Resection Of Necrotic Intestine Research Articles

Early Diagnosis of Necrotizing Enterocolitis in Neonates Using an Electronic Nose

Background: Necrotizing enterocolitis (NEC) is a devastating clinical problem that often necessitates resection of necrotic intestine, leaving infants with a suboptimal length of intestine to absorb nutrition. There are no adequate tests or biomarkers to predict NEC onset. We hypothesized that assessment of biological samples with a novel electronic nose can be used with machine learning algorithms to detect aberrancies in stool and urine volatile organic compounds to predict NEC risk. 
 Methods: 18 infants of gestational age ≤34 weeks in the Riley Hospital NICU were enrolled in the study and underwent stool (38 control, 3 NEC) and urine (42 control, 5 NEC) sample collection. Stool was collected by the bedside nurse via the infant’s diaper or ostomy bag. Urine was collected using a bag around the infant’s perineum or via foley catheter if already present. Stool samples and 250uL urine samples were aliquoted into Eppendorf tubes and covered with Parafilm. Samples were heated to 40°C, 30 minutes for stool, and 10 minutes for urine. Sample headspace was analyzed using the Cyranose 320 electronic nose, creating a “smellprint” comprised of readings from 32 unique sensors. Individual sensors were compared using Mann-Whitney U test. P<0.05 was significant. 
 Results: There was no significant difference in urine or stool signals among the 32 sensors between NEC and control groups. 
 Potential Impact: While no significant difference was found, this study is greatly limited by the number of patients enrolled, with only 2 of the 18 being diagnosed with NEC. Past retrospective studies with this device have found differences between NEC and non-NEC stool. The future goals of this study are to continue enrolling patients to have a more robust data set. Using machine learning, we aim to create a model to predict NEC before its clinical manifestation so that beneficial treatment can be initiated earlier. 
 
 Acknowledgment: This project was funded, in part, with support from the NIH NHLBI Short-Term Training Program in Biomedical Sciences Grant funded, in part by T35HL110854 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Obstrucción intestinal por hernia obturatriz: Serie de casos

Objective : 3 cases of intestinal obstruction that resulted in diagnosis of obturator hernia, their management and a brief international literature review are presented. Material and methods : Discussion of the presentation, images, and management. In all cases surgery was performed the same day from the diagnosis of intestinal obstruction and confirmation of obturator hernia. The management of the hernia and it’s content was adjusted to each patient’s situation. Case 1: 80 year old woman presents with intestinal obstruction and palpable mass in right inguinal region. Images are informed as a femoral hernia and surgery is performed. An obturator hernia is found, unviable intestine is resected and defect repair is made with polipropileno mesh plug. Case 2: 91 year old woman arrives because of abdominal pain and vomits in the last 3 days. Images suggest intestinal obstruction but can not identify a cause. Laparotomy is performed and an obturator hernia is found. Resection of necrotic intestine is made and the defect is repaired with simple suture. Case 3: 78 year old woman with pain in the thigh that radiates to the abdomen. Imagenology informs a femoral hernia. Surgery is performed through preperitoneal approach. An obturator hernia is found and reduced. Repair of the defect is made with polipropileno mesh plug. Results: Our 3 patients, when reviewed retrospectively, had the classic presentations and images of obturator hernia. All of them had a favourable evolution with an early discharge and no complications on follow up. Discussion : Our 3 cases had clinical presentations and imaging studies that correlated well with international literature. Conclusion : Obturator hernia is an infrequent pathology, but appears in a particular type of patient and with classic presentation. Axial computed tomography is an important tool and usually makes the diagnosis previously to surgical exploration. It is important to consider this diagnosis when being faced with patients with intestinal obstruction.

Initial and Middle-Term Outcome of Treatment for Spontaneous Isolated Dissection of Superior Mesenteric Artery.

Symptomatic isolated dissection of the superior mesenteric artery (SIDSMA) represents an extremely rare condition. Although various treatments including conservative treatment, endovascular stenting (ES), and surgical repair are currently available, consensus treatment guideline is absent due to scarce of SIDSMA cases. Thus, we present our experience in the treatment of SIDSMA at our single center.Fourteen cases of SIDSMA were treated with conservative treatment, catheter-directed thrombolysis (CDT), endovascular stenting (ES), or surgical repair at our center between January 2008 and January 2014. Demographics, clinical manifestations, coexisting medical conditions, imaging feature, treatments, and follow-up outcome of these patients were retrospectively collected and analyzed.For 13 patients without peritonitis, conservative treatment was given for 4 to 6 days initially. After the first observation cycle, symptoms and signs were alleviated in 8 patients, and conservative treatments were continued. The remaining 5 patients received technically and clinically successful ES (in 4) or CDT (in 1) due to worsening symptoms and signs during conservative treatment. One patient with peritonitis underwent emergency surgery, with the necrotic small intestine resected. However, the abdominal pain was not alleviated 17 days postoperatively, ES was thus performed and symptoms relieved immediately. Two weeks after ES, a new aneurysm and partial thrombosis in the distal part of the stent were found by computed tomography angiography in this patient. No intestinal infarction or mortality developed during hospitalization. Follow-up was accomplished in 11 cases, ranging from 4 to 74 months (23.5 ± 21.3). Except that one complained with mild abdominal pain, the other 10 achieved complete remission. All patients were free from new aneurysmal formation of SMA and all stents remained patent.For SIDSMA without peritonitis, conservative treatment can be provided with reasonable success rate, while ES may serve as an effective alternative once conservative treatment fails. For SIDSMA with peritonitis, open surgery remains the treatment of choice by resection of necrotic intestine and revasculization.

Mesenteric ischemia in acute aortic dissection.

Mesenteric ischemia complicated by acute aortic dissection (AAD) is uncommon, but serious, as there is no established treatment strategy and it can progress rapidly to multi-organ failure. Diagnosing mesenteric ischemia before necrotic change is difficult, not only for primary care physicians, but even for gastrointestinal or cardiovascular surgeons as it can occur at any time during surgery. Thus, measures need to be in place at the bedside to enable us to obtain information on visceral perfusion. It is often difficult to decide which of laparotomy or aortic repair should be performed first, especially when there is associated shock or malperfusion of other vital organs. The standard surgical procedures for mesenteric ischemia are prompt revascularization of the mesenteric artery and, if needed, resection of necrotic intestine. However, the development of endovascular treatment and the introduction of hybrid ORs have improved the treatment strategies for mesenteric ischemia. This article reviews the issues of "diagnosis" in relation to the mechanism of mesenteric ischemia, and discusses the current "treatment strategies".

Resection and primary anastomosis in necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) is the most common surgical emergency in the newborn. Up to half of babies with NEC develop advanced disease requiring surgical intervention. Options include peritoneal drainage under local anaesthetic, enterostomy only, resection and enterostomies, and resection with primary anastomosis. Resection with enterostomies is favoured by many paediatric surgeons but management of neonatal enterostomies can be difficult. The outcome of 26 infants undergoing surgery for advanced NEC over a 2-year period is reviewed. Resection and primary anastomosis was possible in 18 infants of whom two (11%) died. Recurrent NEC developed in four (22%) and strictures in three (17%) of these infants. An initial enterostomy was fashioned in eight infants, three following resection of necrotic intestine and five as a proximal diverting stoma in infants with pan-intestinal involvement. Five of these eight infants died (63%), giving an overall mortality of 27%. Primary anastomosis is an effective procedure following resection of grossly involved intestine in infants with NEC. The mortality and morbidity in this series compared well with those reported for staged procedures.

Resection and primary anastomosis for necrotising enterocolitis

Necrotizing enterocolitis (NEC) is the most common surgical emergency in the newborn. Up to half of babies with NEC develop advanced disease requiring surgical intervention. Options include peritoneal drainage under local anaesthetic, enterostomy only, resection and enterostomies, and resection with primary anastomosis. Resection with enterostomies is favoured by many paediatric surgeons but management of neonatal enterostomies can be difficult. The outcome of 26 infants undergoing surgery for advanced NEC over a 2-year period is reviewed. Resection and primary anastomosis was possible in 18 infants of whom two (11%) died. Recurrent NEC developed in four (22%) and strictures in three (17%) of these infants. An initial enterostomy was fashioned in eight infants, three following resection of necrotic intestine and five as a proximal diverting stoma in infants with pan-intestinal involvement. Five of these eight infants died (63%), giving an overall mortality of 27%. Primary anastomosis is an effective procedure following resection of grossly involved intestine in infants with NEC. The mortality and morbidity in this series compared well with those reported for staged procedures.