Colorectal Cancer: Correlating the Role of Peritoneal Fluid Cytology to Tumor Biology and Stage: A Prospective Study from Pakistan

Bile leak is a recognised complication in surgery and trauma patients, often resulting in significant morbidity. While various imaging modalities play an important role in diagnosis, their accessibility and feasibility may be limited in clinical settings. Biochemical analysis of peritoneal or drain fluid bilirubin (FB) and fluid-to-serum bilirubin ratio (FSBR) have been proposed as an adjunct diagnostic tool. However, there is limited research on the use of FB or FSBR to diagnose bile leak as various FSBR cut-offs have been proposed in existing literature. We aim to assess the usefulness of FB and FSBR to diagnose bile leak in surgical and trauma patients. The study was conducted in collaboration with Pathology, Surgical and Trauma departments to comprehensively assess pre-analytical, analytical and clinical aspects. We performed a prospective study over a 21-month period (February 2023 to October 2024) at a metropolitan tertiary surgical and trauma centre. Contingency table and receiver operating characteristic area under curve (ROCAUC) analyses were made to assess the usefulness of FB and FSBR. Our study included 84 patients (38 post-operative surgical, 15 trauma and 31 medical control patients). Five patients (four surgical and one trauma) were diagnosed with bile leak based on radiological and clinical criteria. Both FB and FSBR are shown to be reliable markers to diagnose bile leak (ROCAUCs for both FB and FSBR > 0.9), with a FB cut-off of 75 μmol/L providing specificity 93.7% and sensitivity 100%, and a FSBR cut-off of 6.0 providing specificity 98.7% and sensitivity 100%. Our study demonstrates both FB and FSBR to be useful to diagnose bile leak in both surgical and trauma patients. Further validation through larger, multicentre studies may enhance the generalisability of these findings and refine the role of FB and FSBR in clinical practice.

Perforation is a common complication of peptic ulcers. Due to rapidly spreading peritonitis, perforation is a life-threatening complication of peptic ulcer disease. It is associated with a high rate of mortality and morbidity. It needs prompt resuscitation and urgent, appropriate surgical management to reduce morbidity and mortality. This prospective observational study was conducted in the Department of Surgery, Jalalabad Ragib-Rabeya Medical College Hospital, Sylhet, from January 2021 to December 2023 to see early postoperative complications of duodenal ulcer perforation. Sixty duodenal ulcer perforations underwent open repair with omental patch and aged 18 to 60 years were enrolled. All patients were male. The mean age of the patients was 36.43±8.02 years (range, 24-60 years) and 46.7% were within the 31 to 40 years age group. Fifty percent of patients came to the hospital after 48 hours of symptoms. Site of the perforation was in the anterior wall of the first part of the duodenum in all cases. Peritoneal fluid was purulent (80.3%), fibrinous (10%) and bilious (6.7%). The size of the perforation was between 5 to 10 mm in 58.3% of cases, <5 mm in 21 35% and >10 mm in 6.7% of cases. Early postoperative complications were pneumonia (35%) followed by wound infection (28.3%). Mortality was 1.7%. The mean length of postoperative hospital stay was 10.28±2.92 days (range, 4-22 days). In most of the cases, the duration of operations was within 60 to 75 minutes (46.7%). In conclusion, duodenal ulcer perforation is more common in males and young adults. Early postoperative complications are high. Pulmonary infection and wound infections are the most common complications. Jalalabad Med J 2025; 22 (1): 23-27.

To determine if blood and peritoneal fluid levels of syndecan-1, heparan sulfate, and hyaluronan are elevated in horses with small intestinal disease compared to healthy counterparts. 61 horses were categorized into control (n = 20), inflammatory (11), and strangulating (30) groups. Paired peritoneal fluid and blood samples were obtained from each group from December 2016 through December 2024 and analyzed via equine-validated ELISAs for syndecan-1, heparan sulfate, and hyaluronan concentrations. Patient survival to discharge was recorded for all groups. Immunofluorescence staining was performed on sections of healthy and diseased jejunum. Syndecan-1 concentrations were higher in horses with disease (inflammatory and strangulating lesions) compared to controls, in inflammatory peritoneal fluid relative to controls, and in horses that did not survive to discharge. Heparan sulfate concentrations were higher in diseased horses versus controls, in strangulating lesions compared to controls, and in horses that did not survive to discharge. Hyaluronan concentrations were higher in disease compared to control, lower in the peritoneal fluid of strangulating lesions, elevated in plasma from strangulating lesions, and higher in horses that did not survive to discharge. Immunofluorescence revealed a greater number of heparan sulfate-positive cells in diseased intestinal tissue. These findings suggest that endothelial glycocalyx degradation is associated with small intestinal disease and nonsurvival to discharge in equine small intestinal colic. Further investigation is needed to determine if measurement of endothelial glycocalyx biomarkers may offer a novel approach for assessing intestinal injury and guiding clinical decision-making in horses with gastrointestinal disease.

Ovulation-derived extracellular vesicles exhibit sustained oncogenic influence on the exposed fallopian tube fimbrial cells after drainage into peritoneal cavity.

Standardized Brazilian green propolis extract (EPP-AF®) enhances survival in a mouse model of sepsis induced by extraintestinal pathogenic Escherichia coli.

Inequities in imaging: The association between patient demographics and use of point-of-care ultrasound in the ED.

Background: Serous carcinomas are one of the most virulent cancers throughout the world. They can originate from ovary, endometrium, tube, or peritoneal cavity. A combination of immunohistochemical (IHC) markers is necessary to distinguish the primary origin of serous carcinoma, as they have prognostic and therapeutic implications. Aims and Objectives: We have studied the expression of estrogen receptor (ER), progesterone receptor (PR), WT1, and Ki-67 markers in ovarian and endometrial serous carcinomas (ESCs). Materials and Methods: Patients undergoing hysterectomy for ovarian or uterine mass detected radiologically or by previous small biopsy were evaluated. Histopathological examination and IHC were done. Results: Among 50 cases, 46 cases were ovarian serous carcinoma (OSC) and 4 cases were ESC. From 46 OSC cases, 7 cases were low-grade OSC (LGOSC) and 39 cases were high-grade OSC (HGOSC). Mean age of presentation for HGOSC is 51.6±10.8 years, 48.85±7.8 years for LGOSC, and 68±1.6 years for ESC. ER was positive in 78% of OSC and negative in 100% ESC. All LGOSC cases were ER negative and 72% cases of HGOSC cases were ER positive. PR universally stained ESC, but only 65% of OSC. PR comparatively better stained LGOSC cases than HGOSC. Almost all OSC cases stained with WT1 but almost none of ESC cases. WT1 failed to differentiate HGOSC versus LGOSC cases. Ki-67 was high in all cases of ESC and most cases of OSC. Conclusion: Ki-67 can be used to distinguish low-grade from high-grade serous carcinoma. ER and WT1 can be used to differentiate the endometrial versus ovarian origin of serous carcinoma.

An 8-year-old intact male mixed-breed dog presented with a 6-day history of anorexia, lethargy, and vomiting. Antigen testing for Dirofilaria immitis was positive, and circulating microfilaria was detected on a peripheral blood smear. Thoracic radiography showed a normal cardiac silhouette with a generalized bronchial pattern. Abdominal ultrasonography revealed segmental thickening and a loss of layering of the small intestine with marked mesenteric lymphadenopathy. Echocardiography showed heartworms in the main pulmonary artery and an echogenic structure on the right atrial wall. Cardiac computed tomography (CT) angiography (CTA) identified the right atrial structure as a non-enhancing lesion, which was presumed to represent thrombus or granulomatous inflammation. Cardiac CTA confirmed the presence of multiple heartworms and pulmonary thromboembolism and incidentally identified an aneurysmal dilation of the left subclavian artery with a centrally located intimal flap, suggesting an arterial dissection. Abdominal CT revealed a thickened small intestine, fat stranding, and generalized lymphadenopathy. Fine-needle aspiration of a mesenteric lymph node and cytology of the peritoneal fluid confirmed lymphoma. This case presents a rare subclavian artery dissection in a dog with a concurrent heartworm infection and lymphoma and highlights the clinical value of a cardiac CTA protocol for precise visualization of the cardiac and vascular walls.

Peritoneal fibrosis (PF) is a major complication of long-term peritoneal dialysis (PD). This study investigated the protective effects and mechanisms of asiaticoside (AC) against PF. In vitro, HMrSV5 cells were exposed to peritoneal dialysis fluid (PDF) with or without AC, and assessed for viability, migration, fibrosis/mesothelial-to-mesenchymal transition (MMT) markers (α-smooth muscle actin (α-SMA), Collagen I, E-cadherin, Vimentin), reactive oxygen species (ROS), mitochondrial membrane potential, and aryl hydrocarbon receptor (AhR) transcriptional activity using a dual-luciferase reporter assay. Subcellular localization of AhR was evaluated to examine nuclear translocation, and AhR overexpression was employed to confirm pathway dependence and its interaction with nuclear factor erythroid 2 related factor 2 (Nrf2). In vivo, mice received daily intraperitoneal 4.25% PDF with or without oral AC (50 or 100mg/kg), and peritoneal function, histology, and α-SMA/Collagen I expression were quantified. AC co-treatment significantly inhibited PDF-induced MMT, oxidative stress, mitochondrial dysfunction, and AhR nuclear translocation, while enhancing Nrf2 nuclear accumulation; AhR overexpression partially reversed these effects. In mice, AC preserved peritoneal function, reduced fibrosis, and modulated AhR-Nrf2 signaling. These results demonstrate that AC protects against PDF-induced PF by suppressing AhR activation and promoting Nrf2 nuclear translocation, indicating its protective effects in preclinical models of PD-associated PF.

The present investigation was carried out to study the occurrence and causes of ascites in dogs. Out of 4704 dogs screened during the study period 48 dogs were found positive for ascites. Among 48 ascitic dogs, 21 dogs had ascites due to hepatic origin (43.75%). Age wise occurrence was higher in dogs aged between 1-4 years. Labrador retriever was most commonly affected breed. Male animals were most commonly affected than females. The major clinical signs recorded were inappetence (66.67%), vomiting (47.61%), melena (42.85%), weight loss (42.85%), pedal edema (38.09%), dark yellowish urination (71.42%) and icterus (38.09%). Out of 21 dogs suffered with ascites of hepatic origin, grade 1 ascites was observed in 2 dogs, grade 2 ascites in 10 dogs and grade 3 ascites was observed in 9 dogs. Haemato biochemical analysis revealed a significant (P<0.05) decrease in haemoglobin, total protein and albumin whereas significant (P<0.05) increase in ALT, AST ALP levels were noticed in affected dogs. Ground glass appearance with loss of serosal details (75%), hepatomegaly (20%) were major abdominal radiographic findings. Sonographic examination revealed anechoic peritoneal fluid in all the dogs (100%). Overall, the findings emphasize that hepatogenic ascites remains a significant clinical condition in dogs and requires a comprehensive diagnostic approach. This includes incorporating haemato-biochemical analysis together with imaging evaluation for identification of hepatic disorders and to enable timely therapeutic intervention.

Background: Laparotomy for dirty abdominal surgeries in children under five years poses significant clinical challenges due to gross contamination and high risk of postoperative complications. Infants and neonates are particularly vulnerable because of immature immunity, limited physiological reserves, and higher susceptibility to sepsis and peritonitis. Objective: This study aimed to assess the clinical outcomes of children up to five years undergoing laparotomy for dirty surgeries and to evaluate the impact of intraperitoneal gentamicin lavage on postoperative recovery. Methods: A randomized controlled trial was conducted at the Faculty of Pediatric Surgery, Bangladesh Shishu Hospital and Institute, Dhaka, from March 2018 to December 2019. Seventy children undergoing dirty laparotomy were enrolled and randomized into two groups: Group A (n=35) received intraperitoneal lavage with gentamicin in saline, and Group B (n=35) received saline alone. Data collected included demographic parameters, type of disease, peritoneal fluid culture results, postoperative complications, wound infection, wound dehiscence, secondary suturing, and hospital stay. Statistical analysis was performed using SPSS 23.0, with significance set at p<0.05. Results: The majority of subjects were infants aged 1–12 months (65.7% in Group A, 51.4% in Group B). Neonates accounted for 14.3% in Group A and 20% in Group B. Mean weight was 6.1 ± 0.19 kg in Group A and 4.31 ± 0.72 kg in Group B (p>0.05). Common diagnoses included midgut volvulus and ileal perforation in neonates, intussusception in infants, and appendicular or ileal perforation in older children. Peritoneal cultures were predominantly sterile (88.6% in Group A vs. 80% in Group B), with E. coli and Klebsiella as the most frequent isolates. While culture positivity did not differ significantly, children in the gentamicin group experienced reduced postoperative fever, lower surgical site infection rates, and shorter hospital stays compared to

The article describes a rare clinical case of hydroperitoneum in a patient with mantle cell lymphoma. This observation illustrates the diagnostic difficulties in identifying the cause of ascites of unclear etiology and emphasizes the important role of cytological analysis of ascitic fluid. Mantle cell lymphoma is an aggressive mature B-cell lymphoma characterized by the proliferation of abnormal lymphoid cells with typical indolent nuclear circuits. Although extranodal involvement is not uncommon for a given vila lymphoma, the isolated occurrence of ascites as the first manifestation of the disease presents a unique and complex diagnostic situation. The purpose of this clinical example was to demonstrate the importance of including oncological and hematological diseases in the differential diagnostic search for ascites, especially when standard methods (for example, imaging diagnostic methods, biochemical tests) do not reveal an obvious cause. The work analyzes in detail the clinical case of a patient with hydroperitoneum, where a comprehensive diagnostic approach was applied, including ultrasound examination, laboratory tests and, most importantly, cytological and immunophenotypic examination of peritoneal fluid. Cytological analysis of ascitic fluid revealed the presence of atypical lymphoid cells, which made it possible to establish the diagnosis of mantle cell lymphoma with peritoneal damage. This diagnostic method has become key for determining the tactics of patient management and the timely start of specific polychemotherapy. Early detection of specific cells in ascitic fluid allows for an accurate diagnosis, determination of the stage of the disease and immediate initiation of appropriate treatment, ultimately improving the prognosis for the patient.

We investigated the role of the intraperitoneal immune microenvironment in the therapeutic response of gastric cancer with peritoneal metastasis to intraperitoneal paclitaxel. Gastric cancer with peritoneal metastasis has a poor prognosis, even with systemic chemotherapy. Although intraperitoneal paclitaxel administration has demonstrated clinical benefit, treatment resistance remains a major hurdle. Between 2017 and 2023, 30 patients undergoing staging laparoscopy were prospectively enrolled. Immune cell subsets and checkpoint marker expression in peritoneal lavage fluid were analyzed using flow cytometry and immunohistochemistry. Their associations with clinical outcomes were assessed using univariable and multivariable analyses, including Kaplan–Meier, logistic regression, and Ridge regression analyses. Elevated CD4+ T and CD19+ B cell levels were associated with inferior progression-free survival, whereas increased natural killer T-like cell levels correlated with improved survival. High FOXP3 and CTLA-4 expression were linked to worse outcomes. Ridge regression identified CD4+ T cell levels and CTLA-4 expression as unfavorable factors, while the presence of natural killer cells emerged as a favorable factor. An immunoregulatory-dominant immune landscape may drive resistance to intraperitoneal paclitaxel. Immune profiling of ascitic fluid could identify patients likely to benefit from immune-modulating strategies, including those targeting FOXP3+ and CTLA-4+ regulatory cells.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-27936-4.

Circulating tumour DNA as a prognostic tool for surgically treated pancreatic ductal adenocarcinoma.

Peritoneal dialysis is a therapeutic option for end-stage kidney disease patients that offers a better quality of life Peritoneal dialysis is a treatment option for patients with stage V chronic kidney disease that offers a better quality of life compared to hemodialysis. Abdominal wall hernias and scrotal edema are potential complications of peritoneal dialysis that may require discontinuation of the technique. However, radiological diagnosis and treatment of the hernia allow peritoneal dialysis to be resumed. We report here the case of a 72-year-old patient presenting with unilateral recurrence of an inguinal hernia with scrotal edema after bilateral open repair due to leakage of peritoneal dialysis fluid through a patent processus vaginalis, and we reviewed the existing literature. The literature reports that 4 to 14% of peritoneal dialysis patients develop an abdominal hernia and that dialysate leakage or scrotal edema, which are rarer, are often associated with an indirect inguinal hernia or a persistent patent processus vaginalis. Several risk factors have been identified: age, male gender, obesity, polycystic kidney disease, history of hernia, and high dialysate volumes. The diagnosis is based mainly on peritoneal computed tomography. Management may be conservative, but surgical repair using a tension-free technique, preferably according to Lichtenstein, is recommended in cases of confirmed primary or recurrent hernia. The optimal time to resume peritoneal dialysis remains variable, but is most often between 2 and 6 weeks.

Sepsis is characterized by a dysregulated systemic inflammatory response to infection and remains a major global health challenge, underscoring the need for novel therapeutic strategies. Drug repurposing offers a promising strategy, and fluvoxamine (FLV), a selective serotonin reuptake inhibitor (SSRI) widely used in psychiatric treatment, has been reported to exhibit anti-inflammatory properties. Here, we investigated the effects of FLV in a murine model of sepsis induced by cecal ligation and puncture (CLP). Oral pretreatment with FLV for seven days significantly increased the anti-inflammatory cytokine IL-10 in both plasma and peritoneal fluid, without affecting proinflammatory cytokines IL-6 and IL-1β. Conversely, when evaluating the involvement of the central nervous system through intracerebroventricular administration of FLV, a broad reduction in circulating cytokines was observed, encompassing both pro- and anti-inflammatory mediators. In vitro, FLV suppressed inflammatory cytokine production in LPS-stimulated macrophages, indicating a direct effect on immune cells. Notably, these immunomodulatory effects were independent of serotonin signaling and sigma-1 receptor activation, pathways traditionally associated with SSRI mechanisms. We demonstrate that FLV modulates cytokine production through distinct central and peripheral mechanisms. Our findings provide new insights into the immunomodulatory actions of FLV and support its potential repurposing as an adjunctive therapy for inflammatory diseases such as sepsis.

With increasing rates of survival amongst pre-term infants, patients with ventriculoperitoneal shunts are an increasingly common presentation to the emergency department, meaning that paediatricians must be familiar with the potential complications shunts can bring. Abdominal cerebrospinal fluid pseudocyst is a rare complication of ventriculoperitoneal shunts but remains an important cause of distal site failure in children. Irradiating imaging modalities have been traditionally relied upon in the past to help make such diagnoses, however, point of care ultrasound offers many advantages to this and presents itself as a reliable alternative. A 7-year-old girl who was born prematurely at 27 + 6weeks and had a ventriculoperitoneal shunt inserted as an infant was brought to the Paediatric Emergency Department by her grandparents after they noticed her abdomen was distended. Her grandfather stated that he had replaced her gastrostomy recently and had unable to obtain aspirates for the past 48h. POCUS revealed a large anechoic fluid collection with the shunt tip visible within it consistent with a CSF pseudocyst. POCUS was also able to confirm position of the gastrostomy balloon in the expected location helping to exclude malposition as a potential differential diagnosis. In patients with ventriculoperitoneal shunts, POCUS can correctly identify the presence of abdominal CSF pseudocyst differentiating it from other causes of abdominal distension including gastrostomy-related complications. This case supports the role of POCUS as a safe, reliable first-line imaging tool for diagnosing CSF pseudocysts in patients with ventriculoperitoneal shunts, particularly where previous similar complications have existed.

Perforated appendicitis (PA) is the most common cause of intra-abdominal abscess in children and is associated with higher costs, extended hospitalizations, and worse postoperative outcomes compared to uncomplicated appendicitis. Photodynamic therapy (PDT) utilizes a photosensitizer and light to generate cytotoxic reactive species that are efficacious against bacteria. We sought to determine whether PDT could effectively eliminate bacteria isolated from the peritoneal cavities of pediatric patients with perforated appendicitis. After IRB approval, bacterial subcultures from 30 pediatric surgical patients with PA were developed as planktonic monocultures. Samples were derived from standard clinical collection of peritoneal fluid in patients undergoing surgery for PA. Cultures were incubated with the photosensitizer methylene blue (MB) and exposed to a 665 nm laser to perform PDT. Control conditions were MB alone, laser alone, or no MB and no laser. Log reductions in bacterial growth between groups were compared using two-way ANOVA. Bacteria were isolated from 28 (93.3%) specimens, and 26 (86.7%) were polymicrobial. The most prevalent organisms included Escherichia coli (76.7%), the Streptococcus anginosus group (56.7%), Bacteroides fragilis (46.6%), and Pseudomonas aeruginosa (26.7%), with antibiotic resistance common among E. coli isolates. For E. coli, MB-PDT caused a 5.86 ± 0.39 log10 reduction compared to the no-treatment control (p < 0.001). For S. anginosus and P. aeruginosa, MB-PDT resulted in reductions of 5.91 ± 0.88 log10 and 2.23 ± 0.64 log10, respectively (all p < 0.001). PDT showed comparable efficacy in isolates with multiple antibiotic resistance relative to those that were antibiotic pan-susceptible for E. coli (p = 0.760), S. anginosus group (p > 0.999), and P. aeruginosa (p = 0.991). PDT application to bacterial isolates from patients with perforated appendicitis achieved > 99.9% bacterial kill in all isolated strains other than P. aeruginosa, regardless of antibiotic susceptibility, suggesting that PDT may be a viable adjunct to in vivo antimicrobial therapy.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-32137-0.

This study aimed to investigate the microbiome profile in the cystic fluid of ovarian endometrioma and explore its association with the microbial communities present in the lower and upper reproductive tracts. A microbial analysis was conducted across multiple compartments of the reproductive tract in patients diagnosed with ovarian endometrioma. Sixteen female patients aged 25-43 years (mean age: 31.56 years) who underwent laparoscopic surgery for ovarian endometrioma at the First Hospital of Putian City between April 2023 and February 2024 were enrolled in this study. 16S rDNA sequencing was employed to characterize the microbiome of ovarian endometrioma and assess its correlations with clinical symptoms, inflammatory markers, and serum CA125 levels RESULTS: Microbial communities were detected in the posterior vaginal fornix, endometrial fluid, peritoneal fluid, and cystic fluid, exhibiting distinct compositional profiles. Community diversity significantly increased along the anatomical gradient from the posterior vaginal fornix to endometrial fluid, peritoneal fluid, and cystic fluid, with the highest microbial diversity observed in the cystic fluid. Lactobacillus was the predominant genus in the posterior vaginal fornix, whereas Escherichia-Shigella was most abundant in endometrial fluid samples. Hydrogenophaga and Brevundimonas were the dominant taxa in both peritoneal and cystic fluids. Notably, the microbial composition of peritoneal fluid showed the greatest similarity to that of cystic fluid, and functional prediction analyses indicated largely overlapping biological functions between these two sites. Furthermore, Spearman correlation analysis revealed significant associations between specific microbial taxa and certain clinical manifestations or inflammatory factors. This study demonstrates the presence of a unique and highly diverse microbiome within the cystic fluid of ovarian endometrioma. The site-specific microbial profiles and their correlations with clinical parameters suggest a potential role of microbiota in disease pathogenesis through inflammatory and metabolic mechanisms. These findings contribute novel insights that may inform future strategies for the prevention, diagnosis, and treatment of ovarian endometrioma.