An uncommon problem: Overcoming the challenges of rectal foreign bodies-A case series and literature review.

Key Clinical Message: Although rectal foreign bodies are rare presentations, this condition should be considered in patients with preanal pain, lower pelvic pain, or rectal bleeding.Rectal foreign bodies are a rare occurrence and can pose a therapeutic challenge for surgeons. These objects may be inserted through the anus or ingested orally. This study presents a retrospective review of all cases of trapped rectal foreign bodies at a single university hospital. From 2001 to 2020, twelve cases of rectal foreign bodies were diagnosed and treated at Ghaem Hospital in Mashhad. Demographic information, type of foreign body, clinical presentation, and removal method were collected retrospectively. All cases of rectal foreign bodies entered through the anus. Twelve cases involved male patients, with a mean age of 47.5 years (ranging from 24 to 70 years), and two cases involved female patients, with a mean age of 29.5 years (ranging from 29 to 30 years). Patients' main complaint was defecation disorder, accounting for 57% of cases. The types of rectal foreign bodies included two body sprays, two wood pieces, two glass bottles, glasses, eggplants, cucumbers, squash, and anal dilators. One case involved surgical gas. In five cases, rectal foreign bodies were removed under general anesthesia through the rectum by dilatation. Rectal foreign bodies were removed by rectosigmoidoscopy in three cases, forceps in two cases, and abdominal maneuvers in one case. Only one case required laparotomy. Minor complications such as scratches or small mucosal tears were observed in some cases after removal of the foreign body, but no deaths were reported. Although rectal foreign bodies are rare, this condition should be considered in patients with preanal pain, lower pelvic pain, or rectal bleeding when no justification for recent endoscopic examinations is found. Most rectal foreign bodies are removed through the anus under appropriate anesthesia. Rectosigmoidoscopy is a good alternative if needed. Surgical measures are necessary for cases that lead to peritonitis or are likely to cause serious injury.

Virtual Dissection: an Educational Technology to Enrich Medical Students' Learning Environment in Gastrointestinal Anatomy Course.

Background: Virtual dissection provides a digital experience of medical images to visualize anatomy on touchscreen tables. This study aimed to integrate the virtual dissection table (VDT) into the gastrointestinal anatomy course and assess medical students' intended learning outcomes and satisfaction with this educational technology. Methods: This quasi-experimental study enrolled second-year undergraduate medical students who studied anatomical sciences in the autumn semester of 2021-2022 at a single medical school. In the intervention and control groups, the participants were randomized to study anatomy by VDT or topographical anatomy textbooks. The knowledge tests evaluated the students' learning outcomes of gastrointestinal anatomy, and following the course, students completed a satisfaction survey. Results: The findings indicated that a significant gain occurred, and instructional intervention during which the learning environment was enriched with virtual dissection could enhance the students' learning (F = 13.33, df = 2, P < 0.01, partial η2 = 0.20) and satisfaction (T = 6.10, df = 54, P < 0.01, Cohen's d = 1.63, CI95% = 1.02-2.23). Conclusions: This study demonstrates the potential for virtual dissection to augment anatomical science education. Further research is required to consider the contributing features and apply this educational technology to enhance students' anatomy learning. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01867-z.

Effects of Patient Education and Distraction Approaches Using Virtual Reality on Pre-operative Anxiety and Post-operative Pain in Patients Undergoing Laparoscopic Cholecystectomy.

BACKGROUND: Fear of post-operative pain often contributes to pre-operative anxiety; accordingly, pain and anxiety are among the most common complications in patients undergoing laparoscopic cholecystectomy (LC). AIM: The present study aimed to determine the effects of patient education and distraction using virtual reality (VR) on pre-operative anxiety and post-operative pain in patients undergoing LC. METHOD: This randomized clinical trial included 150 patients in the surgery wards of educational hospitals in Mashhad, Iran, in 2020. The participants were randomly assigned to three groups of education, distraction, and control. The education and distraction groups watched two five-minute animations and three 360-degree images of nature using VR glasses 2 hours before and 4 hours after the surgery, respectively. On the other hand, the control group received routine care. Anxiety was measured using Spielberger's State Anxiety Inventory before and half an hour after the intervention. Moreover, the pain was measured using the visual analog scale and McGill Pain Questionnaire. RESULTS: The results demonstrated a significant reduction in the two VR groups regarding the pre-operative anxiety mean scores, compared with the control group (p < .001). Furthermore, a significant reduction was observed in post-operative pain scores of patients in the two intervention groups compared with the control group (p = .001). CONCLUSIONS: As evidenced by the results, both VR approaches of patient education and distraction equally decreased pre-operative anxiety and post-operative pain in patients undergoing LC.

Two connected large epiploic appendixes make a loop: A case report.

Small bowel obstruction (SBO) is a common cause of hospitalization in surgery ward and brings a notable morbidity and mortality with 30,000 annual deaths. In some cases, SBO develops due to the internal hernia. In this case, we present a case of internal hernia in a woman with normal large epiploic appendixes.

Incidence of Pediatric Perforated Appendicitis during the COVID-19 Pandemic; a Systematic Review and Meta-Analysis.

INTRODUCTION: COVID-19 has affected the pattern of referral to medical centers and quarantine against COVID-19 might delay referral and management of surgical emergencies. This study aimed to compare the pooled event rate of pediatric perforated appendicitis before and during the COVID-19 pandemic. METHODS: This was a systematic review and meta-analysis study based on the PRISMA guidelines. Scopus, Web of Sciences, and PubMed databases were searched for studies reporting the rate of perforated appendicitis based on the post-appendectomy observations or imaging methods. The Egger bias test and funnel plot were used to detect and depict publication bias. Statistical analysis was performed in Comprehensive Meta-analysis package version 3. RESULTS: Twelve studies were eligible for inclusion in our study. The pooled prevalence of pediatric perforated appendicitis in the pre-COVID era was 28.5% (CI95%: 28.3 to 28.7%) with a heterogeneity of 99%. In the COVID era, the event rate proportion was 39.4% (CI95%: 36.6 to 42.3%) with a heterogeneity of 99%. There was a significant difference in the subgroup analysis within the pre-COVID and COVID era (P<0.001), showing a higher perforation rate in the COVID era. CONCLUSION: Our study showed that during the COVID-19 pandemic, the rate of perforated appendicitis has significantly increased in comparison to before the COVID-19 pandemic.

An Adrift and Homeless Cyst within the Peritoneal Cavity.

INTRODUCTION: Echinococcosis is a zoonotic infection caused by Echinococcus species. Iran is endemic for Echinococcus granulosus. Here, we present a case of hydatidosis in an 85-year-old man, presented with acute, dull, constant, and generalized abdominal pain. A computed tomography scan (CT scan) showed an intact hydatid cyst on the bladder dome and several hydatid cysts in the liver. Open surgery revealed a cyst with hepatic origin, confirmed with histopathological studies. CONCLUSION: Although a primary abdominal hydatid cyst is very rare, it can be transferred to the abdominal cavity without any rupture as secondary ones. In this case, rupture of the liver wall was the reason for this transfer. As a result, there should be a suspicion of hydatidosis in a patient with a similar presentation.