbidity in this single-center cohort of ELBW infants.

Severe gastroparesis complicated by gastric perforation caused by lightchain amyloidosis.

AL-Amyloidosis is a rare systemic disease that can occur in patients with monoclonal gammopathy or multiple myeloma. As multiple organs may be affected by deposition of amyloid fibrils, the clinical presentation varies considerably, and the diagnostic process may be challenging.We report on a 59-year-old female who suffered from gastroesophageal reflux symptoms, nausea, epigastric pain, and meteorism over several years. Repeated upper GI endoscopies including biopsies and CT scans were unremarkable except for unspecific enlargement of mesenterial lymph nodes.A few weeks after a surgical hiatal hernia repair with fundoplication, the patient developed massive distension of the stomach and the proximal duodenum resulting in gastric perforation. Histopathological staining of gastric biopsies and mesenterial lymph nodes using hematoxylin and eosin was unremarkable. Because of endoscopic findings (submucosal hematomas, and ulcerations) and the unexplained severe motility disorder, histopathological staining was performed using Congo red. Extensive amyloid deposits were seen. Further workup confirmed AL amyloidosis caused by monoclonal gammopathy. Specific oncological treatment was started.The rare differential diagnosis of amyloidosis should be taken into account in patients with unexplained motility disorders, unspecific gastrointestinal symptoms, and abdominal lymphadenopathy. In the presented case, delayed diagnosis of AL amyloidosis in the gastrointestinal tract led to severe gastroparesis resulting in gastric perforation. Specific histopathologic staining can confirm the diagnosis.

Incidence of serious complications following screening colonoscopy in adults aged 76 to 85 years old.

Screening colonoscopy harms data are limited for adults ages 76-85 years. We conducted a retrospective cohort study of screening colonoscopies vs. fecal immunochemical tests (FIT) and general population matched comparators aged 76-85 within 3 integrated healthcare systems (2010-2019). The primary outcome was death or overnight hospitalization within 30 days. A secondary outcome also included nine harms diagnoses. Adjusted risk estimates and risk differences (RD) were obtained using Poisson regression. Narrow analyses excluded outcomes after the next lower endoscopy or colorectal procedure while broad analyses included them. Patients undergoing screening colonoscopy (N=4435) had a higher 10-day cumulative incidence of gastrointestinal bleeding (0.18% [95% CI: 0.09%, 0.35%]) and perforation (0.09% [95% CI: 0.03%, 0.23%]) than FIT (N=17,740) and the general population (N=44,350) in the narrow analysis. Screening colonoscopy patients had a 1.04% (95% CI: 0.74%, 1.34%) risk of death or hospitalization within 30 days in the narrow analysis, similar to FIT (RD = 0% [95% CI: -0.36%, 0.35%]) and the general population (RD=-0.07% [95% CI: -0.39%, 0.25%]). In the broad analysis, risk following colonoscopy was 2.30% (95% CI: 1.85%, 2.75%) with RD=1.13% (95% CI: 0.67%, 1.60%) vs. general population (age 76-80 RD=0.93% [95% CI 0.45%, 1.41%], age 81-85 RD=2.14% [95% CI: 0.74%, 3.54%]). Secondary outcomes followed a similar pattern by age. At ages 76-85, screening colonoscopy including downstream procedures are associated with an increased short-term risk of death or hospitalization. Harms data can be combined with benefits data to guide screening colonoscopy decisions among older adults.

Endoluminal photodynamic therapy with a photoreactive stent‐based catheter system to treat malignant colorectal obstruction

AbstractPhotodynamic therapy (PDT) using photosensitizer (PS)‐embedded silicone membrane‐covered self‐expandable metallic stents (SEMSs) can function in palliative therapeutic option for malignant gastrointestinal tract obstruction. However, stent‐related complications should be considered, and accurate delivery of light sources is technically difficult. Here, a Chlorin e6 (Ce6)‐an embedded stent‐based catheter is developed to improve its therapeutic efficacy and safety. PDT using Ce6‐embedded stent successfully induced cell death of colorectal cancer cell line. PDT‐treated liver tissues showed an increase in ablation depth in proportion to irradiation energy, and 600 J/cm2 demonstrates an even and sufficient ablation depth. Endoluminal PDT using the Ce6‐embedded stent‐based catheter was technically successful in a rat colon model without procedure‐related complications such as colonic perforation or stricture formation. The results in colonoscopy, colonography, and histological examination, along with statistical analysis, suggest that a novel PDT modality using a Ce6‐embedded stent‐based catheter was safely conducted and demonstrated apoptotic cell death at 12 h after PDT, and it gradually recovered from 2 to 4 weeks. Thus, the PDT using the Ce6‐embedded stent‐based catheter may represent a promising new approach for the treatment of malignant colorectal obstruction.

Gastric perforation in pediatrics patients: A case report with management

Gastric perforation in pediatrics patients: A case report with management

Endoscopic management of colonic perforations.

We will review the current management of colonic perforations, with particular emphasis on iatrogenic perforations caused by colonoscopy, the leading etiology. We will focus on recently developed endoscopic techniques and technologies that obviate morbid emergency surgery (the standard management approach in years past). Colonic perforations are rare but potentially fatal complications of both diagnostic and therapeutic colonoscopy resulting in death in approximately 5% of cases with the mortality increasing with delay in diagnosis and treatment. As novel endoscopic techniques and tools have flourished in recent years, our approach to management of these perforations has evolved. With the availability of newer tools such as over the scope clips, enhanced through the scope clips and novel endoscopic suturing devices, colonic perforations can be managed effectively in many or most patients without the morbidity of surgical interventions. With expanding use of colonoscopy, inadvertent outcomes such as perforations are bound to increase as well. Early diagnosis permits minimally invasive, nonsurgical, endoscopic management in most cases if the expertise and tools are available. Centers with high colonoscopy volumes including therapeutic procedures would be well served to invest in the requisite technologies and expertise.

Primary anastomosis versus stoma following urgent sigmoidectomy for sigmoid volvulus: 58-year experience in a tertiary referral center.

Primary anastomosis and stoma are the main options in the restoration of intestinal continuity following urgent sigmoidectomy in sigmoid volvulus (SV). Our purpose was to evaluate the outcomes of both techniques in a 1,083-patient SV series. Total 1,083 cases with SV treated in Ataturk University Research Hospital in 58-year period between June 1966 and July 2024 were included in this study. We reviewed the records of 612 patients (56.5%) retrospectively, while the remaining 471 cases (43.5%) were evaluated prospectively. We investigated some preoperative, operative, and postoperative characteristics in non-matched analyses. Among total 379 patients treated with urgent colectomy, primary anastomosis was used in 173 cases (45.6%), while stoma was required in 206 patients (54.4%). The mean age was significantly lower in primary anastomosis group (P<0.005), while male/female ratios were statistically similar (P>0.05). Mean ASA score (P<0.001) and rates of shock (P<0.001), bowel gangrene (P<0.001), bowel perforation (P<0.01), and risky bowel (P<0.005) were also significantly lower in the primary anastomosis group. When stoma closure was considered, operation time was significantly shorter (P<0.001), additionally, morbidity and mortality rates were significantly lower in the primary anastomosis group (P<0.001, in each). The distributions of reoperation rates were statistically similar in both groups (P>0.05). Conversely, hospitalization time was significantly shorter and cost was significantly lower in the primary anastomosis group (P<0.001, in each). Primary anastomosis has some advantages in comparison to stoma in the restoration of intestinal continuity following urgent sigmoidectomy in SV. However, stoma is generally preferred in patients with bad health status, old age, and risky bowel. New prospective randomized clinical studies or matched analyses may help to clarify the optimal choice.

Acute intestinal obstruction caused by gastrointestinal foreign bodies in children: a comparison of laparoscopically assisted approach and open surgery

ObjectiveThis study aims to explore the appropriate surgical treatment method for acute intestinal obstruction caused by gastrointestinal foreign bodies in children through a comparison of clinical characteristics in patients treated via laparoscopically assisted approach and open surgery.MethodsThis study retrospectively analyzed 12 children with acute intestinal obstruction caused by gastrointestinal foreign bodies treated at Shanghai Children’s Hospital and Huzhou Maternity and Child Care Hospital from June 2019 to June 2024. Basic information, treatment methods, and prognoses of the patients were collected. General data, operation time, postoperative fasting time, postoperative hospital stay, and intraoperative and postoperative complications were compared between the two groups. Categorical data were compared using Fisher’s exact test. Normally distributed continuous data were expressed as mean ± standard deviation and analyzed using an independent samples t-test; non-normally distributed data were expressed as M (P25, P75) and analyzed using the non-parametric Mann-Whitney U test.ResultsSix cases underwent laparoscopic transumbilical extended incision, successfully extracting the intestines and removing the foreign bodies without converting to open surgery. Compared to Six cases undergoing traditional open surgery during the same period, the postoperative fasting time and postoperative hospital stay in the laparoscopic group were 4 (5 ± 3.65) days and 5.5 (5 ± 7.5) days, respectively, while in the traditional open surgery group, they were 5 (4.25 ± 6) days and 6 (5 ± 8.6) days, respectively; the differences were statistically significant (P < 0.05). The laparoscopic group had significantly shorter operation time and faster postoperative recovery. The acceptance of the laparoscopically assisted approach by the families was significantly higher than that of the open surgery treatment.ConclusionThe method of extracting obstructed intestines and removing foreign bodies via laparoscopic-assisted transumbilical extended incision has advantages over open surgery for treating acute intestinal obstruction caused by gastrointestinal foreign bodies, such as shortening hospital stay and operation time. However, for children with secondary gastrointestinal perforation caused by magnetic foreign bodies, open surgery, due to its broader exploration scope, is more advantageous for detecting occult perforations.

An Estimate of Preventable Harms Associated With Screening Colonoscopy Overuse in the U.S.

IntroductionScreening colonoscopy is often performed on patients who are younger or older than the ages specified in national guidelines, or at shorter intervals than recommended. The annual incidence of harms associated with overuse of screening colonoscopy in the United States is not known. This study estimated the incidence of low value screening colonoscopies annually in the United States and the number of preventable harms associated with them. MethodsThe 2018 National Health Interview Survey (NHIS) was used to estimate the number of annual screening colonoscopies. Rates of colonoscopy overuse and serious (bleeding and bowel perforation) and minor harms were drawn from three recent systematic reviews. ResultsApproximately 12.4 million screening colonoscopies were completed in the United States in 2018. Given the credible range of overuse rates of screening colonoscopy, between 2.1 and 3.2 million low value colonoscopies occur per year. Applying the credible ranges identified for serious and minor harms secondary to screening colonoscopy resulted in an estimated annual incidence of serious harm from unnecessary colonoscopies ranging from 9,055 to 11,874. The estimate for minor harms ranged from 359,5790 to 1,566,846. ConclusionsIn the United States, screening colonoscopies are often completed at intervals and in populations that are inconsistent with national recommendations, resulting in unnecessary serious and minor harm. While individual risk is relatively low, the large number of non-indicated screening colonoscopies results in large numbers of adverse events that are preventable with better adherence to recommendations.