Bowel Perforation Research Articles

Complications of deep infiltrative endometriosis of gastrointestinal tract

Objective. To summarize the literature data on the main complications of deep infiltrative endometriosis, including ileocecal. Endometriosis is a complex disease that can begin to develop from birth. Despite all the already existing theories of the origin and development of this disease, further large-scale studies are required to investigate the etiology, pathogenesis, and phenotypes of this nosology and its relationship with pain and infertility. External genital endometriosis often affects various parts of the gastrointestinal tract. The rectosigmoid junction of the colon is most commonly affected (81.3%), followed by the appendix (6.4%), small intestine (4.7%), dome of the cecum (4.1%), and other parts of the gastrointestinal tract (1.7%). In recent years, interest in ileocecal endometriosis and its timely diagnosis and treatment has begun to grow among practicing specialists. Presently, deep infiltrative endometriosis is widely studied by obstetricians–gynecologists and by related specialists, such as general surgeons, coloproctologists, and gastroenterologists, in connection with extragenital lesions leading to severe complications. Cases of intestinal perforation caused by deep infiltrative endometriosis, bleeding, and small intestinal obstruction have been described.

12361 An Unusual Case of Myxedema Coma

Abstract Disclosure: N. Hasan: None. D. Yang: None. T. Othman: None. J. Dai-Ju: None. Background: Most cases of Myxedema Coma are associated with primary hypothyroidism with significantly elevated TSH levels. However the presence severe illness can contribute to decreased TSH release even in the absence of central lesions. Case: 60 year old female was found down covered in feces. She was hypothermic to 89°F, with a pulse of 62. Physical exam revealed hair loss, thick tongue, non-pitting edema, and delayed relaxation of brachial reflexes. Labs showed Sodium of 123, blood glucose of 80. Thyroid function testing revealed only a mildy elevated TSH of 13 with free T4 <0.025. Anti-TPO antibodies were elevated at 157. MRI of the Sella was negative any lesions. Thyroid ultrasound showed atrophic bilateral thyroid lobes. Assessment for hypopituitarism did not show any significant deficiencies with Cortisol 45, ACTH 11, LH 0.5, FSH 8.5, IGF-33, and Total Testosterone 10. She was found to have septic shock secondary to perforated sigmoid colon requiring colectomy. She was initially loaded with Dexamethasone 4mg followed by IV Levothyroxine 100mcg, with steroids being discontinued after AI was ruled out. After treating her sepsis she was transitioned to 150mcg of oral Synthroid with improvement of her thyroid function tests to TSH of 2.7 and free T4 of 1.56. Discussion: The majority of Myxedema Coma is associated with primary hypothyroidism. In these cases, TSH levels are markedly elevated, often greater than 100. When the TSH is not as elevated as we would expect, many factors must be considered, the greatest being central hypothyroidism where TSH secretion may be impaired from pituitary tumors, surgery, radiation, and other causes. Our patient however did not have any central lesions on imaging and was found to have anti TPO antibodies with atrophic thyroid lobes on ultrasound suggestive of primary hypothyroidism. This brings us to the effect of acute illness on the balance of thyroid hormones. Conditions such as sepsis stimulates elevations in inflammatory cytokines which disrupt the physiologic response to release TSH. Previous studies involving sepsis revealed the main cytokines implicated are TNF alpha, Interferon gamma, IL-1, and IL-6. The degree of inadequate TSH secretion is often times proportional to the severity of illness and improves after recovery from the illness. Conclusion: Our body's response to critical illness involves complex hormonal changes which affect the HPA axis and can decrease TSH secretion, even in myxedema coma without central lesions. Presentation: 6/1/2024

8634 Ogilvie Syndrome As A Rare Complication Of Metastatic Pheochromocytoma

Abstract Disclosure: S.K. Beeby: None. J.C. Marcayata, MD: None. D.P. Di Matteo, MD: None. F.F. Souza, MD: None. I.C. Souza, MD: None. M.F. Azevedo, MD: None. F.M. Coelho, MD: None. A. Latronico, MD: None. B.B. Mendonca: None. M.C. Fragoso: None. M.Q. Almeida: None. Background: Ogilvie's Syndrome (acute colonic pseudo-obstruction) is a rare manifestationof pheochromocytoma and paraganglioma. Its pathophysiology can be explained by thehypersecretion of catecholamines, which may reduce peristaltic activity of the gastrointestinaltract due to alpha-adrenergic stimulation. We present here the case of a patient with acuteintestinal pseudo-occlusion due to metastatic pheochromocytoma. Clinical Case: A 60-year-old male with local recurrence of pheochromocytoma presentedwith abdominal pain, anorexia, nausea, vomiting and constipation for 2 weeks. The patientunderwent left adrenalectomy and nephrectomy to resect a 7.5 cm pheochromocytoma 6years ago. On examination, his blood pressure was 186 x 122 mmHg and heart rate was 112bpm. There was abdominal distention and diminished bowel sounds. Diaphoresis was notedmainly at night. Plasma fractionated metanephrines were markedly elevated, withnormetanephrine of 50.2 nmol/L (reference range <0.9 nmol/L) and metanephrine of 0.4nmol/L (reference range <0.5 nmol/L). Abdominal CT scan showed neoplastic lesionoccupying the left adrenal space, measuring 9.0 x 5.0 x 5.5 cm, infiltrating the spleen andpancreatic tail, and para-aortic and aorto-caval lymphomegaly of 1.3 cm. The large intestinewas distended with gas and lodged stool without evident obstructive factors. He was thenstarted on a high-sodium diet and alpha-blocker doxazosin 2 mg tid and propranolol 40 mgtid. Due to the presence of significant orthostatic hypotension, amlodipine 5 mg bid wasinitiated to control blood pressure. Laxatives and enemas were not effective in relieving hissymptoms and decompression with a nasogastric tube was necessary. The patient was thenput on subcutaneous neostigmine, an acetylcholinesterase inhibitor. Unfortunately, colonicpseudo-obstruction did not revert with pharmacological treatment and parenteral nutritionwas started. Since a complete tumor resection was not possible due to extensive invasion oflarge vessels, systemic cytotoxic chemotherapy (cyclophosphamide, vincristine anddacarbazine) was initiated as an attempt to treat the colonic pseudo-obstruction. Clinical lessons: Functioning pheochromocytoma and paraganglioma should be consideredin the differential diagnosis of constipation and acute intestinal obstruction, particularly whenaccompanied by other signs and symptoms of catecholamine excess. This condition should bepromptly diagnosed and managed, as it can lead to bowel perforation with seriouscomplications. Medical management includes alpha-blocking agents and, when feasible,tumor resection has been associated with good response. Support: This work was supported by Sao Paulo Research Foundation (FAPESP) grant2019/15873-6 (to M.Q. Almeida). M.Q.A was also supported by National Council forScientific and Technological Development (CNPq) 304091/2021-9. Presentation: 6/1/2024

Delayed primary skin closure reduce surgical site infection following surgery for gastrointestinal perforation: A systematic review and meta-analysis.

Following surgery for Gastrointestinal (GI) perforation, there is an increased occurrence of Surgical Site Infections (SSI). The beneficial effect of employing delayed primary skin closure (DPC) on severely contaminated incisions subsequent to surgery for GI perforation remains unverified. To systematically evaluate the advantages of the DPC management in surgery for GI perforation. A literature search was performed using ClinicalTrials.gov, Pubmed, Embase, Cocharane, and Web of Science identified all eligible English-language studies related to surgery for GI perforation through October 2023. Randomized clinical trials (RCTs) comparing DPC with primary skin closure (PC) in surgery for GI perforation were included. Two investigators independently performed the inclusion work, and a third investigator was consulted for resolving conflicts. Data were extracted by multiple independent investigators and pooled in a random-effects model. The primary outcome was SSI, defined in accordance with the original studies. The secondary outcome was the length of stay (LOS). Final analysis included 12 RCTs which included a total of 903 patients were randomizing divided into either DPC or PC, including 289 patients with gastroduodenal perforation (32%), 144 patients with small intestine perforation (15.96%), 60 patients with colon perforation (6.64%), and 410 patients with appendix perforation (45.4%). The rates of SSI was significantly decreased after DPC management (OR:0.31, 95%CI:0.15-0.63, p < 0.01), no significant differences were observed between the DPC group and PC group in terms of LOS (MD: - 0.37, 95% CI: - 1.91-1.16, p = 0.63). These results point to the efficacy of DPC management in reducing SSI in patients under surgery for GI perforation, and this strategy did not increase the LOS. This systematic review and meta-analysis may contribute to informed decision-making in the management of severely contaminated wounds associated with GI perforation.

Cat scratch colon and cecal barotrauma perforation during colonoscopy with CO2 insufflation.

Cecal perforation from barotrauma is a rare complication of colonoscopy, even with the use of CO₂ insufflation, which is generally preferred over room air due to its rapid absorption and reduced patient discomfort. A 64-year-old woman with hypertension and dyslipidemia underwent a routine colonoscopy with CO₂ insufflation. Multiple diverticula were noted, and upon reaching the cecum, several parallel linear lesions with spontaneous bleeding, consistent with "cat scratch" colon, were observed. Hemostasis was achieved with 10 endoscopic clips. A subsequent CT scan revealed pneumoperitoneum and the clips in the cecum. The patient was managed conservatively with bowel rest and intravenous antibiotics, showing a favorable clinical course and was discharged on the fifth day. This case highlights the potential for cecal perforation due to barotrauma even with CO₂ insufflation during colonoscopy, emphasizing the need for awareness and prompt management of such complications.

Effect of Preoperative Geriatric Nutritional Risk Index on Prognosis in Patients after Surgery for Lower Gastrointestinal Perforation

Introduction: Geriatric Nutritional Risk Index (GNRI) is a reliable index derived from serum albumin levels, height, and weight. Although various prognostic factors have been studied, the effect of preoperative nutritional status on surgical outcomes remains unexplored. This study aimed to evaluate the efficacy of the GNRI in predicting postoperative outcomes of lower gastrointestinal perforation. Methods: Eighty patients treated at our institution between January 2016 and December 2022 were retrospectively analyzed. This study primarily focused on the correlation between preoperative GNRI and two key outcomes: postoperative hospital stay duration and 1-year mortality rate. Results: Our findings revealed a significant association between low GNRI scores and increased 1-year mortality (odd ratio 4.0, 95% confidence interval [CI] 1.1–16, p = 0.025). Kaplan-Meier analysis and log-rank test showed that patients in the low GNRI group had markedly poorer overall survival rates than those in the high GNRI group (12-month survival rate 0.88 [95% CI: 0.75–0.95] vs. 0.65 [95% CI: 0.47–0.78]; p = 0.018). Additionally, both univariate and multivariate analyses indicated that lower GNRI scores were associated with prolonged hospital stays. Conclusion: We showed that a low GNRI score was associated with high mortality and prolonged hospital stay after emergency surgery for lower gastrointestinal perforation.

Adverse Events of the Over The Scope Endoscopic Clips and Cutters: A MAUDE Database Analysis

The OVESCO® clip system, including the Over-The-Scope Clip (OTSC) and Full-Thickness Resection Device (FTRD), has demonstrated efficacy in managing various gastrointestinal pathologies. However, real-world data on device malfunctions and patient complications are limited. This study aimed to analyze adverse events associated with OVESCO® clips and cutters reported to the FDA Manufacturer and User Facility Device Experience (MAUDE) database. The MAUDE database was searched for reports related to OVESCO® clips and cutters from January 1, 2007, to August 30, 2024. Event date, device type and model, manufacturer, event type, device problem, and patient complications were extracted. Descriptive statistics were used to summarize the findings. Forty-two reports were identified, with 41 involving OVESCO® clips and one involving an OVESCO® cutter. The most common device problem for OVESCO® clips was failure to deploy (61.0%), followed by unintended deployment or misfiring (17.1%). Gastrointestinal perforation was the most frequently reported patient complication (60%). The OVESCO® cutter report described device component breakage and foreign body retention. No clear trends in adverse event reporting were observed over the study period. OVESCO® clips and cutters are associated with potential device malfunctions and patient complications, particularly gastrointestinal perforation. The findings highlight the need for careful patient selection, meticulous technique, and close post-procedural monitoring. Collaborative efforts among stakeholders are essential to optimize device safety and efficacy. Continued post-marketing surveillance and real-world data analysis are crucial for monitoring the performance of endoscopic devices and improving patient outcomes.

Transanal irrigation: a review of indications, key assessments, benefits, contraindications, complications, efficacy and safety

Transanal irrigation (TAI) is a therapeutic procedure designed to manage chronic bowel dysfunction, including constipation and faecal incontinence, particularly in individuals with neurogenic bowel dysfunction. TAI offers symptom relief and improves quality of life by providing autonomy in bowel management. This article explores the benefits, clinical indications and contraindications of TAI. The article also emphasises the importance of thorough patient assessments before initiating TAI, such as evaluating bowel function, manual dexterity and motivation. Furthermore, the review discusses the role of structured education programmes in ensuring long-term adherence and safety, particularly within the first 3 months. In addition, it covers the complications associated with TAI, such as bowel perforation and autonomic dysreflexia, and offers management strategies. Finally, the review outlines the conditions under which TAI should be discontinued and provides guidance on ensuring patient safety throughout the treatment.

Conversion of one-anastomosis gastric bypass to Roux-En-Y gastric bypass: mid-term results from the United Arab Emirates.

One-Anastomosis Gastric Bypass (OAGB) is becoming popular, but some patients may need to convert to Roux-en-Y Gastric Bypass (RYGB) due weight-related difficulties or postoperative complications. The data on conversions is currently limited to 30-day or short-term follow-up studies. As such, the objective of this study was to evaluate the indications and mid-term outcomes for OAGB conversions to RYGB at a tertiary referral center in the United Arab Emirates. A retrospective analysis was conducted on patients who underwent conversion from OAGB to RYGB between February 2016 and May 2023. Demographic information, indications for conversion, intraoperative details, and mid-term outcomes were collected and analyzed. Sixty-four patients underwent conversion from previous OAGB to RYGB. The cohort was 73.4% female (n = 47) with a mean age of 40.8years. Indications for conversion included acid reflux (n = 28, 43.7%), intractable nausea/vomiting (n = 20, 31.2%), protein-calorie malnutrition (n = 7, 10.9%), anastomotic ulcer (n = 6, 9.3%) and weight recidivism (n = 3, 4.7%). The mean operative time was 238 ± 78.3min. During the procedure, three intraoperative complications occurred: two cases of bleeding and one case of bowel perforation; all successfully addressed during surgery. The median hospital stay was 3 ± 15.8days. Three patients (4.6%) experienced major postoperative complications comprising 2 anastomotic leaks and 1 small bowel obstruction. The mean follow-up time was 26.2 ± 19.7months, with 96.2% of patients reporting resolution of symptoms. There were no mortalities. Acid reflux is representing 43.7% of the indications for conversion from OAGB to RYGB. The symptom resolution rate holds significance, standing at a remarkable 96.8%. Despite surgical technique advancements, the complication rate after conversions remains significant at 4.6%, with no mortality reported. OAGB patients should be informed about these risks prior to undergoing conversions from OAGB to RYGB.

Mesenchymal stem cells suppress inflammation by downregulating interleukin-6 expression in intestinal perforation animal model

Introduction: Intestinal perforation has significant fatality due to sepsis contamination and prolonged inflammation. Studies showed that mesenchymal stem cells (MSCs) secreted cytokines and growth factors to reduce inflammation. This study aims to reveal the role of MSCs in controlling inflammation in intestinal perforation wound healing by measuring interleukin-6 (IL-6) and leukocytes in injured tissue. Materials and methods: A total of 48 rat models with a 10-mm longitudinal incision at the small intestine were divided into four groups: sham, control, Treatment group 1 (T1) injected with MSC doses of 1.5×106 cells and Treatment group 2 (T2) with 3×106 cells. IL-6 expressions were determined using western blot analysis, whereas the leukocyte infiltrations were assessed using the histopathological examination. All variables were evaluated on day 3 and 7. Results: Leukocyte infiltration is significantly lower in T1 and T2 compared to control group in day 3 and 7 (P&lt;0.05), while there were no differences between the two treatment groups. The expression of IL-6 was found to be significantly lower in the T1 and T2 groups compared to the control group on days 3 and 7 (P&lt;0.05), with no significant differences observed between the two treatment groups. Conclusion: MSCs administration in rats with intestinal perforation reduced inflammation by controlling leukocyte infiltration and IL-6 expression.

Gastrointestinal involvement in Ehlers-Danlos syndrome: A case series and systematic review

Objective: To explore the clinical and genetic characteristics of patients with Ehlers-Danlos syndrome (EDS) and gastrointestinal involvement. Methods: We retrospectively collected the clinical data of patients with EDS and gastrointestinal involvement from the electronic medical records at Peking Union Medical College Hospital (PUMCH) from January 2003 to September 2023. Additionally, we conducted a systematic review by searching cases with EDS and gastrointestinal involvement in PubMed, Embase, Web of Science, and the Cochrane Library databases from January 2000 to September 2023. Results: Ninety-four patients with EDS and gastrointestinal involvement were retrieved, including five patients from PUMCH and 89 patients from 80 published articles. The average age of patients was (29±14) years. The most common manifestation of gastrointestinal involvement was gastrointestinal perforation (n=46, 48.9%), followed by functional gastrointestinal symptoms (n=33, 35.1%), and digestive arterial disorders (n=10, 10.6%). The most common clinical subtype was vascular-EDS (vEDS) (n=50, 53.2%) followed by hypermobile-EDS (hEDS) (n=20, 21.3%). The most frequent genetic mutation occurred in the COL3A1 gene (n=30, 31.9%). Among patients with vEDS, gastrointestinal manifestations included gastrointestinal perforation (n=33, 66.0%), arterial lesions (n=9, 18.0%), and functional gastrointestinal symptoms (n=7, 14.0%). Among patients with hEDS, gastrointestinal manifestations included functional gastrointestinal symptoms (n=18, 90.0%), visceral prolapse (n=3, 15.0%) and intestinal volvulus (n=1, 5.0%). Conclusions: The most common subtypes of gastrointestinal involvement in EDS were vEDS and hEDS. Patients with hEDS mainly presented with functional gastrointestinal symptoms, whereas those with vEDS primarily showed gastrointestinal perforation and digestive arterial disorders.

Validity of laparoscopic surgery for lower gastrointestinal perforations.

This study aimed to clarify the validity of laparoscopic surgery for lower gastrointestinal perforation by comparing the clinical outcomes of laparoscopic and open emergency surgery. We reviewed the data of patients who underwent surgery for lower gastrointestinal perforation. Patients were categorized into two groups: the laparoscopic group who underwent laparoscopic surgery, and the open group who underwent laparotomy. Clinical and operative outcomes between the two groups were evaluated. A total of 219 patients were included in the study. There were 66 and 153 patients with small bowel and colorectal perforations, respectively. The median operative time in the laparoscopic group was shorter than that in the open group (126 min vs. 146 min, p = .049). The mean amount of intraoperative blood loss was significantly lower in the laparoscopic group (50.4 mL vs. 400.1 mL, p < .001). The incidence of postoperative complication was higher in the open group (20.0% vs. 66.5%, p < .001), especially wound infection (0% vs. 26.3%, p = .002). Median hospital stays were 14 days and 24 days in the laparoscopic and open groups, respectively (p < .001). In the laparoscopic group, hospital mortality was 0%. The laparoscopic approach for small bowel and colorectal perforation in an emergency setting is a safe procedure in carefully selected patients and may contribute to decreased intraoperative blood loss, shortened hospital stay, and decreased incidence of postoperative complications, especially wound infection.

S2884 The Role of Dulaglutide in Bowel Perforation

S2884 The Role of Dulaglutide in Bowel Perforation

Guidelines for diagnosis,treatment and prevention of clostridium difficile infection in China(2024)

Clostridium difficile infection(CDI) is an intestinal infection caused by Clostridium difficile,characterized by clinical symptoms such as fever,abdominal pain,watery diarrhea,and loose stools. Mild cases present with diarrhea,while severe cases can progress to pseudomembranous colitis,often accompany by complications such as toxic megacolon,intestinal perforation,and septic shock. CDI is a significant cause of complications and mortality,especially among elderly patients,and is one of the most common hospital-acquired infections. The purpose of this guideline is to provide guidance on the diagnosis,treatment,and prevention of CDI,covering a total of 20 clinical questions across three domains: diagnosis,treatment,and prevention. The guideline was developed by a collaborative effort of a guideline expert group and a guideline working group. The guideline expert group consists of 37 clinical experts in 18 specialties related to the diagnosis and treatment of CDI and healthcare associated infection control. This guideline was developed using the internationally recognized GRADE method. It includes evidence evaluation and recommendation grading. It categorizes the quality of evidence into four levels: high,medium,low and very low. When formulating recommendations,it considers factors such as the balance of benefits and harms of intervention,quality of evidence,values and preferences,as well as cost and resource consumption. The recommendations are classified into strong and weak recommendations(conditional recommendations). The target audience of this guideline includes Chinese doctors and patients.

Timing of Stoma Closure in Neonates: the ToSCiN mixed-methods study.

Neonates undergoing emergency abdominal surgery frequently require a stoma; closing this stoma with a second operation is an essential part of recovery. Timing of closure varies. Optimal timing is unclear and would be best resolved through a randomised controlled trial; such a trial is likely to be challenging. To determine if it is feasible to conduct a clinical trial comparing 'early' versus 'late' stoma closure in neonates. Mixed methods comprising three parallel workstreams incorporating: a clinician survey, prospective observational cohort study, parent interviews, focus groups, database analyses and consensus meeting. Specialist neonatal surgical centres across the United Kingdom. Neonatologists, neonatal surgeons, neonatal dietitians and neonatal nurses who care for neonates with stomas. Neonates with recent stoma, their parents and the clinicians looking after them. Three existing, overlapping clinical databases. One hundred and sixty-six professionals from all 27 neonatal surgical centres completed the survey: 6 weeks was the most common target time for stoma closure across clinical scenarios, although there was wide variation. Timing of closure was influenced by nutrition, growth and stoma complications. The prospective cohort study enrolled 56 infants from 8 centres. Infants were mostly preterm with necrotising enterocolitis or intestinal perforation. Clinicians identified extreme preterm gestation and clinical conditions as reasons for not randomising babies into a hypothetical trial comparing early and late stoma closure. Parents and healthcare professionals identified that comparator arms needed more clinical flexibility in relation to timing of stoma closure. Analysis of existing databases revealed wide variation in current timing of stoma closure in neonates and identified approximately 300 eligible infants for a trial per annum in the United Kingdom. A trial of 'early' compared to 'late' stoma closure in neonates is feasible and is important to families and health professionals. The population of eligible babies in the United Kingdom is sufficient for such a trial. Challenges centre around lack of equipoise in certain scenarios, specifically: extremely preterm infants; infants waiting too long for stoma closure in the 'late' comparator; and logistical issues in closing a stoma at a trial-allocated time. These challenges are addressable by incorporating flexibility based on gestation at birth, communicating that both trial arms are standard practice and valid treatment options, and providing resources, for example, for operating lists. We recommend the following population, intervention, comparator and outcome as a starting point to inform future trial design. Population: neonates with stomas (excluding those with a fixed treatment pathway). Intervention: stoma closure at 6 weeks and after 32 weeks post conceptual age. Comparator: expectant management with stoma closure undertaken when the clinical team determines is best for the infant. Primary outcomes: weight gain/growth or length of hospital stay. This study is registered as IRAS Project ID 278331, REC Reference 20/LO/1227. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128617) and is published in full in Health Technology Assessment; Vol. 28, No. 71. See the NIHR Funding and Awards website for further award information.

Case Series Analysis of Diagnosis and Treatment of Gastrointestinal Metastasis in Lung Cancer Patients.

This study was designed to investigate the clinical, pathological, endoscopic, and imaging characteristics of gastrointestinal metastasis in patients with lung cancer. The clinical data of 20 patients with primary lung cancer with gastrointestinal metastasis. This study included sixteen men and four women, ranging in age from 31 to 75 years. The time interval from the diagnosis of lung cancer to the detection of gastrointestinal metastasis ranged from 13 to 142 months. The most common sites of metastasis were the small intestine (eight cases), colon (four cases), and upper gastrointestinal tract (eight cases). The major symptoms included obstruction, perforation, abdominal pain, abdominal distension, anorexia, and anemia. The predominant pathological type was poorly differentiated adenocarcinoma (seventeen cases). A single ulcer was mostly seen on endoscopy, and some cases showed a slight depression of the intestinal wall. The CT and PET-CT scan revealed bowel wall thickening, intraluminal polypoid masses, and intestinal perforation. Gastrointestinal metastasis of lung cancer is mainly observed in the small intestine, colon, and stomach, and is often detected when severe complications such as gastrointestinal obstruction and perforation occurred. Regular evaluation of gastrointestinal conditions during lung cancer diagnosis and treatment is recommended to improve the diagnostic accuracy and prevent misdiagnosis.

Magnetic navigation-assisted colonoscopic enteral tube placement in swine (with video): a preliminary study

BackgroundColonoscopic enteral tube placement using current methods has some shortcomings, such as the complexity of the procedure and tube dislodgement. The magnetic navigation technique (MNT) has been proven effective for nasoenteral feeding tube placement, and is associated with reduced cost and time to initiation of nutrition. This study attempted to develop a novel method for enteral tube placement using MNT.MethodsThe MNT device consisted of an external magnet and a 12 Fr tube with a magnet at the end. Ten swine were used, and bowel cleansing was routinely performed before colonoscopy. Intravenous anesthesia with propofol and ketamine was administered. A colonoscopic enteral tube was placed using the MNT. The position of the end of the enteral tube was determined by radiography, and angiography was performed to check for colonic perforations. Colonoscopy was used to detect intestinal mucosal damage after tube removal.ResultsMNT-assisted colonoscopic enteral tube placement was successfully completed in all pigs. The median operating time was 30 (26–47) min. No colon perforation was detected on colonography after enteral tube placement, and no colonic mucosal bleeding or injury was detected after the removal of the enteral tube.ConclusionsMNT-assisted colonoscopic enteral tube placement is feasible and safe in swine and may represent a valuable method for microbial therapy, colonic drainage, and host-microbiota interaction research in the future.

S5057 Mesenteroaxial Volvulus Complicated by Gastric Perforation in an Elderly Patient With Bochdalek Hernia

S5057 Mesenteroaxial Volvulus Complicated by Gastric Perforation in an Elderly Patient With Bochdalek Hernia

Numismedica II: Health Problems Caused by Coins.

Coins occasionally cause health problems. These problems have a wide range of presentations and can affect multiple organ systems. This article updates a 2009 review of the medical literature addressing health problems caused by coins in several ways. The spectrum of clinical findings is expanded by describing new entities associated with coin ingestion, including laryngeal impaction in adults, gastric perforation, and pancreatic disease. Guidelines for differentiating swallowed coins from the potentially life-threatening mimic of swallowed button batteries are summarized. Multiple new case series better define outcomes and management approaches in coin ingestion. Metal toxicity from coins remains rarely reported. The evidence that systemic allergic reactions can result from ingested coins is strengthened by new case reports. Maintaining the perspective that coin ingestion can cause obscure symptoms may lead to both a diagnosis of the cause of such symptoms and the description of clinical findings not yet reported.

S5178 A Rare Case of Collagenous Gastritis in Patient Presenting With Gastric Perforation

S5178 A Rare Case of Collagenous Gastritis in Patient Presenting With Gastric Perforation