Rare presentations of small bowel endometriosis.

Despite endometriosis being a relatively common chronic gynecological condition in women of childbearing age, small bowel endometriosis is rare. Presentations can vary from completely asymptomatic to reported symptoms of abdominal pain, bloating, and diarrhea. The following two cases depict very atypical manifestations of ileal endometriosis that presented as obscure intermittent gastrointestinal bleeding and bowel obstruction requiring surgical intervention. The first case describes a previously healthy 40-year-old woman with severe symptomatic iron deficiency anemia and intermittent melena. A small bowel enteroscopy diagnosed multiple ulcerated strictures in the distal small bowel as the likely culprit. Despite nonsteroidal anti-inflammatory drug-induced enteropathy being initially considered as the likely etiology, histopathological examination of the resected distal ileal segment revealed evidence of endometriosis. The second case describes a 66-year-old with a presumptive diagnosis of Crohn's disease who reported a 10-year history of intermittent perimenstrual abdominal pain, diarrhea, and nausea with vomiting. Following two subsequent episodes of acute bowel obstruction and surgical resection of the patient's stricturing terminal ileal disease, histopathological examination demonstrated active chronic inflammation with endometriosis. Small bowel endometriosis should be considered as an unusual differential diagnosis in women who may present with obscure gastrointestinal bleeding from the small bowel or recurrent bowel obstruction.

Skill Mastery and Learning Curve Analysis in Fenestrated Endovascular Aortic Repair with Physician-Modified Endograft.

Objectives: This study aims to delineate the unique learning curve for fenestrated endovascular aortic repair (FEVAR) at our institution. Materials and Methods: We measured the FEVAR-specific procedure time (FSPT) as the duration from device deployment to bridging stent completion. To maintain consistency in technical complexity, the study focused on 38 cases with four-fenestration FEVAR for juxtarenal abdominal aortic aneurysms, selected from 103 of all FEVAR procedures between June 2011 and February 2024. In these cases, superior mesenteric and bilateral renal arteries were preserved with fenestration with bridging stents insertion, while celiac arteries fenestrations without fenestrations. Learning curve and cumulative sum (CUSUM) analyses assessed FSPT reduction against increased FEVAR experiences. Results: A significant learning curve was observed, with the procedure time (y) and experience (X) correlation given by y = -39.95 log(X) + 283.6 (R2 = 0.5758). CUSUM indicated that 30 to 50 cases were required for skill stabilization and maturation. Conclusion: Our endovascular team required 30-50 cases to establish reliable FEVAR proficiency. Beyond cumulative experiences, pivotal elements in the learning trajectory seemed to include technological advancements and team augmentation.

Neutrophil-Lymphocyte Ratio as a Predictor of Persistent Type 2 Endoleak after Endovascular Aneurysm Repair.

Objectives: One of the important postoperative complications of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is type 2 endoleak (T2EL). However, there is no well-established biomarker. We aimed to evaluate the validity of the neutrophil-lymphocyte ratio (NLR) as a predictor of T2EL. Methods: Data were retrospectively collected from 146 patients who underwent EVAR for AAA at our institution between April 1, 2008 and March 31, 2021. Within 90 days before surgery, preoperative NLR was calculated from the same blood sample. The receiver operating characteristic curve (ROC) was used to determine the cutoff NLR values for persistent T2EL. Univariate and multivariate analyses were performed. Results: Compared with patients without persistent T2EL, those who had persistent T2EL had lower preoperative NLR (P = 0.041), based on a cutoff value of 1.918, and the entire group was then divided into two groups based on these values for comparison. Univariate analysis showed significant differences in NLR, the white blood cell (WBC) count, the percentage of mural thrombus of aneurysm, history of the hypertension, follow-up term, and aneurysm diameter at final follow-up. Multivariate analysis showed that NLR and AAA diameter on the last follow-up were significantly associated with T2EL persistence. Conclusions: Preoperative low NLR can be a useful predictor of postoperative persistent T2EL.

Spinal Cord Infarction after Endovascular Aortic Repair for Infrarenal Abdominal Aortic Aneurysm.

Spinal cord infarction (SCI) is a rare but serious complication of endovascular aortic repair (EVAR) for abdominal aortic aneurysms (AAA). It is difficult to predict, prevent, and treat and can cause significant impairment. We describe the case of a patient who experienced paraplegia and thermal pain dysfunction of the lower extremities shortly after EVAR for an infrarenal AAA. Immediately after confirming SCI, we initiated cerebrospinal fluid drainage, administered steroids, naloxone, and free radical scavengers, and maintained high blood pressure. However, the patient's symptoms did not improve sufficiently. Since the possibility of a SCI exists, prompt treatment should be initiated.

Aortic ulcerated plaque discovery following mesenteric infarction in a 60-year-old patient: a case report.

Introduction: A penetrating aortic ulcer (PAU), which accounts for 2-7% of all acute aortic syndromes, is the ulceration of an aortic atherosclerotic plaque that passes through the internal elastic lamina and into the aortic medium. Although PAUs are frequently seen in the middle and lower descending thoracic aortas, it is rare for them to arise in the ascending aorta. Atherosclerotic vascular illnesses and isolated peripheral arterial illnesses are associated with similar risk factors, such as male sex, advanced age, a history of tobacco use, hypertension, hyperlipidemia, and coronary artery disease. Just 20-54% of people with PAU first exhibit symptoms, suggesting that the condition might sometimes present as an asymptomatic phenomenon. Case presentation: A 60-year-old male came to the emergency department due to severe abdominal pain and abdominal contractures, which were diagnosed as mesenteric infarction with a relatively small infarcted intestinal segment. A part of the intestine was resected. Then he was referred to request a cardiac consultation to search for the source of the mesenteric infarction, which turned out to be an embolus. Clinical discussion: The patient was referred to cardiac surgery to perform aortic grafting. Conclusion: Aortic ulcer and mesenteric infarction together provide a challenging clinical picture that has to be recognized and treated right away. A high index of suspicion is necessary due to the possibility of fast deterioration, particularly in individuals who have risk factors like arteriosclerosis. Improving outcomes depends critically on early diagnostic imaging and intervention.

Postcesarean section abdominal wall endometriosis: a rare case report.

Introduction and importance: Abdominal wall endometriosis (AWE) is a rare but significant complication following cesarean sections. It manifests with recurring right lower quadrant pain, particularly during menstruation, and palpable masses at the cesarean scar site. Recognizing these symptoms is critical for timely diagnosis and effective management. This report discusses the clinical manifestations, diagnostic approach, surgical intervention, and postoperative outcomes of AWE in a specific patient. Case presentation: A 28-year-old female presented with recurrent right lower quadrant pain, exacerbated during menstruation, and a palpable mass at her previous cesarean scar. Imaging revealed a well-defined 3.6 ×3 cm mass infiltrating through all layers of the abdominal wall. Clinical discussion: This case highlights the challenges of diagnosing AWE, often presenting with vague symptoms like cyclic pain and palpable masses. The primary diagnostic tool was a CT scan, with histopathological examination confirming the diagnosis. Surgical excision was performed, resulting in significant symptom relief and a low recurrence rate. Conclusion: This case underscores the importance of vigilance for AWE symptoms in patients with prior cesarean sections. Early recognition and surgical intervention are paramount for effective management and symptom alleviation.

Comparison of the effect of use of preoperative mexiletine tablets and control on reducing postoperative pain in patients undergoing abdominal surgery.

Objective: Postoperative pain is a major concern for patients and healthcare providers following abdominal surgery. This study aimed to compare the effectiveness of mexiletine in reducing postoperative pain in patients undergoing abdominal surgery. Methods: In this double-blind randomized controlled trial, 34 patients were divided into two groups. One group received 600 mg of mexiletine tablets, while the other group received vitamin C tablets (control) two hours before surgery. Postoperative pain levels were assessed at 6, 12, and 24 h by using the Visual Analog Scale (VAS). Additionally, the amount of narcotics received within the first 24 h after surgery was recorded. Results: The results showed that the average postoperative pain score in patients who received mexiletine was significantly lower than in those who received vitamin C tablets (P<0.001). Furthermore, the average amount of narcotics received after surgery was significantly lower in the mexiletine group compared to the control group (P=0.03). Pain scores at 6, 12, and 24 h after surgery were also significantly lower in the mexiletine group (P<0.001). Conclusion: Mexiletine was effective in reducing postoperative pain and the need for narcotics in patients undergoing abdominal surgery. This study highlights the potential of mexiletine as a valuable preoperative intervention for postoperative pain management.

Comparing postoperative pain relief: ketorolac and Nasocalcin spray versus lidocaine and Nasocalcin spray in abdominal surgery patients.

Objectives: Postoperative pain management is critical for patient recovery after abdominal surgery. This study compared intravenous lidocaine and ketorolac for reducing postoperative pain and opioid use, along with Nasocalcin nasal spray. Methods: In this randomized controlled trial, 58 abdominal surgery patients were allocated to receive either intravenous lidocaine plus Nasocalcin spray (n=29) or intravenous ketorolac plus Nasocalcin spray (n=29) before surgery. Pain intensity (visual analog scale) and postoperative opioid consumption were assessed at 1, 6, 12, and 24 h after surgery. Results: Patients receiving ketorolac plus Nasocalcin spray reported significantly lower pain scores at all time points compared to lidocaine plus Nasocalcin (P<0.001). Average 24-h pain scores were 4.5 with ketorolac versus 5.1 with lidocaine. Mean opioid consumption was also lower in the ketorolac group (31.9 mg) versus the lidocaine group (43.9 mg, P<0.001). Conclusion: Preoperative ketorolac plus Nasocalcin nasal spray resulted in superior pain relief and less opioid use compared to lidocaine plus Nasocalcin after abdominal surgery. Ketorolac may be a more effective analgesic option, while Nasocalcin spray is a safe adjunct. These findings can inform clinical practice for optimizing postoperative analgesia.

Abdominal Ectopic Pregnancy: A Case Report of an Uncommon Complication of Pregnancy Without Prenatal Care.

Ectopic pregnancy (EP) is a life-threatening condition requiring a high clinical suspicion. This diagnosis must be considered in all female patients of reproductive age presenting with abdominal pain or discomfort who may possibly be pregnant. Ectopic pregnancies occur in a small percentage of all pregnancies and are a significant cause of maternal morbidity and mortality. Abdominal ectopic pregnancy (AEP) is a rare and potentially fatal form of ectopic pregnancy where the implantation occurs in the abdominal cavity. We present the following case of a 23-year-old female who was transferred following an initial workup for abdominal pain and subsequently found to have an abdominal ectopic pregnancy at 37 weeks gestation. After transferring to our emergency department, the patient continued to have abdominal pain and her presenting FAST exam was positive for free fluid concerning for active hemorrhage and hematoma. Her clinical presentation was consistent with ruptured abdominal ectopic pregnancy, and she was taken to the operating room for emergent exploratory laparotomy and delivery. Her clinical course was complicated by adherent placenta and re-bleeding with significant hemoperitoneum requiring re-entry laparotomy and transfusion. We present the details of this case along with the diagnostic imaging and management of the rarely seen and life-threatening condition of secondary abdominal ectopic pregnancy (AEP).

A Prospective Observational Study to Assess the Neutrophil-to-Lymphocyte Ratio (NLR) and C-reactive Protein-to-Albumin Ratio (CAR) in Predicting Morbidity and Mortality Among Patients Undergoing Emergency Abdominal Surgery.

Background Emergency abdominal surgeries pose significant challenges, especially in the Indian population, due to comorbidities, delayed presentations, and limited resources. Accurately predicting morbidity and mortality is crucial for timely interventions and improved patient care. The neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein-to-albumin ratio (CAR) have shown potential as prognostic markers, balancing inflammation and nutritional status. Aim The study aims to evaluate the predictive efficacy of NLR and CAR with regard to postoperative morbidity and mortality in patients undergoing emergency abdominal surgery, thereby contributing to better risk stratification and management strategies. Patients and methods A prospective observational study was conducted in a tertiary teaching hospital in northern Karnataka from August 2022 to June 2024, involving 102 patients undergoing emergency abdominal surgeries. The sample size (71) was calculated using G*Power software, targeting a 95% power with a 5% significance level. The inclusion criterion was patients aged over 18 years undergoing emergency abdominal surgeries; those who were immunocompromised, on steroid therapy, having malignancies, undergoing radiotherapy, or having chronic liver diseases were excluded from the study. Patients coming into the surgical inpatient department (IPD) with an acute abdomen requiring emergency abdominal surgeries as an emergency were preoperatively assessed using complete blood count (CBC), CRP, and serum albumin tests. NLR and CAR were evaluated preoperatively and at 24 and 48 hours postoperatively. The outcome measures included surgical site infection rates, hospital stay duration, and outcome in the form of recovery or death. SPSS version 20 was used for statistical analyses. Results The study included 102 patients whose mean age was 43.7 ± 18.9 years; 74 of the participants (72.5%) were male. The most common procedures were exploratory laparotomy (64 patients; 62.7%) and appendicectomy (32 patients; 31.4%). A significant increase in CAR levels was observed on postoperative days 1 and 2 compared to baseline (p < 0.05). Preoperative NLR ≥ 8 was significantly associated with higher mortality (65% vs. 50%, p < 0.01). Preoperative albumin > 3.2 g/dL was associated with better outcomes (recovery in 54 patients; 65.9%) compared to < 3.2 g/dL (15 patients; 75% mortality). This study showed that NLR and CAR are valuable predictors of postoperative outcomes, with CAR indicating the risk for surgical site infections (SSI) and NLR predicting mortality. Conclusion The preoperative NLR had a significant association with mortality among the patients. Hence the NLR can be a good marker for the worst outcome and CAR during the postoperative period can be considered as a marker to detect the risk of SSI. NLR and CAR are simple, inexpensive tests readily available from routine blood investigations. The utility of NLR and CAR as valuable prognostic markers in the perioperative assessment of patients undergoing emergency abdominal surgery could enhance the prediction of patient outcomes and guide more effective management strategies to improve patient outcomes in high-risk emergency abdominal surgery.

Association between oxidative balance score and abdominal aortic calcification among middle-aged and elderly population.

BACKGROUND: The Oxidative Balance Score (OBS) was created to evaluate an individual's overall antioxidant status. The objective of this study was to examine the association between OBS and abdominal aortic calcification (AAC) among individuals aged ≥ 40 years. METHODS: This population-based cross-sectional study used data from the National Health and Nutrition Examination Survey in 2013-2014 and included adults aged ≥ 40 years. Survey-weighted multivariable logistic and restricted cubic spline models were used to assess the association between OBS and AAC. RESULTS: Among 2520 participants, 744 were diagnosed with AAC (weighted percentage, 28.13%). Survey-weighted multivariable logistic revealed an inverse association between OBS and AAC [0.98 (0.96, 1.00)], and the nonlinear dose-response relationship was observed. Subgroup analysis and interaction tests revealed that this inverse relationship was consistent across different populations (all P for interaction > 0.05). CONCLUSIONS: OBS was inversely associated with the prevalence of AAC among individuals aged ≥ 40 years. Maintaining a higher OBS may be beneficial in reducing the burden of AAC.

Alpha B-crystallin Ameliorates Imbalance of Redox Homeostasis, Inflammation and Apoptosis in an Acute Lung Injury Model with Rats.

Objective: Ischemia-reperfusion (IR) of the aorta is a significant contributor to the development of postoperative acute lung damage after abdominal aortic surgery. The aim of the present study was to examine the effect of alpha B-crystallin, a small heat shock protein (known as HspB5), on lung injury induced by abdominal aortic IR in rats. Methods: Male Sprague-Dawley rats were divided into three groups: control, ischemia-reperfusion (IR, 90 min ischemia and 180 min reperfusion), and alpha B-crystallin +IR. Alpha B-crystallin (50 µg/100 g) was intraperitoneally administered 1 h before IR. Lung tissue samples were obtained for histological and biochemical analyses of oxidative stress and cytokine and apoptosis parameters in plasma, lung tissues, and bronchoalveolar lavage (BAL) fluid. Results: The levels of malondialdehyde, reactive oxygen species, total oxidant status, tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1ß), nuclear factor kappa B (NFKß), caspase-9 (CASP-9), 8-hydroxy-2'-deoxyguanosine, total antioxidant status, superoxide dismutase, and interleukin-10 levels in lung tissues, plasma, and BAL fluid (p<0.05 versus control) increased in Aortic IR. However, alpha B-crystallin significantly reduced the lung tissue levels of oxidative, inflamatuvar, and apoptotic parameters in the plasma, lung tissues, and BAL fluid (p<0.05 versus aortic IR). Histopathological results showed that alpha B-crystallin ameliorated the morphological changes related to lung injury (p<0.001). Conclusion: Alpha B-crystallin substantially restored disrupted the redox balance, inflammation, and apoptotic parameters in rats exposed to IR. The cytoprotective effect of alpha B-crystallin on redox balance might be attributed to improved lung injury.

Comparison of Aesthetic Results of Mercedes-Y Versus Inverted-V Incision for Umbilical Reconstruction: A Randomized Clinical Trial.

BACKGROUND: The appearance and position of navel which are considered as a marker for overall abdominal aesthetics, are important for the final results of abdominal surgeries. However, reconstructing and improving its appearance have been a challenge in plastic surgery. HYPOTHESIS: In this study, we aimed to compare satisfaction of the patients and the plastic surgery professors with the aesthetic results of the two methods of umbilical reconstruction: Mercedes (Y) incision versus inverted-V incision. METHODS: This is a randomized clinical trial performed on umbilicoplasty patients following abdominoplasty, breast reconstruction, or abdominal flap surgery whom referred to our center. They were divided into two equal groups of twenty patients with Mercedes (Y) incision and patients with inverted-V incision. The results of surgery were compared three months after the surgery by the opinions of patients, plastic surgery professors, and unbiased observers. RESULTS: The average scores of patients, professors, and observers showed that Mercedes (Y) had significantly higher scores compared to inverted-V incision in terms of position, size, shape, natural appearance, and the overall satisfaction. Surgical complications including stenosis, necrosis, and wound dehiscence were not statistically different in our small sample size. CONCLUSION: In this study, Mercedes (Y) incision was preferred by all of the groups in all five parameters that were assessed including size, shape, position, natural appearance, and overall satisfaction. The simplicity of the Y incision with less visible scar makes it a suitable method for further investigations with a larger sample size. Level of Evidence I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Multimodal management of ectopic hepatic pregnancy: a systematic review of the literature.

PURPOSE: Ectopic pregnancies with implantation in the upper abdomen are exceptionally rare. Here we provide a systematic review of hepatic ectopic pregnancies and the corresponding management strategies. Furthermore, this report details a case of ectopic hepatic pregnancy, successfully treated with primary methotrexate (MTX) followed by a two-staged robotic-assisted resection. METHODS: Two independent investigators performed a systematic review using the online search engine PubMed and MEDLINE database. The search utilized the following terms: 'Hepatic Ectopic Pregnancy,' 'Hepatic Extrauterine Pregnancy,' 'Hepatic Abdominal Pregnancy,' and 'Ectopic Liver Pregnancy.' Cross-referencing was employed to identify possible additional publications. FINDINGS: Forty-seven case reports on hepatic pregnancies were identified. Of these, 40 provided manuscripts in the English language. Most patients with hepatic pregnancy presented with mild to moderate abdominal pain, while only a minority exhibited signs of hemodynamically relevant intraperitoneal hemorrhage. Most cases were managed through open surgical removal, although in recent years, there has been an increase in laparoscopically managed cases. Conservative approaches using methotrexate are seldom employed. CONCLUSION: Hepatic pregnancies present a rare and challenging clinical scenario. Until now, these cases have usually been treated primarily with open explorative surgery. As reported in this case, primary conservative treatment approaches with MTX before surgery hold promise as a strategy to reduce surgery-related bleeding and morbidity, particularly for asymptomatic or oligosymptomatic patients.

Abdominal Etching-A Novel Classification Method for Surgical Approach.

BACKGROUND: The abdomen is the aesthetic and physical center of the body. Abdominal etching is used to enhance the appearance of the abdominal musculature. Body contouring and abdominal etching are popular among both men and women, and these procedures have been shown to result in high patient satisfaction and are considered safe. The aim of this study was to describe a novel classification for abdominal etching based on the senior author's technique and experience. METHODS: This single surgeon, nonrandomized, retrospective study was conducted from December 2016 to September 2022. Patients were classified into 4 groups based on their body habitus, abdominal skin pinch test and skin quality, and the surgical plan was tailored accordingly. RESULTS: Sixty-two patients (42 male) with an average age of 36 years underwent abdominal etching during the study period. Subgrouping included 4 (6.45%) in Class 1, 22 (35.5%) in Class 2, 32 (51.6%) in Class 3 and 4 (6.45%) in Class 4. The most common complication was seroma. Concomitant procedures included silicone implants to the pectoral region (male), fat injection to the buttocks, breast reduction and mastopexy and treatment of post-liposuction irregularities. CONCLUSIONS: The abdominal etching technique is safe and reproducible. It has demonstrated long-lasting results and high patient satisfaction. Our classification of patients will enable surgeons to better understand the problem presented and provide aesthetic and efficient results. Use of these guidelines and tailoring treatment options will further improve patient and physician satisfaction. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266.

Clinical predictors of therapeutic laparotomy in anterior abdominal stab injuries: a multicenter study from low-income institutions in Ethiopia.

Purpose: Despite the high incidence of abdominal stab injuries, the rate of nontherapeutic laparotomies and the predictors of therapeutic laparotomies have rarely been studied in low-income settings. Methods: This multicenter retrospective study involved three of the largest academic medical centers in central Ethiopia. All patients who sustained an anterior abdominal stab injury and underwent exploratory laparotomy, regardless of the intraoperative findings, were included over the 3-year course of the study. Results: Of the 117 patients who underwent exploratory laparotomy, 35 patients (29.9%) underwent nontherapeutic laparotomies. Three factors predicted therapeutic laparotomy: hollow viscus evisceration (adjusted odds ratio [AOR], 5.77; 95% confidence interval [CI], 1.16-28.64; P=0.032), localized and generalized peritonitis (AOR, 4.77; 95% CI, 1.90-11.93; P=0.001), and white blood cell count ≥11,500/mm3 (AOR, 2.77; 95% CI, 1.002-7.650; P=0.049). The overall positive predictive value of the therapeutic predictors was 80.2%, while the negative predictive value of all predictor-negative patients was 58.1%. The predictors would have prevented 51.4% of the nontherapeutic laparotomies. Conclusions: Close to one-third of the patients had a nontherapeutic laparotomy. The clinical predictors of therapeutic laparotomy were shown to have a high positive predictive value despite a lower negative predictive value. Further prospective studies that involve all patients who sustain anterior abdominal stab injuries are needed to potentially improve on the negative predictive value of the predictors suggested by our study.

Advanced abdominal pregnancy complicated by pelvic inflammatory disease: A compelling case report.

This case report discusses the rare and complex occurrence of an advanced abdominal pregnancy in a 36-year-old multiparous woman at 26 weeks of gestation, compounded by chronic pelvic inflammatory disease and Fitz-Hugh-Curtis syndrome. The patient was presented with severe symptoms, including abdominal pain, fever, chills, constipation, and vaginal spotting, leading to her hospital admission. Diagnosis was challenging due to the advanced stage of the pregnancy and its abdominal location, particularly in the Douglas pouch, as detected through ultrasonography. According to anatomical standards, this is an intraperitoneal pregnancy rather than an intra-abdominal pregnancy because the fetus developed in the peritoneal cavity. This case is significant for illustrating the critical need for high clinical suspicion and skilled sonographic evaluation to identify such advanced abdominal pregnancies. The successful management of this case through laparotomy, despite the complexities of concurrent conditions, emphasizes the possibility of safe placental removal without increased hemorrhage risk. This report highlights the importance of awareness and expertise in handling rare presentations of ectopic pregnancies, underscoring the potential for positive outcomes with appropriate surgical intervention.

Perforated Jejunal Diverticulum Mimicking Diverticulitis: A Case Report of Acute Abdominal Pain in an Elderly Patient.

Jejunal diverticulosis is a rare form of diverticulosis characterized by acquired pseudodiverticula in the small bowel. Although most cases are asymptomatic, the condition can present diagnostic challenges due to its atypical presentation. Complications such as perforation can lead to acute abdomen, significantly increasing morbidity and mortality. We report a rare case of perforated jejunal diverticulitis in an 84-year-old female with a known history of diverticular disease. The patient presented to the emergency department with worsening left lower quadrant abdominal pain. A computed tomography (CT) scan revealed a focus of air adjacent to the mesentery, indicative of bowel perforation. An urgent exploratory laparotomy was performed, which identified a 4-cm perforated jejunal diverticulum. The affected segment of the small bowel was resected, followed by primary side-to-side jejunal anastomosis. The patient was discharged home in stable condition following uneventful postoperative recovery. This case highlights the importance of including jejunal diverticulosis in the differential diagnosis of acute abdomen, particularly in elderly patients with a history of diverticular disease. Due to the nonspecific presentation, prompt imaging is crucial for diagnosis. Surgical intervention is often necessary in cases of perforation. Increased clinical awareness of this rare condition may help reduce diagnostic delays and improve patient outcomes.

Interaction between CYP1A1 gene polymorphism and environment factors on risk of endometrial cancer.

BACKGROUND: The purpose of this study was to investigate the impact of single nucleotide polymorphisms (SNPs) of the CYP1A1 gene and the gene-environment interaction on the susceptibility to endometrial cancer in Chinese women. METHOD: Logistic regression was performed to investigate the association between the four SNPs of the CYP1A1 gene and the risk of endometrial cancer. Generalized multifactor dimensionality reduction (GMDR) was employed to analyze the gene-environmental interaction. RESULTS: A total of 934 women with a mean age of 61.7 ± 10.5 years were selected, including 310 endometrial cancer patients and 624 normal controls. The frequency of rs4646421- T allele was higher in endometrial cancer patients than normal controls, the T allele of rs4646421 was 28.1% in endometrial cancer patients and 21.0% in normal controls (p < 0.001). Logistic regression analysis showed that the rs4646421 - T allele was associated with increased risk of endometrial cancer, OR (95% CI) were 1.52 (1.11-1.97) and 1.91 (1.35-2.52), respectively. GMDR analysis found a significant two-locus model (p = 0.0107) involving rs4646421 and abdominal obesity (defined by waist circumference), indicating a potential gene-environment interaction between rs4646421 and abdominal obesity. Abdominal obese subjects with rs4646421- CT or TT genotype have the highest risk of endometrial cancer, compared to non-abdominal obese subjects with the rs4646421- CC genotype, the OR (95%CI) was 2.23 (1.62-2.91). CONCLUSIONS: Both the rs4646421- T allele and the interaction between rs4646421 and abdominal obesity were associated with increased risk of endometrial cancer.

Oxytocin Analogues for the Oral Treatment of Abdominal Pain.

Abdominal pain presents an onerous reality for millions of people affected by gastrointestinal disorders such as irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD). The oxytocin receptor (OTR) has emerged as a new analgesic drug target with OTR expression upregulated on colon-innervating nociceptors in chronic visceral hypersensitivity states, accessible via luminal delivery. However, the low gastrointestinal stability of OTR's endogenous peptide ligand oxytocin (OT) is a bottleneck for therapeutic development. Here, we report the development of potent and fully gut-stable OT analogues, laying the foundation for a new area of oral gut-specific peptide therapeutics. Ligand optimisation guided by structure-gut-stability-activity relationships yielded highly stable analogues (t1/2 >24 h, compared to t1/2 <10 min of OT in intestinal fluid) equipotent to OT (~3 nM) and with enhanced OTR selectivity. Intra-colonic administration of the lead ligand significantly reduced colonic mechanical hypersensitivity in a concentration-dependent manner in a mouse model of chronic abdominal pain. Moreover, oral administration of the lead ligand also displayed significant analgesia in this abdominal pain mouse model. The generated ligands and employed strategies could pave the way to a new class of oral gut-specific peptides to study and combat chronic gastrointestinal disorders, an area with substantial unmet medical needs.