New application of intestinal obstruction catheter in enterocutaneous fistula:A case report

BACKGROUND Enterocutaneous fistula(ECF)is an abnormal connection between the gastrointestinal tract and the skin.ECF can lead to massive body fluid loss,hypercatabolism,and malnutrition.Therefore,nutritional support plays a crucial role in managing ECFs and promoting the healing of fistulas.For nutritional support,enteral nutrition(EN)is the preferred method when gastrointestinal function is recovering.Currently,various EN approaches have been applied for different anatomical positions of the ECF.However,the effectiveness of administering EN support for treating lower ECFs still needs further exploration and improvement.CASE SUMMARY We present the case of a 46-year-old male who underwent gastrointestinal stromal tumour resection.Six days after the surgery,the patient presented with fever,fatigue,severe upper abdominal pain,and septic shock.Subsequently,lower ECFs were diagnosed through laboratory and imaging examinations.In addition to symptomatic treatment for homeostasis,total parenteral nutrition support was administered in the first 72 h due to dysfunction of the intestine.After that,we gradually provided EN support through the intestinal obstruction catheter in consideration of the specific anatomic position of the fistula instead of using the nasal jejunal tube.Ultimately,the patient could receive optimal EN support via the catheter,and no complications were found during the treatment.CONCLUSION Nutritional support is a crucial element in ECF management,and intestinal obstruction catheters could be used for early EN administration.

Pharmacodynamic Experiment of Dachengqi Decoction and Separated Decoction on Incomplete Intestinal Obstruction in Rats

[Objectives]To investigate the effect and mechanism of Dachengqi Decoction and separated decoction on incomplete intestinal obstruction in rats.[Methods]80 healthy SD rats were selected to establish incomplete intestinal obstruction model by silk ligation.The dosage was 20 mL/kg for 3 d,and the damage index of ileocecal mucosa was analyzed;the morphology of ileocecal mucosa was observed by HE staining;the serum levels of IL-1α,IL-1β,IL-6,IL-18,Ach,NO,ET,IL-1,TNF-αand ultra-micro Na+-K+-ATPase were detected by ELISA.[Results]Compared with the model group,the mucosal damage index of Dachengqi Decoction and each separated decoction group decreased significantly(P<0.05);compared with the normal group and sham operation group,the serum level of IL-1,IL-6,TNF-αand other factors in the model group increased significantly(P<0.05);compared with the model group,the serum IL-1,IL-6 and TNF-αsecretion levels of rats in Dachengqi Decoction group and separated decoction group decreased(P<0.01).[Conclusions]Dachengqi Decoction and each separated decoction can effectively improve intestinal tissue pathological damage in the incomplete intestinal obstruction model rats,and reduce the inflammatory reaction in the rat body.

Nursing Care of a Patient with Active Crohn’s Disease Complicated with Small Intestinal Obstruction

This study summarizes the nursing experience of a patient with active Crohn’s disease in the acute stage,complicated by small bowel obstruction.Key aspects of nursing include psychological response guidance during the active phase of Crohn’s disease,support before and after various gastroenteroscopy procedures and related reports,and self-monitoring guidance for symptoms such as intestinal obstruction combined with endoscopic mucosal ulcers.Using the 5A nursing model,nursing staff assessed the patient’s needs,provided targeted nursing recommendations in stages,implemented health behavior strategies,and offered continuous nursing care,including positive support for sexual health beliefs.These interventions helped the patient overcome psychological challenges,such as resistance to indwelling gastric tubes,and adopt healthy behaviors.After six weeks of follow-up through phone and WeChat consultations,the patient demonstrated significant improvement,including a weight gain of 15 kg.Various test results indicated normalized nutritional and inflammatory indexes,and the Crohn’s Disease Activity Index decreased by≥70 points.In conclusion,establishing a nursing team and applying the 5A nursing model to formulate detailed nursing diagnoses and interventions can significantly improve outcomes for patients with active Crohn’s disease complicated by small intestinal obstruction.

Relevance of Medical Imaging in the Pre-Therapeutic Evaluation of Acute Intestinal Obstruction at CIMED

Objective: We initiated this work with the aim of studying the contribution of imaging in the diagnosis of acute intestinal obstruction at CIMED. Patients and methods: This was a prospective, descriptive and analytical study involving 96 patients collected at the radiology and medical imaging department of CIMED, from January 2022 to January 2023. Result: The age of our patients varied between 11 and 86 years with an average age of 36 years. There was a male predominance of 64.6% compared to 35.4% for women, i.e. a sex ratio of 1.82. The notion of previous surgery was found in 61.5% of our patients. Pain was present in all patients. Radiography of the ASP was performed in 89.6% of patients. It showed hydro-aerial levels in 96.5% of patients. Abdominopelvic CT was performed in 12 patients and made it possible to make the diagnosis of occlusion in all patients. The results of the positive diagnosis were concordant with those intraoperatively in 92% of cases. 8% of our patients, compared to the treatment, spontaneously resumed their transit, 91% benefited from surgical treatment and 1% died before surgery. The outcome was favorable in 80 patients or 83.3%, poor with death in 16 patients or 16.7% of cases. Conclusion: Acute intestinal obstruction remains a serious pathology for which ASP radiography often remains the only radiological examination performed urgently. However, abdominopelvic CT seems widely indicated thanks to its contribution both for the positive diagnosis and for the serious and etiological diagnoses. However, this imaging technique is largely underused in our practice due to its high cost and lack of availability.

Postoperative abdominal herpes zoster complicated by intestinal obstruction:A case report

BACKGROUND Intestinal obstruction is a common occurrence in clinical practice.However,the occurrence of herpes zoster complicated by intestinal obstruction after abdominal surgery is exceedingly rare.In the diagnostic and treatment process,clinicians consider it crucial to identify the primary causes of its occurrence to ensure effective treatment and avoiding misdiagnosis.CASE SUMMARY Herein,we present the case of a 40-year-old female patient with intestinal obstruction who underwent laparoscopic appendectomy and developed herpes zoster after surgery.Combining the patient's clinical manifestations and relevant laboratory tests,it was suggested that the varicella zoster virus reactivated during the latent period after abdominal surgery,causing herpes zoster.Subsequently,the herpes virus invaded the visceral nerve fibers,causing gastrointestinal dysfunction and loss of intestinal peristalsis,which eventually led to intestinal obstruction.The patient was successfully treated through conservative treatment and antiviral therapy and subsequently discharged from the hospital.CONCLUSION Pseudo-intestinal obstruction secondary to herpes zoster infection is difficult to distinguish from mechanical intestinal obstruction owing to various causes.In cases of inexplicable intestinal obstructions,considering the possibility of a viral infection is essential to minimize misdiagnosis and missed diagnoses。

Risk factors for congenital nasolacrimal duct obstruction in children under two years of age

·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz,Iran,from June 2022 to June2024.A control group of 122 age-matched children without CNLDO was also included for comparison.Data was collected from the children's medical records.·RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors,such as preeclampsia,the use of levothyroxine,hypothyroidism,having more than three pregnancies(gravidity>3),natural pregnancy,and gestational diabetes mellitus.Additionally,in children,factors,such as oxygen therapy,anemia,reflux,jaundice,and a family history of CNLDO in first-degree relatives were associated with CNLDO,and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.·CONCLUSION:Given that CNLDO affects both premature and full-term children,the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction,thereby preventing the onset of chronic dacryocystitis.

Internal hernia as a rare cause of small bowel obstruction:An insight from 13 years of experience

BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.

Revisiting malignant gastric outlet obstruction: Where do we stand?

The scope of management of malignant gastric outlet obstruction is ever-expanding.The therapeutic use of endoscopy is gaining popularity not just owing to its technical advancement and satisfactory patient outcomes.With technical success rates close to 96%,stent placement for palliating gastric obstruction has ensured a median survival of about 2 months post-deployment of gastro-duodenal stents.Understanding the correct concept of palliation is the need of the hour in management.Identifying the right patient for palliation,selecting the appropriate intervention and auditing the outcome are vital in delivering optimal care.Also,newer procedures such as endoscopic gastro-enterostomy offer promising outcomes in palliative care.

Harnessing multi-omics approaches to elucidate the role of Chinese herbal compounds in chemotherapy-induced gastrointestinal damage

In this editorial,we discuss the findings reported by Wang et al in the latest issue of the World Journal of Gastrointestinal Oncology.Various research methodologies,including microbiome analysis,assert that the Tzu-Chi Cancer-Antagonizing and Life-Protecting II Decoction of Chinese herbal compounds mitigates inflammatory responses by inhibiting the NF-κB signaling pathway.This action helps maintain the dynamic equilibrium of the intestinal microecology and lessens chemotherapy-induced gastrointestinal damage.The efficacy of these compounds is intimately linked to the composition of intestinal microbes.These compounds regulate intestinal microecology by virtue of their specific compatibility and effectiveness,thereby enhancing the overall therapeutic outcomes of cancer chemotherapy.Nonetheless,the exact mechanisms underlying these effects warrant further investigation.Multi-omics technologies offer a systematic approach to elucidate the mechanisms and effectiveness of Chinese herbal compounds in vivo.This manuscript reviews the application of multi-omics technologies to Chinese herbal compounds and explores their potential role in modulating the gastrointestinal microenvironment following cancer chemotherapy,thus providing a theoretical foundation for their continued use in adjunct cancer treatment.

Small bowel obstruction due to intra-abdominal hernia:New thoughts on diagnosis and treatment

Internal herniation(IH)refers to the movement of intra-abdominal organs or tissues out of their original position through normal or abnormal orifices and fissures in the peritoneum or mesentery and into an anatomic space within the abdominal cavity.Although the incidence of small bowel obstruction(SBO)caused by IH is very low(approximately 0.2%to 0.9%),its incidence may be increased in certain specific populations or in postoperative patients.Recently Kaw et al shared their 13-year experience of managing IHs in a tertiary care hospital in India.This retrospective study analyzed and determined the clinico-demographic profiles,radiological and operative findings and postoperative course of patients with IH and the association with SBO.The results provide valuable insights into early diagnosis and establishment of a timely treatment regimen for this condition and emphasize the importance of combining rapid imaging evaluation with the traditional therapeutic approach of laparoscopic surgery,thus providing a novel perspective on the diagnosis and treatment of SBO caused by IH.

Gastrointestinal bleeding due to small bowel metastasis from lung adenocarcinoma:A case report

BACKGROUND Lung cancer is the most prevalent malignant tumor in human body,and is characterized by a high level of malignancy.The most common metastatic sites include the liver,bone,brain,and adrenal gland,while lung cancer resulting in gastrointestinal tract metastasis is uncommon.CASE SUMMARY A 74-years-old man with lung cancer was hospitalized owing to blood in the stool,The cause was identified as metastasis to the small intestine,and the patient subsequently underwent radical resection of the small intestine tumor.Currently,the overall condition of the patient is good,and undergoing combined chemotherapy.CONCLUSION Early intervention in patients with metastatic tumors can significantly improve prognosis.

Clinical significance of perioperative probiotic intervention on recovery following intestinal surgery

Restoring the balance of gut microbiota has emerged as a critical strategy in treating intestinal disorders,with probiotics playing a pivotal role in maintaining bacterial equilibrium.Surgical preparations,trauma,and digestive tract reconstruction associated with intestinal surgeries often disrupt the intestinal flora,prompting interest in the potential role of probiotics in postoperative recovery.Lan et al conducted a prospective randomized study on 60 patients with acute appendicitis,revealing that postoperative administration of Bacillus licheniformis capsules facilitated early resolution of inflammation and restoration of gastrointestinal motility,offering a novel therapeutic avenue for accelerated postoperative recovery.This editorial delves into the effects of perioperative probiotic supplementation on physical and intestinal recovery following surgery.Within the framework of enhanced recovery after surgery,the exploration of new probiotic supplementation strategies to mitigate surgical complications and reshape gut microbiota is particularly intriguing.

Protective effects of probiotics against methotrexate-induced intestinal toxicity in the mice model

Objective:The objective of this study was to determine the level of methotrexate(MTX)toxicity in the intestines of mice and to evaluate the protective effect of probiotics composed of Streptococcus,Bifidobacterium,and Lactobacillus species on intestinal cells during MTX treatment.Methods:Mice were divided into three groups:control,MTX group(received MTX injections),and MTX+probiotics group(received MTX injections along with a diet containing probiotics).Morphological and histological changes,the level of mitochondrial DNA(mtDNA)damage,the level of lipid peroxidation products,and gene expression in the mice’s small intestine were assessed.Results:We demonstrated that intraperitoneal MTX injections significantly increased mtDNA damage in the liver(p<0.001),small intestine(p<0.001),and blood of mice(p<0.01).MTX elevated the quantity of lipid peroxidation products in the liver and small intestine,indicating its strong prooxidative properties.MTX induced structural changes in the mice’s intestines,characterized by leukocytic infiltration of tissues.Probiotic therapy in mice partially mitigated the morphological and histological changes in the small intestine induced by MTX,reduced oxidative stress,and promoted increased expression of quinone oxidoreductase 1(Nqo1),which participates in both cell protection against oxidative stress and drug/xenobiotic detoxification.Probiotics prevented the upregulation of the proinflammatory cytokine IL-1b in the small intestine and induced increased expression of genes associated with the Nuclear factor erythroid 2-related factor 2/Antioxidant response element(Nrf2/ARE)pathway,an important mechanism of cell protection.Conclusions:Probiotics can be considered an effective approach to reducing the toxicity of MTX during psoriasis or cancer treatment.

Proximal small intestinal bypass outperforms Roux-en-Y and jejunoileal bypass in glucose regulation in streptozotocin induced diabetic rats

BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their glycemic control outcomes.We hypothesize that proximal small intestinal bypass(PSIB)is superior in blood glucose reduction over Roux-en-Y gastric bypass(RYGB)and jejunoileal bypass(JIB).AIM To compare the effectiveness of PSIB,RYGB,and JIB in lowering blood glucose.METHODS Rats with streptozotocin-induced diabetes were randomly divided into PSIB,RYGB,JIB,and sham-operated groups.Body weight,food intake,fasting blood glucose level,oral glucose tolerance test,insulin tolerance test,liver enzymes,and blood lipids were measured.RESULTS Postoperatively,only the JIB group had a lower body weight compared to the sham group.The food intake of the rats in all three surgical groups was significantly less than that in the sham group.Fasting blood glucose was reduced in all surgical groups and was lower in the PSIB group than in the RYGB and JIB groups.Glucose tolerance and insulin sensitivity improved in all three surgical groups compared to the sham group,but the improvement appeared earliest in the PSIB group.At six weeks postsurgery,the PSIB group showed a reduction in alanine transaminase levels and maintained a normal lipid profile.CONCLUSION PSIB demonstrated excellent hypoglycemic effects in the early postoperative period,and had better efficacy than RYGB and JIB.

Extracellular matrix gene set and microRNA network in intestinal ischemia-reperfusion injury:Insights from RNA sequencing for diagnosis and therapy

Intestinal ischemia-reperfusion injury(IIRI)is a complex and severe pathophysiological process characterized by oxidative stress,inflammation,and apoptosis.In recent years,the critical roles of extracellular matrix(ECM)genes and microRNAs(miRNAs)in IIRI have garnered widespread attention.This review aims to systematically summarize the diagnostic and therapeutic potential of ECM gene sets and miRNA regulatory networks in IIRI.First,we review the molecular mechanisms of IIRI,focusing on the dual role of the ECM in tissue injury and repair processes.The expression changes and functions of ECM components such as collagen,elastin,and matrix metalloproteinases during IIRI progression are deeply analyzed.Second,we systematically summarize the regulatory roles of miRNAs in IIRI,particularly the mechanisms and functions of miRNAs such as miR-125b and miR-200a in regulating inflammation,apoptosis,and ECM remodeling.Additionally,this review discusses potential diagnostic biomarkers and treatment strategies based on ECM genes and miRNAs.We extensively evaluate the prospects of miRNA-targeted therapy and ECM component modulation in preventing and treating IIRI,emphasizing the clinical translational potential of these emerging therapies.In conclusion,the diagnostic and therapeutic potential of ECM gene sets and miRNA regulatory networks in IIRI provides new directions for further research,necessitating additional clinical and basic studies to validate and expand these findings for improving clinical outcomes in IIRI patients.

Investigating the impact of intestinal glucagon-like peptide-1 on hypoglycemia in type 1 diabetes

Recent advances in understanding type 1 diabetes(T1D)highlight the complexity of managing hypoglycemia,a frequent and perilous complication of diabetes therapy.This letter delves into a novel study by Jin et al,which elucidates the role of intestinal glucagon-like peptide-1(GLP-1)in the counterregulatory response to hypoglycemia in T1D models.The study employed immunofluorescence,Western blotting,and enzyme-linked immunosorbent assay to track changes in GLP-1 and its receptor expression in diabetic mice subjected to recurrent hypoglycemic episodes.Findings indicate a significant increase in intestinal GLP-1 and GLP-1 receptor expression,correlating with diminished adrenal and glucagon responses,crucial for glucose stabilization during hypoglycemic events.This letter aims to explore the implications of these findings for future therapeutic strategies and the broader understanding of T1D management.

Keratin 1 modulates intestinal barrier and immune response via kallikrein kinin system in ulcerative colitis

BACKGROUND External factors in ulcerative colitis(UC)exacerbate colonic epithelial permea-bility and inflammatory responses.Keratin 1(KRT1)is crucial in regulating these alterations,but its specific role in the progression of UC remains to be fully eluci-dated.AIM To explore the role and mechanisms of KRT1 in the regulation of colonic epithelial permeability and inflammation in UC.METHODS A KRT1 antibody concentration gradient test,along with a dextran sulfate sodium(DSS)-induced animal model,was implemented to investigate the role of KRT1 in modulating the activation of the kallikrein kinin system(KKS)and the cleavage of bradykinin(BK)/high molecular weight kininogen(HK)in UC.RESULTS Treatment with KRT1 antibody in Caco-2 cells suppressed cell proliferation,induced apoptosis,reduced HK expression,and increased BK expression.It further downregulated intestinal barrier proteins,including occludin,zonula occludens-1,and claudin,and negatively impacted the coagulation factor XII.These changes led to enhanced activation of BK and HK cleavage,thereby intensifying KKS-mediated inflammation in UC.In the DSS-induced mouse model,administration of KRT1 antibody mitigated colonic injury,increased colon length,alleviated weight loss,and suppressed inflammatory cytokines such as interleukin(IL)-1,IL-6,tumor necrosis factor-α.It also facilitated repair of the intestinal barrier,reducing DSS-induced injury.CONCLUSION KRT1 inhibits BK expression,suppresses inflammatory cytokines,and enhances markers of intestinal barrier function,thus ameliorating colonic damage and maintaining barrier integrity.KRT1 is a viable therapeutic target for UC.

Modified Pulsatilla decoction alleviates 5-fluorouracil-induced intestinal mucositis by modulating the TLR4/MyD88/NF-κB pathway and gut microbiota

BACKGROUND Modified Pulsatilla decoction(PD),a PD with licorice and ejiao,is a classic Traditional Chinese Medicine formula with significant efficacy in treating intestinal mucositis(IM)induced by tumor therapy.However,its specific molecular and biological mechanisms remain unclear.AIM To investigate the therapeutic effect and mechanism of modified PD in IM.METHODS This study used an IM mouse model established using 5-fluorouracil injections to investigate the effects of the modified PD(3,6,and 12 g/kg)in IM.The primary chemical components of the modified PD were identified using liquid chromatography-mass spectrometry.Body weight loss,diarrhea scores,intestinal length,histopathological scores,and inflammatory cytokine levels were measured to evaluate the effects of the modified PD in IM.Effects on the TLR4/MyD88/NF-κB pathway were evaluated using western blot analysis.The intestinal microbiota was characterized using Illumina NovaSeq sequencing.RESULTS The results showed that modified PD significantly improved weight loss and diarrhea and shortened the intestines in IM mice.Mechanistically,modified PD suppressed the TLR4/MyD88/NF-κB pathway and downregulated the expression of reactive oxygen species,lipopolysaccharides,and pro-inflammatory cytokines(IL-1β,TNF-α,IFN-γ,IL-6,IL-8,and IL-17),while increasing the expression of the anti-inflammatory cytokine IL-10.Furthermore,modified PD protected the intestinal mucosal barrier by increasing the expression of tight junction proteins(occludin-1,claudin-1,and ZO-1)and mucin-2.Finally,16S rDNA sequencing revealed that modified PD improved intestinal dysbiosis.CONCLUSION Our research offers new insights into the potential mechanism of modified PD in alleviating IM and provides experimental evidence supporting its pharmaceutical application in clinical IM treatment.

Lipoma within inverted Meckel’s diverticulum as a cause of recurrent partial intestinal obstruction and hemorrhage: A case report and review of literature

Lipoma within an inverted Meckel's diverticulum presen- ting with hemorrhage and partial intestinal obstruction is an exceptional clinical entity. We report a case of 47-year-old male with a history of recurrent episodes of partial intestinal obstruction and melena due to a subserosal lipoma located in the base of an inverted Meckel's diverticulum. According to our knowledge, this is the first case of a lipoma within a Meckel's diverticulum giving rise to this clinical scenario without the existence of heterotrophic gastric or pancreatic tissues.

Phasic study of intestinal homeostasis disruption in experimental intestinal obstruction

AIM: To investigate the phasic alteration of intestinal homeostasis in an experimental model of intestinal obstruction.