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Diagnostics (Basel, Switzerland) Apr 2024Crohn's disease (CD) is a progressive, multifactorial, immune-mediated disease characterized by chronic inflammation of any part of the gastrointestinal (GI) tract....
Crohn's disease (CD) is a progressive, multifactorial, immune-mediated disease characterized by chronic inflammation of any part of the gastrointestinal (GI) tract. Pediatric patients present with a more extensive form of the disease, especially in the upper GI tract with various histopathological inflammatory patterns. Our study aims to analyze the clinical, laboratory, endoscopic, and histopathological findings in children with diagnosed CD and compare results on the initial and follow-up tests. We have included 100 children and adolescents with CD, with performed endoscopic and histopathological (HP) procedures. The results of multiple biopsies executed in these 8 years were matched and compared. We found a statistically significant frequency reduction in stool changes (65.52% to 18.18%), weight loss (35.24% to 4%), and abdominal pain (41.86% to 6.67%) as presenting symptoms. There was an improvement in all laboratory values: fecal calprotectin (1000 to 60,8 μg/g), C-reactive protein (12.2 to 1.9 mg/L), and albumin (36 to 41 g/L). On esophagogastroduodenoscopy and ileo-colonoscopy 36.59% and 64.86% patients had specific findings, respectively. A total of 32 patients had evidence of Crohn's disease in the upper GI tract. Non-caseating granulomas were found on 9% of oesophageal, 18% of gastric, and 12% of duodenal biopsies. In the lower GI tract, we have observed a disease progression in the rectum (72.29 to 82.22%) and descending colon (73.49 to 80%). There was no registered disease progression in the upper GI tract. Our study demonstrated a significant decline in the frequency of symptoms and an improvement in laboratory values on the follow-up examinations. More than a third of our patients had specific endoscopic and HP findings in the upper GI tract, and an additional 23% had HP findings highly suggestive of CD. We demonstrated the importance of regular clinical, laboratory, endoscopic, and histopathological assessments of pediatric CD patients.
PubMed: 38732292
DOI: 10.3390/diagnostics14090877 -
International Journal of Biological... Jun 2024Elicited pumpkin was evaluated as a potential daily consumption product able to modulate the gut microbiota. An in vitro dynamic colonic fermentation performance with...
Elicited pumpkin was evaluated as a potential daily consumption product able to modulate the gut microbiota. An in vitro dynamic colonic fermentation performance with microbiota from obese volunteers was used. Prebiotic effects were observed after the pumpkin treatment. Bifidobacterium abundance was maintained during the treatment period whereas Lactobacillus increased in the transversal and descending colon. Conversely, Enterobacteriaceae and Clostridium groups were more stable, although scarce decreasing trends were observed for same species. Increments of Lactobacillus acidophilus and Limosilactobacillus fermentum (old Lactobacillus fermentum) were observed in the whole colonic tract after the treatment period. However, modulatory effects were mainly observed in the transversal and descending colon. Diverse bacteria species were increased, such as Akkermansia muciniphila, Bacteroides dorei, Cloacibacillus porcorum, Clostridium lactatifermentans, Ruminococcus albus, Ruminococcus lactaris, Coprococcus catus, Alistipes shahii or Bacteroides vulgatus. The prebiotic effect of the elicited pumpkin was provided by the fiber of the pumpkin, suggesting a release of pectin molecules in the transversal and distal colonic tract through low cellulosic fiber degradation, explaining the increases in the total propionic and butyric acid in these colonic sections. Also, a possible modulatory role of carotenoids from the sample was suggested since carotenes were found in the descending colon. Hence, the results of this research highlighted pumpkin as a natural product able to modulate the microbiota towards a healthier profile.
Topics: Gastrointestinal Microbiome; Cucurbita; Humans; Dysbiosis; Dietary Fiber; Prebiotics; Fermentation; Male; Adult; Female; Colon
PubMed: 38723828
DOI: 10.1016/j.ijbiomac.2024.132130 -
Journal of Medical Cases May 2024It is extremely rare for blunt abdominal trauma to result in serious injuries to hollow organs. Degloving injuries of the colon are one of the rarest injuries following...
It is extremely rare for blunt abdominal trauma to result in serious injuries to hollow organs. Degloving injuries of the colon are one of the rarest injuries following blunt abdominal trauma. Intestinal degloving is often seen following rapid deceleration, changes in velocity, crushes and motor vehicle collisions (MVCs). Victims with intestinal degloving injuries can experience vague symptoms despite the severity of the lesion. We present the case of a 21-year-old male with insulin-dependent type 1 diabetes who was involved in a high-speed MVC. He sustained second- and third-degree burns to the extremities, right carotid artery dissection, and multiple fractures to the mandible, pelvis and forearm. Free fluid was also noted in the pelvis prompting an emergent exploratory laparotomy. In the operating room, he was found to have a cecal serosal injury involving more than 50% of the circumference and a sigmoid and descending colon degloving injury of 50 cm. The injured segments were resected, and primary anastomoses were created. Degloving of the colon is extremely rare and the sigmoid is one of the more frequently documented locations of injury. Our case contributes to the limited literature available pertaining to the treatment of evolution of these severe colon injuries.
PubMed: 38715915
DOI: 10.14740/jmc4205 -
OncoTargets and Therapy 2024Primary cancer of the ileum is rare, and when it occurs in conjunction with primary colon cancer, it becomes even more infrequent and challenging to diagnose prior to...
Synchronous Multiple Primary Malignant Adenocarcinoma of the Descending Colon and Fungating Bleeding Adenocarcinoma of the Terminal Ileum Presenting Massive Rectal Bleeding: A Trap for the Unwary.
Primary cancer of the ileum is rare, and when it occurs in conjunction with primary colon cancer, it becomes even more infrequent and challenging to diagnose prior to surgical intervention. Primary small bowel cancers can be overlooked and may be misidentified as small bowel mesenchymal tumours or advanced metastases from colon cancer. We present an exceedingly uncommon case of ruptured primary ileal cancer combined with primary descending colon cancer presenting with gastrointestinal bleeding. Based on our understanding, instances of dual tumours concurrently occurring are exceedingly infrequent. In this patient, there was a preoperative suspicion of bleeding from colon cancer in the descending region. However, intraoperative exploration revealed that the location of the bleeding was a terminal ileal mass. Following the surgical intervention, the patient recovered satisfactorily. Intraoperative exploration of the entire gastrointestinal tract is therefore necessary in patients with gastrointestinal haemorrhage, especially in those who require urgent surgery without adequate preoperative investigations. If a mass is detected at the end of the ileum, intraoperative pathology should be performed if feasible. Subsequently, if the diagnosis reveals an adenocarcinoma, terminal ileocolic resection and right hemicolectomy are necessary for appropriate resection.
PubMed: 38711919
DOI: 10.2147/OTT.S453682 -
Current Medical Imaging Apr 2024
Background: Congenital enterocolic fistula, an abnormal connection between the small intestine and the colon, is a rare condition with the potential for significant...
Background: Congenital enterocolic fistula, an abnormal connection between the small intestine and the colon, is a rare condition with the potential for significant complications affecting the patient's quality of life. Case Report: A 2 year and 7 months old girl presented with abdominal pain and diarrhea lasting more than 10 days. The formation of the intestinal fistula was first detected by ultrasound, and the blood flow in the intestinal wall was preliminally analyzed. Surgical exploration revealed a colonic fistula formed by the attachment of the jejunum to the descending colon. Postoperatively, symptoms improved; no secondary infection occurred and the fistula healed well. Conclusion: Congenital colon fistula is rarely reported, and ultrasound is becoming more and more important in its diagnosis. Here, we report a case of congenital colonic fistula diagnosed by ultrasound. Ultrasound can dynamically and in real-time observe the intestinal condition, which is conducive to the early diagnosis and staging of congenital intestinal diseases and the determination of diagnosis and treatment schemes.
.PubMed: 38676486
DOI: 10.2174/0115734056286242240222092226 -
Colorectal Disease : the Official... Apr 2024
PubMed: 38671578
DOI: 10.1111/codi.17003 -
Medicine Apr 2024Colorectal endoscopic submucosal dissection (ESD) is a promising but challenging procedure. It is not widely performed due to its technical difficulty. We aimed to find...
Predictive factors associated with technical difficulty in colorectal endoscopic submucosal dissection: A Honam Association for the Study of Intestinal Disease (HASID) multicenter study.
Colorectal endoscopic submucosal dissection (ESD) is a promising but challenging procedure. It is not widely performed due to its technical difficulty. We aimed to find the predictive factors associated with technical difficulty in colorectal ESD before the procedure. Clinical data from patients who underwent ESD for colorectal tumors in 5 hospitals in Honam province of South Korea between 2015 and 2020 were reviewed retrospectively. Technically difficult colorectal ESD procedure was defined in 3 points. Long procedure time (longer than 60 minutes), occurrence of perforation, and failure of en bloc resection. Factors associated with technically difficult ESD were included as main outcome measure. 1446 patients were identified and their data were analyzed. Median procedure time was 30.0 minutes and median long axis of the tumor was 20.1 mm. Technically difficult procedures including long procedure time were 231 cases (16.0%), perforation occurred in 34 cases (2.3%), and en bloc resection was done in 1292 cases (89.3%). Tumor size larger than 35 mm (odd ratio [OR]: 1.474, P = .047), central depression or ulceration in the lesion (OR: 1.474, P = .013), previous endoscopic mucosal resection (EMR) or polypectomy procedure (OR: 2.428, P = .020) were associated with technically difficult ESD. Descending colon-located tumor (OR: 5.355, P < .001), and use of IT knife (OR: 4.157, P = .003) were associated with perforation. Recognizing factors associated with technically difficult ESD can help in planning the ESD procedure beforehand.
Topics: Humans; Endoscopic Mucosal Resection; Male; Female; Colorectal Neoplasms; Middle Aged; Retrospective Studies; Aged; Republic of Korea; Operative Time; Risk Factors; Colonoscopy
PubMed: 38669427
DOI: 10.1097/MD.0000000000037936 -
Case Reports in Gastroenterology 2024Crohn's disease (CD) is complicated by intestinal strictures and fistula formation; however, intestinal perforation is relatively rare.
INTRODUCTION
Crohn's disease (CD) is complicated by intestinal strictures and fistula formation; however, intestinal perforation is relatively rare.
CASE PRESENTATION
Following a traffic accident in the evening, a 39-year-old woman experienced abdominal pain that worsened the following morning and was taken to the emergency department. She had a 17-year history of CD and eight endoscopic balloon dilations for descending colonic strictures. She presented with a high fever of 40.0°C, along with tenderness and rebound pain throughout her abdomen, with the most substantial point being in the lower left abdomen. Computed tomography showed thickening of the descending colon wall, increased fat concentration around the wall, and a slight presence of air in the mesentery near the intestinal wall. We diagnosed the patient with generalized peritonitis due to traumatic penetration of the mesentery of the descending colon and performed emergency surgery. Intraoperative observation of the abdominal cavity with a laparoscope revealed purulent ascites but no apparent perforation or edematous mesentery, with white moss and redness in the descending colon. This prompted the decision to perform peritoneal lavage drainage and a transverse colonic double colostomy. The postoperative course was favorable, and the patient was discharged from the hospital on the postoperative day 14. Four months after discharge, colostomy closure was performed.
CONCLUSION
Relatively minor trauma in patients with CD can result in colon injury. An injured bowel is usually accompanied by active lesions due to CD; however, caution is required, as endoscopic balloon dilatation without accompaniment may be a background factor.
PubMed: 38665146
DOI: 10.1159/000537973 -
Urologiia (Moscow, Russia : 1999) Mar 2024Urolithiasis occupies one of the leading places in terms of the frequency of requests for urgent urological care and emergency hospitalization in specialized... (Review)
Review
Urolithiasis occupies one of the leading places in terms of the frequency of requests for urgent urological care and emergency hospitalization in specialized departments. Percutaneous surgery for urolithiasis, like any of the surgical methods, is associated with a number of specific and non-specific complications. Of course, the frequency of occurrence is dominated by hemorrhagic and inflammatory complications. But damage to the colon is quite rare and amounts to 0.3-0.4%. Focusing on the literature data, it is possible to identify risk factors for colon damage and clinical manifestations of this complication. Given the small clinical experience, both in the world and in the domestic literature, there is no recommendatory base for the management of patients with colon damage during percutaneous interventions. Publications available for analysis indicate the possibility of both an operative approach with the removal of a colostomy and conservative management of patients with such complications. The article presents a clinical observation of successful conservative management of a patient with damage to the descending colon during percutaneous nephrolithotomy. An assessment of risk factors for colon damage in this patient was given. Imaging methods are presented that confirm the presence of this complication and the resulting recovery during the follow-up examination.
Topics: Humans; Nephrolithotomy, Percutaneous; Colon; Male
PubMed: 38650414
DOI: No ID Found -
Revista Espanola de Enfermedades... Apr 2024A 62 year-old-man with low anterior rectal resection and protective ileostomy, for low rectal neo and neoadjuvant QT +RT. Then ileostomy closure without incidences. On...
A 62 year-old-man with low anterior rectal resection and protective ileostomy, for low rectal neo and neoadjuvant QT +RT. Then ileostomy closure without incidences. On the 3rd postoperative day, he started with fever peaks and diarrhea. An abdominal CT scan showed diffuse thickening of the wall of the descending colon compatible with colitis and colonoscopy showed deep rectal ulcers with punch-like morphology with hyperemic mucosa with erythematous stippling of erosive appearance, showing this ulcerative pattern with numerous lesions and intensely edematous and congestive mucosa covered with abundant fibrinopurulent exudate in the descending colon. Biopsies and stool cultures were negative, but serologies were positive for CMV. Suspected CMV infection in a immunosuppressed by chemotherapy patient, he was treated with ganciclovir. The patient presented clinical improvement, without fever or diarrhea and improvement of the punch ulcers in the endoscopic controls, so he could be discharged from the hospital with follow-up in the outpatient consulting offices.
PubMed: 38634867
DOI: 10.17235/reed.2024.10435/2024