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1.
Anticancer Res ; 41(4): 1959-1970, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813402

RESUMO

BACKGROUND/AIM: The diagnosis of acute small bowel obstruction (ASBO) may be difficult and the decision to operate is based on clinical findings. So far, the diagnostic scores (DSs) for ASBO detection have been rarely evaluated. PATIENTS AND METHODS: A cohort of 1,333 acute abdominal pain (AAP) patients with 54 ASBO patients, were included in the study. The most significant diagnostic findings (in multivariate logistic regression analysis) were used to construct DS formulas for ASBO diagnosis with location of pain at diagnosis (LP+) and without location of pain at diagnosis (LP-). Meta-analytical techniques were used to calculate the summary sensitivity (Se) and specificity (Sp) estimates for each data sets (history-taking, findings, and DS formulas). RESULTS: In SROC analysis, the AUC values for i) clinical history-taking, ii) diagnostic findings and tests, iii) DSLP- and iv) DSLP+ were as follows: i) AUC=0.638 (95%CI=0.600-0.676); ii) AUC=0.694 (95%CI=0.630-0.724), iii) AUC=0.962 (95%CI=0.940-0.986), and for iv) AUC=0.971 (95%CI=0.952-0.988). In roccomp analysis for the AUC values, the differences are significant as follows: between i) and ii) p=0.312; between i) and iii) p<0.0001; between i) and iv) p<0.0001; between ii) and iii) p<0.0001; between ii) and iv) p<0.0001; and between iii) and iv) p=0.317. CONCLUSION: The present study is the first to provide data that the DS could be used for clinical diagnosis of ASBO without radiological or laboratory analyses, to reach a high diagnostic accuracy in AAP patients.


Assuntos
Abdome Agudo/diagnóstico , Técnicas de Diagnóstico do Sistema Digestório , Obstrução Intestinal/diagnóstico , Intestino Delgado/patologia , Abdome Agudo/etiologia , Abdome Agudo/patologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/patologia , Doença Aguda , Área Sob a Curva , Estudos de Coortes , Conjuntos de Dados como Assunto , Diagnóstico Diferencial , Humanos , Obstrução Intestinal/complicações , Obstrução Intestinal/patologia , Anamnese , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Projetos de Pesquisa , Sensibilidade e Especificidade
2.
Ann R Coll Surg Engl ; 103(4): e127-e130, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682463

RESUMO

A wandering spleen is a very rare event characterised by the absence of the spleen in its anatomical position due to the hyperlaxity of its ligaments. We present a case of wandering spleen complicated by splenic vascular pedicle torsion, thrombosis and subsequent splenic infarction. Compression of the infarcted spleen on the rectosigmoid junction led to the development of a sigmoid volvulus, which presented as an acute large bowel obstruction. The patient underwent emergency laparotomy, splenectomy, sigmoid decompression and sigmoidopexy. After a follow-up period of two years, the volvulus had not recurred.


Assuntos
Obstrução Intestinal/etiologia , Volvo Intestinal/etiologia , Doenças do Colo Sigmoide/etiologia , Infarto do Baço/diagnóstico , Baço Flutuante/diagnóstico , Doença Aguda , Feminino , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Volvo Intestinal/diagnóstico , Volvo Intestinal/cirurgia , Pessoa de Meia-Idade , Doenças do Colo Sigmoide/diagnóstico , Doenças do Colo Sigmoide/cirurgia , Esplenectomia , Infarto do Baço/complicações , Infarto do Baço/cirurgia , Baço Flutuante/complicações , Baço Flutuante/cirurgia
3.
J Postgrad Med ; 67(1): 39-42, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33533746

RESUMO

An elderly hypertensive lady presented with fever, respiratory symptoms, and mild abdominal discomfort and was diagnosed to have COVID-19 pneumonia. Respiratory symptoms improved with steroids, awake proning, high flow nasal cannula oxygen therapy and antibiotics. After 4 days, she developed non-occlusive superior mesenteric artery thrombosis, which initially responded to anticoagulants but was complicated on tenth day by intestinal obstruction necessitating emergency surgery. Challenges encountered perioperatively were multi systemic involvement, pneumonia, ventilation- perfusion mismatch, sepsis along with technical difficulties like fogging of goggles, stuck expiratory valve on anesthesia machine, inaudibility through stethoscope and discomfort due to personal protective equipment. Perioperative focus should be on infection prevention, maintenance of hemodynamics, and optimization of oxygenation with preoperative high flow nasal cannula oxygen therapy. Ultrasound lung helps in correct placement of endotracheal tube. We recommend daily machine check, taping of N95 mask to face and ambient operation theatre temperatures of 20-22°C to reduce technical problems.


Assuntos
Anestesia Geral/métodos , Doenças do Íleo/cirurgia , Obstrução Intestinal/cirurgia , Laparotomia , /diagnóstico , Emergências , Feminino , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/virologia , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/virologia , Pessoa de Meia-Idade
4.
Vet J ; 269: 105608, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33593497

RESUMO

Intestinal epiploic foramen entrapment (EFE) is an important differential diagnosis in horses with colic, but disappointing short- and long-term outcomes are reported in the scientific literature. Many horses are euthanased during surgery due to a predicted poor prognosis or due to uncontrollable intraoperative haemorrhage. The ileum is involved in the majority of cases. Several risk factors for the development of EFE are described; crib-biting/windsucking being the most important one. The recurrence rate of EFE is low despite the described risk factors, probably due to spontaneous closure of the EF after EFE colic surgery in about 40% of the cases. Safe laparoscopic techniques to obliterate the EF preventively in horses at risk or as part of surgical management of EFE at laparotomy are described. Methods for improved outcomes including utilising recently gained anatomical insights of the region while manipulating entrapped intestines, critical revision of anastomosis techniques and avoiding the occurrence of post-operative reflux are discussed.


Assuntos
Cólica/veterinária , Doenças dos Cavalos/diagnóstico , Obstrução Intestinal/veterinária , Intestino Delgado , Omento , Animais , Perda Sanguínea Cirúrgica/veterinária , Cólica/diagnóstico , Diagnóstico Diferencial , Doenças dos Cavalos/cirurgia , Cavalos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Prognóstico , Recidiva , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
5.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542016

RESUMO

The differential diagnosis for ulcerating small bowel strictures is extensive and includes exposure to non-steroidal anti-inflammatory drugs (NSAIDs), Crohn's disease, infections, gastrointestinal lymphoma and vasculopathy. It also encompasses the exceptionally rare and poorly understood diagnosis of cryptogenic multifocal ulcerative stenosing enterocolitis (CMUSE), often a diagnosis of exclusion and considerable difficulty. We present a case of persistent proximal jejunal ulcerating stenoses in a 75-year-old Caucasian man, which continued despite cessation of NSAIDs. After extensive clinical, radiographic, laboratory and ultimately surgical pathological appraisal-as well as failure to improve with both misoprostol and budesonide-he was diagnosed with CMUSE and managed with limited small bowel resection. In the presentation of this case, we aim to underscore the diagnostic challenges that clinicians face in differentiating CMUSE from other more common diagnoses, particularly NSAIDs-induced enteropathy.


Assuntos
Enterite/diagnóstico , Obstrução Intestinal/diagnóstico , Intestino Delgado/patologia , Úlcera/diagnóstico , Dor Abdominal/etiologia , Idoso , Anti-Inflamatórios não Esteroides , Antiulcerosos/uso terapêutico , Constrição Patológica , Diagnóstico Diferencial , Humanos , Masculino , Misoprostol/uso terapêutico , Tomografia Computadorizada por Raios X
6.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462047

RESUMO

Knotting or twisting of the peritoneal catheter around a bowel segment, causing bowel obstruction and necrosis, is extremely rare. Only six cases have been reported in the literature. This report described the second case of an adult patient with spontaneous knotting of the peritoneal catheter around a small-bowel segment, causing bowel obstruction and necrosis. The presentation of a knotted ventriculoperitoneal shunt around a bowel loop is stereotypical. Treatment and general recommendations have been made to help guide clinicians when encountering such cases. Evidence of small-bowel obstruction in a twisted, coiled or knotted peritoneal catheter may need surgical intervention. In the setting of progressive abdominal manifestations, knotting of the peritoneal catheter around bowel loops may cause bowel obstruction and may present with acute life-threatening manifestations. Efficient and expedite diagnosis should be made to coordinate multispecialty intervention and follow-up appropriately.


Assuntos
Cateteres de Demora/efeitos adversos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/etiologia , Derivação Ventriculoperitoneal/efeitos adversos , Adulto , Humanos , Hidrocefalia/cirurgia , Obstrução Intestinal/cirurgia , Doenças do Jejuno/cirurgia , Masculino , Necrose
7.
BMJ Case Rep ; 13(12)2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33370929

RESUMO

Syphilitic proctitis is a rare presentation of sexually transmitted infection that poses a diagnostic challenge as it mimics rectal cancer clinically, radiologically and endoscopically. We report a case of a 66-year-old male patient with a background of HIV infection presenting with obstructive bowel symptoms and initial diagnosis of rectal cancer on CT. Sigmoidoscopy and histopathology were non-diagnostic. A diagnosis of secondary syphilis was suspected after obtaining sexual history and diagnostic serology, avoiding planned surgical intervention.


Assuntos
Infecções por HIV , Obstrução Intestinal , Penicilinas/administração & dosagem , Proctite/diagnóstico , Neoplasias Retais/diagnóstico , Reto , Treponema pallidum , Idoso , Antibacterianos/administração & dosagem , Diagnóstico Diferencial , Infecções por HIV/complicações , Infecções por HIV/terapia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Masculino , Proctite/etiologia , Proctite/fisiopatologia , Proctite/terapia , Reto/diagnóstico por imagem , Reto/microbiologia , Reto/patologia , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/terapia , Sigmoidoscopia/métodos , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/terapia , Tomografia Computadorizada por Raios X/métodos , Treponema pallidum/imunologia , Treponema pallidum/isolamento & purificação
8.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370988

RESUMO

Cholecystocolonic fistula with associated idiopathic megabowel (megacolon and megarectum) is a rare presentation as acute large bowel obstruction. Frequently presenting with chronic constipation, acute bowel obstruction is rarely encountered in the presence of concomitant cholecystocolonic fistula. This presents diagnostic and management difficulties with no consensus on appropriate surgical approach. This case highlights the outcomes following emergency total colectomy and subtotal cholecystectomy as a single-stage procedure for a 68-year-old man presenting with cholecystocolonic fistula secondary to idiopathic megabowel as acute large bowel obstruction.


Assuntos
Fístula Biliar/etiologia , Doenças da Vesícula Biliar/etiologia , Fístula Intestinal/etiologia , Obstrução Intestinal/etiologia , Megacolo/complicações , Doenças Retais/complicações , Idoso , Fístula Biliar/diagnóstico , Fístula Biliar/cirurgia , Colecistectomia , Colectomia , Colo/diagnóstico por imagem , Colo/cirurgia , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/diagnóstico , Doenças da Vesícula Biliar/cirurgia , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/cirurgia , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Masculino , Megacolo/diagnóstico , Megacolo/cirurgia , Doenças Retais/diagnóstico , Doenças Retais/cirurgia , Reto/diagnóstico por imagem , Reto/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
Rev. cuba. cir ; 59(3): e912, jul.-set. 2020. graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144441

RESUMO

RESUMEN Introducción: El íleo biliar representa el 4 por ciento de las causas de obstrucción intestinal en la población general. Objetivo: Mostrar un paciente con cuadro de oclusión intestinal por íleo biliar que fue diagnosticado y tratado en el transoperatorio. Caso clínico: Paciente de 78 años de edad con un cuadro oclusivo por un íleo biliar, al cual se le realizó enterolitotomía como tratamiento definitivo. Conclusiones: El íleo biliar es una causa de oclusión intestinal que todo cirujano general debe tener presente ante un anciano con elementos clínicos e imaginológicos de oclusión y sin intervenciones quirúrgicas previas o hernias de la pared abdominal(AU)


ABSTRACT Introduction: Gallstone ileus represents 4 percent of the causes of intestinal obstruction in the general population. Objective: To present a patient with intestinal obstruction due to gallstone ileus and who was diagnosed and treated during the intraoperative period. Clinical case: The is presented of a 78-year-old patient with an occlusive condition due to gallstone ileus, who underwent enterolithotomy as definitive management procedure. Conclusions: Gallstone ileus is a cause of intestinal occlusion that every general surgeon should be aware of in the presence of an elderly with clinical and imaging elements of occlusion and without previous surgical interventions or hernias of the abdominal wall(AU)


Assuntos
Humanos , Masculino , Idoso , Procedimentos Cirúrgicos Operatórios/métodos , Colelitíase/complicações , Cálculos Biliares/cirurgia , Obstrução Intestinal/diagnóstico
11.
BMC Gastroenterol ; 20(1): 269, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32799796

RESUMO

BACKGROUND: Cancer patients are at increased risk of novel coronavirus disease 2019 (COVID-19). Currently, surgeries for cancer patients with COVID-19 are generally suggested to be properly delayed. CASE PRESENTATION: We presented a 69-year-old Chinese female colon cancer patient with COVID-19, the first case accepted the surgical treatment during the pandemic in China. The patient developed a fever on January 28, 2020. After treatments with Ceftriaxone and Abidol, her fever was not moderated yet. A repeat chest computed tomography (CT) scan showed significantly exacerbated infectious lesions with a positive result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid. An abdomen CT scan indicated the tumor of ascending colon with local wrapped changes. She was diagnosed with 'Severe novel coronavirus pneumonia' and 'Incomplete bowel obstruction: Colon cancer?'. After actively anti-inflammatory and anti-viral therapies, a right colectomy with lymph node dissection was performed on March 11, followed by a pathological examination. The patient successfully recovered from COVID-19 pneumonia and incomplete bowel obstruction after surgery without any postoperative related complications and was discharged on the 9th day after operation. Significant degeneration, necrosis and slough of focal intestinal and colonic mucosal epithelial cells were observed under microscope. No surgeons, nurses or anesthetists in our team were infected with SARS-CoV-2. CONCLUSIONS: It is meaningful and imperative to share our experience of protecting health care personnels from SARS-CoV-2 infection and providing references for optimizing treatment of cancer patients, at least for the operative intervention with absolute necessity or surgical emergency, during the outbreak of COVID-19.


Assuntos
Betacoronavirus/isolamento & purificação , Colectomia/métodos , Neoplasias do Colo , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Idoso , Colo Ascendente/diagnóstico por imagem , Colo Ascendente/patologia , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/patologia , Neoplasias do Colo/fisiopatologia , Neoplasias do Colo/cirurgia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Feminino , Humanos , Controle de Infecções/métodos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
Ann R Coll Surg Engl ; 102(9): e1-e3, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32508109

RESUMO

Splenosis is the autotransplantation of splenic tissue into abnormal locations due to trauma or iatrogenically. Usually, this causes no symptoms, but in rare cases the mass effect of the transplanted nodules can cause small bowel obstruction. Resection of the culprit splenic tissue is recommended, but not more extensive dissection of non-involved nodules. Our patient presented at 43 years of age with abdominal pain, distention and bilious vomiting. He had undergone a splenectomy at the age of 13 years due to splenic rupture after a motor vehicle collision. Computed tomography demonstrated a small bowel obstruction with multiple nodules suspicious of splenosis. The obstructing mass and compromised bowels. were resected. Final pathology confirmed the diagnosis. Splenosis is an uncommon aetiology of small bowel obstruction and must be considered in patients who had previous splenic trauma or surgery.


Assuntos
Obstrução Intestinal/etiologia , Esplenectomia/efeitos adversos , Esplenose/complicações , Adulto , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/etiologia , Doenças do Íleo/cirurgia , Valva Ileocecal/diagnóstico por imagem , Valva Ileocecal/cirurgia , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Masculino , Radiografia Abdominal , Esplenose/etiologia , Fatores de Tempo , Tomografia Computadorizada por Raios X
15.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 55(3): 169-172, mayo-jun. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-196165

RESUMO

El íleo biliar es una complicación rara y potencialmente grave de la colelitiasis. Se define como una obstrucción intestinal mecánica secundaria a la presencia de un cálculo biliar en la luz intestinal. La causa más frecuente es la impactación del cálculo en el íleon tras su paso a través de una fístula bilioentérica. Presenta una elevada morbimortalidad, debido principalmente a la dificultad y el retraso diagnóstico. Presentamos un estudio retrospectivo de 4 casos de íleo biliar tratados entre 2013 y 2017 en el Hospital Nuestra Señora del Prado. Se analizaron las características clínicas, las pruebas diagnósticas y el tratamiento quirúrgico realizado


Gallstone ileus is a rare and potentially serious complication of cholelithiasis. It is defined as a mechanical intestinal obstruction secondary to the presence of a gallstone in the intestinal luz. The most frequent cause is impaction of the calculus in the ileum after passing through a bilioenteric fístula. It has a high morbidity and mortality rate, mainly due to the difficulty and delay in its diagnosis. A retrospective study is presented of 4 cases of gallstone ileus treated between 2013 and 2017 in the Hospital Nuestra Señora del Prado. An analysis was performed on the clinical characteristics, diagnostic tests, and surgical treatment


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Doenças do Íleo/diagnóstico , Obstrução Intestinal/diagnóstico , Cálculos Biliares/diagnóstico , Doenças do Íleo/cirurgia , Obstrução Intestinal/etiologia , Doenças do Íleo/complicações , Cálculos Biliares/complicações , Tomografia Computadorizada por Raios X , Ultrassonografia , Dor Abdominal/etiologia
16.
Niger J Clin Pract ; 23(5): 741-743, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32367885

RESUMO

Obturator hernia (OH) is a relatively rare pelvic hernia. OH is usually seen in elderly, multiparous females and patients with a low body weight. Obturator hernia accounts for 0.07-0.4% of all intraabdominal hernias and 0.2-5.8% of small bowel hernias. The diagnosis of obturator hernia can be difficult and often delayed. Any therapeutic delay is associated with serious complications and higher mortality rates. The correct preoperative diagnosis of obturator hernia is facilitated by computed tomography (CT). Our case was admitted to our emergency unit with intolerance to oral intake for one week. Abdominal ultrasonography was not helpful. The CT of the abdomen revealed the incarcerated intestinal segment. Diagnostic laparoscopy confirmed the CT findings. The intestine was gangrenous and perforated. Segmental resection and anastomosis was performed. Early diagnosis and surgical intervention are essential. This demonstrates that emergency CT scan is useful for the diagnosis of obturator hernia in patients presenting with mechanical intestinal obstruction of unknown origin.


Assuntos
Hérnia do Obturador , Obstrução Intestinal , Intestino Delgado , Idoso , Feminino , Hérnia do Obturador/complicações , Hérnia do Obturador/diagnóstico , Hérnia do Obturador/cirurgia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Laparoscopia , Tomografia Computadorizada por Raios X
17.
Ann R Coll Surg Engl ; 102(7): e155-e157, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32326724

RESUMO

Small bowel obstruction from internal hernias is a familiar pathology for the surgeon, with an incidence of 0.5-5.8%. However, pericaecal hernia is a very uncommon type of internal hernia. Diagnosis and early treatment are essential to avoid strangulation and necrosis of the incarcerated small bowel. We report a case of an 84-year-old woman with no previous history of abdominal surgery who came to our hospital having endured 6 hours of abdominal pain and vomiting. Following physical examination and computed tomography, a diagnosis of small bowel obstruction caused by pericaecal hernia was made and emergency surgery was performed. The hernia was successfully reduced with a laparoscopic approach. Although pericaecal hernia is a rare disease, surgeons should bear it in mind as a differential diagnosis in small bowel obstruction.


Assuntos
Hérnia Abdominal/complicações , Herniorrafia/métodos , Obstrução Intestinal/etiologia , Intestino Delgado/cirurgia , Laparoscopia/métodos , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/cirurgia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Tomografia Computadorizada por Raios X
19.
PLoS One ; 15(4): e0231796, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32287314

RESUMO

BACKGROUND: Antimicrobial peptide expression is associated with disease activity in inflammatory bowel disease (IBD) patients. IBD patients have abnormal expression of elafin, a human elastase-specific protease inhibitor and antimicrobial peptide. We determined elafin expression in blood, intestine, and mesenteric fat of IBD and non-IBD patients. METHODS: Serum samples from normal and IBD patients were collected from two UCLA cohorts. Surgical resection samples of human colonic and mesenteric fat tissues from IBD and non-IBD (colon cancer) patients were collected from Cedars-Sinai Medical Center. RESULTS: High serum elafin levels were associated with a significantly elevated risk of intestinal stricture in Crohn's disease (CD) patients. Microsoft Azure Machine learning algorithm using serum elafin levels and clinical data identified stricturing CD patients with high accuracy. Serum elafin levels had weak positive correlations with clinical disease activity (Partial Mayo Score and Harvey Bradshaw Index), but not endoscopic disease activity (Mayo Endoscopic Subscore and Simple Endoscopic Index for CD) in IBD patients. Ulcerative colitis (UC) patients had high serum elafin levels. Colonic elafin mRNA and protein expression were not associated with clinical disease activity and histological injury in IBD patients, but stricturing CD patients had lower colonic elafin expression than non-stricturing CD patients. Mesenteric fat in stricturing CD patients had significantly increased elafin mRNA and protein expression, which may contribute to high circulating elafin levels. Human mesenteric fat adipocytes secrete elafin protein. CONCLUSIONS: High circulating elafin levels are associated with the presence of stricture in CD patients. Serum elafin levels may help identify intestinal strictures in CD patients.


Assuntos
Colite Ulcerativa/sangue , Doença de Crohn/complicações , Elafina/sangue , Obstrução Intestinal/diagnóstico , Gordura Abdominal/citologia , Gordura Abdominal/metabolismo , Adipócitos/metabolismo , Adulto , Estudos de Casos e Controles , Linhagem Celular , Colite Ulcerativa/patologia , Colo/diagnóstico por imagem , Colo/patologia , Colonoscopia , Constrição Patológica/sangue , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Doença de Crohn/sangue , Doença de Crohn/diagnóstico , Doença de Crohn/patologia , Elafina/metabolismo , Feminino , Fibroblastos , Voluntários Saudáveis , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Obstrução Intestinal/sangue , Obstrução Intestinal/etiologia , Obstrução Intestinal/patologia , Masculino , Cultura Primária de Células , Estudos Prospectivos , Índice de Gravidade de Doença
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