Epithelial Regeneration Ability of Crohn's Disease Assessed Using Patient-Derived Intestinal Organoids.

Little is known about the ability for epithelial regeneration and wound healing in patients with inflammatory bowel diseases. We evaluated the epithelial proliferation and wound healing ability of patients with Crohn's disease (CD) using patient-derived intestinal organoids. Human intestinal organoids were constructed in a three-dimensional intestinal crypt culture of enteroscopic biopsy samples from controls and CD patients. The organoid-forming efficiency of ileal crypts derived from CD patients was reduced compared with those from control subjects (p < 0.001). Long-term cultured organoids (≥6 passages) derived from controls and CD patients showed an indistinguishable microscopic appearance and culturing behavior. Under TNFα-enriched conditions (30 ng/mL), the organoid reconstitution rate and cell viability of CD patient-derived organoids were significantly lower than those of the control organoids (p < 0.05 for each). The number of EdU+ cells was significantly lower in TNFα-treated organoids derived from CD patients than in TNFα-treated control organoids (p < 0.05). In a wound healing assay, the unhealed area in TNFα-treated CD patient-derived organoids was significantly larger than that of TNFα-treated control organoids (p < 0.001). The wound healing ability of CD patient-derived organoids is reduced in TNFα-enriched conditions, due to reduced cell proliferation. Epithelial regeneration ability may be impaired in patients with CD.

Mucormycosis-induced ileocecal perforation: A case report and review of literature.

Gastrointestinal mucormycosis is a rare form of invasive mucormycosis with high fatality rate due to difficulty in establishing its diagnosis. The classic risk-factors include immunosuppression and metabolic derangement. A case of ileocecal mucormycosis following intracardiac repair of congenital heart disease in a 17-year-old boy is described here who lacked the typical risk-factors for mucormycosis. Ileocecal mucormycosis affecting an individual without the classic risk-factors is uncommon.

First case of Candida auris infection in Belgium in a surgical patient from Kuwait.

Objective and importance: Candida auris is a relatively new yeast species and an emerging opportunistic pathogen. It was first reported in 2009 in East Asia, as a difficult-to-identify Candida species of uncertain clinical relevance. In recent years, it has appeared globally as a cause of invasive infections, not infrequently eliciting nosocomial outbreaks. Species identification in clinical laboratories has been challenging, as traditional phenotypic and biochemical methods have been generally unreliable. Clinical management is often complicated by multidrug resistance in many isolates. Additionally, C. auris has demonstrated an unusual ability for persistence in the hospital environment and in asymptomatic patients. We present the first Belgian case of C. auris infection along with a brief review of the literature.Clinical presentation: A patient was referred from Kuwait for surgical treatment after a complicated bariatric procedure. Few days after transferral, she developed a catheter-related blood stream infection with C. auris. We obtained a low-confidence identification of C. auris with the Bruker Biotyper MALDI-TOF MS system (Bruker Corporation, Billerica, MA, U.S.A.), and of Candida haemulonii with the Vitek YST identification system, version 7.01 (bioMérieux, Marcy-L'Etoile, France). Definite identification was obtained using Internal Transcribed Spacer (ITS) sequencing. As most C. auris isolates, our strain was resistant to fluconazole, and the patient was eventually treated with catheter removal and anidulafungin therapy. We documented persistence of C. auris clones with acquired echinocandin resistance in our patient up to 18 months after the infection.Conclusion: Clinicians and microbiologists should be aware of this globally emerging yeast, that poses important challenges in identification, treatment and hospital infection control.

Intestinal perforation in unusual location.

Meckel's diverticulum is the most frequent congenital gastrointestinal malformation and the clinical presentation varies from the absence of symptoms to intestinal obstruction or secondary perforation due to a foreign body. When reviewing the literature we found an interesting article by Fonseca et al., which describes the perforation of a Meckel's diverticulum by a fishbone. In this case, no imaging tests were used for diagnosis as there was a high clinical suspicion of a Meckel's diverticulitis. Recently, we had a similar patient to the one described by Fonseca et al.

Ingestion of Bell Clappers by a Shaman in Jumla, Nepal: A Case Report.

Accidental foreign body ingestion is a common problem encountered in Emergency. Deliberate foreign body ingestion may result due to an act of insanity or an act of daring. A shaman locally known as Dhami was brought to Emergency with the history of ingestion of bell clappers. He denied the history of psychiatric illness or substance abuse. On physical examination, there were signs of peritonitis. Laparotomy was done to remove the foreign bodies. Post-operative period was uneventful. Apart from the surgical intervention, psychological counselling was given to him. This is a rare interesting case due to the fact that the 15 cm long foreign bodies passing all the way through without significant injury and finally causing obstruction in ileocecal junction and perforation in the distal ileum. Keywords: foreign bodies; Nepal; shaman.

Successful closure of ileostomy in a patient with intestinal Behçet's disease after therapy with adalimumab: A case report.

RATIONALE: Behçet's disease (BD) is a chronic immune-mediated inflammatory disorder involving multiple organ systems. In BD, intestinal ulcers can present as a refractory lesion capable of perforation, which makes the choice of treatment difficult. PATIENT CONCERNS: A 34-year-old male who was diagnosed with intestinal BD and suffered with an ileocecal perforation. He underwent surgery for an ileostomy and was given corticosteroids as treatment. However, the ulcerative lesion remained resistant to the therapy that was provided which delayed the closure operation. DIAGNOSIS: Intestinal BD with severe post-operative complication. INTERVENTIONS: A course of adalimumab (ADa) therapy was started. Subsequently surgery was performed. And ADa and thalidomide were used as a maintenance therapy. OUTCOMES: In this case, a course of ADa therapy was given which healed the intestinal ulcers and allowed us to successfully perform the closure operation. LESSONS: This case indicates that ADa may be an effective treatment option in future cases, minimizing complications and allowing the closure operation to be performed successfully.

Sonographic and CT imaging features of intestinal perforation from a pill and packing: A case report.

RATIONALE: Sharp foreign bodies such as toothpicks or chicken bones can lead to intestinal perforation. Small intestinal perforation secondary to foreign body ingestion is usually manifested as an acute abdomen without a history of trauma. Here we describe the diagnosis and treatment of a case of small bowel perforation caused by an ingested pill and its outer packing. PATIENT CONCERNS: An 84 years old male patient complained of right lower abdominal pain for 4 days and the pain was becoming progressively worse. DIAGNOSES: The patient, who has Alzheimer's disease, mistakenly took the pill (oxiracetam) without removing the outer packaging. This resulted in perforation of the small intestine. INTERVENTIONS: During the ultrasound examination, the scanning physician discovered that the abnormal sonographic findings present could not be explained by the leading diagnosis of perforation of the small intestine at the time. This led the physician to suspect small bowel perforation secondary to a foreign body. The subsequent computerized tomography (CT) examination further confirmed the ultrasound findings. OUTCOMES: Emergency laparotomy was performed and the foreign body was removed. After the surgical procedure, the patient resumed anti-inflammatory treatment (Cefoxitin sodium 2000mg tid) and rehydration therapy (Sodium Chloride Solution 100mL tid). LESSONS: Because ingestion of foreign bodies of this type is relatively rare, when patients cannot provide an accurate history, diagnosis can be quite difficult. In this paper, the imaging features associated with intestinal perforation secondary to foreign body ingestion on ultrasound and CT are described. This series of events demonstrate how imaging findings can guide and alter a clinician's decision-making.

Modified Finney enteroplasty: a bowel sparing damage control stapled technique for penetrating jejunal and ileal injuries.

The rise in gun violence and other penetrating trauma constitutes one of the main challenges in the modern practice of Acute Care Surgery. Expertise in the emergency management of this type of injuries is needed if one is to avoid preventable complications, such as short bowel syndrome. Revisiting and sometimes repurposing old surgical techniques may facilitate this task. The use of a modified Finney enteroplasty as a bowel sparing damage control technique for penetrating jejunal and ileal injuries was studied on 87 gunshot wound victims. The results show this to be a safe and efficient bowel sparing approach to the management of these injuries.

[Results after surgical management of ileal perforation due to typhoid fever, about 29 cases in Ouahigouya (Burkina Faso)]. / Résultats de la prise en charge des perforations iléales typhiques : à propos de 29 cas à Ouahigouya (Burkina Faso).

The aim of this study was to determine the results of management of typhoid perforations. This was a descriptive cross-sectional study carried out from January 1, 2016 to December 31, 2016 in the General Surgery Department of the Regional Teaching Hospital Center of Ouahigouya (Burkina Faso). It involved 29 operated patients, in whom the diagnosis of typhoid perforation was confirmed at laparotomy: age, sex, admission time, clinical, therapeutic and prognostic aspects were analyzed. Typhoid perforations accounted for 20% of acute generalized peritonitis and 38.1% of digestive perforations. Twenty-three patients were males and six were females (sex-ratio: 3.8). The average age of patients was 19 years. The mean diagnostic time was 9.8 days. The excision-suture of the perforation was the most used technique with 62% of the cases. The treatment lead to complications in 10 cases with a morbidity of 34.5%. Four deaths were recorded, representing an overall mortality of 13.8%. Prognostic factors were diagnostic delay, age, number of perforations and resection-anastomosis.

Bowel perforation presenting three months after suprapubic catheter insertion.

An 82-year-old male with multiple comorbidities, including previous laparotomies, had a suprapubic catheter (SPC) inserted under guidance with ultrasound and a flexible cystoscope. Three months following the procedure, having returned for a flexible cystoscopy for ongoing bladder pain syndrome, he became peritonitic postoperatively.A CT scan and subsequent laparotomy confirmed the SPC to be passing through a section of terminal ileum. The bowel was resected and he recovered well after a long hospital admission. A literature search found this delayed presentation of bowel perforation following SPC insertion to be rare, with only a few other cases reported. In particular, previous abdominal surgery increases the risk of this complication. This case serves as a reminder of the rare but potentially significant risk of SPC insertion and unusually highlights that this may not present immediately.

Fatal case of accidental perforation of ileum by pace wires during coronary bypass grafting.

In many centres, epicardal pace wires are routinely implanted during coronary artery bypass surgery to treat postoperative tachy- and brady-arrhythmias. We describe the case of an 88-year-old male, with severe comorbidity, who underwent a successful CABG, but incurred an unacknowledged iatrogenic perforation of the ileum with the placement of an epicardial pace wire. The patient developed septic shock and multi organ failure despite intra-abdominal surgical interventions and intensive care therapy, and died 6 days after CABG.

Hernia of the umbilical cord associated with a patent omphalomesenteric duct.

Congenital hernia of the cord is a different type of ventral abdominal wall defect in which the bowel usually herniates into the base of normally inserted umbilical cord through a patent umbilical ring. It is rare congenital anomaly with incidence of 1 in 5000. Although it was described as a distinct entity since 1920s it is often misdiagnosed as a small omphalocele. We present an unusal case of term male newborn with umbilical cord hernia associated with patent omphalomesenteric duct. The diagnose was made after birth despite antenatal ultrasound scans and it is managed successfully with uneventful recovery. If this is missdiagnosed, it could cause iatrogenic atresia of the ileum by clamping the umbilical cord after birth.

Bilateral femoral neck fractures associated with complex pelvic ring injuries in a pediatric patient: a case report.

Femoral neck and pelvic fractures are rarely encountered in the pediatric population secondary to the resilient nature of the immature skeleton. Both fracture types usually result from high-energy blunt trauma including motor vehicle collisions, motor vehicle-pedestrian accidents, and falls from height. Considerable studies have been published on the natural history, management, and complications of pediatric pelvis and femoral neck fractures. However, few case reports have documented both fracture types in the same patient. Management of concomitant injuries presents unique challenges both for operative stabilization and for clinical postoperative care. After appropriate consent was obtained, a thorough review was performed of the patient's hospital records and imaging history. The senior author of the report also provided insight into the management of the patient's initial injuries and subsequent complications. Our case involves a 4-year-old female who was overrun by an all-terrain vehicle. Her orthopedic injuries included a nondisplaced Delbet type 3 fracture of the right femoral neck, a completely displaced Delbet type 3 fracture of the left femoral neck, bilateral sacroiliac fracture-dislocations, severe comminution of her left pubic rami, and a free-floating right pubic rami segment spanning from the triradiate cartilage to the pubic symphysis with severe rotational deformity. Her postoperative recovery was complicated by refracture of her left femoral neck (Delbet type 1), left hip osteomyelitis, and left femoral head avascular necrosis. The salient features of her operative management, subsequent complications, and functional recovery are described in this report. Cases of bilateral femoral neck fractures and multiple pelvic fractures in pediatric patients are sparsely documented in the literature because of their infrequent occurrence. Pediatric pelvic fractures typically do well with conservative treatment secondary to the incredible remodeling ability of the immature pelvis. Femoral neck fractures, in contrast, are highly associated with complications including coxa vara, nonunion, infection, physeal closure, and avascular necrosis. This case report documents two rare fracture types in the same patient and describes the challenges encountered throughout the duration of her recovery. LEVEL OF EVIDENCE: Level V, Case report.

Feasibility and safety study for the use of wound protectors during robotic radical cystectomy and ileal conduit.

Robot-assisted laparoscopic radical cystectomy (RALRC) is increasingly being performed for the treatment of muscle-invasive bladder cancer. There is increased tension while performing the ureteroileal anastomosis through a small incision. Patients are at risk to suffer wound and skin complications perioperatively due to possible contamination with bowel contents. The Alexis® retractor helps with retraction of small incisions potentially reducing tension and also reduces wound infection rates as reported in the colorectal literature. This pilot study evaluates the use of the Alexis® wound protector (WP) in RALRC with ileal conduit (IC). The WP was used in 15 consecutive patients at a single institution who all underwent RALRC with IC. All patients had preoperative bowel preparations, antibiotics, and had surgical preparation with chlorhexidine with alcohol in the standard fashion. The Alexis® device was placed following RALRC to protect the skin and fascia during ileal conduit formation. The ileal conduit was then created extracorporeally through the WP in the standard fashion. RALRC with IC was successfully completed in all 15 patients. Patients had no wound complications defined as documentation of cellulitis or hernia on progress or follow-up notes. Using our technique with the WP we had no cases of surgical site infection. Wound barrier protection has been recommended for use in colorectal surgery and we believe that these recommendations translate to RALRC with IC due to the use of bowel to form the urinary diversion. Further studies with the use of WP in this procedure are necessary to validate our findings.