Perforation Of Small Intestine Research Articles

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.

Risk analysis of enfortumab vedotin: A real-world approach based on the FAERS database

PurposeTo analyze the risk of enfortumab vedotin (EV), a targeted therapy for advanced bladder cancer, using real-world data from the U.S. Food and Drug Administration's Federal Adverse Event Reporting System (FAERS). MethodsA retrospective pharmacovigilance analysis was conducted using FAERS data from Q1 2020 to Q1 2024. Adverse drug events (ADEs) related to EV were identified and categorized according to the System Organ Classes (SOCs) and specific events. Statistical methods, such as the proportional reporting ratio, reporting odds ratio (ROR), Bayesian confidence propagation neural network, and empirical Bayesian geometric mean were used to detect safety signals. ResultsOf the 7,449,181 FAERS case reports, 1,617 EV-related ADEs were identified, including 101 preferred terms and 22 SOCs. The key SOCs included skin and subcutaneous tissue, metabolic, and nutritional disorders. Rare ADEs, such as lichenoid keratosis (n = 4; ROR 26.89), small intestinal perforation (n = 3; ROR 24.51), pigmentation disorder (n = 9; ROR 18.16), and cholangitis (n = 8; ROR 17.48), showed significant disproportionality. ConclusionWhile most findings aligned with the existing data, new signs such as lichenoid keratosis and small intestinal perforation were identified. Further studies are necessary to validate these findings and emphasize the need for the clinical monitoring of EV-related ADEs.

Efficacy of the Mannheim Peritonitis Index in Predicting the Prognosis of Small Intestinal Perforation: A Retrospective Study

Efficacy of the Mannheim Peritonitis Index in Predicting the Prognosis of Small Intestinal Perforation: A Retrospective Study

Subcutaneous epcoritamab + GemOx in patients with relapsed or refractory DLBCL: Updated results from EPCORE NHL-2.

7037 Background: Gemcitabine + oxaliplatin (GemOx) is commonly used with rituximab to treat relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL); however, outcomes are suboptimal: 33% complete response (CR) rate; 5 mo median progression-free survival (PFS); 10 mo median overall survival (OS; Cazelles et al, Leuk Lymphoma 2021). We report additional efficacy and safety results of epcoritamab + GemOx in difficult-to-treat R/R DLBCL (EPCORE™ NHL-2 phase 1/2 trial, NCT04663347). Methods: Adults with R/R CD20+ DLBCL who failed or were ineligible for autologous stem cell transplant (ASCT) enrolled to receive subcutaneous (SC) epcoritamab (2 step-up doses followed by 48-mg full doses) in 28-d cycles (C): QW, C1–3; Q2W, C4–9; Q4W, C≥10 until unacceptable toxicity or disease progression. GemOx was given Q2W in C1–4. The primary endpoint was overall response rate (ORR) per Lugano criteria. Subgroup analyses by prior treatment (tx) and response were performed. Results: As of Sept 1, 2023, 97 pts with ≥6 mo of follow-up had received epcoritamab 48 mg + GemOx (median follow-up, 9.7 mo). Pts had a median of 2 prior lines of tx (pLOT; range, 1–6); 55% had primary refractory disease, 38% had bulky disease (&gt;6 cm), 30% had prior CAR T, and 9% had prior ASCT. Median age was 72 y, with 34% of pts ≥75 y. A median of 7 cycles of epcoritamab and 4 cycles of GemOx were initiated. At data cutoff, tx was ongoing in 46% of pts. ORR was 78% and CR rate was 55%. Median time to CR was 1.7 mo; median duration of CR was 13.3 mo. Additional efficacy outcomes are shown in the Table. Safety was consistent with previous reports. The most common tx-emergent AEs (TEAEs) of any grade (G) were hematologic AEs (68% thrombocytopenia; 59% neutropenia [6% febrile neutropenia]; 51% anemia) and CRS (51%). CRS was primarily low grade (27% G1, 23% G2), with only 1 pt experiencing G3 CRS; all events resolved and none led to tx discontinuation. ICANS was reported in 3 pts (G1, n=2; G3, n=1); all events resolved, but 1 pt discontinued tx. There were 13 fatal TEAEs; in 3 cases, the contribution of epcoritamab + GemOx could not be ruled out: COVID-19, multiple organ dysfunction syndrome, and small intestinal perforation. Conclusions: These long-term results continue to demonstrate that SC epcoritamab in combination with GemOx leads to deep, durable responses, which translate to high rates of PFS and OS in challenging-to-treat, high-risk pts with R/R DLBCL. CR rates were consistently high across prespecified subgroups. Higher CR rates in pts with 1 vs ≥2 pLOT indicate that earlier use may further improve outcomes. No new safety signals were identified. The benefit-risk profile of this combination supports the combinability of epcoritamab in R/R DLBCL. Clinical trial information: NCT04663347 . [Table: see text]

A Nature-Derived, Hetero-Structured, Pro-Healing Bioadhesive Patch for High-Performance Sealing of Wet Tissues.

Tissue adhesives are promising alternatives to sutures and staples to achieve wound closure and hemostasis. However, they often do not work well on tissues that are soaked in blood or other biological fluids, and organs that are typically exposed to a variety of harsh environments such as different pH values, nonhomogeneous distortions, continuous expansions and contractions, or high pressures. In this study, a nature-derived multilayered hetero-bioadhesive patch (skin secretion of Andrias davidianus (SSAD)-Patch) based on hydrophilic/hydrophobic pro-healing bioadhesives derived from the SSAD is developed, which is designed to form pressure-triggered strong adhesion with wet tissues. The SSAD-Patch is successfully applied for the sealing and healing of tissue defects within 10 s in diverse extreme injury scenarios in vivo including rat stomach perforation, small intestine perforation, fetal membrane defect, porcine carotid artery incision, and lung lobe laceration. The findings reveal a promising new type of self-adhesive regenerative SSAD-Patch, which is potentially adaptable to broad applications (under different pH values and air or liquid pressures) in sutureless wound sealing and healing.

Gastrointestinal histoplasmosis with small intestinal perforation: 20-year experience.

Postmortem studies show gastrointestinal tract involvement in as many as 70% of patients affected by disseminated histoplasmosis. Although gastrointestinal involvement is common in disseminated disease, the presentation of small intestinal perforation is exceedingly rare with few reported cases in the literature. Herein we present our institutional case series. The aim of the study is to describe small intestinal perforation in gastrointestinal histoplasmosis with attention to management and outcomes. This is a retrospective single-institution review of patients ≥ 18years of age treated for small intestinal perforation due to gastrointestinal histoplasmosis. A prospectively maintained institutional database was searched from 2002 to 2022.Data obtained included demographics, comorbidities, treatment course, and outcomes. Five patients with a mean age of 54years (range 25-72) were identified. Pertinent underlying comorbid conditions included Crohn's disease, psoriatic arthritis, rheumatoid arthritis, and solid organ transplantation. All patients were on chronic immunosuppressive medication(s) with the most common being tumor necrosis factors alpha inhibitors and corticosteroids. Four had a clinical diagnosis of perforation based on physical examination and imaging. All patients underwent segmental resection(s) of the small intestineandreceived medical treatment with intravenous amphotericin B and eventual transition to an oral antifungal. No patients experienced complications related to surgery. The limitations of the study include nonrandomized retrospective review, single-institution experience, and small patient sample size. Although rare, histoplasmosis should be considered in the differential of patients on chronic immunosuppressive therapy who present with gastrointestinal symptoms concerning perforation, especially from endemic areas. Small intestinal perforation due to gastrointestinal histoplasmosis can be successfully treated with resection and antifungal therapy.

Small intestinal perforation manifesting as post-transplant lymphoproliferative disorder occurring 23 years after living lung transplantation: a case report

A Japanese female patient underwent a living lung transplant at age 29 and has been on immunomodulatory drug therapy since then. At age 52, she presented with sudden hematochezia. Despite abdominal computed tomography scan, esophagogastroduodenoscopy, and colonoscopy, no definitive source of bleeding was identified. Considering the possibility of small bowel bleeding, video capsule endoscopy was performed, which revealed a suspected ulcerative lesion in the jejunum. Subsequent per-oral double-balloon endoscopy confirmed the presence of an ulcerative lesion in the jejunum. A potential pathological diagnosis of post-transplant lymphoproliferative disorder (PTLD) was considered based on endoscopic biopsy specimens from the jejunal lesion. However, before the pathologic biopsy results were available, the patient experienced small intestinal perforation, necessitating emergency partial resection. Pathologic examination revealed a dense proliferation of medium-to-large atypical lymphocytes with neutrophilic infiltration in the perforated area of the small intestinal wall. Immunostaining showed lymphoid cells positive for CD20 but negative for CD3. Epstein-Barr virus (EBV) -encoded RNA was detected by in situ hybridization, and Ki-67 staining demonstrated a higher percentage of positive cells. Consequently, an EBV-positive diffuse large B-cell lymphoma, developed as PTLD, was diagnosed. Complete remission was achieved with a reduced immunomodulatory drug dosage and rituximab therapy. She has been alive for 8 months postoperatively without recurrence. This case suggests that PTLD should be considered in assessing patients presenting with abdominal symptoms following organ transplantation.

A Case of Intraoperative Embolic Events during EVAR Causing Multiple Sequential Complications of Lower Limb Ischemia, Small Intestinal Perforation, and Iliopsoas Hematoma

A Case of Intraoperative Embolic Events during EVAR Causing Multiple Sequential Complications of Lower Limb Ischemia, Small Intestinal Perforation, and Iliopsoas Hematoma

Decellularized small intestine scaffolds: a potential xenograft for restoration of intestinal perforation

ABSTRACTSmall intestine perforation is a serious medical condition that requires immediate medical attention. The traditional course of treatment entails resection followed by anastomosis; however, it has complications such as small bowel syndrome (SBS), anastomotic leakage, and fistula formation. Here, a novel strategy is demonstrated, that utilizes the xenogeneic, decellularized goat small intestine as a patch for small intestine regeneration in cases of intestinal perforation. The goat small intestine scaffold underwent sodium dodecyl sulfate decellularization, which revealed consistent, quick, and effective decellularization. Decellularization contributed the least amount of extracellular matrix degradation while maintaining the intestinal architecture. By implanting the decellularized goat small intestine scaffolds (DGSIS) on the chorioallantoic membrane (CAM), no discernible loss of angiogenesis was seen in the CAM region, and this enabled the DGSIS to be evaluated for biocompatibility in ovo. The DGSIS was then xeno-transplanted as a patch on a small intestine perforation rat model. After 30 days post transplant, barium salt used as contrast gastrointestinal X-ray imaging revealed no leakage or obstruction in the small intestine. Histology, scanning electron microscopy, and immunohistochemistry assisted in analyzing the engraftment of host cells into the xeno patch. The xeno-patch expressed high levels of E-cadherin, α-smooth muscle actin (α-SMA), Occludin, Zonnula occluden (ZO-1), Ki 67, and Na+/K+-ATPase. The xeno-patch was consequently recellularized and incorporated into the host without causing an inflammatory reaction. As an outcome, decellularized goat small intestine was employed as a xenograft and could be suitable for regeneration of the perforated small intestine.

Epcoritamab SC + GemOx Leads to High Complete Metabolic Response Rates in Patients with Relapsed/Refractory Diffuse Large B-Cell Lymphoma Ineligible for Autologous Stem Cell Transplant: Updated Results from Epcore NHL-2

Background: Patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) who fail or are ineligible for autologous stem cell transplant (ASCT) have poor outcomes with standard chemotherapy, and novel, effective therapeutic options are needed. A retrospective analysis showed that treatment with rituximab and gemcitabine + oxaliplatin (GemOx) in a transplant-ineligible population resulted in a complete response rate of 33% in the overall population; among patients refractory to previous therapy, 10% achieved complete response (Cazelles et al, Leuk Lymphoma 2021). Epcoritamab, a subcutaneously administered (SC) CD3xCD20 bispecific antibody, has demonstrated deep, durable responses with a manageable safety profile as a single agent in patients with R/R DLBCL. Based on these data, epcoritamab SC was approved by the US FDA for the treatment of adults with R/R DLBCL, not otherwise specified, including DLBCL arising from indolent lymphoma, and high-grade B-cell lymphoma, after ≥2 lines of systemic therapy. In the EPCORE ™ NHL-2 phase 1/2 trial (NCT04663347), epcoritamab + GemOx treatment showed encouraging preliminary efficacy with overall expected and manageable safety in patients with R/R DLBCL who failed or were ineligible for ASCT. Here, we present updated results with longer follow-up. Methods: Adults with R/R CD20 + DLBCL who had failed or were ineligible for ASCT were enrolled. Patients received epcoritamab SC in 28-d cycles (Cs) as follows: weekly, C1-3; every 2 weeks, C4-9; every 4 weeks, C≥10 until progressive disease or unacceptable toxicity. Patients received GemOx every 2 weeks in C1-4. Step-up epcoritamab dosing (step-up doses 1 and 2 followed by 48-mg full doses) and corticosteroid prophylaxis were required in C1 to mitigate CRS. The primary endpoint was overall response rate (ORR) as assessed by PET-CT per Lugano criteria. Results: A total of 34 patients (median age, 71 y; range, 47-87) with a median follow-up of 20.3 mo (range, 1.0+ to 26.8) received epcoritamab SC 48 mg + GemOx on or prior to August 24, 2022. At the data cutoff date (April 24, 2023), treatment was ongoing in 35% of patients. A majority of patients (68%) had stage III or IV disease, 53% had primary refractory disease, 38% were refractory to ≥2 consecutive lines of prior therapy, and 79% were refractory to the last line of therapy. The median number of prior lines of treatment was 2 (range, 1-6); 11 patients (32%) had 3 or more prior lines of treatment. A total of 7 patients (21%) had prior CAR T, and 5 patients (15%) had previously received ASCT. The most common treatment-emergent AEs (TEAEs) of any grade (G) were thrombocytopenia/decreased platelet count (68%), diarrhea (59%), anemia (56%), CRS (56%), and neutropenia/decreased neutrophil count (56%). This trial was conducted amid the COVID-19 pandemic and 32% of patients experienced COVID-19. Most CRS events were low grade (53% G1-2; 3% G3) and primarily occurred following the first full dose (C1D15); no incidence of CRS resulted in epcoritamab discontinuation, and all events resolved. ICANS (G1) was reported in 1 patient; this event resolved in 2 d. No clinical tumor lysis syndrome was reported. There were 10 G5 TEAEs; in 2 cases, the contribution of epcoritamab could not be ruled out by the investigator (small intestinal perforation and multiple organ dysfunction syndrome; both patients had multiple confounding factors). The ORR was 91% (31/34), with 59% (20/34) of patients achieving complete metabolic response (CMR). Median times to response and CMR were 1.5 mo and 2.6 mo, respectively. The ORR and CMR rates were 94% and 39% among patients with primary refractory disease, 89% and 78% among patients ≥75 y of age, and 90% and 50% among patients with IPI ≥3 ( Table). Response rates were comparable for patients with and without prior CAR T treatment: ORR of 86% and CMR rate of 57% among patients with prior CAR T; ORR of 93% and CMR rate of 59% among CAR T-naive patients. Conclusions: Epcoritamab SC + GemOx led to high CMR rates in this difficult-to-treat R/R DLBCL population ineligible for transplant with high unmet medical need. No new safety signals were identified, and the safety profile was consistent with those of the individual drugs. These data are encouraging and underline the versatility of epcoritamab SC for the treatment of R/R DLBCL. Additional data and subgroup analyses will be presented.

Surgical Tactics in Perforations of Stomach and Small Intestine in Children (Literature Review)

INTRODUCTION: Currently, the number of pediatric patients urgently hospitalized with different variants of gastrointestinal perforations complicated with peritonitis, remains high. In the given work, the variants of the surgical treatment depending on the location of the perforation defect (stomach, duodenum, small intestine) are presented, and the most common causes of such conditions encountered in clinical practice, are described (perforation of Meckels diverticulum, spontaneous perforation of small intestine and stomach in children with extremely low body mass, patients with EhlersDanlos syndrome).&#x0D; AIM: To determine the most relevant variants of surgical tactics in children with perforations of different parts of the gastrointestinal tract (in particular, stomach, small intestine) in conditions of peritonitis.&#x0D; MATERIALS AND METHODS: In the process of studying the literature, 142 scientific publications were analyzed on Google Academy, PubMed, eLIBRARY information resources, published from 2002 to 2022. With this, works describing intestinal perforation with the underlying necrotic enterocolitis, were excluded from the study, since this category of patients requires a separate discussion and description of approaches to treatment.&#x0D; CONCLUSION: According to the results of the analysis of scientific literature, variants of surgical tactics used in perforations of the gastric wall include (in the order from the most commonly used to the least common): laparotomy and suturing with excision of the edges of the defect; suturing in conditions of laparoscopy; atypical resection with the formation of a gastric tube on the probe; resection of stomach. In duodenal perforations, the following methods are used: rhomboid duodeno-duodenoanastomosis according to Kimura, intracorporeal suture with endovideosurgical access; laparotomy and suturing of the defect in extensive necrosis. In spontaneous perforation in the small intestine, resection of the part of the intestine is advisable anastomosis according to Santulli in combination with terminal ileostomy, simultaneous end-to-end anastomosis or application of intestinal stomas.

Rapunzel Syndrome: A Rare Presentation with Multiple Small Intestinal Bands and Perforation

Rapunzel Syndrome: A Rare Presentation with Multiple Small Intestinal Bands and Perforation

Primary anastomosis and suturing combined with vacuum-assisted abdominal closure in patients with secondary peritonitis due to perforation of the small intestine: a retrospective study

BackgroundIntestinal resection and a proximal stoma is the preferred surgical approach in patients with severe secondary peritonitis due to perforation of the small intestine. However, proximal stomas may result in significant nutritional problems and long-term parenteral nutrition. This study aimed to assess whether primary anastomosis or suturing of small intestine perforation is feasible and safe using the open abdomen principle with vacuum-assisted abdominal closure (VAC).MethodsBetween January 2005 and June 2018, we performed a retrospective chart review of 20 patients (> 18 years) with diffuse faecal peritonitis caused by small intestinal perforation and treated with primary anastomosis/suturing and subsequent open abdomen with VAC.ResultsThe median age was 65 years (range: 23–90 years). Twelve patients were female (60%). Simple suturing of the small intestinal perforation was performed in three cases and intestinal resection with primary anastomosis in 17 cases. Four patients (20%) died within 90-days postoperatively. Leakage occurred in five cases (25%), and three patients developed an enteroatmospheric fistula (15%). Thirteen of 16 patients (83%) who survived were discharged without a stoma. The rest had a permanent stoma.ConclusionsPrimary suturing or resection with anastomosis and open abdomen with VAC in small intestinal perforation with severe faecal peritonitis is associated with a high rate of leakage and enteroatmospheric fistula formation.Trial registrationThe study was approved by the Danish Patient Safety Authority (case number 3-3013-1555/1) and the Danish Data Protection Agency (file number 18/28,404). No funding was received.

Non-Traumatic Small Intestine Perforation

Non-Traumatic Small Intestine Perforation

Clinical Profile and Management of Perforation Peritonitis in a Tertiary Care Centre, Kerala, India

Peritonitis, an inflammation of the peritoneum and peritoneal cavity, is often brought on by a localised or systemic infection. Primary and secondary peritonitis are the two types of peritonitis. Once the clinical diagnosis of peritonitis is made, rapid institution of both physiologic support and aggressive anti-infective therapy are imperative. The objective was to study the frequency of perforation peritonitis in relation to various parameters ,and to study the post-operative complications and mortality. Cross-sectional study was conducted during the time period of 1 year. Findings were noted intra-operatively, patients were followed up until discharge or death. It was found that males were more affected than females, and majority was in the 21-35 years age group. Most common perforation was appendicular perforation followed by gastric and small intestine perforation. Diagnosis is made clinically and confirmed by presence of free gas under diaphragm. Mortality was 10% and the most common post-operative complication was wound infection.

Patch Repair for Intestinal Perforation Closure in an Ex-Vivo Porcine Model with Burst Pressure Characterization

Background: Bowel perforation is the loss of intestinal wall integrity and can occur by several mechanisms including infection, obstruction, inflammation, trauma and iatrogenic causes. Incidences of bowel perforation range from 1-7% in pediatric trauma patients and 0.02-8% in adults. There is no specific classification for gastrointestinal perforations, but several methods have been used to describe perforations based on etiology, including systemic, inflammatory, medication, neoplastic and instrumentation-induced perforations. We assessed the feasibility of closing small intestine perforations with a mesh patch instead of sutures only. Methods and Findings: Nine porcine ex-vivo small intestine specimens were incised 0.5 cm to simulate bowel perforations. Control group perforations were sutured closed without mesh. The two experimental groups were closed by mesh sewn to the outside (first group) or inside (second group) of the bowel wall. Each specimen was submerged in normal saline and insufflated until air bubbles leaked from the perforation. That insufflation pressure was recorded as the burst pressure. The control group burst at 78.0±17.9 mmHg. The “patch outside” group burst at 54.7±9.1 mmHg. The “patch inside” group burst at 32.0 ±4.6 mmHg. Only the “patch inside” group had statistically significant inferiority, but both groups trended towards inferiority. Conclusions: Preliminary research indicates that patch repair of intestinal perforations is likely inferior to sutures alone, although repair with the patch outside the bowel wall cannot be completely excluded because of the high variability of the data. Further research may try alternate patch types or different variations to find a non-inferior closure method. A sample size of n=9 each would give 80% power to detect a minimal detectable difference of 20 mmHg.

A commentary on 'Does speed equal quality? Time pressure impairs minimally invasive surgical skills in a prospective crossover trial' (Int J Surg 104 (2022) 106813).

Dear Editor, Time pressure is an important influencing factor in clinical work. Even though less operation time reduces patient exposure to surgical stressors or anesthetic time, leading to less infection and bleeding, lots of research indicate management failure of time pressure may lead to operating error and nosocomial damage1. A better understanding of the effect of time pressure in the clinic, especially during surgery, is meaningful work. In the impressive study from the University Hospital Carl Gustav Carus, the author stated that time pressure during minimally invasive surgery might improve procedural time but impair the quality of surgical performance in terms of the incidence of errors and force exertion. Accumulation of experience seems to be the only solution. The study makes time pressure detectable and indicates the antipressure ability of surgeons mainly based on experience accumulation. However, some issues in this article may need further interpretation. First, before the test, the surgeon group did not get the same training or pretest as the novice group. Although surgeons have more experience in daily surgery, the same training is still needed to diminish the difference in skills in four tasks: PEG (percutaneous endoscopic gastrostomy) transfer, precision cutting, balloon resection, and surgical sutures and knots. For example, in this research, the novice group spend much less time than the surgeon group only in PEG transfer but much more time in the other three tasks. And actually, the surgeon group showed higher error occurrences than the novice group in all kinds of error statistics except balloon perforation. It is hard to believe surgeons are less skillful. Lack of training can be a proper explanation for such a paradox. And interestingly, no matter whether time stress is applied or not, the surgeon group showed a noteworthy lower stress level than the novice group even though they had more errors and spent a long time during testing. When compared with invoices, the self-cognition of the surgeon may have a role that cannot be ignored in stress management2. Second, the difference between novice surgeons and skillful surgeons is not only in experience but also differs greatly in standardization of operation and operational fluency. Indeed, excessive force can lead to a medical injury. But in this research, the force of both groups is all far from 10.3N3, which leads to human small intestine perforations. On the other side, weak or fluctuating forces may also be related to a lack of self-confidence or hesitation, which leads to a stumbling surgery process. The meaning of force diversity should be explained not only in static but also in dynamic. Adding action mode analysis to force recording may help us have better awareness of the effect of time pressure. Finally, before and after the application of pressure, the experience of operating under no pressure can be ignored for the novice who has been trained for a long time, but it can make a big difference for the surgeons who have not received pretest and only rely on surgical techniques. As surgeons themselves have good operational skills, only one time of test could help them get a better understanding and movement to achieve better performance in the pressure-applied task. In conclusion, dealing with time pressure is an important issue during minimally invasive surgery. Distler provides a measurable method for stress evaluation and reveals that accumulation of experience is important for time pressure management. It is crucial that not only static force measurement but also dynamic recording and analysis should be considered. And with a larger sample size, the differences between surgeons with different seniority may better illustrate the role of time pressure in surgery. Ethical approval This manuscript was based on the previously published study; thus, no ethical approval is required. Patient consent N/A Sources of funding Chongqing Medical Scientific Research Project (Joint project of Chongqing Health Commission and Science and Technology Bureau) (2020FYYX189). Author contribution Z.L.: drafted the article; Y.S.: reviewed the article. Conflicts of interest disclosure There are no conflicts of interest. Research registration unique identifying number (UIN) None. Guarantor Yan Shu, Department of Clinical Laboratory, Chongqing University FuLing Hospital, Chongqing 408000, People’s Republic of China, E-mail: [email protected] Data availability statement Data sharing is not applicable to this article as no new data were created or analyzed in this study. Provenance and peer review None.

A Case of Small Intestine Perforation Due to Cytomegalovirus Infection in a Patient with Fabry’s Disease

A Case of Small Intestine Perforation Due to Cytomegalovirus Infection in a Patient with Fabry’s Disease

Small Intestinal Perforation Caused by Enteric-coated Low-dose Aspirin: A Case Report.

A 77-year-old man presented with abdominal pain for 1 week. He was taking enteric-coated low-dose aspirin (LDA) to prevent secondary cardiovascular events and a proton pump inhibitor (PPI). Computed tomography indicated a small intestinal perforation; thus, small intestine resection was performed. Two months after surgery, he experienced a recurrence of the perforation. Since his repeated perforation was suspected to be due to LDA, LDA was discontinued. He has experienced no further recurrence since then. This is the first case of small intestinal perforation caused by enteric-coated LDA. Enteric-coated LDA may cause small intestinal perforation in patients with severe atherosclerosis under PPI administration.

Clinical Study of non-traumatic causes and management of generalized peritonitis

Background: Peritonitis refers to an inflammatory response of the peritoneum in the abdominal cavity in terms of activation of local mediator cascades by different stimuli. Therefore, bacterial, viral and chemical agents may cause inflammation of the peritoneal layer. Secondary peritonitis is usually due to spillage of gastrointestinal or genitourinary microorganisms into the peritoneal cavity as a result of loss of integrity of the mucosal barrier. Methods: Cross sectional observational study was performed. All patients admitted and treated for perforation secondary to non-traumatic hollow viscus perforation in surgical units of Department of General Surgery, Government Medical College, Nalgonda, Telangana, India, during the period of October 2019 - September 2021. A detailed history was taken and all the patients were subjected to thorough clinical examination. Patients subjected to laparotomy are followed in post-operative period to know the complications, morbidity and mortality rates. General condition at the time of admission was monitored by noting presenting complaints, pulse, BP, respiratory rate, hydration status. Operative findings were recorded. Necessary surgical intervention done is recorded; post operatively patients will be followed up for any complications. Each case will be studied as per the proforma. Results: The most common age group was 40- 60yrs (53.3%) in the present study. Major etiological factor noted is gastric perforation and next is appendicular perforation&amp; duodenal ulcer perforation. In this study pain abdomen was the predominant symptom and was presented in all cases (100%). In this study guarding/rigidity was seen in all cases (100%). Most of the cases had a mean duration of 10-19days of hospital stay. Mortality rate was found to be 16.6%. Conclusion: In our study, youngest age of small intestine perforation was 23years and oldest was 80 years. Most cases had a duration of hospital stay of 10- 19 days. Main presenting complaint was pain abdomen, vomiting, fever and distension of abdomen. Risk factors for perforations were smoking, tobacco, alcohol and NSAIDs.