1
|
Faucheron JL, Vincent D, Barbut M, Jacquet-Perrin I, Sage PY, Foote A, Bellier A, Quesada JL, Tidadini F, Trilling B. Abdominal massage to prevent ileus after colorectal surgery. A single-center, prospective, randomized clinical trial: the MATRAC Trial. Tech Coloproctol 2024; 28:42. [PMID: 38517591 DOI: 10.1007/s10151-024-02914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/18/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND There is scarce literature on the effect of mechanical abdominal massage on the duration of ileus after colectomy, particularly in the era of enhanced recovery after surgery (ERAS). The aim of this study was to determine whether abdominal massage after colorectal surgery with anastomosis and no stoma helps toward a faster return of intestinal transit. METHODS This study was a superiority trial and designed as a prospective open-label, single-center, randomized controlled clinical trial with two parallel groups. Patients scheduled to undergo intestinal resection and follow an ERAS protocol were randomly assigned to either the standard ERAS group or the ERAS plus massage group. The primary endpoint was the return of intestinal transit, defined as the first passage of flatus following the operation. Secondary endpoints included time of the first bowel motion, maximal pain, 30 day complications, complications due to massage, anxiety score given by the Hospital Anxiety and Depression (HAD) questionnaire, and quality of life assessed by the EQ-5D-3L questionnaire. RESULTS Between July 2020 and June 2021, 36 patients were randomly assigned to the ERAS group or the ERAS plus massage group (n = 19). Patients characteristics were comparable. There was no significant difference in time to passage of the first flatus between the ERAS group and the ERAS plus abdominal massage group (1065 versus 1389 min, p = 0.274). No statistically significant intergroup difference was noted for the secondary endpoints. CONCLUSION Our study, despite its limitations, failed to demonstrate any advantage of abdominal massage to prevent or even reduce symptoms of postoperative ileus after colorectal surgery. TRIAL REGISTRATION NUMBER 38RC20.021.
Collapse
Affiliation(s)
- Jean-Luc Faucheron
- University Grenoble Alpes, CNRS, Grenoble INP, TIMC, UMR 5525, VetAgro Sup, 38000, Grenoble, France.
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France.
| | - Damien Vincent
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - Mihaela Barbut
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - Isabelle Jacquet-Perrin
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - Pierre-Yves Sage
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - Alison Foote
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - Alexandre Bellier
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Fatah Tidadini
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - Bertrand Trilling
- University Grenoble Alpes, CNRS, Grenoble INP, TIMC, UMR 5525, VetAgro Sup, 38000, Grenoble, France
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| |
Collapse
|
2
|
Patwardhan UM, Floan GM, Calvo RY, Acker SN, Choi PM, Prieto JM, Bansal V, Sise MJ, Thangarajah H, Fairbanks TJ, Lazar DA, Ignacio RC. A Comparative Study of Laparoscopic versus Open Management of Index Small Bowel Obstruction in Children. J Pediatr Surg 2024; 59:416-420. [PMID: 37978001 DOI: 10.1016/j.jpedsurg.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION There is limited literature on the optimal approach to treat adhesive small bowel obstruction (ASBO) in children. We sought to compare rates and outcomes of laparoscopic (LAP) and open (OPEN) surgery for pediatric ASBO. METHODS A California statewide database was used to identify children (<18 years old) with an index ASBO from 2007 to 2020. The primary outcome was the type of operative management: LAP or OPEN. Secondary outcomes were hospital characteristics, patient demographics, and postoperative complications. We excluded patients treated non-operatively. RESULTS Our study group had 545 patients. 381 (70%) underwent OPEN and 164 (30%) LAP during the index admission. Over the study period, there was increasing use of laparoscopic surgery, with higher use in older children (p < 0.001). LAP was associated with fewer overall complications (65.2% vs. 81.6%, p < 0.001), with a decreasing trend in complications over time (p < 0.001). The LAP group had significantly lower rates of bowel resection (4.9% vs. 17.1%, p < 0.001), length of stay (LOS) (17 vs. 23 days, p < 0.001), and TPN use (12.2% vs. 29.1%, p < 0.001). Mortality rates were equivalent. Although the LAP group had lower readmission rates (22.6% vs. 37.3%, p < 0.001), the length of time between discharge and readmission was similar (171 vs. 165 days, p = 0.190). DISCUSSION The use of laparoscopic surgery for index ASBO increased over the study period. However, it was less commonly utilized in younger children. LAP had fewer overall complications as well as shorter LOS, decreased TPN use, and fewer readmissions. The benefits and risks of each approach must be weighed. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Utsav M Patwardhan
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - Gretchen M Floan
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - Richard Y Calvo
- Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA
| | - Shannon N Acker
- Colorado Children's Hospital, 13123 E 16th Ave, Aurora, CO 80045, USA
| | - Pamela M Choi
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - James M Prieto
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - Vishal Bansal
- Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA
| | - Michael J Sise
- Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA
| | - Hari Thangarajah
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Timothy J Fairbanks
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - David A Lazar
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Romeo C Ignacio
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| |
Collapse
|
3
|
Li B, Wu Z, Wang J. The target sign: a significant CT sign for predicting small-bowel ischemia and necrosis. Radiol Med 2024; 129:368-379. [PMID: 38355906 PMCID: PMC10942902 DOI: 10.1007/s11547-024-01793-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To investigate the correlation between changes in the thickness and density of diseased small-bowel wall and small-bowel ischemia and necrosis (SBN) on CT imaging when small-bowel obstruction (SBO) occurs. METHODS We retrospectively analyzed 186 patients with SBO in our hospital from March 2020 to June 2023. The patients were divided into simple SBO (control group) and SBN (case group) groups. We used logistic regression analysis, the chi-square test, and Fisher's exact test to analyze the correlation between the changes in the thickness and density of the diseased intestinal wall and the SBN. A receiver operating characteristic (ROC) curve was used to calculate the accuracy of the multivariate analysis. RESULTS Of the 186 patients with SBO, 98 (52.7%) had simple SBO, 88 (47.3%) had SBN, and the rate of SBN was 47.3% (88/186). Multivariate regression analysis revealed that six CT findings were significantly correlated with SBN (p < 0.05), namely, thickening of the diseased intestinal wall with the target sign (OR = 21.615), thinning of the diseased intestinal wall (OR = 48.106), increase in the diseased intestinal wall density (OR = 13.696), mesenteric effusion (OR = 21.635), decrease in the diseased intestinal wall enhancement on enhanced scanning (OR = 41.662), and increase in the diseased intestinal wall enhancement on enhanced scanning (OR = 15.488). The AUC of the multivariate analysis reached 0.987 (95% CI 0.974-0.999). Specifically, the target sign was easily recognizable on CT images and was a significant CT finding for predicting SBN. CONCLUSION We identified 6 CT findings that were significantly associated with SBN, and may be helpful for clinical treatment.
Collapse
Affiliation(s)
- Bo Li
- Eighth Hospital of Shanxi Medical University, Yuncheng Central Hospital, No.3690 Hedong East Street, Yanhu District, Yuncheng City, Shanxi Province, China
| | - Zhifeng Wu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, No. 99 Longcheng Street, Taiyuan City, Shanxi Province, China.
| | - Jinjun Wang
- Eighth Hospital of Shanxi Medical University, Yuncheng Central Hospital, No.3690 Hedong East Street, Yanhu District, Yuncheng City, Shanxi Province, China
| |
Collapse
|
4
|
Xu A, Kong C, Li J. Gallstone ileus due to cholecystoenteric fistula accompanied by diabetes mellitus. Am J Med Sci 2024; 367:e33-e34. [PMID: 37980968 DOI: 10.1016/j.amjms.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Aihua Xu
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Chaonan Kong
- Department of Radiology, Rushan Hospital of Traditional Chinese Medicine, Rushan, Shandong, China
| | - Jun Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China.
| |
Collapse
|
5
|
Yin MD, Hao LL, Li G, Li YT, Xu BL, Chen XR. Adult-onset congenital intestinal malrotation: A case report and literature review. Medicine (Baltimore) 2024; 103:e37249. [PMID: 38394530 DOI: 10.1097/md.0000000000037249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Intestinal malrotation is an infrequent congenital anomaly primarily observed in neonates, and adult-onset cases are exceedingly rare. Studies on adult congenital intestinal malrotation are limited. METHODS A case with congenital intestinal malrotation is reported in our study. The clinical data were collected and the treatment process and effect were evaluated. RESULTS A 45-year-old female who had been experiencing vomiting for over 40 years was admitted to our hospital. According to the result of CT scan, intestinal volvulus accompanied by bowel obstruction was suspected. Then laparoscopic examination was applied to the patient and was ultimately diagnosed with adult congenital intestinal malrotation. We performed Ladd's procedure combined with gastrojejunostomy and Braun anastomosis. The patient recovered well and was successfully discharged from the hospital on the 13th day after surgery. After a 6-month follow-up, the symptom of vomiting was significantly alleviated and body weight was gained for 10 kg. She was very satisfied with the treatment. CONCLUSION Adult congenital intestinal malrotation is a rare disease that is often misdiagnosed owing to nonspecific clinical manifestations. Therefore, awareness about this condition should be enhanced. Surgery remains the cornerstone of treatment for this disease. Combining gastrojejunostomy and Braun anastomosis with the traditional Ladd procedure can optimize surgical outcomes.
Collapse
Affiliation(s)
- Meng-Di Yin
- Linyi People's Hospital, Jinzhou Medical University, Linyi 276000, China
| | - Li-Liang Hao
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Guang Li
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Yu-Tao Li
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Bao-Li Xu
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Xin-Rui Chen
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
| |
Collapse
|
6
|
Moore ZJ, Eldredge RS, Russell KW. Acute superior mesenteric artery syndrome complicated by severe gastric, pancreatic and renal ischaemia. BMJ Case Rep 2024; 17:e259177. [PMID: 38383132 PMCID: PMC10882347 DOI: 10.1136/bcr-2023-259177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Superior mesenteric artery syndrome (SMAS) is a rare and potentially life-threatening cause of small bowel obstruction in which the superior mesenteric artery impinges on the third portion of the duodenum. SMAS is typically encountered in patients with low body fat and a history of rapid weight loss and is often diagnosed as a chronic or subacute condition. Here, we describe a case of a healthy adolescent boy without typical SMAS prodromal symptoms presenting with a severe, hyperacute proximal small bowel obstruction due to SMAS. Complications arising from massive gastric and duodenal distension, including gastric, pancreatic and renal ischaemia, necessitated emergent surgical intervention consisting of the duodenojejunostomy bypass with partial gastric resection. The patient recovered without significant lasting consequences.
Collapse
Affiliation(s)
| | - Richard Scott Eldredge
- Department of Surgery, The University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of General Surgery, Mayo Clinic Arizona, Scottsdale, Phoenix, Arizona, USA
| | - Katie W Russell
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
7
|
Li X, Tian M, Liu Y, Zhang Y, Chen J. Predictive Factors of Intestinal Ischaemia in Adhesive Small Bowel Obstruction. J Coll Physicians Surg Pak 2024; 34:146-150. [PMID: 38342862 DOI: 10.29271/jcpsp.2024.02.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/22/2023] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To identify the predictive factors of intestinal ischaemia in adhesive small bowel obstruction (ASBO) and develop an intestinal ischaemia risk score. STUDY DESIGN Observational study. Place and Duration of the Study: Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China, from January 2017 to February 2022. METHODOLOGY ASBO was determined by findings at laparotomy. The assessment of small bowel's viability was conducted through surgical inspection and subsequent histological examination of the surgical specimen. Univariate and multivariate analyses were conducted to ascertain the risk factors associated with intestinal ischaemia. RESULTS In total, 79 patients were included. Factors entered into multivariate analysis associated with intestinal ischaemia were; rebound tenderness (odds ratio (OR): 7.8, 95% confidence interval (CI):1.7-35.3; p=0.008), procalcitonin (PCT) >0.5 ng/mL (OR: 11.7, 95% CI: 2.3-58.1; p=0.003), and reduced bowel wall enhancement on computerised tomography (CT) scan (OR: 12.2, 95% CI:2.4-61.5; p=0.003). Among patients with 0, 1, 2, and 3 factors, the rate of intestinal ischaemia increased from 0% to 49%, 72%, and 100%, respectively. According to the number of risk factors, the area under the receiver operating characteristic curve for the determination of intestinal ischaemia was 0.848 (95% CI: 0.764-0.932). CONCLUSION Rebound tenderness, PCT levels >0.5 ng/mL, and reduced bowel wall enhancement are risk factors of intestinal ischemic injury that require surgery within the context of ASBO. These factors need to be closely monitored that could assist clinicians in avoiding unnecessary laparotomies and selecting patients eligible for surgery. KEY WORDS Intestinal obstruction, Ischaemia, Adhesions.
Collapse
Affiliation(s)
- Xiangmin Li
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | | | - Yulin Liu
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Yongbo Zhang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Jingbo Chen
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| |
Collapse
|
8
|
Huang SH, Hong ZJ, Chen MF, Tsai MW, Chen SJ, Cheng CP, Sytwu HK, Lin GJ. Melatonin inhibits the formation of chemically induced experimental encapsulating peritoneal sclerosis through modulation of T cell differentiation by suppressing of NF-κB activation in dendritic cells. Int Immunopharmacol 2024; 126:111300. [PMID: 38016346 DOI: 10.1016/j.intimp.2023.111300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 11/30/2023]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a severe complication of peritoneal dialysis (PD). Surgery is a therapeutic strategy for the treatment of complete intestinal obstruction. However, complete intestinal obstruction in long-term PD results in high mortality and morbidity rates after surgery. Immunopathogenesis participates in EPS formation: CD8, Th1, and Th17 cell numbers increased during the formation of EPS. The anti-inflammatory and immunomodulatory effects of melatonin may have beneficial effects on this EPS. In the present study, we determined that melatonin treatment significantly decreases the Th1 and Th17 cell populations in mice with EPS, decreases the production of IL-1β, TNF-α, IL-6, and IFN-γ, and increases the production of IL-10. The suppression of Th1 and Th17 cell differentiation by melatonin occurs through the inhibition of dendritic cell (DC) activation by affecting the initiation of the NF-κB signaling pathway in DCs. Our study suggests that melatonin has preventive potential against the formation of EPS in patients with PD.
Collapse
Affiliation(s)
- Shing-Hwa Huang
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan; Department of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of General Surgery, En Chu Kong Hospital, New Taipei, Taiwan
| | - Zhi-Jie Hong
- Department of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Mei-Fei Chen
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Meng-Wei Tsai
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Shyi-Jou Chen
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Pi Cheng
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Huey-Kang Sytwu
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Gu-Jiun Lin
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
| |
Collapse
|
9
|
Walter M, Hansen E, Hamid S, Carozza D, Mann G, Roche C, George A, Attwood K, Case A. Palliative Management of Inoperable Malignant Bowel Obstruction: Prospective, Open Label, Phase 2 Study at an NCI Comprehensive Cancer Center. J Pain Symptom Manage 2024; 67:20-26. [PMID: 37769820 DOI: 10.1016/j.jpainsymman.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023]
Abstract
CONTEXT Malignant bowel obstruction (MBO) is a common complication of intra-abdominal cancer, frequently seen in advanced gastrointestinal and gynecologic cancer. Management of MBO can be challenging, particularly if the patient is not a surgical candidate. No consensus exists on how best to manage these patients medically. Retrospective studies suggest that the combination of dexamethasone, octreotide and metoclopramide may lead to relief of obstruction and improvement in symptoms associated with the obstruction. OBJECTIVES This study seeks to prospectively evaluate the combination of drug "triple therapy" dexamethasone 4 mg BID, metoclopramide 10 mg Q6 and octreotide 300 mcg TID to assess tolerability, safety, and effect on symptoms and deobstruction. METHODS Adults admitted at Roswell Park Comprehensive Cancer Center with malignant bowel obstruction were eligible. Eligible patients who constented to the study were started on the triple therapy with close monitoring of symptoms and for adverse effects. RESULTS A total of 15 patients enrolled in the study. Two patients experienced bradycardia as adverse effect and there was no incidence of bowel perforation. All patients who completed the study had complete resolution of their nausea, and improvement in other symptoms including pain, constipation, tolerance of oral intake and resumption of bowel movements. Only two of the 15 patients were alive to complete the six-month post study follow up. CONCLUSION "Triple therapy" with dexamethasone, metoclopramide, and octreotide for management of nonsurgical MBO in this small sample size appears safe and well tolerated however a diagnosis of inoperable MBO remains associated with poor prognosis and death within months.
Collapse
Affiliation(s)
- Michelle Walter
- Department of Palliative and Supportive Care (M.W., E.H., D.C., A.C.), Rowell Park Comprehensive Cancer Center, Buffalo, NY, USA.
| | - Eric Hansen
- Department of Palliative and Supportive Care (M.W., E.H., D.C., A.C.), Rowell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Showkat Hamid
- Department of Medicine (S.H.), Rowell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Desi Carozza
- Department of Palliative and Supportive Care (M.W., E.H., D.C., A.C.), Rowell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gary Mann
- Department of Surgical Oncology (G.M.), Rowell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Charles Roche
- Department of Diagnostic Radiology (C.R.), Rowell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Anthony George
- Department of Biostatistics and Bioinformatics (A.G., K.A.), Rowell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics (A.G., K.A.), Rowell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Amy Case
- Department of Palliative and Supportive Care (M.W., E.H., D.C., A.C.), Rowell Park Comprehensive Cancer Center, Buffalo, NY, USA
| |
Collapse
|
10
|
Basilisco G, Marchi M, Coletta M. Chronic intestinal pseudo-obstruction in adults: A practical guide to identify patient subgroups that are suitable for more specific treatments. Neurogastroenterol Motil 2024; 36:e14715. [PMID: 37994282 DOI: 10.1111/nmo.14715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
Chronic intestinal pseudo-obstruction is a rare and heterogeneous syndrome characterized by recurrent symptoms of intestinal obstruction with radiological features of dilated small or large intestine with air/fluid levels in the absence of any mechanical occlusive lesion. Several diseases may be associated with chronic intestinal pseudo-obstruction and in these cases, the prognosis and treatment are related to the underlying disease. Also, in its "primary or idiopathic" form, two subgroups of patients should be determined as they require a more specific therapeutic approach: patients whose chronic intestinal pseudo-obstruction is due to sporadic autoimmune/inflammatory mechanisms and patients whose neuromuscular changes are genetically determined. In a context of a widely heterogeneous adult population presenting chronic intestinal pseudo-obstruction, this review aims to summarize a practical diagnostic workup for identifying definite subgroups of patients who might benefit from more specific treatments, based on the etiology of their underlying condition.
Collapse
Affiliation(s)
- Guido Basilisco
- Gastroenterology and Endoscopic Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Margherita Marchi
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Marina Coletta
- Gastroenterology and Endoscopic Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
11
|
Basiliya K, Galanopoulos M, Papaefthymiou A, Webster G, Carroll N, Fearnhead NS, Corbett G. Similar success rate in proximal and distal colonic stent placement: a retrospective multi-center study. Scand J Gastroenterol 2024; 59:108-111. [PMID: 37694882 DOI: 10.1080/00365521.2023.2254877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES Stenting of malignant colon obstruction is used as a bridge to surgery or as an alternative to surgical colostomy in a palliative setting. Current guidelines recommend stent placement as the first line of treatment in colonic obstruction in both curative and palliative settings. However, it is unclear whether the location of the malignant obstruction influences the outcome of the stenting procedure. The goal of this study was to compare the outcomes of colonic stents between proximal and distal colonic strictures with regard to technical and clinical success and the risk of adverse events. METHODS A multi-center retrospective cohort was composed of patients who underwent a colonic stent placement at two tertiary hospitals between 2013 and 2021. The technical and clinical outcome, stent type used, duration of post-procedural hospital stay and complications were noted. RESULTS A total of 148 patients who underwent colonic stenting were identified. 41 patients underwent stent placement in the proximal colon and 107 patients underwent a distal stent placement. There was no difference in technical success (100% vs 96.3%, p = 0.209), clinical success (97.0% vs 89.6%, p = 0.199) or complications (24.4% vs 37.4%, p = 0,135). CONCLUSION Technical success and clinical success rates are high and do not differ between stent locations. There is no significant difference in complication rates between proximal and distal colonic stents.
Collapse
Affiliation(s)
- K Basiliya
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Galanopoulos
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Papaefthymiou
- Pancreaticobiliary Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - G Webster
- Pancreaticobiliary Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - N Carroll
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - N S Fearnhead
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Department of General Surgery, Colorectal Surgery Unit, Cambridge, UK
| | - G Corbett
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
12
|
Shang R, Han X, Zeng C, Lv F, Fang R, Tian X, Ding X. Colonic stent as a bridge to surgery versus emergency rection for malignant left-sided colorectal obstruction: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e36078. [PMID: 38115371 PMCID: PMC10727616 DOI: 10.1097/md.0000000000036078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION The role of self-expanding metal stent (SEMS) implantation as a bridge to surgery in malignant left-sided colorectal obstruction (MLCO) remains controversial. OBJECTIVE To evaluate the safety of SEMS implantation versus emergency surgery (ER) in the treatment of MLCO. METHODS Four major literature databases (Cochrane Library, Embase, PubMed, and Web of Science) were searched to collect articles published before April 20, 2023. After determining random or fixed-effect models based on heterogeneity tests, odds ratios (RR) or standardized mean differences (SMD) with their respective 95% confidence intervals (CI) were calculated. RESULTS Nineteen randomized controlled studies were included. The main outcomes included overall tumor recurrence rate, 30-day mortality rate, and overall incidence of complications. Secondary outcomes included mortality-related indicators, tumor recurrence-related indicators, surgery-related indicators, and other relevant indicators. The study found that there was no significant difference in the 30-day mortality rate between the SEMS group and the er group. However, the SEMS group had a lower overall incidence of complications (RR = 0.787, P = .004), lower incision infection rate (RR = 0.472, P = .003), shorter operation time (SMD = -0.591, P = .000), lower intraoperative blood loss (SMD = -1.046, P = .000), lower intraoperative transfusion rate (RR = 0.624, P = .021), lower permanent stoma rate (RR = 0.499, P = .000), lower overall stoma rate (RR = 0.520,P = .000), shorter hospital stay (SMD = -0.643, P = .014), and more lymph node dissections during surgery (SMD = 0.222, 95% CI: 0.021-0.423, P = .031), as well as a higher primary anastomosis rate (RR = 0.472, 95% CI: 0.286-0.7 77, P = .003), among other advantages. However, the SEMS group had a higher overall tumor recurrence rate (RR = 1.339, P = .048). CONCLUSION SEMS has significant advantages over er in relieving clinical symptoms and facilitating postoperative recovery in MLCO, but does not reduce the tumor recurrence rate. Neoadjuvant chemotherapy combined with SEMS may provide a new approach to the treatment of MLCO.
Collapse
Affiliation(s)
- Rumin Shang
- Department of Gastroenterology, Wuhan Pu’ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Xiangming Han
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cui Zeng
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Fei Lv
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Rong Fang
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Xiaochang Tian
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Xiangwu Ding
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| |
Collapse
|
13
|
Fawaz J, Lucidarme O, Pocard M. Intraoperative appearance of radiation enteritis: What should be resected? J Visc Surg 2023; 160:479-480. [PMID: 37858430 DOI: 10.1016/j.jviscsurg.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Radiation enteritis can appear up to 30 years after radiotherapy. Outside acute complications, it usually manifests itself as chronic intestinal obstruction. If medical treatment (corticosteroid therapy) fails, surgical treatment is indicated, namely resection of the affected bowel, with removal of the ileo-caecal valve.
Collapse
Affiliation(s)
- Jade Fawaz
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Olivier Lucidarme
- Department of Radiology, Pitié-Salpêtrière Hospital, AP-HP, , 47-83, boulevard de l'Hôpital, Paris, France
| | - Marc Pocard
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Université Paris Cité, Inserm, U1275 CAP Paris Tech, 75010 Paris, France
| |
Collapse
|
14
|
Zhuang Y, Fu H, Yan B, Shu Y. A case of cholecystoduodenal fistula complicating gallstone ileus was documented. Asian J Surg 2023; 46:5599-5600. [PMID: 37640649 DOI: 10.1016/j.asjsur.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023] Open
Affiliation(s)
- Yuandan Zhuang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Hongrui Fu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.
| | - Bo Yan
- Department of Gynecology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Yixiong Shu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.
| |
Collapse
|
15
|
Slama L, El Filali A, Rhazi R, Taheri H, Saadi H, Bouziane M, Mimouni A. Deep endometriosis of ileocecum complicated by acute intestinal obstruction: a case report. J Int Med Res 2023; 51:3000605231191584. [PMID: 38082449 PMCID: PMC10718053 DOI: 10.1177/03000605231191584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 06/21/2023] [Indexed: 12/18/2023] Open
Abstract
Endometriosis is a frequent gynecological pathology. Digestive localization complicated by acute intestinal obstruction is exceptionally rare. We herein report a case involving a 48-year-old woman who had a long-term history of endometriosis symptoms. She was diagnosed with endometriosis by ultrasound 1 month before her admission to the emergency room with acute intestinal obstruction. The diagnosis was confirmed by histopathological examination following surgical resection. Further medical management resulted in a satisfactory outcome.
Collapse
Affiliation(s)
- Loubna Slama
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Mohammed VI, Oujda, Morocco
| | - Amal El Filali
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Mohammed VI, Oujda, Morocco
| | - Reda Rhazi
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Mohammed VI, Oujda, Morocco
| | - Hafsa Taheri
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Mohammed VI, Oujda, Morocco
| | - Hanane Saadi
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Mohammed VI, Oujda, Morocco
| | - Mohammed Bouziane
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Mohammed VI, Oujda, Morocco
| | - Ahmed Mimouni
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Mohammed VI, Oujda, Morocco
| |
Collapse
|
16
|
Nozu T, Miyagishi S, Ishioh M, Takakusaki K, Okumura T. Phlorizin attenuates postoperative gastric ileus in rats. Neurogastroenterol Motil 2023; 35:e14659. [PMID: 37574874 DOI: 10.1111/nmo.14659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/04/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Postoperative ileus (POI) is a major complication of abdominal surgery (AS). Impaired gut barrier mediated via Toll-like receptor 4 (TLR4) and interleukin-1 (IL-1) receptor is involved in the development of POI. Phlorizin is a nonselective inhibitor of sodium-linked glucose transporters (SGLTs) and is known to improve lipopolysaccharide (LPS)-induced impaired gut barrier. This study aimed to clarify our hypothesis that AS-induced gastric ileus is mediated via TLR4 and IL-1 signaling, and phlorizin improves the ileus. METHODS AS consisted of a celiotomy and manipulation of the cecum for 1 min. Gastric emptying (GE) in 20 min with liquid meal was determined 3 h after the surgery in rats. The effect of subcutaneous (s.c.) injection of LPS (1 mg kg-1 ) was also determined 3 h postinjection. KEY RESULTS AS delayed GE, which was blocked by TAK-242, an inhibitor of TLR4 signaling and anakinra, an IL-1 receptor antagonist. LPS delayed GE, which was also mediated via TLR4 and IL-1 receptor. Phlorizin (80 mg kg-1 , s.c.) significantly improved delayed GE induced by both AS and LPS. However, intragastrical (i.g.) administration of phlorizin did not alter it. As gut mainly expresses SGLT1, SGLT2 may not be inhibited by i.g. phlorizin. The effect of phlorizin was blocked by ghrelin receptor antagonist in the LPS model. CONCLUSIONS & INFERENCES AS-induced gastric ileus is mediated via TLR4 and IL-1 signaling, which is simulated by LPS. Phlorizin improves the gastric ileus via activation of ghrelin signaling, possibly by inhibition of SGLT2. Phlorizin may be useful for the treatment of POI.
Collapse
Affiliation(s)
- Tsukasa Nozu
- Department of Regional Medicine and Education, Asahikawa Medical University, Asahikawa, Japan
- Center for Medical Education, Asahikawa Medical University, Asahikawa, Japan
| | - Saori Miyagishi
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa, Japan
| | - Masatomo Ishioh
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa, Japan
| | - Kaoru Takakusaki
- Department of Physiology, Division of Neuroscience, Asahikawa Medical University, Asahikawa, Japan
| | - Toshikatsu Okumura
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa, Japan
- Department of General Medicine, Asahikawa Medical University, Asahikawa, Japan
| |
Collapse
|
17
|
Laterza V, Covino M, Schena CA, Russo A, Salini S, Polla DD, de'Angelis N, Quero G, Tondolo V, La Greca A, Merra G, Sganga G, Gasbarrini A, Franceschi F, Landi F, Alfieri S, Rosa F. The Clinical Frailty Scale (CFS) as an Independent Prognostic Factor for Patients ≥80 Years with Small Bowel Obstruction (SBO). J Gastrointest Surg 2023; 27:2177-2186. [PMID: 37674098 PMCID: PMC10579164 DOI: 10.1007/s11605-023-05820-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND SBO is a potentially life-threatening condition that often affects older patients. Frailty, more than age, is expected to play a crucial role in predicting SBO prognosis in this population. This study aims to define the influence of Clinical Frailty Scale (CFS) on mortality and major complications in patients ≥80 years with diagnosis of SBO at the emergency department (ED). METHODS All patients aged ≥80 years admitted to our ED for SBO from January 2015 to September 2020 were enrolled. Frailty was assessed through the CFS, and then analyzed both as a continuous and a dichotomous variable. The endpoints were in-hospital mortality and major complications. RESULTS A total of 424 patients were enrolled. Higher mortality (20.8% vs 8.6%, p<0.001), longer hospital stay (9 [range 5-14] days vs 7 [range 4-12] days, p=0.014), and higher rate of major complications (29.9% vs 17.9%, p=0.004) were associated with CFS ≥7. CFS score and bloodstream infection were the only independent prognostic factors for mortality (OR 1.72 [CI: 1.29-2.29], p<0.001; OR 4.69 [CI: 1.74-12.6], p=0.002, respectively). Furthermore, CFS score, male sex and surgery were predictive factors for major complications (OR 1.41 [CI: 1.13-1.75], p=0.002; OR 1.67 [CI: 1.03-2.71], p=0.038); OR 1.91 [CI: 1.17-3.12], p=0.01; respectively). At multivariate analysis, for every 1-point increase in CFS score, the odds of mortality and the odds of major complications increased 1.72-fold and 1.41-fold, respectively. CONCLUSION The increase in CFS is directly associated with an increased risk of mortality and major complications. The presence of severe frailty could effectively predict an increased risk of in-hospital death regardless of the treatment administered. The employment of CFS in elderly patients could help the identification of the need for closer monitoring and proper goals of care.
Collapse
Affiliation(s)
- Vito Laterza
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8,, 00168, Rome, Italy
| | - Marcello Covino
- Università Cattolica del Sacro Cuore, Rome, Italy
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Carlo Alberto Schena
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8,, 00168, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, Paris, France.
| | - Andrea Russo
- Geriatrics Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Sara Salini
- Geriatrics Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Davide Della Polla
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, Paris, France
| | - Giuseppe Quero
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8,, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Tondolo
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8,, 00168, Rome, Italy
| | - Antonio La Greca
- Università Cattolica del Sacro Cuore, Rome, Italy
- Emergency and Trauma Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giuseppe Merra
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gabriele Sganga
- Università Cattolica del Sacro Cuore, Rome, Italy
- Emergency and Trauma Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- Università Cattolica del Sacro Cuore, Rome, Italy
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Franceschi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Landi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Geriatrics Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Sergio Alfieri
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8,, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fausto Rosa
- Università Cattolica del Sacro Cuore, Rome, Italy
- Emergency and Trauma Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| |
Collapse
|
18
|
Wei Y, Liao T, Shangguan X, Ouyang M, Chen Z, Zheng E, Lin B, Chen X. A multi-analysis of nomogram model for the identification of banded adhesions and matted adhesions in adhesive small bowel obstruction. Eur J Trauma Emerg Surg 2023; 49:2277-2285. [PMID: 37029198 DOI: 10.1007/s00068-023-02270-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/02/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Preoperative diagnosis of the cause of adhesive small bowel obstruction (ASBO) is very challenging for surgeons. We aimed to develop a nomogram model for the identification of banded adhesions (BA) and matted adhesions (MA) of ASBO. METHODS This retrospective study enrolled patients with ASBO between January 2012 and December 2020, classified into BA and MA groups according to the intraoperative findings. A nomogram model was developed by using multivariable logistic regression analysis. RESULTS A total of 199 patients were included, with 117 (58.8%) cases of BA and 82 (41.2%) cases of MA. There were 150 patients designed for training the model, and the other 49 cases for validation. Multivariate logistic regression analysis showed that prior surgery for once (p = 0.008), white blood cells (WBC) (p = 0.001), beak sign (p < 0.001), fat notch sign (p = 0.013), and mesenteric haziness (p = 0.005) were independently associated with BA. The AREA under the receiver operating characteristic curve (AUC-ROC) of the nomogram model in the training and validation sets were 0.861 (95% CI 0.802-0.921) and 0.884 (95% CI 0.789-0.980), respectively. The calibration plot demonstrated a good agreement. A decision curve analysis demonstrated that the nomogram model was clinically useful. CONCLUSIONS The multi-analysis of the nomogram model might have a favorable clinical applicability for the identification of BA and MA in patients with adhesive small bowel obstruction.
Collapse
Affiliation(s)
- Yong Wei
- Department of Emergency Surgery (General Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Tianran Liao
- Department of Emergency Surgery (General Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Xinchang Shangguan
- Department of Emergency Surgery (General Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Manduo Ouyang
- Department of Emergency Surgery (General Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Zhiyong Chen
- Department of Radiology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Enshuang Zheng
- Department of Radiology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Bingqiang Lin
- Department of Emergency Surgery (General Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Xianqiang Chen
- Department of Emergency Surgery (General Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
| |
Collapse
|
19
|
Sebastian-Valverde E, Téllez C, Burdío F, Poves I, Grande L. Individualization of the best approach for adhesive small bowel obstruction. ANZ J Surg 2023; 93:2132-2137. [PMID: 37530170 DOI: 10.1111/ans.18649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Laparoscopic postoperatives outcomes in adhesiolysis are promising but conversion and morbidity remains high. The objective of our study was to determine preoperative factors to individualize and select the most appropriate approach for each patient. METHODS Patients ≥18 years old undergoing emergent surgery for adhesive small bowel obstruction and internal hernias were evaluated. Bivariate and multivariate analysis were performed to investigate factors related to conversion to open surgery and to the type of adhesions. RESULTS Of 333 patients, 224 were operated by laparotomy and 109 by laparoscopy (conversion rate: 40%). Previous abdominal wall mesh, type of adhesions, bowel lesion, need for intestinal resection and laparoscopic skills were statistically related to conversion. In the multivariate analysis, complex adhesions (OR 4.3, 95% CI 1.5-12.2; P = 0.006), the need for intestinal resection (OR 14.16, 95% CI 2.55-78.68; P = 0.002), and non-advanced laparoscopy surgeons (OR 4.31, 95% CI 1.56-11.94; P = 0.005) were independent factors for conversion to open surgery. ASA III-IV, previous surgeries, previous abdominal mesh and previous adhesiolysis were related to complex adhesions. Previous laparoscopic surgery and internal hernia or closed loop in computed tomography were associated with simple adhesions as a cause of the obstruction. In the multivariate, previous adhesiolysis (OR 4.76, 95% CI 1.23-18.3; P = 0.023) and the findings on computed tomography were significantly related with the type of adhesion. CONCLUSION Some preoperative factors allow to individualize the surgical approach in the adhesive small bowel obstruction improving surgical outcomes.
Collapse
Affiliation(s)
- Enric Sebastian-Valverde
- Department of Surgery, Hospital de Sant Boi, Sant Boi de Llobregat, Spain
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
| | - Clara Téllez
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
| | - Fernando Burdío
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
- Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ignasi Poves
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
| | - Luis Grande
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
20
|
Wang H, Liang X, Jian L, Chen S. Diagnosis and surgical treatment of adult megacolon complicating intestinal obstruction: Report of 5 case. Asian J Surg 2023; 46:3807-3808. [PMID: 37012156 DOI: 10.1016/j.asjsur.2023.03.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Affiliation(s)
- Hao Wang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
| | - Xuemin Liang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Lisi Jian
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Shiwei Chen
- The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
21
|
Yule A, Sills D, Smith S, Spiller R, Smyth AR. Thinking outside the box: a review of gastrointestinal symptoms and complications in cystic fibrosis. Expert Rev Respir Med 2023; 17:547-561. [PMID: 37345513 DOI: 10.1080/17476348.2023.2228194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/19/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Gastrointestinal (GI)-related symptoms, complications, and comorbidities in cystic fibrosis (CF) are common and research to reduce their burden is a priority for the CF community. To enable future research, this review aimed to summarize the range of GI symptoms, complications and comorbidities seen in CF, the underlying pathophysiology, and treatments. AREAS COVERED This was a rapid systematic review undertaken using the recommendations from the Cochrane Rapid Reviews Methods Group. We searched databases including PubMed, Embase, Medline and the Cochrane database and identified those studies reporting GI-related symptoms, complications, or comorbidities in CF or their treatment. Our searches identified 2,930 studies and a total 119 studies met our inclusion criteria. Where a prevalence could be determined, GI symptoms were reported in 33.7% of study participants. The range of symptoms reported was broad and the highest median prevalence included flatulence (43.5%), bloating and abdominal distension (36%), and fatty stool (36%). Meconium ileus was reported in 12% and distal intestinal obstruction syndrome in 8.5. EXPERT OPINION GI-related symptoms, complications, and comorbidities in CF are common. More consistent characterization and recording of these symptoms in clinical studies may help achieve the priority of reducing the burden of GI disease in CF.
Collapse
Affiliation(s)
- Alexander Yule
- Academic Unit of Lifespan & Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Biomedical Research Centre, Nottingham University Hospital NHS Trust and University of Nottingham, Nottingham, UK
| | - Darren Sills
- Nutrition and Dietetics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sherie Smith
- Academic Unit of Lifespan & Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Robin Spiller
- NIHR Biomedical Research Centre, Nottingham University Hospital NHS Trust and University of Nottingham, Nottingham, UK
- Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alan R Smyth
- Academic Unit of Lifespan & Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Biomedical Research Centre, Nottingham University Hospital NHS Trust and University of Nottingham, Nottingham, UK
| |
Collapse
|
22
|
Ono A, Mori K, Fukura S, Kondo S, Yokota N, Ishibashi H. A case of strangulated intestinal obstruction in which disease progression was recognized on ultrasonography: importance of "string-like structure". J Med Ultrason (2001) 2023; 50:459-460. [PMID: 37071256 DOI: 10.1007/s10396-023-01302-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/27/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Akemi Ono
- Department of Pediatrics, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, Tokushima, 770-8539, Japan.
| | - Kazuhiro Mori
- Department of Pediatrics, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, Tokushima, 770-8539, Japan
| | - Shoko Fukura
- Department of Pediatrics, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, Tokushima, 770-8539, Japan
| | - Shuji Kondo
- Department of Pediatrics, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, Tokushima, 770-8539, Japan
| | - Noriko Yokota
- Department of Pediatric Surgery and Pediatric Endoscopic Surgery, Tokushima University Hospital, Tokushima, Japan
| | - Hiroki Ishibashi
- Department of Pediatric Surgery and Pediatric Endoscopic Surgery, Tokushima University Hospital, Tokushima, Japan
| |
Collapse
|
23
|
Bakkaloglu OK, Bavunoglu I, Aslan S, Eskazan T, Celik S, Kepil N, Hatemi I, Erzin Y, Celik AF. Does intestinal obstruction influence hypo-albuminemia: assessment of the physio-pathogenesis of protein-losing enteropathy with literature review. Eur Rev Med Pharmacol Sci 2023; 27:5767-5774. [PMID: 37401313 DOI: 10.26355/eurrev_202306_32815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Non-steroidal anti-inflammatory drug (NSAID) use may cause diaphragm-like lesions in the bowel. Although NSAID-enteropathy is among the causes of protein-losing enteropathy (PLE), intractable hypoalbuminemia is rare. CASE REPORT Here, we discuss a case of NSAID-enteropathy with a diaphragm-like disease that presented with Protein Losing Enteropathy (PLE) rather than obstruction. The hypoalbuminemia recovered immediately after resection of the obstructive segment, despite ongoing annular ulcerations in the early postoperative period. Thus, it was not clear whether obstructive mechanisms influenced resistant hypoalbuminemia besides the ulcers. We also reviewed the English-written literature for "diaphragm-type lesion, NSAID-enteropathy, obstruction, and protein-losing enteropathy". We noted that the role of obstruction in the pathophysiology of PLE was not clear. CONCLUSIONS As our case and a couple of cases reported in literature, slow-onset obstructive pathology seems to contribute to well-known factors: inflammatory response, exudation, tight-junction dysfunction, and increase in permeability in the physiopathology of NSAID-induced PLE. Factors such as distention-induced low-flow ischemia and reperfusion, cholecystectomy-related continuous bile flow, bacterial overgrowth-related bile deconjugation and concomitant inflammation are among other potential influencers. The possible role of a slow-onset obstructive pathology in the physiopathology of NSAID-induced and other PLE needs to be further elucidated.
Collapse
Affiliation(s)
- O K Bakkaloglu
- Department of Gastroenterology, Cerrahpasa Medical Faculty, Istanbul University Cerrahpasa, Istanbul, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Carmichael SP, Kline DM, Mowery NT, Miller PR, Meredith JW, Hanchate AD. Geographic Variation in Operative Management of Adhesive Small Bowel Obstruction. J Surg Res 2023; 286:57-64. [PMID: 36753950 PMCID: PMC10034859 DOI: 10.1016/j.jss.2022.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/06/2022] [Accepted: 12/25/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Variation in surgical management exists nationally. We hypothesize that geographic variation exists in adhesive small bowel obstruction (aSBO) management. MATERIALS AND METHODS A retrospective analysis of a national commercial insurance claims database (MarketScan) sample (2017-2019) was performed in adults with hospital admission due to aSBO. Geographic variation in rates of surgical intervention for aSBO was evaluated by state and compared to a risk-adjusted national baseline using a Bayesian spatial rates Poisson regression model. For individual-level analysis, patients were identified in 2018, with 365-d look back and follow-up periods. Logistic regression was performed for individual-level predictors of operative intervention for aSBO. RESULTS Two thousand one hundred forty-five patients were included. State-level analysis revealed rates of operative intervention for aSBO were significantly higher in Missouri and lower in Florida. On individual-level analysis, age (P < 0.01) and male sex (P < 0.03) but not comorbidity profile or prior aSBO, were negatively associated with undergoing operative management for aSBO. Patients presenting in 2018 with a history of admission for aSBO the year prior experienced a five-fold increase in odds of representation (odds ratio: 5.4, 95% confidence interval: 3.1-9.6) in 2019. Patients who received an operation for aSBO in 2018 reduced the odds of readmission in the next year by 77% (odds ratio: 0.23, 95% confidence interval: 0.1-0.5). The volume of operations performed within a state did not influence readmission. CONCLUSIONS Surgical management of aSBO varies across the continental USA. Operative intervention is associated with decreased rates of representation in the following year. These data highlight a critical need for standardized guidelines for emergency general surgery patients.
Collapse
Affiliation(s)
- Samuel P Carmichael
- Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
| | - David M Kline
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Nathan T Mowery
- Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Preston R Miller
- Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - J Wayne Meredith
- Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Amresh D Hanchate
- Division of Public Health Sciences, Department of Social Science and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| |
Collapse
|
25
|
Besser P N, Riquoir A C, Bellolio R F. [Bowel obstruction secondary to a spontaneous intramural hematoma. Report of one case]. Rev Med Chil 2022; 150:1681-1684. [PMID: 37906790 DOI: 10.4067/s0034-98872022001201681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/23/2023] [Indexed: 11/02/2023]
Abstract
Spontaneous intramural hematoma (IMH) is an uncommon cause of bowel obstruction, generally secondary to trauma. Even rarer is the spontaneous hematoma, mainly described in anticoagulated patients. We report a 73-year-old female in anticoagulant therapy who presented with a bowel obstruction. A computed tomography (CT) of the abdomen showed a segmentary wall thickening of the distal jejunum, compatible with an IMH which obliterated the lumen and produced dilatation of the proximal bowel loops. Support management was initiated, achieving satisfactory evolution, allowing her discharge 12 days after admission.
Collapse
Affiliation(s)
- Nicolás Besser P
- Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Christophe Riquoir A
- Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Bellolio R
- Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
26
|
Lee JS, Kim SH, Lee JY, Ye JB, Sul YH, Seok J, Yoon SY, Kim HR, Choi JH, Kim Y. Intestinal obstruction caused by small bowel entrapment within a lumbar fracture: A case report. Medicine (Baltimore) 2022; 101:e31273. [PMID: 36281106 PMCID: PMC9592479 DOI: 10.1097/md.0000000000031273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Intestinal obstruction associated with traumatic vertebral fracture is extremely rare. We report a case of obstructive small bowel injury caused by entrapment of the small intestine at the fracture site of the 5th lumbar vertebra due to trauma. CASE PRESENTATION A 55-year-old man fell from a height of 4 m and visited the emergency room of a local hospital with complain of back pain. During the examination, a 5th lumbar vertebral body fracture and left psoas muscle hematoma were observed, and the patient was admitted to the neurosurgery department for conservative treatment. The patient received conservative treatment for 2 days, but new symptoms of intestinal obstruction and fever occurred. A neurosurgeon at the hospital suspected duodenal perforation and transferred the patient to the regional trauma center for treatment. Our medical staff reviewed the patient's symptoms and imaging data and decided to perform an emergency operation because of small bowel entrapment in the 5th lumbar vertebrae fracture and perforation of the small intestine. We found that the small bowel, approximately 160 cm below the ligament of Treitz, was incarcerated at the 5th lumbar vertebral fracture site. After careful manual reduction of the entrapment of the small intestine, a small bowel resection of 25 cm, including the injury site, was performed with anastomosis. CONCLUSION If symptoms of intestinal obstruction are observed in patients with traumatic spinal injury, medical staff must consider the exceedingly rare possibility of bowel entrapment.
Collapse
Affiliation(s)
- Jin Suk Lee
- Trauma Surgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Se Heon Kim
- Trauma Surgery, Chungbuk National University Hospital, Cheongju, South Korea
- *Correspondence: Se Heon Kim, Department of Trauma Surgery, Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju 28644, South Korea (e-mail: )
| | - Jin Young Lee
- Trauma Surgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Jin Bong Ye
- Trauma Surgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Young Hoon Sul
- Trauma Surgery, Chungbuk National University Hospital, Cheongju, South Korea
- Trauma Surgery, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Junepill Seok
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Su Young Yoon
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Hong Rye Kim
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Jung Hee Choi
- Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Yook Kim
- Department of Radiology, Chungbuk National University Hospital, Cheongju, South Korea
| |
Collapse
|
27
|
Liu A, Guo J, Liu H, Xu Y, Wu J, Mao T, Tian Z, Ding X. Ustekinumab is effective against ulcerative colitis with intestinal stenosis: A case report. Medicine (Baltimore) 2022; 101:e31213. [PMID: 36281114 PMCID: PMC9592401 DOI: 10.1097/md.0000000000031213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Intestinal stricture and obstruction are rare complications of ulcerative colitis (UC). Currently, there are only a few studies on the treatment of UC with intestinal stenosis, however there are no reports on the treatment of UC with benign intestinal stenosis with ustekinumab (UST). PATIENT CONCERNS A 22-year-old woman was admitted to our hospital due to a 3-year history of recurrent bloody mucous in stool with intermittent abdominal pain and distension developed in the past month. She was steroid-dependent and had developed a secondary loss of response to infliximab. DIAGNOSES She was diagnosed with UC combined with incomplete intestinal obstruction due to stenosis. The stricture had a mixed pattern with both inflammatory and fibrotic components, with the former covering a larger section of the intestine. INTERVENTIONS The patient was given UST for 56 weeks. OUTCOMES The patient's symptoms subsided after treatment with UST. The ulcers healed, and the stenosis was reduced. LESSONS UST is effective against UC with benign intestinal stenosis. It is thought that UST inhibits the production of transforming growth factor-β and interleukin-17, leading to the suppression of myofibroblast proliferation, ultimately alleviating intestinal stenosis.
Collapse
Affiliation(s)
- Ailing Liu
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing Guo
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hua Liu
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yonghong Xu
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jun Wu
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tao Mao
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zibin Tian
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xueli Ding
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
28
|
Xie Y, Zheng C, Tan X, Li Z, Zhang Y, Liu Y. Clinical efficacy of acupuncture in patients with adhesive intestinal obstruction: A meta-analysis. Medicine (Baltimore) 2022; 101:e30257. [PMID: 36221368 PMCID: PMC9542758 DOI: 10.1097/md.0000000000030257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adhesive intestinal obstruction (AIO) is a common surgical emergency. Surgical exploration has a considerable risk of intestinal injury, and surgical treatment may greatly reduce the quality of life after surgery and cause AIO after re-operation. The nonsurgical treatment is effective for approximately 70% to 90% of patients with adhesive small bowel obstruction (ASBO). However, the high recurrence (30%) and mortality (2%) rates of ASBO are concerning. Moreover, the ideal management method of ASBO remains debatable. Studies have shown that acupuncture can also promote postoperative gastrointestinal function recovery and prevent postoperative complications such as nausea, vomiting, and visceral pain. AIM We aimed to evaluate the effectiveness of acupuncture in the treatment of AIO. METHODS Randomized controlled trials investigating the effectiveness of acupuncture for adhesive bowel obstruction published until November 2021 were identified by searching 8 comprehensive databases. Data analysis was performed using RevMan v. 5.4 and Stata software v. 16.0. The random-effects model and the fixed-effects model were used to perform the meta-analysis on the experimental group and control group. RESULTS Twelve studies with a total of 892 participants were included. The results showed that the experimental group had a significantly higher effective rate (relative risk: 1.20; 95% confidence interval (CI): 1.11-1.28; P < .00001) and a markedly shorter time of the first defecation (mean difference: -11.49, 95% CI: -19.31 to -3.66; P = .004) than the control group. The experimental group also showed a reduction in the duration of abdominal pain, and the reduced length of hospital stay. However, no statistical differences were observed between the 2 groups in terms of the surgery conversion rate. CONCLUSION Acupuncture is effective in the treatment of AIO. It can remarkably alleviate some clinical symptoms in patients with AIO.
Collapse
Affiliation(s)
- Yujia Xie
- Basic Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chengwen Zheng
- Basic Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiyue Tan
- Basic Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zongyu Li
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yiyi Zhang
- Basic Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuan Liu
- Basic Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Yuan Liu, Basic Medical School, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China (e-mail: )
| |
Collapse
|
29
|
Aksit MA, Ling H, Pace RG, Raraigh KS, Onchiri F, Faino AV, Pagel K, Pugh E, Stilp AM, Sun Q, Blue EE, Wright FA, Zhou YH, Bamshad MJ, Gibson RL, Knowles MR, Cutting GR, Blackman SM. Pleiotropic modifiers of age-related diabetes and neonatal intestinal obstruction in cystic fibrosis. Am J Hum Genet 2022; 109:1894-1908. [PMID: 36206743 PMCID: PMC9606479 DOI: 10.1016/j.ajhg.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
Individuals with cystic fibrosis (CF) develop complications of the gastrointestinal tract influenced by genetic variants outside of CFTR. Cystic fibrosis-related diabetes (CFRD) is a distinct form of diabetes with a variable age of onset that occurs frequently in individuals with CF, while meconium ileus (MI) is a severe neonatal intestinal obstruction affecting ∼20% of newborns with CF. CFRD and MI are slightly correlated traits with previous evidence of overlap in their genetic architectures. To better understand the genetic commonality between CFRD and MI, we used whole-genome-sequencing data from the CF Genome Project to perform genome-wide association. These analyses revealed variants at 11 loci (6 not previously identified) that associated with MI and at 12 loci (5 not previously identified) that associated with CFRD. Of these, variants at SLC26A9, CEBPB, and PRSS1 associated with both traits; variants at SLC26A9 and CEBPB increased risk for both traits, while variants at PRSS1, the higher-risk alleles for CFRD, conferred lower risk for MI. Furthermore, common and rare variants within the SLC26A9 locus associated with MI only or CFRD only. As expected, different loci modify risk of CFRD and MI; however, a subset exhibit pleiotropic effects indicating etiologic and mechanistic overlap between these two otherwise distinct complications of CF.
Collapse
Affiliation(s)
- Melis A Aksit
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Hua Ling
- Department of Genetic Medicine, Center for Inherited Disease Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Rhonda G Pace
- Marsico Lung Institute/UNC CF Research Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Karen S Raraigh
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Frankline Onchiri
- Children's Core for Biostatistics, Epidemiology and Analytics in Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Anna V Faino
- Children's Core for Biostatistics, Epidemiology and Analytics in Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Kymberleigh Pagel
- The Institute for Computational Medicine, The Johns Hopkins University, Baltimore, MD 21218, USA
| | - Elizabeth Pugh
- Department of Genetic Medicine, Center for Inherited Disease Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Adrienne M Stilp
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Quan Sun
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Elizabeth E Blue
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA; Brotman Baty Institute for Precision Medicine, Seattle, WA 98195, USA
| | - Fred A Wright
- Department of Statistics, North Carolina State University, Raleigh, NC 27797, USA; Bioinformatics Research Center, North Carolina State University, Raleigh, NC 27797, USA; Department of Biological Sciences, North Carolina State University, Raleigh, NC 27797, USA
| | - Yi-Hui Zhou
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC 27797, USA
| | - Michael J Bamshad
- Brotman Baty Institute for Precision Medicine, Seattle, WA 98195, USA; Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, WA 98195, USA; Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA; Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Ronald L Gibson
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, WA 98105, USA; Department of Pediatrics, Division of Pulmonary & Sleep Medicine, University of Washington School of Medicine/Seattle Children's Hospital, Seattle, WA, USA
| | - Michael R Knowles
- Marsico Lung Institute/UNC CF Research Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Garry R Cutting
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Scott M Blackman
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| |
Collapse
|
30
|
Park CH, Lee JW, Kim BS, Cho MR, Song SK. Prolonged ileus in traumatic pelvic ring injury patients who underwent arterial angio-embolization: A retrospective study. Medicine (Baltimore) 2022; 101:e30684. [PMID: 36181072 PMCID: PMC9524902 DOI: 10.1097/md.0000000000030684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Paralytic ileus occurs in up to 18% of the patients with pelvic bone fractures. The aim of this study is to determine if massive bleeding requiring arterial angio-embolization is related with the duration of ileus in patients with traumatic pelvic ring injuries. This retrospective study included 25 patients who underwent arterial angio-embolization for traumatic pelvic ring injuries. Data were collected from prospectively maintained databases of two independent hospitals. Demographic characteristics (such as age, sex, body mass index, and Charlson Comorbidity Index), cause of trauma, and severity of pelvic injuries were similar in the non-prolonged and prolonged ileus groups. As expected, the prolonged ileus group had a significantly longer duration of ileus than the non-prolonged ileus group (8.0 ± 4.2 days vs 1.2 ± 0.4 days, respectively; P < .001). The mortality rate was higher in the prolonged ileus group (20% vs 0%), but it was not significantly different (P = .13). Interestingly, the prolonged ileus group received significantly higher amounts of packed red blood cell transfusions (6.1 ± 2.1 units vs 3.8 ± 2.5 units; P = .02). The amount of packed red blood cell transfusions was associated with a greater risk of prolonged ileus development (P = .03, odds ratio = 2.04, 95% confidence interval = 1.08-3.88). This study supports the idea that the duration of the ileus is related with the amount of bleeding caused by the traumatic pelvic ring injury. In order to prevent further complications, conservative treatments of the ileus should be considered.
Collapse
Affiliation(s)
- Chan-Hee Park
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Republic of Korea
| | - Jeong-Woo Lee
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Republic of Korea
| | - Beom-Soo Kim
- Department of Orthopaedic Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Republic of Korea
| | - Myung-Rae Cho
- Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University Hospital, Daegu, Republic of Korea
| | - Suk-Kyoon Song
- Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University Hospital, Daegu, Republic of Korea
- *Correspondence: Suk-Kyoon Song, Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University Hospital, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, Republic of Korea (e-mail: )
| |
Collapse
|
31
|
Straarup D, Gotschalck KA, Mikalone R, Thorlacius-Ussing O. Preoperative findings on non-specific CT in patients with primary acute intestinal ischemia: a case-control study. Eur J Trauma Emerg Surg 2022; 48:3025-3032. [PMID: 34216221 DOI: 10.1007/s00068-021-01741-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/19/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Primary acute intestinal ischaemia (AII) is an abdominal catastrophe caused by intravascular obstruction of blood supply. It is difficult to diagnose. Computerized tomography (CT) scan is the modality of choice for diagnostic evaluation. Majority of previous studies have evaluated CT findings in patients where AII was suspected. However, unveiling the unique radiological findings also in not initially suspected AII patients, might lead to the timely management of AII patients, and is the aim of this study. METHODS In a single-center, retrospective case-control study, preoperative radiological findings from abdominal CT scans in 48 patients with primary AII were compared with 80 non-ischemic controls. Radiological findings were analyzed using multivariable logistical regression with adjustment for age and gender and reported as odds ratios (OR) with 95% confidence intervals (CI) and p values. RESULTS Thirty-nine (81%) cases with AII were referred to an abdominal CT scan without a specific clinical suspicion of AII. Three main radiological categories (intestinal wall pathology [OR 7.4, CI 2.3-24.0, p value < 0.001], gastrointestinal vessel pathology [OR 19.3, CI 4.6-80.5, p value < 0.001) and intestinal diameter [OR 4.7, CI 1.6-13.4, p value 0.004]) were significantly different in AII patients. Subgroup analysis implied that pneumatosis intestinalis, increased contrast enhancement in the bowel wall, inferior mesenteric artery arteriosclerosis and colonic contraction were predictors of AII. CONCLUSION Radiological changes within the intestinal wall, luminal diameter and gastrointestinal vessels are independent predictors of AII. Awareness of these radiological findings, therefore, plays a central role in patients with an indistinct clinical picture in early recognition and treatment of a life-threatening AII. TRIAL REGISTRATION NUMBER NCT04361110 (April 24, 2020), retrospectively registered.
Collapse
Affiliation(s)
- David Straarup
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark.
- Department of Surgery, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjørring, Denmark.
| | - Kåre Andersson Gotschalck
- Department of Gastrointestinal Surgery, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NØ, Denmark
| | - Rasa Mikalone
- Department of Diagnostic Radiology, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark
| | - Ole Thorlacius-Ussing
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Niels Jernes Vej 10, 9220, Aalborg, Denmark
| |
Collapse
|
32
|
Hidalgo-Pujol M, Biondo S, Die Trill J, Vigorita V, Paniagua Garcia-Señorans M, Pascual Migueláñez I, Prieto-La Noire F, Timoteo A, Cornejo L, Martín Parra JI, Fidalgo García M, Solís-Peña A, Cirera de Tudela A, Rodriguez González A, Sánchez-Guillen L, Bustamante Recuenco C, Pérez-Alonso C, Hurtado Caballero E, Pascual M, García Septiem J, Mora López L, Cervera-Aldama J, Guadalajara H, Espín E, Kreisler E. Upfront surgery versus self-expanding metallic stent as bridge to surgery in left-sided colonic cancer obstruction: A multicenter observational study. Surgery 2022; 172:74-82. [PMID: 35168815 DOI: 10.1016/j.surg.2021.12.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Oncological outcomes of self-expanding metallic stent used as a bridge to surgery in potential curative patients with left-sided colonic cancer obstruction remain unclear. The aim of this study was to investigate perioperative and mid-term oncological outcomes of 2 of the currently most commonly performed treatments in left-sided colonic cancer obstruction. METHODS This is a retrospective multicenter study including patients with left-sided colonic cancer obstruction treated with curative intent between 2013 and 2017. The presence of metastasis at diagnosis was an exclusion criterion. The primary outcome was to evaluate the noninferiority, in terms of overall survival, of bridge to surgery strategy compared with emergency colonic resection. The secondary outcomes were perioperative morbimortality, disease free survival, local recurrence, and distant recurrence. RESULTS A total of 564 patients were included, 320 in the emergency colonic resection group and 244 in the bridge to surgery group. Twenty-seven patients of the bridge-to-surgery group needed urgent operation. Postoperative morbidity rates were statistically higher in the emergency colonic resection group (odds ratio [95% confidence interval] 0.37 [0.24-0.55], P < .001). There was no difference in 90-day mortality between groups (odds ratio [95% confidence interval] 0.85 [0.36-1.99], P = .702). The median follow-up was 3.80 years (2.29-4.92). The results show the noninferiority of bridge to surgery versus emergency colonic resection in terms of overall survival (hazard ratio [95% confidence interval) 0.78 [0.56-1.07], P = .127). There were no differences in disease free survival, distant recurrence, and local recurrence rates between bridge to surgery and emergency colonic resection groups. CONCLUSION Self-expanding metallic stent as bridge to surgery might not lead to a negative impact on the long-term prognosis of the tumor compared with emergency colonic resection in expert hands and selected patients.
Collapse
Affiliation(s)
- Marta Hidalgo-Pujol
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain; University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain.
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain; University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Javier Die Trill
- Department of General and Digestive Surgery, Coloproctology Unit, Ramón y Cajal University Hospital, Madrid, Spain
| | - Vincenzo Vigorita
- Division of Coloproctology, Department of General and Digestive Surgery, University Hospital Complex of Vigo, Vigo, Spain; General Surgery Research Group, SERGAS-UVIGO, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | - Marta Paniagua Garcia-Señorans
- Division of Coloproctology, Department of General and Digestive Surgery, University Hospital Complex of Vigo, Vigo, Spain; General Surgery Research Group, SERGAS-UVIGO, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | | | | | - Ander Timoteo
- Department of General and Digestive Surgery, Doctor Josep Trueta University Hospital, Girona, Spain
| | - Lidia Cornejo
- General and digestive surgery research group. Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - José Ignacio Martín Parra
- Division of Coloproctology, Department of General and Digestive Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | - María Fidalgo García
- Department of General and Digestive Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Alejandro Solís-Peña
- Department of General and Digestive Surgery, Coloproctology Unit, Vall d'Hebron University Hospital, Autonomic University of Barcelona, Barcelona, Spain
| | - Arturo Cirera de Tudela
- Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Araceli Rodriguez González
- Department of General and Digestive Surgery, Emergency Surgery Unit, Donostia University Hospital, San Sebastián, Spain
| | - Luís Sánchez-Guillen
- Department of General and Digestive Surgery, Coloproctology Unit, Elche University Hospital, Alicante, Spain
| | - Carlos Bustamante Recuenco
- Department of General and Digestive Surgery, Nuestra Señora del Prado Hospital, Talavera de la Reina, Toledo, Spain
| | - Carla Pérez-Alonso
- Department of General and Digestive Surgery, La Fe University Hospital, Valencia, Spain
| | - Elena Hurtado Caballero
- Department of General and Digestive Surgery, Coloproctology Unit, Gregorio Marañón University Hospital, Madrid, Spain
| | - Marta Pascual
- Department of General and Digestive Surgery, Coloproctology Unit, Hospital del Mar, Barcelona, Spain
| | - Javier García Septiem
- Department of General and Digestive Surgery, La Princesa University Hospital, Madrid, Spain
| | - Laura Mora López
- Department of General and Digestive Surgery, Parc Taulí University Hospital, Sabadell, Spain
| | - Jorge Cervera-Aldama
- Coloproctology Unit. General and Digestive Surgery Department. Cruces University Hospital. Barakaldo, Bizkaia, Spain
| | - Héctor Guadalajara
- Department of General and Digestive Surgery, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Eloy Espín
- Department of General and Digestive Surgery, Coloproctology Unit, Vall d'Hebron University Hospital, Autonomic University of Barcelona, Barcelona, Spain
| | - Esther Kreisler
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain; University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| |
Collapse
|
33
|
Şık N, Uzun A, Öztürk A, Aydın E, Zeki Karakuş O, Duman M, Yılmaz D. Uncommon presentation of Meckel's diverticulum in a child with decompensated hypovolemic shock. ULUS TRAVMA ACIL CER 2022; 28:1031-1034. [PMID: 35775669 PMCID: PMC10493833 DOI: 10.14744/tjtes.2020.39887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/03/2020] [Indexed: 11/20/2022]
Abstract
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and may cause serious complications such as intestinal obstruction, gastrointestinal hemorrhage, or inflammation with/without perforation, which can present with non-spe-cific symptoms and signs. We report on the case of a 2.5-year-old boy admitted to our emergency department in poor condition, with compatible signs of decompensated hypovolemic shock. This case finally resulted in intestinal volvulus and internal hernia, a very rare combination of two complications of MD, as determined in the operating room.
Collapse
Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Aslıhan Uzun
- Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Ali Öztürk
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Efil Aydın
- Department of Pediatric Surgery, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Osman Zeki Karakuş
- Department of Pediatric Surgery, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| |
Collapse
|
34
|
Valerii G, Ormando VM, Cellini C, Sacco L, Barbera C. Endoscopic management of intramural spontaneous duodenal hematoma: A case report. World J Gastroenterol 2022; 28:2243-2247. [PMID: 35721883 PMCID: PMC9157618 DOI: 10.3748/wjg.v28.i20.2243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/12/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intramural duodenal hematoma is a rare condition described for the first time in 1838. This condition is usually associated with blunt abdominal trauma in children. Other non-traumatic risk factors for spontaneous duodenal haematoma include several pancreatic diseases, coagulation disorders, malignancy, collagenosis, peptic ulcers, vasculitis and upper endoscopy procedures. In adults the most common risk factor reported is anticoagulation therapy. The clinical presentation may vary from mild abdominal pain to acute abdomen and intestinal obstruction or gastrointestinal bleeding.
CASE SUMMARY The aim of this case summary is to show a case of intramural spontaneous hematoma with symptoms of intestinal obstruction that was properly drained endoscopically by an innovative system lumen-apposing metal stent Hot AXIOS™ stent (Boston Scientific Corp., Marlborough, MA, United States).
CONCLUSION Endoscopic lumen-apposing metal stent Hot AXIOS™ stent is a safe and feasible treatment of duodenal intramural hematoma in our case.
Collapse
Affiliation(s)
- Giorgio Valerii
- Gastroenterology and Endoscopy Unit, Ospedale G. Mazzini, Teramo 64100, Italy
| | | | - Carlo Cellini
- Gastroenterology and Endoscopy Unit, Ospedale G. Mazzini, Teramo 64100, Italy
| | - Luca Sacco
- Surgery Unit, Ospedale G. Mazzini, Teramo 64100, Italy
| | - Carmelo Barbera
- Gastroenterology and Endoscopy Unit, Ospedale G. Mazzini, Teramo 64100, Italy
| |
Collapse
|
35
|
McDaniel C, Bell R, Farha N, Vozzo C, Bullen J, Rosen M, Romero-Marrero C, Partovi S, Kapoor B. Risk of hernia-related complications after transjugular intrahepatic portosystemic shunt creation in patients with pre-existing ventral abdominal hernias: 15-year experience at a quaternary medical center. BMJ Open Gastroenterol 2022; 9:bmjgast-2022-000876. [PMID: 35318192 PMCID: PMC8943763 DOI: 10.1136/bmjgast-2022-000876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/16/2022] [Indexed: 11/12/2022] Open
Abstract
Objective Transjugular intrahepatic portosystemic shunt (TIPS) placement is used to treat the sequelae of portal hypertension, including refractory variceal bleeding, ascites and hepatic hydrothorax. However, hernia-related complications such as incarceration and small bowel obstruction can occur after TIPS placement in patients with pre-existing hernias. The aim of this study was to determine the incidence of hernia complications in the first year after TIPS placement and to identify patient characteristics leading to an increased risk of these complications. Design This retrospective analysis included patients with pre-existing abdominal hernias who underwent primary TIPS placement with covered stents at our institution between 2004 and 2018. The 1-year hernia complication rate and the average time to complications were documented. Using a Wilcoxon rank-sum test, the characteristics of patients who developed hernia-related complications versus the characteristics of those without complications were compared. Results A total of 167 patients with pre-existing asymptomatic abdominal hernias were included in the analysis. The most common reason for TIPS placement was refractory ascites (80.6%). A total of 36 patients (21.6%) developed hernia-related complications after TIPS placement, including 20 patients with acute complications and 16 with non-acute complications. The mean time to presentation of hernia-related complications was 66 days. Patients who developed hernia-related complications were more likely than those without complications to have liver cirrhosis secondary to alcohol consumption (p=0.049), although this association was no longer significant after multivariate analysis. Conclusion Within 1 year after TIPS placement, approximately 20% of patients with pre-existing hernias develop hernia-related complications, typically within the first 2 months after the procedure. Patients with pre-existing hernia undergoing TIPS placement should be educated regarding the signs and symptoms of hernia-related complications, including incarceration and small bowel obstruction.
Collapse
Affiliation(s)
- Charles McDaniel
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ruth Bell
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Natalie Farha
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Catherine Vozzo
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jennifer Bullen
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Rosen
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Sasan Partovi
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | | |
Collapse
|
36
|
Vasilescu AM, Tarcoveanu E, Bradea C, Lupascu C, Stagnitti F. Gallstone Ileus. What therapeutic options are there? Ann Ital Chir 2022; 92:300-306. [PMID: 35122424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Gallstone ileus is a rare disorder in emergency surgical practice with diagnosis usually difficult and only achieved at surgery. The current approaches are: enterolithotomy, cholecystectomy and fistula repair (one-stage surgery), enterolithotomy with cholecystectomy performed later (two-stage surgery) and only enterolithotomy (most reported surgical procedure). METHODS The clinical, operative and follow-up data on 14 consecutive patients treated in our clinic for gallstone ileus was retrospectively reviewed. RESULTS Gallstone ileus was recorded in 0.06% of all operations for biliary lithiasis and 1% of all enteric occlusions. There were 11 women and one men, with a mean age of 77.3 (range 67-100) years. There was a mean delay of 3.16 days for onset of symptoms to admission. Urgent laparotomy confirmed gallstone obstruction and a cholecysto-duodenal fistula (13 cases) or cholecysto-colonic fistula (1 case). We performed one stage surgery in 4 cases, enterolithotomy alone in 8 cases (one case operated initially in another surgical service), Hartman procedure, cholecystectomy and fistula repair in one case and a spontaneous evacuation of the gallstone with cholecystectomy and fistula repair later in another case. We recorded 2 deaths in patients with multiple comorbidities in which only enterolithotomy was performed and with 1 and 2 reinterventions, respectively. Postoperative stay was 9.4 days for cases with simple enterolithotomy and 18.6 days for cases with radical treatment. We did not record any recurrence. CONCLUSIONS Although rarely encountered in surgical practice, gallstones ileus should be noted in the differential diagnosis of intestinal obstruction in patients with a past history of biliary disease, occlusive syndrome, pneumobilia and possibly ectopic gallstone. The one-stage procedure should be the offered to stabilized patients, but in cases with associated comorbidities, only enterolithotomy represent a best option. KEY WORDS Gallstone ileus, Cholecystoduodenal fistula, Intestinal Obstruction.
Collapse
|
37
|
Abstract
Abdominal pain in an immunocompromised patient represents a common clinical scenario that may have uncommon causes. Evaluation relies first on identifying the immunocompromise, whether due to congenital immunodeficiencies, malignancy, hematopoietic stem cell transplant, solid organ transplant, or human immunodeficiency virus/acquired immunodeficiency syndrome. Based on this determination, the emergency physician may then build a focused differential of pathophysiologic possibilities. Careful evaluation is necessary given the absence of classic physical examination findings, and liberal use of laboratory and cross-sectional imaging is prudent. Conservative evaluation and disposition of these high-risk patients is important to consider.
Collapse
Affiliation(s)
- Carmen Wolfe
- Department of Emergency Medicine, Vanderbilt University Medical Center, 1313 21st Avenue South, Oxford House 703, Nashville, TN 37232, USA.
| | - Nicole McCoin
- Department of Emergency Medicine, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| |
Collapse
|
38
|
Barberi C, Colaizzi C, Guerrini J, Kurihara H. Whirl sign: a common misinterpreted radiological entity. Intern Emerg Med 2021; 16:1703-1705. [PMID: 33386605 DOI: 10.1007/s11739-020-02571-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Caterina Barberi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Chiara Colaizzi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Jacopo Guerrini
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Hayato Kurihara
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| |
Collapse
|
39
|
Schmidt-Wilcke P, Knorr S, Wilhelm T. [The somewhat different cause of an obturation in stenosing terminal ileitis : Case report of a 39-year-old male patient with Crohn's disease]. Internist (Berl) 2020; 61:1298-1303. [PMID: 32945927 DOI: 10.1007/s00108-020-00872-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A possible classical complication of Crohn's disease is the formation of a stenosis, which can occur throughout the course of the disease and can present differently depending on the narrowing of the lumen. This article reports the case of a 39-year-old male patient with a stenosing terminal ileitis, which was ultimately only manifested after obstruction by a foreign body.
Collapse
Affiliation(s)
- P Schmidt-Wilcke
- Abteilung für Allgemein- und Viszeralchirurgie, St. Vinzenz Hospital Köln, Mehrheimerstr. 221-223, 50733, Köln-Nippes, Deutschland.
| | - S Knorr
- Abteilung für Allgemein- und Viszeralchirurgie, St. Vinzenz Hospital Köln, Mehrheimerstr. 221-223, 50733, Köln-Nippes, Deutschland
| | - T Wilhelm
- Abteilung für Allgemein- und Viszeralchirurgie, St. Vinzenz Hospital Köln, Mehrheimerstr. 221-223, 50733, Köln-Nippes, Deutschland
| |
Collapse
|
40
|
Baad M, Delgado J, Dayneka JS, Anupindi SA, Reid JR. Diagnostic performance and role of the contrast enema for low intestinal obstruction in neonates. Pediatr Surg Int 2020; 36:1093-1101. [PMID: 32572600 DOI: 10.1007/s00383-020-04701-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE We aim to evaluate the diagnostic performance and relationship between clinical characteristics, imaging findings, and final diagnosis for the neonatal contrast enema (CE). METHODS Retrospective 10-year review of all neonatal CEs including imaging findings, clinical information, indication, and final diagnosis from discharge summaries, surgical reports, and pathology (reference standard). Two blinded pediatric radiologists reinterpreted 366 CEs for obstruction, microcolon, rectosigmoid index (RSI), serrations, meconium, ileal cut-off, transition zone, diagnosis, and level of confidence. CE diagnostic performance was calculated versus reference standard. RESULTS Diagnoses included Hirschsprung disease (HD) (15.8%), small left colon syndrome (14.8%), small intestinal atresia/colonic atresia (SIA/CA) (12.6%), meconium ileus (MI) (4.4%), and normal (48.9%). CE had a moderate specificity (87.7%) and low sensitivity (65.5%) for HD; abnormal RSI and serrations showed high specificities (90.3%, 97.4%) but low sensitivities (46.6%, 17.2%). CE showed high specificity (97.4%) and low sensitivity (56.3%) for MI blinded to cystic fibrosis status. Microcolon was specific (96.6%) but not sensitive (68.8%) for MI. CE showed highest PPV (73.1%) (specificity 95.6%, sensitivity 82.6%) for SIA/CA. Microcolon with an abrupt cut-off was specific (99.1%) but not sensitive (41.3%) for atresias. CONCLUSION Neonatal CE demonstrates high specificities and low to moderate sensitivities across all diagnoses, with lowest performance in HD. CLINICAL TRIAL REGISTRATION None.
Collapse
Affiliation(s)
- Michael Baad
- Department of Radiology, Weill Cornell Medicine, 525 E 68th Street, Starr 8A-37, New York, NY, 10065, USA.
| | - Jorge Delgado
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jillian S Dayneka
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd, 3NW13, Philadelphia, PA, 19104, USA
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd, 3NW13, Philadelphia, PA, 19104, USA
| | - Janet R Reid
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd, 3NW13, Philadelphia, PA, 19104, USA
| |
Collapse
|
41
|
Sohail M, Alyson T, Sim SK, Nik Azim NA. Intestinal knotting: A case report and brief literature review. Med J Malaysia 2020; 75:606-608. [PMID: 32918439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Ileo-ileal knotting is a rare cause of intestinal obstruction. In this condition, one bowel loop makes a knot with an adjacent bowel loop, resulting in mechanical obstruction and even gangrene of the bowel. We present a case of a young girl with ileo-ileal knotting resulting in a closed-loop obstruction and gangrene of the small bowel loop. This is a difficult condition to diagnose; a high index of suspicion and early surgical intervention are essential to reduce morbidity and mortality.
Collapse
Affiliation(s)
- M Sohail
- Universiti Malaysia Sarawak, Faculty of Medicine and Health Sciences, Kota Samarahan, Sarawak, Malaysia.
| | - T Alyson
- Sarawak General Hospital, Department of Surgery, Jalan Hospital, Kuching, Sarawak, Malaysia
| | - S K Sim
- Universiti Malaysia Sarawak, Faculty of Medicine and Health Sciences, Kota Samarahan, Sarawak, Malaysia
| | - N A Nik Azim
- Sarawak General Hospital, Department of Surgery, Jalan Hospital, Kuching, Sarawak, Malaysia
| |
Collapse
|
42
|
Xie TH, Fu Y, Ren XX, Zhang J. Incarcerated hernia of the hypogastric linea alba accompanied by intestinal obstruction. Asian J Surg 2020; 43:870-871. [PMID: 32622531 DOI: 10.1016/j.asjsur.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/19/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Tian-Hao Xie
- Department of General Surgery, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China.
| | - Yan Fu
- Baoding First Central Hospital, Baoding, Hebei, 071000, China
| | - Xiang-Xiang Ren
- Department of General Surgery, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| | - Jing Zhang
- Department of General Surgery, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| |
Collapse
|
43
|
Lee MS, Shen M, Williams A, Kendrick D, Weizer A, Montgomery J. Retroureteral Small Bowel Herniation Resulting in Bowel Obstruction Following Robotic Cystectomy With Extracorporeal Ileal Conduit. Urology 2020; 147:3-6. [PMID: 32603744 DOI: 10.1016/j.urology.2020.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/29/2020] [Accepted: 06/07/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Matthew S Lee
- Department of Urologic Oncology, University of Michigan, Ann Arbor, MI.
| | - Mary Shen
- Department of General Surgery, University of Michigan, Ann Abor, MI
| | - Aaron Williams
- Department of General Surgery, University of Michigan, Ann Abor, MI
| | - Daniel Kendrick
- Department of General Surgery, University of Michigan, Ann Abor, MI
| | - Alon Weizer
- Department of Urologic Oncology, University of Michigan, Ann Arbor, MI
| | | |
Collapse
|
44
|
Abstract
INTRODUCTION Enteropathy-associated T-cell lymphoma (EATL) is a very rare form of lymphoma in the gastrointestinal tract. The proximal jejunum and ileum are the most common sites of EATL, whereas EATL rarely arises in the duodenum, and EATL involving metastasis of the bilateral ovaries is even rarer. PATIENT CONCERNS A 43-year-old female suffered from upper abdominal pain and weight loss for 3 months. DIAGNOSIS Type II EATL. INTERVENTIONS The patient was initially treated with chemotherapies, including 4 cycles of the CHOP-E and 2 cycles of the DHAP+ chidamide chemotherapy regimens. However, the patient did not respond well to chemotherapy. Surgical treatment of the duodenal obstruction, with perforation of small intestine and the duodenum, was performed successively. OUTCOMES The patient died of septic shock only 1 day after the surgery for the second perforation. Her overall survival was 11 months from the time of initial diagnosis. CONCLUSION This case suggests that EALT is highly invasive and its clinical course is very aggressive. Intestinal perforation, intestinal obstruction, or involvement of extraintestinal organs may occur in EALT patients. Additionally, EALT patients respond poorly to chemotherapy and have an extremely unfavorable prognosis.
Collapse
Affiliation(s)
| | - Liang He
- Department of Gastroenterological Surgery
| | - Yan Jiao
- Department of Hepatobiliary and pancreatic surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Helei Wang
- Department of Gastroenterological Surgery
| | - Jian Suo
- Department of Gastroenterological Surgery
| |
Collapse
|
45
|
Lu C, Baraty B, Robertson HL, Filyk A, Shen H, Fung T, Novak K, Ma C, Panaccione R, Achkar JP, Ouali SE, Bruining D, Jairath V, Feagan B, Rieder F. Systematic review: medical therapy for fibrostenosing Crohn's disease. Aliment Pharmacol Ther 2020; 51:1233-1246. [PMID: 32406116 PMCID: PMC7777136 DOI: 10.1111/apt.15750] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/16/2020] [Accepted: 04/05/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Medical therapy and/or endoscopic balloon dilation with intralesional therapies are options for the treatment of small bowel fibrostenotic Crohn's disease (CD). AIM To perform a systematic review summarising evidence for efficacy of systemic and endoscopic intralesional medical therapy in established small bowel strictures in adult CD patients. METHODS A systematic search of MEDLINE, EMBASE, CENTRAL and Scopus was conducted. Primary outcomes were rates of surgical resection and repeat endoscopic dilation. Pooled event rates from random effects models across studies with 95% confidence intervals were reported. RESULTS Ten studies describing systemic medical therapy and eight studies of intralesional injection were included. One randomised controlled trial each for systemic therapy and intrastricture injection were identified. Only observational studies were found for systemic biologic therapies, which exclusively included tumour necrosis factor (TNF) antagonists, while intralesional therapies all involved corticosteroids except for one study that evaluated infliximab. Pooled event rates for surgical resection after systemic and intralesional therapy were 28.3% (95% CI: 18.2%-41.3%) and 18.5% (95% CI: 8.3%-36.2%), respectively over a median follow-up of 23 months (range 5.5-105.8), and 21.8 months (range 5-47). Risk of repeat endoscopic balloon dilation in those with intralesional therapy was 58.3% (95% CI: 36.6%-77.3%) over a median follow-up of 21.8 months (range 5-47). CONCLUSIONS There are no favoured therapies for patients with stricturing small bowel CD. Data are lacking for ustekinumab and vedolizumab. No endoscopic intralesional medications provided a clear benefit for prevention of repeat EBD or surgery.
Collapse
Affiliation(s)
- Cathy Lu
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Brandon Baraty
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Gastroenterology, University of Sydney, Sydney, Australia
| | | | - Alexis Filyk
- Department of Life Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Hua Shen
- Department of Mathematics and Statistics, University of Calgary, AB, Canada
| | - Tak Fung
- Department of Mathematics and Statistics, University of Calgary, AB, Canada
| | - Kerri Novak
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Ma
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Robarts Clinical Trials Inc., London, Ontario, Canada; Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Paul Achkar
- Department of Gastroenterology, Hepatology & Nutrition; Digestive Diseases and Surgery Institute; Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sara El Ouali
- Department of Gastroenterology, Hepatology & Nutrition; Digestive Diseases and Surgery Institute; Cleveland Clinic Foundation, Cleveland, OH, USA
| | - David Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Vipul Jairath
- Robarts Clinical Trials Inc., London, Ontario, Canada; Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London Ontario, Canada
| | - Brian Feagan
- Robarts Clinical Trials Inc., London, Ontario, Canada; Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London Ontario, Canada
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition; Digestive Diseases and Surgery Institute; Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
46
|
Hwang S, Kim J, Jung JY, Ham EM, Park JW, Kwon H, Kim DK, Kwak YH. The epidemiology of childhood intussusception in South Korea: An observational study. PLoS One 2019; 14:e0219286. [PMID: 31860649 PMCID: PMC6924652 DOI: 10.1371/journal.pone.0219286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 06/20/2019] [Indexed: 11/19/2022] Open
Abstract
Intussusception is one of the most common causes of intestinal obstruction in young children. We report a retrospective, observational study of the epidemiology of intussusception in South Korea using the National Health Insurance Service-National Sample Cohort (NHIS-NSC). A cohort of newborns born between 2002 and 2008 was selected. The primary objective was to assess the incidence of intussusception in the pediatric population of Korea. The secondary objectives were to describe the basic epidemiological characteristics of intussusception and to identify risk factors. A total of 362 children were identified. The highest incidence of intussusception (2.6 per 1,000) was observed in children aged 1-2 years. A total of 58.8% of the children were male, and there was no significant difference in incidence according to the birth year (P = 0.804). Most of the children diagnosed with intussusception underwent air reduction, while only 0.6% had surgery. In all, 82.3% of the children were admitted to the hospital, 0.8% of them had to be admitted to the ICU, and the 6-month mortality was only 0.3%. In this retrospective, observational study, the incidence of intussusception was highest among children between 1 and 2 years of age. Most of the children underwent air reduction.
Collapse
Affiliation(s)
- Soyun Hwang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnan-si, Gyeonggi-do, Republic of Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail:
| | - Eun Mi Ham
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnan-si, Gyeonggi-do, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
47
|
Cao Y, Gu J, Deng S, Li J, Wu K, Cai K. Long-term tumour outcomes of self-expanding metal stents as 'bridge to surgery' for the treatment of colorectal cancer with malignant obstruction: a systematic review and meta-analysis. Int J Colorectal Dis 2019; 34:1827-1838. [PMID: 31515615 DOI: 10.1007/s00384-019-03372-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE To explore the long-term oncological results of self-expanding metal stents (SEMS) as a surgical transition compared with those of simple emergency surgery. METHODS A systematic review of studies involving long-term tumour outcomes comparing SEMS with emergency surgery was conducted. All studies included information on 3-year and 5-year survival rates, 3-year and 5-year disease-free survival (DFS) rates, and local and overall recurrence rates; the results were expressed as odds ratios. RESULTS Overall, 24 articles and 2508 patients were included, including 5 randomised controlled trials, 3 prospective studies, and 16 retrospective studies. The 3-year survival rate (odds ratio (OR) = 0.88, 95% confidence interval (CI) 0.69-1.12, P = 0.05), 5-year survival rate (OR = 0.91, 95% CI 0.70-1.17, P = 0.67), 3-year DFS rate (OR = 1.14, 95% CI 0.91-1.42, P = 0.65), 5-year DFS rate (OR = 1.35, 95% CI 0.91-2.02, P = 0.17), overall recurrence rate (OR 1.04, 95% CI 0.77-1.41, P = 0.14), and local recurrence rate (OR 1.37, 95% CI 0.84-2.23, P = 0.92) were determined. There was no significant difference between the randomised and observational studies in the subgroup analysis, and the 5-year survival rate was higher in studies with a stent placement success rate of ≥ 95%. CONCLUSION SEMS implantation was a viable alternative in malignant left colon obstruction as a transition to surgery; its long-term survival results, including 5-year DFS and overall survival, were equivalent to those of emergent surgery.
Collapse
Affiliation(s)
- Yinghao Cao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Junnan Gu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Shenghe Deng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Jiang Li
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Ke Wu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
| | - Kailin Cai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
| |
Collapse
|
48
|
Abstract
RATIONALE There have been a few reported cases of subacute combined degeneration (SCD) associated with vitamin E deficiency, but the period of intestinal malabsorption was more than several years. We present a rare case of acute onset SCD that occurred in a relatively short period of several weeks with vitamin E deficiency related to small bowel obstruction. PATIENT CONCERNS A 50-year-old woman had abdominal pain. A small bowel obstruction was suspected and conservative treatment was performed. She underwent bowel surgery after 2 weeks without any improvement. Following the operation, she was in a state of reduced consciousness. She was treated in an intensive care unit. Her consciousness level gradually recovered to alert in a week, but other symptoms such as ataxia, weakness on limbs, severe dysarthria, and dysphagia occurred. Since then, she had spent nearly 6 weeks in a bed-ridden state without improving. DIAGNOSIS SCD associated with vitamin E deficiency was confirmed by laboratory investigations, electrophysiologic test, and whole spine magnetic resonance imaging scans. INTERVENTIONS For vitamin E supplementation, she was administered a dose of 1200 mg/d. Physical therapy was focused on strengthening exercise, balance, and walker gait training. Occupational therapy was focused on activities of daily living training and dysphagia rehabilitation. OUTCOMES After 6 weeks, her muscle strengths and functional level were substantially improved. The vitamin E level was recovered to normal range. LESSONS This case suggests that if neurological symptoms occur in patients with intestinal obstruction, clinicians need to consider a deficiency of micronutrients such as vitamin E and vitamin B12. Patients with short clinical courses suffer less neurological damage and achieve faster recovery.
Collapse
Affiliation(s)
- Jong Burm Jung
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Yuntae Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Kiyoung Oh
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Soo A Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Joung Hyun Doh
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Hye Jeong Oh
- Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Jin Myoung Seok
- Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| |
Collapse
|
49
|
Lee MJ, Sayers AE, Drake TM, Singh P, Bradburn M, Wilson TR, Murugananthan A, Walsh CJ, Fearnhead NS. Malnutrition, nutritional interventions and clinical outcomes of patients with acute small bowel obstruction: results from a national, multicentre, prospective audit. BMJ Open 2019; 9:e029235. [PMID: 31352419 PMCID: PMC6661661 DOI: 10.1136/bmjopen-2019-029235] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the nutritional status of patients presenting with small bowel obstruction (SBO), along with associated nutritional interventions and clinical outcomes. DESIGN Prospective cohort study. SETTING 131 UK hospitals with acute surgical services. PARTICIPANTS 2069 adult patients with a diagnosis of SBO were included in this study. The mean age was 67.0 years and 54.7% were female. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was in-hospital mortality. Secondary outcomes recorded included: major complications (composite of in-hospital mortality, reoperation, unplanned intensive care admission and 30-day readmission), complications arising from surgery (anastomotic leak, wound dehiscence), infection (pneumonia, surgical site infection, intra-abdominal infection, urinary tract infection, venous catheter infection), cardiac complications, venous thromboembolism and delirium. RESULTS Postoperative adhesions were the most common cause of SBO (49.1%). Early surgery (<24 hours postadmission) took place in 30.0% of patients, 22.0% underwent delayed operation and 47.9% were managed non-operatively. Malnutrition as stratified by Nutritional Risk Index was common, with 35.7% at moderate risk and 5.7% at severe risk of malnutrition. Dietitian review occurred in just 36.4% and 55.9% of the moderate and severe risk groups. In the low risk group, 30.3% received nutritional intervention compared with 40.7% in moderate risk group and 62.7% in severe risk group. In comparison to the low risk group, patients who were at severe or moderate risk of malnutrition had 4.2 and 2.4 times higher unadjusted risk of in-hospital mortality, respectively. Propensity-matched analysis found no difference in outcomes based on use or timing of parenteral nutrition. CONCLUSIONS Malnutrition on admission is associated with worse outcomes in patients with SBO, and marked variation in management of malnutrition was observed. Future trials should focus on identifying effective and cost-effective nutritional interventions in SBO.
Collapse
Affiliation(s)
- Matthew James Lee
- Department of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, South Yorkshire, UK
| | - Adele E Sayers
- General Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, Kingston upon Hull, UK
| | - Thomas M Drake
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Pritam Singh
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Timothy R Wilson
- General Surgery, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | - Ciaran J Walsh
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Nicola S Fearnhead
- Colorectal Surgery, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| |
Collapse
|
50
|
Kuang LQ, Tang W, Li R, Cheng C, Tang SY, Wang Y. Optimized protocol of multiple post-processing techniques improves diagnostic accuracy of multidetector computed tomography in assessment of small bowel obstruction compared with conventional axial and coronal reformations. World J Gastroenterol 2019; 25:1100-1115. [PMID: 30862998 PMCID: PMC6406184 DOI: 10.3748/wjg.v25.i9.1100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/13/2019] [Accepted: 02/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Axial and coronal reformations have been a widely used image post-processing protocol for the ordinary multidetector computed tomography (MDCT) examination of patients with small bowel obstruction (SBO) or other abdominal diseases. The diagnostic accuracy of MDCT for assessing SBO is expected to be further improved through the use of multiple post-processing techniques.
AIM To systemically evaluate the diagnostic accuracy and efficiency of an optimized protocol using multiple post-processing techniques for MDCT assessment of SBO and secondary bowel ischemia.
METHODS This retrospective cross-sectional study included 106 patients with clinically suspected SBO. Two readers applied three protocols to image post-processing and interpretation of patients’ MDCT volume data. We compared the three protocols based on time spent, number of images, diagnostic self-confidence, agreement, detection rate, and accuracy of detection of SBO and secondary bowel ischemia.
RESULTS Protocol 2 resulted in more time spent and number of images than protocols 1 and 3 (P < 0.01), but the results of the two readers using the same protocol were not different (P > 0.05). Using protocol 3, both readers added multiple post-processing techniques at frequencies of 29.2% and 34.9%, respectively, for obstruction cause, and 32.1% and 30.2%, respectively, for secondary bowel ischemia. Protocols 2 and 3 had higher total detection rates of obstruction cause and secondary bowel ischemia than protocol 1 (P < 0.01), but no difference was detected between protocols 2 and 3 (P > 0.05). The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of protocols 2 and 3 were superior to those of protocol 1 for evaluating obstruction cause and secondary bowel ischemia.
CONCLUSION Our optimized protocol of multiple post-processing techniques can both guarantee efficiency and improve diagnostic accuracy of MDCT for assessing SBO and secondary bowel ischemia.
Collapse
Affiliation(s)
- Lian-Qin Kuang
- Department of Radiology, Army Medical Center of PLA, Army Medical University, Chongqing 400042, China
| | - Wei Tang
- Department of Radiology, Army Medical Center of PLA, Army Medical University, Chongqing 400042, China
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Ran Li
- Department of Radiology, Army Medical Center of PLA, Army Medical University, Chongqing 400042, China
| | - Cheng Cheng
- Department of Radiology, Army Medical Center of PLA, Army Medical University, Chongqing 400042, China
| | - Shuang-Yue Tang
- Department of Radiology, Army Medical Center of PLA, Army Medical University, Chongqing 400042, China
| | - Yi Wang
- Department of Radiology, Army Medical Center of PLA, Army Medical University, Chongqing 400042, China
| |
Collapse
|