Late anastomotic perforation of the ileum 3 years after intestinal resection.

Late perforation of the ileum is a rare and potentially life-threatening complication following intestinal resection. We present a unique case of a woman in her 60s with a history of appendiceal carcinoid tumour, who underwent a right hemicolectomy. Positron emission tomography and surveillance CTs showed normal surgical changes and no recurrent malignancy. Three years postoperatively, she presented with severe abdominal pain. CT revealed a perforation along the ileal wall of the ileocolonic anastomosis. She underwent emergent resection and repeat ileocolonic anastomosis. We conclude that the patient had subclinical ischaemia of the anastomosis, which eventually progressed to perforation 3 years later. We discuss a literature review on late small intestinal anastomotic perforations and their associated risk factors. Our case and literature review emphasise the importance of considering delayed anastomotic leak in postoperative patients with a history of intestinal cancer, inflammatory bowel disease, Roux-en-Y enteroenterostomy or side-to-side anastomosis.

Age and pain score before gastrointestinal endoscopies in children are predictors for post procedure pain.

BACKGROUND: Gastrointestinal endoscopy may be associated with pain and anxiety. Predictors for high pain scores after endoscopies in children are not known. The aim of our study was to identify risk factors for prolonged recovery and higher pain scores after gastrointestinal endoscopy in children. METHODS: All the children that were electively admitted for gastrointestinal endoscopies were included. We retrospectively collected demographic, clinical and endoscopic data as well as information on the recovery process. A numerical rating scale and the Faces, Legs, Activity, Cry, and Consolability Scale were used for pain scoring. RESULTS: During the study period (01/2016-10/2016), 284 children (median age 10.7 years, interquartile range 6.7-14.8) were recruited. In a univariate analysis, older age, higher pre-procedure pain scores, longer procedure durations, higher number of biopsies and longer recovery duration were associated with higher post-procedure pain scores. In a multivariate analysis higher pain scores before the procedure (OR 12.42, 95% CI 3.67-42, P < 0.001) and older age (OR 1.016, 95% CI 1.007-1.025, P < 0.001) were associated with higher pain scores after the procedure. Children with a higher pain score before the procedure also had a longer recovery period (OR 5.28, 95% CI (1.93-14.49), P = 0.001). CONCLUSION: Older age and higher pain score before the procedure were identified as predictors for higher pain score after pediatric gastrointestinal endoscopies. Children with these risk factors should be identified before the procedure in order to personalize their post-procedure management.

Histopathology of Catostomus commersoni (White Sucker) Infected with the Acanthocephalan Pomphorhynchus bulbocolli.

This study was undertaken to assess the damage caused by Pomphorhynchus bulbocolli to Catostomus commersoni (white sucker). Three specimens of C. commersoni were collected during early September 2014 via gill net from Canadarago Lake (Otsego County, New York), then dissected and examined for intestinal parasites. One C. commersoni , collected from a tributary of Otsego Lake (Otsego County, New York), was used as a control in this study because it was not infected with intestinal helminths. Upon dissection, damage to the fish intestine was macroscopically visible, with the intestine perforated when infected with P. bulbocolli. Intestines observed to be infected with P. bulbocolli were opened with a longitudinal incision and fixed in neutral buffered formalin with the acanthocephalans remaining attached. Histological sections of intestine with P. bulbocolli attached were compared with histological sections of intestine in which no worms were present. Examination of sections revealed full penetration of the intestinal wall and tissue destruction to the mucosa, submucosa, stratum compactum, and circular and longitudinal muscle layers, as well as an extensive host immune response in the form of proliferation of cells at the sites of wounds. While these results were consistent with previous histopathological studies on this host and parasite species, the occurrence of pockets of hyaline degeneration in the muscularis reported here is a new finding for this host-parasite system, and it appears to be quite rare in the parasitological literature. It is hypothesized that the presence of hyaline degeneration may be related to secretion of trypsinlike proteins from the presoma of the acanthocephalan, a phenomenon suggested previously for the congener Pomphorhynchus laevis . The host-parasite interaction involving physical damage, secretion of enzymes, and an extensive host immune response may be the cause of the damage, but further research is needed to investigate the nature of these interactions.