The Management of Neonatal Peritonitis in the Paediatric Surgery Department of the Donka National Hospital

Introduction: Neonatal peritonitis is a rare but serious condition requiring early diagnosis and management. The lack of antenatal diagnosis, the precariousness of neonatal intensive care, and the delay in diagnosis and treatment are the factors of poor prognosis. The objective of this study was to study the epidemiological, diagnostic and therapeutic aspects of neonatal peritonitis in order to improve its management in the pediatric surgery department of the CHU-Donka. Materials and Methods: This is a retrospective descriptive study of the records of patients treated for neonatal peritonitis from January 1, 2017 to December 31, 2022. Results: Results: We compiled 17 records of patients operated on for neonatal peritonitis, representing a frequency of 3.85% and an incidence of 2.83 cases/year. The mean age of our patients was 8.29 days, with extremes of D0 and D25. Males were more dominant, with a frequency of 71% and a sex ratio of 2.4. The average consultation time was 72 h, with extremes of 12 h and 144 h. Abdominal bloating was the main reason for consultation (100%). Fever and vomiting were frequent, at 70.59% and 82.35% respectively. PSA revealed pneumoperitoneum in 12 patients (70.59%). The colon was the most frequent site of perforation at 29.41%. ECUN was the main etiology with 35.29%. Ostomy was the main surgical procedure in 58.82% of cases, followed by suture excision in 29.41%. Postoperative follow-up was simple in 3 patients (17.65%) and complicated in 14 (82.35%). Sepsis was the main cause of death (47.59%). The mortality rate was 76.47%. Conclusion: Mortality from neonatal peritonitis remains high in developing countries. Early diagnosis, early surgical management, and the presence of well-equipped neonatal intensive care units with qualified staff are essential for an improvement in the prognosis of neonatal peritonitis.

Procalcitionin as a diagnostic marker to distinguish upper and lower gastrointestinal perforation

AIM To assess the accuracy of serum procalcitionin(PCT)as a diagnostic marker in verifying upper and lower gastrointestinal perforation(GIP).METHODS This retrospective study included 46 patients from the surgical intensive care unit(ICU)of the Second Affiliated Hospital of Harbin Medical University who were confirmed to have GIP between June 2013 and December 2016.Demographic and clinical patient data were recorded on admission to ICU.Patients were divided into upper(n=19)and lower(n=27)GIP groups according to the perforation site(above or below Treitz ligament).PCT and WBC count was obtained before laparotomy and then compared between groups.Meanwhile,the diagnostic accuracy of PCT was analyzed.RESULTS Patients with lower GIP exhibited significantly higher APACHE II score,SOFA score and serum PCT level than patients with upper GIP(P=0.017,0.004,and0.001,respectively).There was a significant positive correlation between serum PCT level and APACHE II score or SOFA score(r=0.715 and r=0.611,respectively),while there was a significant negative correlation between serum PCT level and prognosis(r=-0.414).WBC count was not significantly different between the two groups,and WBC count showed no significant correlation with serum PCT level,APACHE II score,SOFA score or prognosis.The area under the receiver operating characteristic curve of PCT level to distinguish upper or lower GIP was 0.778.Patients with a serum PCT level above 17.94 ng/d L had a high likelihood of lower GIP,with a sensitivity of 100%and a specificity of 42.1%.CONCLUSION Serum PCT level is a reliable and accurate diagnostic marker in identifying upper or lower GIP before laparotomy.

Role of over the scope clips in the management of iatrogenic gastrointestinal perforations

Advances in endoscopic and surgical techniques have increased the frequency and complexity of these procedures and associated complications such as gastrointestinal perforation. With the advancements in the field of gastroenterology, the promising use of an over the scope clips(OTSC) has fulfilled the unmet need for a reliable endoscopic devise in approximation of gastrointestinal perforation. This novel approach has raised the level of confidence in endoscopist in dealing with this serious complication during endoscopy. Here we have shared our experience with OTSC to evaluate its efficacy and safety in managing iatrogenic gastrointestinal perforations during endoscopy.

Subcutaneous cervical emphysema and pneumomediastinum due to a lower gastrointestinal tract perforation

This case report describes a 69-year-old man presen-ting with an extensive subcutaneous emphysema in his neck and generalized peritonitis caused by a lower gastrointestinal tract perforation. This case emphasizes that subcutaneous emphysema patients with negative thoracic findings should be scrutinized for signs of retroperitoneal hollow viscus perforation.

Risk factors for postoperative sepsis in patients with gastrointestinal perforation

BACKGROUND Sepsis is fatal in patients with gastrointestinal perforation(GIP).However,few studies have focused on this issue.AIM To investigate the risk factors for postoperative sepsis in patients with GIP.METHODS This was a retrospective study performed at the Department of General Surgery in our treatment center.From January 2016 to December 2018,the medical records of patients with GIP who underwent emergency surgery were reviewed.Patients younger than 17 years or who did not undergo surgical treatment were excluded.The patients were divided into the postoperative sepsis group and the non-postoperative sepsis group.Clinical data for both groups were collected and compared,and the risk factors for postoperative sepsis were investigated.The institutional ethical committee of our hospital approved the study.RESULTS Two hundred twenty-six patients were admitted to our department with GIP.Fourteen patients were excluded:Four were under 17 years old,and 10 did not undergo emergency surgery due to high surgical risk and/or disagreement with the patients and their family members.Two hundred twelve patients were finally enrolled in the study;161 were men,and 51 were women.The average age was 62.98±15.65 years.Postoperative sepsis occurred in 48 cases.The prevalence of postoperative sepsis was 22.6%[95%confidence interval(CI):17.0%-28.3%].Twenty-eight patients(13.21%)died after emergency surgery.Multiple logistic regression analysis confirmed that the time interval from abdominal pain to emergency surgery[odds ratio(OR)=1.021,95%CI:1.005-1.038,P=0.006],colonic perforation(OR=2.761,CI:1.821–14.776,P=0.007),perforation diameter(OR=1.062,95%CI:1.007-1.121,P=0.027),and incidence of malignant tumorrelated perforation(OR=5.384,95%CI:1.762-32.844,P=0.021)were associated with postoperative sepsis.CONCLUSION The time interval from abdominal pain to surgery,colonic perforation,diameter of perforation,and the incidence of malignant tumor-related perforation were risk factors for postoperative sepsis in patients with GIP.

Diagnosis of upper gastrointestinal perforation complicated with fistula formation and subphrenic abscess by contrast-enhanced ultrasound:A case report

BACKGROUND Gastrointestinal perforation complicated by subphrenic abscess is a surgical emergency.Its diagnosis relies mainly on X-ray or computed tomography(CT),while the value of ultrasound,especially contrast-enhanced ultrasound(CEUS),has been underestimated.CASE SUMMARY A 37-year-old man presented with fever and edema of the lower extremities for 10 d.He had a history of laparoscopic repair of gastroduodenal perforation 6 mo prior.His first-time intravenous CEUS indicated a diagnosis of subphrenic abscess.He received antibiotic therapy and ultrasound-guided percutaneous drainage of the abscess.However,second-time intravenous CEUS revealed an unsatisfactory therapeutic effect.Intracavitary CEUS was proposed,and this examination detected communication between the abscess and the stomach.Upper gastrointestinal perforation complicated by fistula formation and subphrenic abscess was diagnosed with the help of CEUS.Abdominal CT and esophagogastroduodenoscopy confirmed the diagnosis.The patient recovered after the perforation was repaired by surgery.CONCLUSION Intravenous and intracavitary CEUS provides helpful information for the diagnosis of upper gastrointestinal perforation complicated by fistula formation and subphrenic abscess.

Endoscopic management of iatrogenic gastrointestinal perforations

Iatrogenic perforation(IP)is a rare but severe complication of endoscopy,and occurrences grow with the expansion of interventional endoscopy.Apart from symptoms and physical signs,CT scans provide an immediate and comprehensive diagnosis of IP and its severity.The general treatment is broad-spectrum antibiotics,intravenous nutrition,and close monitoring.Endoscopic treatments are considered as the first-line therapy.Endoclips are usually utilized for small perforations,while endoclips with endoloops and over the scope clip system are preferred for large ones.Covered self-expandable metal stents are effective for esophageal perforations.Fibrin glue and band ligation can be attempted,when the location of perforation is difficult for the clip placement.Close observation is required after the procedure.If endoscopic closure fails or deterioration occurs,surgical treatments should be requested.

Perinatal risk factors in newborns with gastrointestinal perforation

AIMTo investigate correlation of perinatal risk factors in newborns with gastrointestinal perforation (GIP).METHODSSingle-center retrospective cohort study was conducted between January 1990 and December 2012. Medical records on all newborns with GIP were reviewed (n = 35). Surgical records and histopathologic examination of all perforated intestine samples were also reviewed.RESULTSThe most common cause of GIP was necrotizing enterocolitis (51.4%). The most common site of perforation was large intestine. Mortality rate was 31%. Infants with GIP more frequently had very low birth weight (< 1500 g), especially birth weight below 10th percentile according to gestational age. Ponderal index was not differing between infants with GIP and control subjects. In infants with GIP anemia was more frequently found than in control group.CONCLUSIONGIP in newborns is mostly disease of infants with birth weight below 10th percentile according to gestational age. GIP occurs more often in infants with anemia.

Therapeutic effect of Western Medicine plus Traditional Chinese Medicine in the treatment of upper gastrointestinal tract perforation

OBJECTIVE: To explore the clinical efficacy of Traditional Chinese Medicine(TCM) combined with Western Medicine in the treatment of upper gastrointestinal tract perforation.METHODS: Totally 100 patients with upper gastrointestinal tract perforation hospitalized between January 2010 and January2015 were included and randomly divided into the control group and the observation group, 50 patients in each group. The patients in the control group received the conventional nonsurgical treatment of Western Medicine, whereas those in the observation group were treated by TCM plus the treatment given to the control group. The first period was defined as the closed perforation period, during which electro-acupuncture was performed at acupoints of Zusanli(ST36) and Zhongwan(Ren 12); the second period as the absorption period, during which Dachengqi Decoction was administered to restore normal bowel movement; the third period as the ulcer healing period,during which the TCM treatment was admini-stered based on the formula of Pingweisan. Patients in both groups were reexamined by endoscopy after 2 weeks of treatment.RESULTS: The time to relieve abdominal pain, the time to pass gas and the length of stay in the observation group were significantly improved compared with those in the control group(P<0.05). The cure rate of the observation group was significantly higher than that of the control group(P<0.05).After two weeks of treatment, in the observation group, the cured patients showed closed perforation, with disappearing mucosal congestion and edema, less white fur on the ulcers and shallower ulcers in the size of 3 to 5 mm; the ulcer was in the healing period and none of the patients showed acute perforation again. While in the control group, two patients were given endoscopy after 10 days of treatment, after which ulcer and acute perforation recurred.CONCLUSIONS: The treatment of upper gastrointestinal tract perforation by Western Medicine and TCM in combination could, at different stages, significantly shorten the time to relieve abdominal pain, the time to pass gas, and the length of stay, thus improving the cure rate.

Hepatic abscess induced by foreign body:Case report and literature review

Hepatic abscess due to perforation of the gastrointestinal tract caused by ingested foreign bodies is uncommon. Pre-operative diagnosis is difficult as patients are often unaware of the foreign body ingestion and symptoms and imagiology are usually non-specific. The authors report a case of 62-year-old woman who was admitted with fever and abdominal pain. Further investigation revealed hepatic abscess, without resolution despite antibiotic therapy. A liver abscess resulting from perforation and intra-hepatic migration of a bone coming from the pilorum was diagnosed by surgery. The literature concerning foreign body-induced perforation of the gastrointestinal tract complicated by liver abscess is reviewed.

In situ Injectable Tetra-PEG Hydrogel Bioadhesive for Sutureless Repair of Gastrointestinal Perforation

Hydrogel bioadhesives represent promising and efficient alternatives to sutures or staples for gastrointestinal(GI)perforation management.However,several concerns remain for the existing bioadhesives including slow and/or weak adhesive,poor mechanical strength,low biocompatibility,and poor biodegradability,which largely limit their clinical application in GI perforation repair.In this work,we introduce an in situ injectable Tetra-PEG hydrogel bioadhesive(SS)composed of tetra-armed poly(ethylene glycol)amine(Tetra-PEG-NH2)and tetra-armed poly(ethylene glycol)succinimidyl succinate(Tetra-PEG-SS)for the sutureless repair of GI defects.The SS hydrogel exhibits rapid gelation behavior and high burst pressure and is capable of providing instant robust adhesion and fluid-tight sealing in the ex vivo porcine intestinal and gastric models.Importantly,the succinyl ester linkers in the SS hydrogel endow the bioadhesive with suitable in vivo degradability to match the new GI tissue formation.The in vivo evaluation in the rat GI injured model further demonstrates the successful sutureless sealing and repair of the intestine and stomach by the SS hydrogel with the advantages of neglectable postsurgical adhesion,suppressed inflammation,and enhanced angiogenesis.Together,our results support potential clinical applications of the SS bioadhesive for the high-efficient repair of GI perforation.

Hepatic abscess secondary to a rosemary twig migrating from the stomach into the liver

The ingestion of a foreign body that penetrates the gastric wall and migrates to the liver,where it causes an abscess is uncommon. A case of an ingested rosemary twig perforating the gastric antrum,then migrating to the liver,complicated by hepatic abscess and Staphylococcus aureus sepsis is reported. A 59-year-old man without a history of foreign body ingestion was admitted to our hospital because of sepsis and epigastralgia,which had progressively worsened. No foreign body was identified at preoperative imaging,but a rosemary twig was discovered during laparotomy. The liver abscess and sepsis were controlled successfully with surgery and antibiotics. This unusual condition should be kept in mind when dealing with cases of hepatic abscess,or even sepsis of unknown origin. Despite the improvement of non-surgical techniques such as percutaneous drainage and interventional endoscopy,surgery still remains important in the treatment of hepatic abscess caused by an ingested foreign body.

Malignant atrophic papulosis:Two case reports

BACKGROUND Malignant atrophic papulosis is a rare and potentially lethal thrombo-occlusive microvasculopathy characterized by cutaneous papules and gastrointestinal perforation.The precise pathogenesis of this disease remains obscure.CASE SUMMARY We describe the case of a 67-year-old male patient who initially presented with cutaneous aubergine papules and dull pain in the epigastrium.One week after symptom onset,he was admitted to the hospital for worsening abdominal pain.Exploratory laparotomy showed patchy necrosis and subserosal white plaque lesions on the small intestinal wall,along with multiple perforations.Histological examination of the small intestine showed extensive hyperemia,edema,necrosis with varying degrees of inflammatory reactions in the small bowel wall,small vasculitis with fibrinoid necrosis and intraluminal thrombosis in the mesothelium.Based on the mentioned evidence,a diagnosis of malignant atrophic papulosis was made.We also present the case of a 46-year-old man with known cutaneous manifestations,abdominal pain,nausea and vomiting.His physical examination showed positive rebound tenderness.A computed tomography scan revealed free intraperitoneal air.He required surgical intervention on admission and then developed an esophageal perforation.He ultimately died of a massive hemorrhage.CONCLUSION In previously published cases of this disease,the cutaneous lesions initially appeared as small erythematous papules.Subsequently,the papules became porcelain-white atrophic depression lesions with a pink,telangiectatic peripheral rim.In one of the patients,the cutaneous lesions appeared as aubergine papules.The other patient developed multiple perforations in the gastrointestinal tract.Due to malignant atrophic papulosis affecting multiple organs,many authors speculated that it is not a specific entity.This case series serves as additional evidence for our hypothesis.