BACKGROUND Irreversible transmural intestinal necrosis(ITIN)is associated with high mortality rates in patients with acute occlusive mesenteric ischemia(AOMI).Currently,there are not many studies on the use of dual en...BACKGROUND Irreversible transmural intestinal necrosis(ITIN)is associated with high mortality rates in patients with acute occlusive mesenteric ischemia(AOMI).Currently,there are not many studies on the use of dual energy computed tomography(DECT)for evaluating ITIN.AIM To evaluate the diagnostic value of DECT for ITIN in AOMI.METHODS The cases and computed tomography(CT)images of 102 patients with clinically diagnosed AOMI(including 48 ITIN)from January 2012 to January 2022 were retrospectively collected.The CT scans included both multidetector CT and DECT.The raw data from DECT portal-venous phase were reconstructed into 120 kVp mixed energy image,50 keV virtual monoenergetic imaging,and iodine map.Two radiologists independently completed the subjective visual assessment of CT signs related to AOMI.Objective parameters,including the attenuation of the normal and_(lesion)intestinal wall segment(CT50 keV_(lesion),CT_(50 keV normal/lesion))and iodine concentrations(IC_(lesion)and I_(Cnormal/lesion)),were quantified.Furthermore,multivariate logistic regression,receiver operating characteristic curves,and area under the curve(AUC)values were used to evaluate the subjective and objective indicators in predicting ITIN.RESULTS Regarding subjective signs,logistic regression analysis revealed reduced or absent bowel wall enhancement[odds ratio(OR)=5.576,95%confidence interval(CI):1.547-20.093],bowel dilation(OR=11.613,95%CI:3.790-35.586),and parenchymatous organ infarction(OR=4.727,95%CI:1.536-14.551)were independent risk factors for the ITIN.CT subjective signs had a high diagnostic efficacy for ITIN(AUC=0.853).The two DECT objective parameters also exhibited excellent diagnostic value for ITIN,with an AUC of 0.79,a cut-off value of CT50 keV normal/_(lesion)=2.81,and an AUC of 0.777 with a cut-off value of I_(Cnormal/lesion)=2.39.The Delong test showed that there was no significant difference in the efficacy of subjective CT signs and objective DECT parameters(P>0.05).Importantly,we observed that I_(Cnormal/lesion)combined with subjective signs(bowel dilation and parenchymatous organ infarction)had the highest predictive performance(AUC=0.894),sensitivity(100%),and specificity(70.83%),which was statistically different from the AUC of CT subjective signs(P=0.017).CONCLUSION I_(Cnormal/lesion)(DECT-based features)combined with CT subjective signs(bowel dilatation and parenchymatous organ infarction)showed favorable predictive performance for ITIN in AOMI,which may help clinicians develop timely treatment strategies.展开更多
AIM:To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.METHODS:Three patients in our study were trapped inside collapsed structures ...AIM:To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.METHODS:Three patients in our study were trapped inside collapsed structures for 22,21 and 37 h,respectively,The patients underwent 3-4 operations after sustaining their injuries,Mechanical ventilation,intermittent hemodialysis and other treatments were also provided.The patients showed signs of peritoneal irritation on postoperative days 10-38.Small intestinal necrosis was confirmed by emergency laparotomy,and for each patient,part of the small bowel was removed.RESULTS:Two patients who all performed 3 operations died of respiratory complications on the first and second postoperative days respectively.The third patient who performed 4 operations was discharged and made a full recovery.Three patients had the following common characteristics:(1) Multiple severe trauma events with no direct penetrating gastrointestinal injury;(2) Multiple surgeries with impaired renal function and intermittent hemodialysis treatment;(3) Progressive abdominal pain and tenderness,and peritoneal irritation was present on post-traumatic days 10-38;(4) Abdominal operations confirmed segment ulcer,necrosis of the small intestine,hyperplasia and stiffness of the intestinal wall;and(5) Pathological examinations suggested submucosal hemorrhage,necrosis,fibrosis and hyalinization of the vascular wall.Pathological examinations of all 3 patients suggested intestinal necrosis with fistulas.CONCLUSION:Intestinal necrosis is strongly associated with stress from trauma and post-traumatic complications;timely exploratory laparotomy maybe an effective method for preventing and treating stressinduced intestinal necrosis.展开更多
BACKGROUND Congenital intestinal malrotation(CIM)is a common malformation in neonates.Early diagnosis and surgical intervention can improve the prognosis.CIM combined with congenital gastric wall defect is a potential...BACKGROUND Congenital intestinal malrotation(CIM)is a common malformation in neonates.Early diagnosis and surgical intervention can improve the prognosis.CIM combined with congenital gastric wall defect is a potentially fatal condition.We present a severe case of CIM with gastric wall defect causing extensive gut necrosis and short gut syndrome.After three operations,the neonate survived and subsequently showed normal growth and development during infancy.CASE SUMMARY A male neonate(age:4 d)was hospitalized due to bloody stools and vomiting for 2 d,and abdominal distention for 1 d.Emergent exploratory laparotomy revealed black purplish discoloration of the bowel loops.Bowel alignment was abnormal with congestion and dilatation of the entire intestine,and clockwise mesentery volvulus(720°).The posterior wall of the gastric body near the greater curvature showed a defect in the muscularis layer(approximately 5.5 cm),and a circular perforation(approximately 3 cm diameter)at the center of this defect.Ladd’s procedure was performed and gastric wall defect was repaired.Third operation performed 53 d after birth revealed extensive adherence of small intestine and peritoneum,and adhesion angulated between many small intestinal loops.We performed intestinal adhesiolysis,resection of necrotic intestine,and small bowel anastomosis.CONCLUSION This case highlights that prolonged medical treatment may help improve intestinal salvage after surgical removal of necrotic intestines,and improve patient prognosis.展开更多
BACKGROUND Meckel's diverticulum is a common congenital anomaly of the gastrointestinal tract,with a higher incidence rate in children under 7 years old.The condition is characteristically asymptomatic but may bec...BACKGROUND Meckel's diverticulum is a common congenital anomaly of the gastrointestinal tract,with a higher incidence rate in children under 7 years old.The condition is characteristically asymptomatic but may become a clinical concern when complications such as intestinal obstruction,bleeding,perforation,or diverticulitis precipitate acute abdominal presentations.CASE SUMMARY This report describes the case of a middle-aged man initially suspected of having acute appendicitis,which rapidly progressed to acute peritonitis with concomitant intestinal obstruction observed during preoperative assessment.Surgical exploration confirmed the diagnosis of Meckel's diverticulum-induced internal hernia,accompanied by intestinal obstruction and necrosis.In addition,the hernial ring base exhibited entrapment resembling a surgical knot.CONCLUSION Meckel's diverticulum is a rare cause of small bowel obstruction in adults,and it should be considered in a differential diagnosis.展开更多
基金Supported by The Project of Nantong City Health Committee,No.MS2023027 and WKZL2018017The“333”Talent Funding Project of Jiangsu Province,No.BRA2020198+1 种基金The Project of Jiangsu Provincial Health Commission,No.ZD2021059The Youth Research Fund of Nantong Municipal Health Commission,No.QNZ2023027.
文摘BACKGROUND Irreversible transmural intestinal necrosis(ITIN)is associated with high mortality rates in patients with acute occlusive mesenteric ischemia(AOMI).Currently,there are not many studies on the use of dual energy computed tomography(DECT)for evaluating ITIN.AIM To evaluate the diagnostic value of DECT for ITIN in AOMI.METHODS The cases and computed tomography(CT)images of 102 patients with clinically diagnosed AOMI(including 48 ITIN)from January 2012 to January 2022 were retrospectively collected.The CT scans included both multidetector CT and DECT.The raw data from DECT portal-venous phase were reconstructed into 120 kVp mixed energy image,50 keV virtual monoenergetic imaging,and iodine map.Two radiologists independently completed the subjective visual assessment of CT signs related to AOMI.Objective parameters,including the attenuation of the normal and_(lesion)intestinal wall segment(CT50 keV_(lesion),CT_(50 keV normal/lesion))and iodine concentrations(IC_(lesion)and I_(Cnormal/lesion)),were quantified.Furthermore,multivariate logistic regression,receiver operating characteristic curves,and area under the curve(AUC)values were used to evaluate the subjective and objective indicators in predicting ITIN.RESULTS Regarding subjective signs,logistic regression analysis revealed reduced or absent bowel wall enhancement[odds ratio(OR)=5.576,95%confidence interval(CI):1.547-20.093],bowel dilation(OR=11.613,95%CI:3.790-35.586),and parenchymatous organ infarction(OR=4.727,95%CI:1.536-14.551)were independent risk factors for the ITIN.CT subjective signs had a high diagnostic efficacy for ITIN(AUC=0.853).The two DECT objective parameters also exhibited excellent diagnostic value for ITIN,with an AUC of 0.79,a cut-off value of CT50 keV normal/_(lesion)=2.81,and an AUC of 0.777 with a cut-off value of I_(Cnormal/lesion)=2.39.The Delong test showed that there was no significant difference in the efficacy of subjective CT signs and objective DECT parameters(P>0.05).Importantly,we observed that I_(Cnormal/lesion)combined with subjective signs(bowel dilation and parenchymatous organ infarction)had the highest predictive performance(AUC=0.894),sensitivity(100%),and specificity(70.83%),which was statistically different from the AUC of CT subjective signs(P=0.017).CONCLUSION I_(Cnormal/lesion)(DECT-based features)combined with CT subjective signs(bowel dilatation and parenchymatous organ infarction)showed favorable predictive performance for ITIN in AOMI,which may help clinicians develop timely treatment strategies.
基金Supported by The Fund of the People's Liberation Army Gen-eral Hospital of Chengdu Command,No.2011YG-B24
文摘AIM:To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.METHODS:Three patients in our study were trapped inside collapsed structures for 22,21 and 37 h,respectively,The patients underwent 3-4 operations after sustaining their injuries,Mechanical ventilation,intermittent hemodialysis and other treatments were also provided.The patients showed signs of peritoneal irritation on postoperative days 10-38.Small intestinal necrosis was confirmed by emergency laparotomy,and for each patient,part of the small bowel was removed.RESULTS:Two patients who all performed 3 operations died of respiratory complications on the first and second postoperative days respectively.The third patient who performed 4 operations was discharged and made a full recovery.Three patients had the following common characteristics:(1) Multiple severe trauma events with no direct penetrating gastrointestinal injury;(2) Multiple surgeries with impaired renal function and intermittent hemodialysis treatment;(3) Progressive abdominal pain and tenderness,and peritoneal irritation was present on post-traumatic days 10-38;(4) Abdominal operations confirmed segment ulcer,necrosis of the small intestine,hyperplasia and stiffness of the intestinal wall;and(5) Pathological examinations suggested submucosal hemorrhage,necrosis,fibrosis and hyalinization of the vascular wall.Pathological examinations of all 3 patients suggested intestinal necrosis with fistulas.CONCLUSION:Intestinal necrosis is strongly associated with stress from trauma and post-traumatic complications;timely exploratory laparotomy maybe an effective method for preventing and treating stressinduced intestinal necrosis.
文摘BACKGROUND Congenital intestinal malrotation(CIM)is a common malformation in neonates.Early diagnosis and surgical intervention can improve the prognosis.CIM combined with congenital gastric wall defect is a potentially fatal condition.We present a severe case of CIM with gastric wall defect causing extensive gut necrosis and short gut syndrome.After three operations,the neonate survived and subsequently showed normal growth and development during infancy.CASE SUMMARY A male neonate(age:4 d)was hospitalized due to bloody stools and vomiting for 2 d,and abdominal distention for 1 d.Emergent exploratory laparotomy revealed black purplish discoloration of the bowel loops.Bowel alignment was abnormal with congestion and dilatation of the entire intestine,and clockwise mesentery volvulus(720°).The posterior wall of the gastric body near the greater curvature showed a defect in the muscularis layer(approximately 5.5 cm),and a circular perforation(approximately 3 cm diameter)at the center of this defect.Ladd’s procedure was performed and gastric wall defect was repaired.Third operation performed 53 d after birth revealed extensive adherence of small intestine and peritoneum,and adhesion angulated between many small intestinal loops.We performed intestinal adhesiolysis,resection of necrotic intestine,and small bowel anastomosis.CONCLUSION This case highlights that prolonged medical treatment may help improve intestinal salvage after surgical removal of necrotic intestines,and improve patient prognosis.
文摘BACKGROUND Meckel's diverticulum is a common congenital anomaly of the gastrointestinal tract,with a higher incidence rate in children under 7 years old.The condition is characteristically asymptomatic but may become a clinical concern when complications such as intestinal obstruction,bleeding,perforation,or diverticulitis precipitate acute abdominal presentations.CASE SUMMARY This report describes the case of a middle-aged man initially suspected of having acute appendicitis,which rapidly progressed to acute peritonitis with concomitant intestinal obstruction observed during preoperative assessment.Surgical exploration confirmed the diagnosis of Meckel's diverticulum-induced internal hernia,accompanied by intestinal obstruction and necrosis.In addition,the hernial ring base exhibited entrapment resembling a surgical knot.CONCLUSION Meckel's diverticulum is a rare cause of small bowel obstruction in adults,and it should be considered in a differential diagnosis.
