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.

Intestinal Invagination in Adults: About a Case at the “Mother-Child” Hospital Le Luxembourg in Mali

Intussusception is a pathology of infants and young children. Its occurrence in adults is very unusual. In the vast majority of cases, it is secondary to a benign or malignant tumor. Small bowel malignancies are relatively rare, 1% - 5% of malignant tumors of the gastrointestinal tract. Acute intussusception, a rare pathology in adults, often presents with non-specific symptoms. Contrary to children, the organic origin remains preponderant in the elderly, where the origin of neoplasia must be suspected in first intention. We report the case of a 49-year-old patient admitted urgently from the Luxembourg “Mère Enfant” hospital center in Bamako, Mali, for an occlusive syndrome. Several abdomino-pelvic ultrasounds were performed in several clinics with mixed conclusions: Hydro-aeric distension and a cessation of matter and gas without a clearly visible mass (04/09/2022);Demonstration of the central hydro-aeric levels wider than high containing fine and regular folds corresponding to connivents whose aspect is in factor of left acute small intestine occlusion, to be completed by the surgical opinion (06/09/2022) and a third ultrasound showed a normal appearance of the liver, gallbladder, kidneys, pancreas, spleen, bladder and prostate;diffuse aero-colic distention without lesion of secondary appearance (21/11/2022). A frontal standing ASP dated 11/25/2022 showed hail-like hydro-aeric levels. Surgical management consisted of an open oncological resection of an obstructive bowel tumor with ileo-ileal invagination. The anatomopathological and immunohistochemical study of the surgical specimen concluded to diffuse small cell non-Hodgkin’s lymphoma, without vascular embolism. The resection limits pass into the healthy zone.

Aetiology of Vesico Vaginal Fistula (VVF)—Observation in Patients Managed at CCBRT (Comprehensive Community Based Rehabilitation in Tanzania) Hospital, Dar es Salaam, Tanzania. January to March 2016

In this manuscript the authors have studied the various causes of vesico-vaginal fistula (VVF) and described etiology, clinical characteristics, and surgical outcome of VVF patients managed at CCBRT. They show that out of 155 patients 104 had surgery for VVF, 25 for stress incontinence (SI), 7 for perineal tears, 6 for recto-vaginal fistula (RVF) and 5 for other reasons, such as urethral strictures and bladder stones. They found a rate of 37 (35.58% out of 104 patients) with definitely iatrogenic fistula and therefore support the observation also made by others that there is a shift in etiology of VVF.

Seasonal Frequency in Esophageal Atresia/Tracheo-Esophageal Fistula: Is there an Environmental Etiology?

Background: Esophageal Atresia and Tracheo-Esophageal Fistula (EA/TEF) occurs sporadically and its eti-ology is poorly understood. We observed six cases of EA/TEF within three weeks of October 2007 at the Lagos University Teaching Hospital (LUTH), Nigeria. Aims: To analyze the monthly trends of presentation of EA/TEF at the LUTH from 2002-7, test the hypothesis that the October figures were not due to chance and correlate data with known local disease patterns. Setting: Lagos University Teaching Hospital, Nigeria. Patients, Materials, Method: A retrospective analysis of all EA/TEFs managed at the LUTH within stated period. Results: 25 babies with EA/TEF presented over the period. 10 (40%) were seen in the month of Oc-tober, 5 (20%) occurred in May while the rest were spread over the rest of the months. Chi-square analysis confirmed that the EA/TEF cases occurred significantly more frequently in October (P < 0.001) and this ob-servation was unlikely due to chance. Conclusions: There seems to be a seasonal variation in the occurrence of EA/TEF in Lagos, with a significantly higher frequency in the month of October. 96% of mothers of ba-bies with EA/TEF lived in low socioeconomic parts of Lagos. This study highlights the possibility of local viral etiology of EA/TEF.

Biliary phytobezoar resulting in intestinal obstruction

Phytobezoar is the most common type of bezoar.It is composed of indigestible vegetable matter and is usually found in the stomach.Biliary phytobezoar is extremely rare and difficult to diagnose preoperatively.The pathogenesis is not clear,and there have been only a few reports of biliary bezoars associated with sphincteric impairmentat the ampulla of Vater.Here,we present a report of biliary bezoar that resulted in jejunal obstruction.We were unable to identifythe bezoar in the extrahepatic bile duct until it obstructed the small bowel lumen.To our knowledge,this is the first report of small bowel obstruction resulting frommigration of a biliary bezoar.

Gastrin,somatostatin,and experimental disturbance of the gastrointestinal tract in rats

INTRODUCTIONThe field of gastrointestinal hormones has expanded at a dizzying rate[1-4].Gastrointestinal hormones as regulatory peptides that appear to be major components of bodily integration and have important regulatory actions on physioligical function of the gastrointestinal tract .The successful isolation of some gastrointestinal hormones and the development of sensitive methods for their detection have led to the unexpected finding that they also exist in the brain .

Extracellular matrices for gastrointestinal surgery:Ex vivo testing and current applications

AIM:To assess the effects of bile and pancreatic juice on structural and mechanical resistance of extracellular matrices(ECMs) in vitro.METHODS:Small-intestinal submucosa(SIS),porcine dermal matrix(PDM),porcine pericardial matrix(PPM) and bovine pericardial matrix(BPM) were incubated in human bile and pancreatic juice in vitro.ECMs were examined by macroscopic observation,scanning electron microscopy(SEM) and testing of mechanical resistance.RESULTS:PDM dissolved within 4 d after exposure to bile or pancreatic juice.SIS,PPM and PDM retained their integrity for > 60 d when incubated in either digestive juice.The effect of bile was found to be far more detrimental to mechanical stability than pancreatic juice in all tested materials.In SIS,the loss of mechanical stability after incubation in either of the digestive secretions was less distinct than in PPM and BPM [mFmax 4.01/14.27 N(SIS) vs 2.08/5.23 N(PPM) vs 1.48/7.89 N(BPM)].In SIS,the extent of structural damage revealed by SEM was more evident in bile than in pancreatic juice.In PPM and BPM,structural damage was comparable in both media.CONCLUSION:PDM is less suitable for support of gastrointestinal healing.Besides SIS,PPM and BPM should also be evaluated experimentally for gastrointestinal indications.

A combined pig model to determine the net absorption of volatile fatty acids in the large intestine under different levels of crude fiber

Background:This study aimed to develop a combined model to quantify the net absorption of volatile fatty acids(VFA)in the large intestine(LI)of pigs.Methods:Fifteen female growing pigs(Duroc×Large White×Landrace)were ranked by body weight(30±2.1 kg)on day 0 and assigned to one of three treatments,namely the basal diet containing different crude fiber(CF)levels(LCF:3.0%CF,MCF:4.5%CF,and HCF:6.0%CF).The pigs were implanted with the terminal ileum fistula and the cannulation of the ileal mesenteric vein(IMV),portal vein(PV),and left femoral artery(LFA)from days 6 to 7.[13 C]-Labeled VFA and P-aminohippuric acid were constantly perfused into the terminal ileum fistula and the cannulation of the IMV(day 15),respectively.Blood samples were collected from the PV and the LFA during perfusion(5 h),and LI samples were collected.Results:The net flux of[12 C]-acetic acid in the PV was greater for LCF versus MCF(p=0.045),but no difference was observed in the net flux of[12 C]-propionic acid(p=0.505)and[12 C]-butyric acid(p=0.35)in the PV among treatments.The deposition of[12 C]-acetic acid in the LI was greater for LCF versus MCF(p=0.014),whereas the deposition of[12 C]-propionic acid(p=0.007)and[12 C]-butyric acid(p=0.037)in the LI was greater for LCF versus HCF.Conclusions:In conclusion,this pig model was found conducive to study the net absorption of VFAs in the LI,and LCF had more net absorption of VFAs in the LI than MCF and HCF.

Etiologies, Clinical Presentation and Outcome of Adult Patients Presenting with Bowel Obstruction on a Virgin Abdomen

Context: Generally in Africa, BO remains the leading cause of acute abdomen. We therefore sought to study the current etiological factors of intestinal obstruction on a virgin abdomen or unhealed abdomen at the central hospital of Yaoundé in order to better understand the main causes and to better anticipate and improve the diagnosis, management and the evolution of intestinal obstruction on a virgin abdomen. Method: The patients were prospectively included from June 2021 to May 2022, these patients were recruited from the digestive and emergency surgery units of the Yaoundé Central Hospital during the study period and who met the inclusion criteria, with suspicion of partial or total intestinal obstruction or those with an intraoperative confirmed diagnosis were enrolled. Results: We recruited 73 patients including 43 (60.3%) men and 29 (39.7%) women whose mean age was 42.5 years with extremes ranging from 16 to 70 years. Most of them consulted after 72 hours, i.e. 65.2% of cases due to self-medication or even prior consultations in the lower level center at the Central Hospital of Yaoundé. The patients retained for this work presented in majority the symptoms according to the abdominal pains, the stop of the materials and gases;meteorism and vomiting. Abdominal wall hernias with incarcerated intestinal loops were the most common cause of intestinal obstruction in an unscarred abdomen in adults at 38.4% of cases, followed by digestive tumors 23.3% and adhesions 17.8%. Exceptionally, a cluster of roundworms was found as the cause of intestinal obstruction in two of our patients. Complications occurred in 25 patients or 31.5% of cases and were dominated respectively by nausea and hematoma (36%), local infections (24%) and malaria (24%). Death occurred in 5 of our patients, or 6.8% of cases, and was mostly caused by hypovolemic shock (40%) and pulmonary embolism (40%). Conclusion: Intestinal obstructions on the abdomen without scarring remain the prerogative of young adults and are caused by strangulated hernias with incarcerated intestinal loops, tumors and adhesions. The rate of complications remains high and they are dominated by infectious pathology. Their mortality is clearly improving.

超声在克罗恩病并发症诊断中的应用

克罗恩病的并发症主要包括狭窄、肠瘘及脓肿等,给克罗恩病患者带来极大的痛苦,尤其是肠瘘及纤维性狭窄的形成更是外科手术的主要适应证,早期诊断并进行干预有助于改变克罗恩病远期临床结局。超声作为一种实时、经济、简便、有效的检查方式,在克罗恩病诊断中发挥重要作用,且各种超声技术的发展也给克罗恩病并发症的诊断带来更加积极的作用。本文就超声的各种技术在克罗恩病并发症诊断中的应用作一综述。

1例小肠双腔造瘘合并急性胰腺炎超高龄患者的营养支持护理

报道1例小肠双腔造瘘合并急性胰腺炎超高龄患者的营养支持护理经验。护理要点包括以营养状况评估、个体化的营养支持方案、使用肠内营养耐受性评估管理工具和中医适宜技术为主的营养支持护理,辅以功能锻炼和小肠双腔造口护理。患者急性胰腺炎期经过积极治疗,早期鼻空肠营养,及时调整营养支持方案为改良式(轻断食)喂养,现已恢复正常鼻饲量,营养状态良好。目前,小肠双腔造瘘合并急性胰腺炎的营养支持护理的相关报道较少,现将该患者的护理过程整理报道,以期为更多患者提供借鉴。

黄河三角洲地区135例小肠溃疡的临床分析

目的:总结黄河三角洲地区小肠溃疡患者的病因构成、内镜表现及临床特点,为临床诊治提供依据。方法:回顾性分析2020年5月1日—2023年3月1日于滨州医学院附属医院经小肠镜或胶囊内镜首次诊断为小肠溃疡的135例患者的临床资料。结果:黄河三角洲地区小肠溃疡多发于40~59岁,男女比例为1.55︰1。小肠溃疡的病因主要以克罗恩病最多见,临床表现多为腹痛、腹泻、便血和黑便,影像学检查特点为小肠管壁增厚、肠系膜淋巴结肿大及小肠管腔狭窄。小肠镜及胶囊内镜检出率分别为26.83%及8.67%,常见溃疡部位为回肠、回盲部和空肠,内镜下溃疡特点以不规则样、纵行、环形、节段性为主,病理改变主要是黏膜慢性炎和伴炎细胞浸润。结论:小肠溃疡的病因复杂,临床特点缺乏特异性,小肠镜及胶囊内镜有助于小肠溃疡的诊断,但内镜下的表现常有重叠,病理活检在疾病的诊断中仍具有一定的局限性,应进一步探究CT等辅助检查在小肠溃疡诊断及鉴别诊断中的作用。

重症肺炎从肠论治探析

肺与大肠相表里是中医整体观念的诸多表现形式之一,对医者的临床诊疗具有极大的指导意义。本文通过探讨中西医对重症肺炎的认识;肺与大肠的病理、生理相互影响;肺肠相关性的现代研究,以从肠治肺、肺肠合治角度来治疗重症肺炎。以大柴胡汤、黄连解毒汤法泄热通腑;以麻杏石甘汤、宣白承气汤法宣肺顺气;以玉屏风散、桂枝加龙骨牡蛎汤法补肺涩肠,培土生金。肺与大肠相表里理论下的肺肠合治原则避免了肺病治肺、肠病治肠的惯性模式,为重症肺炎的治疗提供了中医思路的支持。

基于“脾为之卫”理论探讨慢性荨麻疹因机证治

慢性荨麻疹作为临床中最为常见的过敏性皮肤病之一,其发作时瘙痒难耐且易反复发作的特性给患者身心带来了极大的困扰。在中医诊疗过程中,作者发现其诸多证候均与脾及卫气的失常有关。基于此,该文从古代文献中挖掘“脾为之卫”的理论内涵,认为脾具有在外调节卫气固护机表、在内运化水谷充养五脏的功用,同时胃肠道黏膜免疫系统和肠道菌群可作为“脾为之卫”的现代医学理论基础并与慢性荨麻疹的发病密切相关。在慢性荨麻疹的发病过程中,风邪侵袭是其产生、发展的外在病因,而脾失之卫是其迁延难愈的内在病机。基于上述病因病机,在用药方面需以健脾化湿、益气复卫为根本,以调和营卫、祛风达邪为关键;在针灸方面可选用足三里、血海、曲池为主穴,共奏培土生金、祛风止痒之效。综上所述,基于“脾为之卫”理论探讨慢性荨麻疹的病因、病机、证候及治疗,有助于丰富“脾为之卫”的理论内涵,并从整体观念的角度为临床辨治慢性荨麻疹提供有益思路和方法。

肠外瘘的外科阶段治疗策略

目的:总结肠瘘不同阶段的治疗经验及分期手术策略在肠瘘确定性手术治疗中的应用。方法:采用回顾性病例数据,收集2016年1月—2019年12月清华大学附属北京清华长庚医院收治的255例肠瘘患者的临床资料,包括患者年龄、性别、原发疾病、致瘘原因、瘘的部位、瘘的数量、瘘的性质、瘘发生到就诊时间、肠瘘诊断评估方式、营养风险、营养支持方式、入院感染状态等进行初步总结。根据肠瘘病理生理特点进行肠瘘阶段治疗:肠瘘急性阶段-肠瘘稳定阶段-肠瘘确定性手术阶段。肠瘘确定性手术分期治疗:I期手术和分期手术。并分析各个阶段治疗策略和治疗效果。结果:肠瘘急性阶段(141例),局部感染患者与严重感染患者之间的腹腔脓肿处理方式有明显差异(P=0.023),损伤控制外科手术适合严重感染患者。141例均进入肠瘘稳定阶段,其中112例患者接受全过程治疗,28例放弃,1例死亡。112例完整治疗患者中,75例治愈(治愈率83.7%),37例保守无效进入肠瘘确定性手术阶段;联合114例外院保守无效肠瘘患者;共计151例进入肠瘘确定性手术阶段;其中134例行Ⅰ期手术,17例行分期手术。151例患者手术治疗的总体结局,138例治愈(治愈率为91.4%)。结论:根据肠瘘患者的发生和病理生理,正确归入肠瘘急性阶段、肠瘘稳定阶段或肠瘘确定性手术阶段并进行相应的治疗至关重要。另外,合理的手术时机和分期手术策略也是手术治疗肠瘘的关键所在。

腹腔镜根治术治疗胃癌的疗效及对肿瘤标志物及氧化应激反应的影响

目的 探讨腹腔镜根治术治疗胃癌的临床效果及对患者肿瘤标志物及氧化应激水平的影响。方法 选取78例胃癌患者,按随机数字表法分为2组,各39例。对照组行开腹根治术治疗,观察组行腹腔镜根治术治疗。比较两组手术情况、肿瘤标志物、氧化应激水平、炎症水平及并发症发生情况。结果 观察组手术、排气及住院时间分别为(221.52±13.25)min、(1.52±0.39)d、(10.98±2.04)d,较对照组[(257.63±14.13)min、(2.38±0.43)d、(14.39±2.18)d]短,出血量为(209.63±12.43)ml,低于对照组的(296.87±15.38)ml,有统计学差异(P<0.05);观察组术后癌胚抗原(CEA)、糖类抗原199(CA199)、糖类抗原125(CA125)水平分别为(14.63±2.08)ng/ml、(34.35±3.82)U/ml、(37.25±3.96)U/ml,较对照组[(18.28±2.24)ng/ml、(40.16±4.02)U/ml、(42.58±4.23)U/ml]低,有统计学差异(P<0.05);观察组术后超氧化物岐化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)水平分别为(67.85±6.14)U/ml、(218.96±23.52)pg/ml,高于对照组的(55.73±6.05)U/ml、(186.74±19.68)pg/ml,丙二醛(MDA)水平为(25.37±3.19)U/L,低于对照组的(30.82±3.57)U/L,有统计学差异(P<0.05);观察组术后C反应蛋白(CRP)、白介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平分别为(20.41±2.86)mg/L、(25.96±3.12)ng/L、(69.85±5.37)ng/L,低于对照组的(26.93±3.12)mg/L、(31.52±3.45)ng/L、(78.52±6.05)ng/L,并发症发生率低于对照组,有统计学差异(P<0.05)。结论 腹腔镜根治术治疗胃癌效果优于开腹根治术,能降低CA199、CEA、CA125水平,减轻机体创伤,抑制氧化应激反应,阻止炎症因子活化,减少并发症发生,值得广泛应用。

负压辅助冲洗引流在肠外瘘伤口管理中的应用效果

目的探讨负压辅助冲洗引流在肠外瘘伤口管理中的应用效果。方法对南昌市第一医院2012年8月至2023年8月收治的22例采用负压辅助冲洗引流进行伤口管理的肠外瘘患者的临床资料进行回顾性分析。结果22例患者经负压辅助冲洗引流治疗后治愈19例(86.4%),其中瘘口自行闭合9例、经手术治疗痊愈10例;死亡2例,其中1例为高流量瘘、1例因肿瘤复发自发肠外瘘。22例患者治疗后白细胞、中性粒细胞计数均较治疗前显著降低(P<0.01)。结论负压辅助冲洗引流能有效管理肠外瘘伤口,促进感染恢复。

老年原发性胃癌患者腹腔镜手术后肠瘘发生的相关影响因素

目的研究老年原发性胃癌患者接受腹腔镜手术治疗后发生肠瘘的相关影响因素。方法择取150例老年原发性胃癌患者作为研究对象。所有患者均接受腹腔镜手术治疗,依据术后是否发生肠瘘进行分组,将发生肠瘘的40例患者纳入观察组,将未发生肠瘘的110例患者纳入对照组。对2组患者的资料数据展开比对分析,针对有统计学意义的单因素开展多元回归分析,以明确导致患者术后发生肠瘘的影响因素。结果观察组年龄≥75岁、糖尿病、肝硬化、术前营养不良患者占比均高于对照组,其消化道重建方式为BillroNhⅠ患者占比亦高于对照组(P<0.05);多元回归分析中,糖尿病、肝硬化、术前营养状态以及消化道重建方式为术后发生肠瘘的主要影响因素。结论老年原发性胃癌患者接受腹腔镜手术治疗后并发肠瘘与糖尿病、肝硬化、手术前营养状态以及消化道重建方式等因素有关。

肠道菌群与帕金森病相关性的研究进展

帕金森病(PD)是老年人常见的神经退行性疾病,其病因复杂多样,目前尚无治愈方法。PD的发病与肠道菌群有密切联系,健康人群和PD患者的肠道菌群存在很大差异,PD患者的肠道菌群失调会引起宿主肠道炎症反应、肠道屏障的破坏和多巴胺能神经元的丢失,导致PD的发病或症状加重,甚至会影响患者药物治疗的效果。而粪菌移植可通过改善患者的肠道微生物种群的多样性和功能而达到治疗PD的目的。未来对PD与肠道菌群的关系进行深入研究,能为PD的预防及治疗提供新思路。

1例结肠癌术后吻合口瘘伴腹壁瘘病人应用气囊导管冲洗治疗的护理

总结1例结肠癌术后吻合口瘘伴腹壁瘘病人应用气囊导管冲洗治疗的护理经验。护理要点包括体位管理、腹壁瘘管的冲洗和引流的护理、营养支持的护理、心理护理。经41 d治疗后,病人瘘口愈合良好,腹壁皮肤瘢痕愈合,未发生护理并发症,效果满意。