Uterine-ileal perforation post pregnancy related dilatation and curettage managed by laparoscopic small bowel resection and primary anastomosis: A case report

Although rare,small bowel perforation post pregnancy related dilation and curettage presents a serious complication.Herein,we reported a case of 34-year-old female patient presenting for uterine-ileal perforation post pregnancy related dilatation and curettage managed successfully by laparoscopic small bowel resection and primary anastomosis.

Incidence and risk factors for incisional surgical site infection in patients with Crohn’s disease undergoing bowel resection

Background:Patients with Crohn’s disease(CD)are often reported to be at a high risk for incisional surgical site infection(SSI).The aim of this study was to identify the risk factors associated with post-operative incisional SSI in CD patients after bowel resection.Method:CD patients undergoing bowel resection between 2007 and 2015 were enrolled.Demographic and clinical features related to post-operative incisional SSI were analysed using both univariate and multivariate logistical analyses.Results:Of all eligible patients(n=159),123(77.4%)were male,with a mean age at surgery of 33.4611.8 years.A total of 35(22.0%)CD patients developed post-operative incisional SSI.Post-operative incisional SSI was more likely to happen in patients who had penetrating type of disease(P=0.018),underwent bowel resection for the indication of chronic fistula(P=0.005)and had an intra-operative finding of fistula(P=0.001).A greater proportion of patients with post-operative incisional SSI were found to have anemia(P=0.019)but elevated levels of white blood cells(P=0.027),neutrophils(P=0.006)as well as an elevated percentage of neutrophils(P=0.005).Multivariate logistic regression analysis showed that anemia(odds ratio[OR]:3.31,95%confidence interval[CI]:1.05-10.46,P=0.041),an elevated percentage of neutrophils(OR:2.85,95%CI:1.23-6.59,P=0.014)and an intra-operative finding of fistula(OR:3.76,95%CI:1.53-9.21,P=0.004)were significantly associated with the risk for post-operative incisional SSI.Conclusions:Anemia,elevated percentage of neutrophils and intra-operative finding of fistula are predictors for the development of post-operative incisional SSI in CD patients undergoing bowel resection.Favorable pre-operative nutrition status and low inflammatory status may lessen the incidence of post-operative incisional SSI.

Xanthogranulomatous inflammation requiring small bowel anastomosis revision: A case report

BACKGROUND Xanthogranulomatous inflammation(XGI)is an uncommon process involving an accumulation of inflammatory cells,commonly lipid-laden macrophages.XGI has been described to occur throughout the body but only rarely in the lower gastrointestinal tract.We describe a case of XGI contributing to chronic obstructive symptoms in the terminal ileum,in which the patient had an initial diagnostic laparoscopy,continued to have symptoms,then proceeded to have the definitive treatment.To our knowledge,this is the first report of XGI associated with a prior small bowel anastomosis.CASE SUMMARY We report the case of a 42-year-old female who presented with intermittent epigastric pain and subjective fevers.She had undergone a laparoscopic small bowel resection for Meckel’s diverticulum five years prior.Her workup was notable for computed tomography scan demonstrating mild inflammation and surrounding stranding at the level of the prior anastomosis.She underwent a laparotomy,resection of the prior anastomosis and re-anastomosis,with final histopathological examination findings consistent with mural XGI.CONCLUSION XGI can occur at the site of a prior bowel anastomosis and cause chronic obstructive symptoms.

Concise review on short bowel syndrome: Etiology, pathophysiology, and management

Adults have approximately 20 feet of small intestine,which is the primary site for absorbing essential nutrients and water.Resection of the intestine for any medical reason may result in short bowel syndrome(SBS),leading to loss of major absorptive surface area and resulting in various malabsorption and motility disorders.The mainstay of treatment is personalized close dietary management.Here we present SBS with its pathophysiology and different nutritional management options available.The central perspective of this paper is to provide a concise review of SBS and the treatment options available,along with how proper nutrition can solve major dietary issues in SBS and help patients recover faster.

Surgical treatments of recurrent small intestine metastatic melanoma manifesting with gastrointestinal hemorrhage and intussusception:A case report

BACKGROUND Melanoma is the most aggressive form of skin cancer,with a tendency to metastasize to any organ.Malignant melanoma is the most frequent cause of skin cancer-related deaths worldwide.Small intestine cancers especially small intestine metastases are relatively rare.Small intestine metastases are seldom described and likely underdiagnosed.Intussusception is most common in pediatric age,and in adults are almost 5%of all cases.CASE SUMMARY A 75-year-old man with a history of acral malignant melanoma was admitted to the Gastroenterology Department of our hospital,complaining of intermittent melena for 1 mo.Magnetic resonance enterography showed partial thickening of the jejunal wall and formation of a soft tissue mass,indicating a neoplastic lesion with jejunojejunal intussusception.The patient underwent partial small bowel resection.Pathological findings and immunohistochemical staining indicated small intestine metastatic melanoma.The patient refused further anti-tumor treatment after the surgery.Ten months after the first surgery,the patient presented with melena again.Computed tomography enterography showed the anastomotic stoma was normal without thickening of the intestinal wall,and routine conservative treatment was given.Three months later,the patient developed melena again.The patient underwent a second surgery,and multiple metastatic melanoma lesions were found.The patient refused adjuvant anti-tumor treatment and was alive at the latest follow-up.CONCLUSION Small intestine metastatic melanoma should be suspected in any patient with a history of malignant melanoma and gastrointestinal symptoms.

Intestinal erosion caused by meshoma displacement:A case report

BACKGROUND A meshoma formation and erosion to the small intestine is rare.Herein,we report one case of a meshoma that was not treated early;causing it to displace and erode the small intestine,with infection,complete control of symptoms was achieved after removal of the infected patch mass,no recurrence of hernia after 2 years of follow-up.CASE SUMMARY A 62-year-old male patient presented with recurrent abdominal pain repeatedly for 1 wk,which has worsened 2 d before admition,accompanied by fever.Five years before presentation he underwent right inguinal hernia Plug and patch repair approach.Two years ago,a computed tomography scan revealed a right lower abdominal mass with soft tissue density,measuring approximately 30 mm×17 mm,which was diagnosed as meshoma that was not treated.The patient had poorly controlled diabetes in the past year.CONCLUSION The formation of meshoma is rare,and that if not treated in time it might erode and require resection of the involved organ.