BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-...BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.展开更多
Resume of the study & Background: Radial forearm free flap with all its present day modifications is the workhorse of soft tissue reconstruction. Although there are several advantages, it requires sacrifice of a m...Resume of the study & Background: Radial forearm free flap with all its present day modifications is the workhorse of soft tissue reconstruction. Although there are several advantages, it requires sacrifice of a major artery of forearm. Several modifications are described in harvesting a forearm flap. In order to achieve a reliable, safe flap harvest & design one must have a very clear understanding of radial artery perforators, relative to its distribution, territory & flow. The purpose of this study is to determine the location, size & vascular territory of the radial artery cutaneous perforators & to demonstrate application of shape modification of radial forearm free flap based on its distal & proximal perforators in various head & neck defects. Materials & Methods: Anatomical Study: 12 fresh human cadavers & 24 cadaveric forearms were dissected to determine the number, location, size & vascular territory of radial artery perforator. The cutaneous territory of distally dominant perforators was analyzed using methylene blue injections & three-dimensional computed tomographic angiogram to determine the vascular network. Clinical Study: 15 patients with various head neck defects following oncological resections were reconstructed with shape modified adipo-fascio cutaneous free forearm flap. All these patients were prospectively followed for donor site healing, motor & sensory nerve deficit, function & quality of life questioner for donor site assessment. Results: 12 fresh human cadavers & 24 cadaveric forearms were dissected, and a total of 222 perforators were dissected for an average of 18.5 perforators per forearm. 118 were smaller than 0.5 mm in diameter (53.15%) & were not clinically significant. 104 perforators were greater than 0.5 mm in diameter (46.84%) & were clinically significant. 127 perforators (57.20%) were radially distributed & 95 perforators (42.79%) had ulnar distribution. 90 perforators (40.54%) were identified on distal side (Radial styloid) & 132 perforators (59.45%) were identified on proximal side (Lateral epicondyle). Mean number of perforators, on radial side was 10.6 & 7.9 on ulnar side;comparison of both using student t paired test gives a P value of 0.006, which is significant. Comparison of mean number of perforators on the distal side was 7.5 & proximal side was 11.0;Student Paired t test gives a P value of 0.003, which was statistically significant. Comparison of mean diameter of perforators on Distal side (1.11) & Proximal side (0.86), side using Student Paired t test gives a P value of 0.01 which was statistically significant. A chi square test was done to compare mean diameter of perforators on distal side, which was more than 1 mm (80%) & less than 1 mm (20%) & on proximal side more than 1 mm (35.6%) & less than 1 mm (64.4%). Chi square value of 42.406 was obtained, degree of freedom value was 1 & P value of Conclusion: Increase in knowledge of vascular territory of radial artery perforators with regards to numbers, size, location, & cutaneous territory can lead to expanded use of radial forearm flap based on either distal or proximal perforator alone. Shape modified technique for harvesting radial forearm flap allows primary closure of donor site. Donor site is better healed and shows a predicted pattern, which is functionally and aesthetically good.展开更多
Utilizing finite element analysis,the ballistic protection provided by a combination of perforated D-shaped and base armor plates,collectively referred to as radiator armor,is evaluated.ANSYS Explicit Dynamics is empl...Utilizing finite element analysis,the ballistic protection provided by a combination of perforated D-shaped and base armor plates,collectively referred to as radiator armor,is evaluated.ANSYS Explicit Dynamics is employed to simulate the ballistic impact of 7.62 mm armor-piercing projectiles on Aluminum AA5083-H116 and Steel Secure 500 armors,focusing on the evaluation of material deformation and penetration resistance at varying impact points.While the D-shaped armor plate is penetrated by the armor-piercing projectiles,the combination of the perforated D-shaped and base armor plates successfully halts penetration.A numerical model based on the finite element method is developed using software such as SolidWorks and ANSYS to analyze the interaction between radiator armor and bullet.The perforated design of radiator armor is to maintain airflow for radiator function,with hole sizes smaller than the bullet core diameter to protect radiator assemblies.Predictions are made regarding the brittle fracture resulting from the projectile core′s bending due to asymmetric impact,and the resulting fragments failed to penetrate the perforated base armor plate.Craters are formed on the surface of the perforated D-shaped armor plate due to the impact of projectile fragments.The numerical model accurately predicts hole growth and projectile penetration upon impact with the armor,demonstrating effective protection of the radiator assemblies by the radiator armor.展开更多
An analytical model of a floating heaving box integrated with a vertical flexible porous membrane placed right next to the box applications to wave energy extraction and breakwater systems is developed under the reduc...An analytical model of a floating heaving box integrated with a vertical flexible porous membrane placed right next to the box applications to wave energy extraction and breakwater systems is developed under the reduced wave equation.The theoretical solutions for the heave radiating potential to the assigned physical model in the corresponding zones are attained by using the separation of variables approach along with the Fourier expansion.Applying the matching eigenfunction expansion technique and orthogonal conditions,the unknown coefficients that are involved in the radiated potentials are determined.The attained radiation potential allows the computation of hydrodynamic coefficients of the heaving buoy,Power Take-Off damping,and wave quantities.The accuracy of the analytical solution for the hydrodynamic coefficients is demonstrated for different oblique angles with varying numbers of terms in the series solution.The current analytical analysis findings are confirmed by existing published numerical boundary element method simulations.Several numerical results of the hydrodynamic coefficients,power capture,power take-off optimal damping,and transmission coefficients for numerous structural and physical aspects are conducted.It has been noted that the ideal power take-off damping increases as the angle of incidence rises,and the analysis suggests that the ability to capture waves is more effective in shallower waters compared to deeper ones.展开更多
Aim:Anterolateral thigh(ALT)flap is widely used in reconstruction of various defects.Preoperative imaging facilitates perforator mapping,overcoming intraoperative uncertainty.The purpose of this study was to investiga...Aim:Anterolateral thigh(ALT)flap is widely used in reconstruction of various defects.Preoperative imaging facilitates perforator mapping,overcoming intraoperative uncertainty.The purpose of this study was to investigate the utility of multi-detector row computed tomography angiography(MDCTA)and a handheld Doppler in locating ALT perforators.Methods:Twenty patients were randomized into two groups.Group 1 patients received MDCTA and Doppler studies whereas Group 2 received only a Doppler study.The number,location,course,and source of all cutaneous and sizable perforators were compared with intraoperative findings.Surgeons’stress levels during flap harvest and flap harvest time were compared.Results:MDCTA findings correlated well with intraoperative findings for perforator type and segmental distribution with 100%concordance.Doppler alone had a 52%rate of concordance.The sensitivity and specificity for MDCTA in demonstrating the presence of perforators were 85.71%and 97.22%,respectively;whereas for Doppler alone the sensitivity and specificity were 80%and 87.91%,respectively.In demonstrating perforator source,MDCTA showed a sensitivity of 100%and specificity of 91.66%,with 100%accuracy.Sensitivity and specificity for sizable perforators were 90%each,with 88.88%accuracy.Doppler studies were unable to provide this information.Comparison of surgeon stress levels showed no differences between the two groups,although the time for flap harvest was significantly shorter in Group 1.Conclusion:MDCTA compared to Doppler is more sensitive,specific,and accurate with respect to location,course,and source of perforators.展开更多
Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases.During the last few years,the incidence rate of perforations in colonoscopi...Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases.During the last few years,the incidence rate of perforations in colonoscopic procedures has increased,especially in therapeutic colonoscopies.The recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection,endoscopic full-thickness resection,and endoscopic submucosal dissection(ESD)could be a risk factor for this increased risk.The incidence rate of mortality of serious colonoscopic perforations is 7.1%.The management plan for these perforations starts with conservative treatment in mild cases,endoscopic closure,and surgical management in severe cases.Recently,endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case reports.This editorial provides an overview of the current guidelines for the management of iatrogenic colorectal perforations.These insights are from the perspectives of endoscopists and gastroenterologists.We also present a management algorithm based on the guidelines of the European Society of Gastrointestinal Endoscopy,the American Gastroenterological Association,and the World Society of Emergency Surgery.We also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.展开更多
An abrasive water jet(AWJ)is commonly used to develop deep geothermal resources,such as drilling in hot dry rock(HDR).The influence of rock mineral properties,such as mineral types,mineral contents,and grain size,on t...An abrasive water jet(AWJ)is commonly used to develop deep geothermal resources,such as drilling in hot dry rock(HDR).The influence of rock mineral properties,such as mineral types,mineral contents,and grain size,on the formation of perforation by AWJ is unclear yet.In this study,we investigate AWJ impacts on three types of granite samples with different mineral fractions using a polarizing microscope and scanning electron microscope(SEM).The results show that when the grain size is doubled,the perforation depth increases by 16.22%under the same type of structure and properties.In general,fractures are more likely to be created at the position of rough surfaces caused by abrasive impact,and the form of fractures is determined by the mineral type.In addition,microstructure analysis shows that transgranular fractures typically pass through large feldspar particles and quartz removal occurs along mineral boundaries.The longitudinal extension of perforation depends mainly on the strong kinetic energy of the jet,while the lateral extension is controlled by the backflow.The results contribute to a better understanding of the process involved in the breaking of hard rock by abrasive jets during deep geothermal drilling.展开更多
A theoretical analysis on the perforation of Weldox 460E steel plates struck by flat-nosed projectiles is presented using a previously developed model within a unified framework.This model contains a dimensionless emp...A theoretical analysis on the perforation of Weldox 460E steel plates struck by flat-nosed projectiles is presented using a previously developed model within a unified framework.This model contains a dimensionless empirical equation to describe the variation of energy absorbed through global deformation as a function of impact velocity.The study further investigates the energy absorption mechanisms of Weldox 460E steel plates,with particular focus on the“plateau”phenomenon,i.e.,limited increase in ballistic limit with increasing plate thickness.This phenomenon is explained and compared with results from previously studied 2024-T351 aluminium plates.The model predictions agree well with experimental data for Weldox 460E steel plates impacted by flat-nosed projectiles,including:relationship between global deformation and impact velocity,ballistic limit,residual velocity,and critical conditions for the transition of failure modes.Moreover,the model effectively predicts the“plateau”phenomenon observed in intermediate plate thickness range.It is also found that the indentation absorption energy contributes a significantly larger fraction of the total absorption energy in Weldox 460E steel plates perforated by flat-nosed projectiles than in 2024-T351 aluminium plates,due to the differences in material properties.展开更多
BACKGROUND Perforated gastric cancer(GC)is a rare but life-threatening surgical emergency.Optimal surgical management remains controversial,and evidence from highvolume centers,especially in Western countries,is limit...BACKGROUND Perforated gastric cancer(GC)is a rare but life-threatening surgical emergency.Optimal surgical management remains controversial,and evidence from highvolume centers,especially in Western countries,is limited.AIM To evaluate surgical and survival outcomes of patients with perforated GC(PGC)according to the initial treatment strategy.METHODS A retrospective cohort study was conducted including all patients with pathologically confirmed perforated gastric adenocarcinoma treated at a single tertiary cancer center between January 2009 and March 2024.Surgical strategies were categorized as gastrectomy or primary perforation repair.Outcomes analyzed included 30-and 90-day mortality,postoperative major complications,and overall survival(OS).RESULTS Among 1586 GC patients undergoing surgical treatment,36(2.3%)presented with PGC.The mean age was 62.5 years,and 55%were male.American Society of Anesthesiologists(ASA)class III/IV was present in 58.3%,and 83%had stage IV disease,with distant metastasis in 50%.Perforation repair was performed in 26 patients(72.2%),while 10(27.8%)underwent one-stage gastrectomy.ASA III/IV status(57.7%vs 30%,P=0.260)and metastatic disease(57.7%vs 30%,P=0.137)were more frequent in the Perforation Repair Group,though not statistically significant.This group also had a higher rate of diffuse-type and poorly differentiated tumors(P=0.024 and P=0.014,respectively).Thirty-and 90-day mortality were higher in the Perforation Repair Group(61.5%vs 30%,P=0.139;and 65.4%vs 30%,P=0.073),without significance.Three patients initially repaired were later referred for gastrectomy.OS was significantly better in the Gastrectomy Group(P=0.002),with median survival of 8.8 months vs 0.5 months.On multivariable analysis,gastrectomy was independently associated with improved survival(P=0.026).CONCLUSION When clinically feasible,gastrectomy—either immediate or delayed—provides superior survival compared to local perforation repair alone in patients with PGC.展开更多
BACKGROUND Motorcycle accidents often result in abdominal trauma in patients seeking emergency care.Injuries to the hollow viscera,including the duodenum,jejunum,urinary bladder,and colorectum,are relatively common.In...BACKGROUND Motorcycle accidents often result in abdominal trauma in patients seeking emergency care.Injuries to the hollow viscera,including the duodenum,jejunum,urinary bladder,and colorectum,are relatively common.In contrast,owing to the protective function of the anterior rib cage,gastric rupture is exceptionally rare,with an incidence of<1.7%.Gastric rupture typically occurs in the anterior wall and rarely presents as multiple ruptures.This report describes an unusual case of multiple gastric ruptures resulting from blunt trauma.CASE SUMMARY A 21-year-old man,who was involved in a motorcycle collision at 70 km/hour after consuming a large meal,presented with hypotension.Physical examination revealed abdominal tenderness.Laboratory test results indicated elevated amylase,lipase,and liver enzyme levels.Computed tomography showed pneumoperitoneum,hemoperitoneum,and gastric wall discontinuation,suggesting gastric perforation alongside pancreatic,splenic,and hepatic injuries.Angiographic embolization was performed because of active contrast leakage in the left gastric and right gastroepiploic arteries.Emergency laparotomy revealed substantial blood loss,hematoma,and gastric contents scattered throughout the abdominal cavity.Two 10 cm gastric perforations in the anterior and posterior walls were identified,as well as severe liver damage,splenic injury,and pancreatic contusion.Surgical interventions included primary closure of the gastric wall,splenectomy,and partial hepatectomy.After temporary abdominal closure,the patient underwent a second surgery without further bleeding.The gastric repair site was resected and reinforced for optimal tissue healing.CONCLUSION Gastric rupture following blunt trauma is fatal.However,patients without severe complications can recover through surgical interventions and postoperative care.展开更多
Diverticular disease(DD)represents a prevalent clinical challenge,especially in the aging population.The sigmoid colon is the most frequently affected area.However,the presence of DD in the upper gastrointestinal trac...Diverticular disease(DD)represents a prevalent clinical challenge,especially in the aging population.The sigmoid colon is the most frequently affected area.However,the presence of DD in the upper gastrointestinal tract,including the duodenum and jejunum,underscores the need for comprehensive understanding and management.In this minireview we analyzed the epidemiology,pathogenesis,clinical presentation,diagnosis,and management of DD with a specific focus on jejunal diverticulosis.Although the incidence of gastrointestinal DD increases with age,the male and female prevalence is the same.Clinical presentation is either asymptomatic or with unclear abdominal symptoms.However,complications such as perforation and bleeding can occur in a subset of patients and demand urgent diagnosis and surgical treatment.Imaging alternatives,including CT and enteroscopy,play key roles in diagnosis.Surgical management is warranted in cases with persistent bleeding or more complicated acute abdomen.Jejunal diverticulosis(JD)is a less common condition and poses a unique diagnostic and therapeutic challenge.Bleeding has been reported as the most important complication in JD.Therefore,early diagnosis and management are critical to improve patient outcomes and reduce morbidity and mortality.This article highlighted the importance of considering JD in the differential diagnosis of gastrointestinal bleeding,especially in patients with concurrent colon diverticulosis in which the bleeding source remains unidentified.Therefore,current challenges in JD are better understanding the etiopathology and optimal management strategies.展开更多
BACKGROUND Complications occur in approximately 12%of cases of diverticulitis,with perforation occurring in up to 10%of complications.Typically,patient with perforated diverticulitis present intraperitoneally with abd...BACKGROUND Complications occur in approximately 12%of cases of diverticulitis,with perforation occurring in up to 10%of complications.Typically,patient with perforated diverticulitis present intraperitoneally with abdominal pain and peritoneal signs.By contrast,pneumoretroperitoneum and pneumomediastinum are rare complications and lack typical symptoms,making their diagnosis difficult and often delayed,leading to increased morbidity and mortality.CASE SUMMARY A 66-year-old man presented with lower abdominal pain for 3 days.On examination,his vital signs were stable,and the abdomen was soft with mild distension and left lower quadrant tenderness,but no peritoneal signs were noted.Laboratory tests indicated leukocytosis and a markedly elevated C-reactive protein level.Abdominal computed tomography(CT)revealed focal wall thickening and fat stranding near the rectosigmoid junction as well as pneumoretroperitoneum,pneumomediastinum,and minor pneumoperitoneum.Suspecting hollow organ perforation,an emergent exploratory laparotomy was performed which revealed a retroperitoneal abscess with mesocolonic necrosis,likely due to perforated sigmoid diverticulitis.The patient underwent sigmoid resection with Hartmann’s procedure and retroperitoneal drainage.Follow-up CT on postoperative day 14 confirmed resolution of the free air,and the patient was discharged on postoperative day 40 with an uneventful recovery.CONCLUSION Pneumoretroperitoneum and pneumomediastinum are rare complications of perforated diverticulitis,often with delayed diagnosis due to the absence of peritoneal signs.CT aids detection,and timely surgical intervention is crucial.展开更多
This letter discusses the findings of Pang et al retrospective study on omental patch repair as a balanced treatment for gastric ulcer perforation.We acknowledge its clinical value while highlighting a critical limita...This letter discusses the findings of Pang et al retrospective study on omental patch repair as a balanced treatment for gastric ulcer perforation.We acknowledge its clinical value while highlighting a critical limitation:Conventional mechanical closure often results in fibrotic scarring and functional impairment across the mucosal,muscular,and neurovascular layers.To address this,we propose the innovative concept of“multi-layer repair”and present a proof-ofconcept three-dimensional bioprinted functional biopatch.This patch features a multilayer structure:An inner layer laden with gastric mucosal organoids and an outer layer containing primary gastric muscle cells,both integrated onto a wetadhesive electrospun membrane.Preliminary animal studies have yielded encouraging results,supporting its potential to promote functional restoration beyond mechanical sealing.展开更多
BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and ...BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and an ideal postoperative antiinfective approach for PPA management has yet to be established.AIM To examine the spectrum of pathogenic bacteria in pediatric PPA and to summarize the postoperative experience with carbapenem(CBP)and cephalosporin(CPS)antibiotics.METHODS We retrospectively analyzed medical records of 65 children(43 boys,22 girls;mean age 6.92±3.41 years)with PPA who underwent surgery at our hospital between December 2019 and August 2022.Data were collected in September 2023.Based on postoperative antibiotic selection,patients were divided into CBP(32 cases)and CPS(33 cases)groups.Chi-square and T-tests compared recovery outcomes,while univariate and multivariate regression models identified independent factors affecting postoperative recovery.RESULTS There were no significant differences between the two groups in gender,age,weight,height,body mass index,baseline ear temperature,or heart rate(P>0.05).Escherichia coli(40.00%)and Pseudomonas aeruginosa(24.62%)were the most common pathogens in PPA.Postoperative analysis showed significantly shorter C-reactive protein(CRP)recovery times in the CPS group than in the CBP group[(6.18±1.84)vs(8.12±3.48)days,P=0.009].Univariate logistic regression indicated CPS selection(OR=0.32,95%CI:0.10-0.97,P=0.044)was significantly associated with a higher CRP recovery rate within 7 days.Multivariate analysis confirmed CPS selection(OR=3.49,95%CI:1.19-10.24,P=0.023)as an independent factor affecting CRP recovery within 7 days postoperatively.CONCLUSION The choice of CBP or CPS independently affects CRP recovery within 7 days.CBP offers no advantage over CPS in treating PPA,with CPS also demonstrating favorable clinical outcomes.展开更多
BACKGROUND Post-polypectomy syndrome(PPS)is a rare but relevant complication of endo-scopic colorectal polyp removal.Although its course is usually benign,it may conceal more severe conditions.This case report present...BACKGROUND Post-polypectomy syndrome(PPS)is a rare but relevant complication of endo-scopic colorectal polyp removal.Although its course is usually benign,it may conceal more severe conditions.This case report presents several complications resulting from a colorectal polypectomy.CASE SUMMARY We report the case of a 67-year-old man who presented with asthenia and abdo-minal discomfort after a scheduled polypectomy.The patient was initially diagnosed with PPS and managed conservatively.However,progressive clinical deterioration led to hospital admission.Imaging revealed a right-sided intra-abdominal abscess secondary to colonic perforation.The initial polyp was iden-tified as a subepithelial lipoma.The patient underwent successful percutaneous drainage,antibiotic therapy,and recovered without the need for surgical inter-vention.CONCLUSION This case highlights the importance of accurate endoscopic diagnosis and te-chnique selection.PPS should not preclude the consideration of concurrent comp-lications.Early identification and a tailored therapeutic approach can prevent Core Tip:Although therapeutic colonoscopy is generally safe,it may be associated with significant complications.This case illustrates how post-polypectomy syndrome can mask a colonic perforation with subsequent abscess formation.It em-phasizes the importance of an accurate initial endoscopic assessment,the use of advanced resection and closure techniques,and close clinical follow-up.Recognizing this spectrum of complications and intervening early can help prevent major surgical procedures and improve patient outcomes.展开更多
BACKGROUND Single-balloon enteroscopy(SBE)is an established procedure for evaluating small bowel lesions.While its efficacy is well recognized,the incidence of major complications and their associated risk factors in ...BACKGROUND Single-balloon enteroscopy(SBE)is an established procedure for evaluating small bowel lesions.While its efficacy is well recognized,the incidence of major complications and their associated risk factors in a large population remain unclear.AIM To investigate the complications and risk factors associated with diagnostic SBE.METHODS This multicenter retrospective study included consecutive patients who underwent diagnostic SBE at three tertiary care hospitals between January 2016 and September 2024.Data on baseline characteristics,procedural parameters,indications,findings,and major complications were collected and analyzed.RESULTS A total of 2865 SBE procedures were performed in 1840 patients.The mean age was 51±18 years,and 64.5%were male.The most common indication was obscure gastrointestinal bleeding(57.1%),followed by abdominal pain(30.5%).The major complication rate was 0.4%(7/1840),all of which involved acute intestinal perforation identified during the procedure.Among the perforation cases,6 occurred in patients undergoing SBE for abdominal pain and 1 for obscure gastrointestinal bleeding.The perforation sites included the ileum(6/7)and duodenum(1/7).All cases were successfully managed surgically.Previous abdominal surgery and the use of abdominal compression were significantly associated with an increased risk of perforation(P value<0.001 for both).In subgroup analysis,perforation rates were 2.1%(6/288)in patients with prior abdominal surgery and 1.6%(7/428)with abdominal compression.CONCLUSION Acute intestinal perforation is a rare but serious complication.Prior abdominal surgery and abdominal compression are important risk factors,and careful patient selection is recommended to minimize complications.展开更多
Several issues should be considered before the surgical treatment of gastric ulcer perforations,including morbidity,mortality,and recurrence.However,an oftenoverlooked issue is determining the cause of the perforation...Several issues should be considered before the surgical treatment of gastric ulcer perforations,including morbidity,mortality,and recurrence.However,an oftenoverlooked issue is determining the cause of the perforation.When the perforation is secondary to an underlying and undiagnosed malignancy,stomach resection inadequately treats the oncological disease and may increase postoperative morbidity and require re-surgery.展开更多
This pictorial review discusses the imaging approach to evaluate for proper placement or complications of pediatric gastrostomy tube(G-tube)placement and long-term use.G-tubes are crucial for long-term nutritional sup...This pictorial review discusses the imaging approach to evaluate for proper placement or complications of pediatric gastrostomy tube(G-tube)placement and long-term use.G-tubes are crucial for long-term nutritional support in patients facing challenges with oral intake.The article depicts the role of imaging such as contrast radiography,fluoroscopy,ultrasound,and computed tomography scans for confirming G-tube position and evaluating complications,in addition to basic anatomical considerations and placement techniques.Complications discussed include malposition,intraperitoneal placement,buried bumper syndrome,and tube malfunction.Specific imaging techniques and checklists are provided to guide clinicians in assessing G-tube placement accurately.The latter half of the review is a comprehensive exploration of pearls and pitfalls of imaging when employed to detect complications to avoid false positives and negatives.展开更多
Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reco...Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reconstruction techniques and outcomes in patients with myelomeningocele at our center.Methods: A retrospective study was conducted on reconstruction methods and outcomes in patients with myelomeningocele referred to the Plastic and Reconstructive Unit,Hospital Universiti Sains Malaysia(HUSM),Kelantan,for wound coverage from to 1997–2023.Data on patient demographics,defect size,reconstruction methods,operation duration,flap-related complications,and secondary repairs were collected and analyzed.Results: Thirteen patients were identified in this retrospective study,comprising 5 female patients,7 male patients,and 1 ambiguous gender patient.Wound closures were performed using primary closure method,local flaps,or regional flap closure.Nine(69.2%) of the thirteen patients underwent soft tissue reconstruction using the local flap,three(23.1%) underwent primary closure,and only one(7.7%) patient underwent wound closure with a regional flap.Flap-related complications were observed in four of the thirteen patients,including wound breakdown in two cases and partial flap necrosis in two cases.Of these four patients,secondary repair was required in three: split-thickness skin grafting was performed in two,and primary closure in one.The remaining patient was managed conservatively with dressings.Patients were followed up for a mean duration of56.6(±62.4) months,and complete healing was achieved in all cases.Conclusion: Myelomeningocele repair remains challenging,and a multidisciplinary approach is recommended.We demonstrated various local and regional flap closure methods with good outcomes.Reconstruction techniques should be tailored for individual cases based to the surgeon expertise.展开更多
BACKGROUND Intestinal obstruction(IO)in pregnancy,though rare(1:1500-1:66000),carries high maternal(6%-10%)and fetal mortality(26%).Adhesions from prior surgery are the leading cause.Diagnosis is often delayed due to ...BACKGROUND Intestinal obstruction(IO)in pregnancy,though rare(1:1500-1:66000),carries high maternal(6%-10%)and fetal mortality(26%).Adhesions from prior surgery are the leading cause.Diagnosis is often delayed due to symptom overlap with nor-mal pregnancy,increasing risks of perforation and sepsis.CASE SUMMARY A 25-year-old gravida 2 para 1 woman at 28 weeks of gestation presented with 1-week constipation,feculent vomiting,and abdominal distension.She had a history of exploratory laparotomy in 2015 for blunt abdominal trauma.The diagnosis of IO in pregnancy was confirmed via abdominopelvic ultrasound and clinical findings.Interventions included conservative measures(nasogastric tube decompression,enemas)followed by emergency laparotomy with bowel resec-tion/anastomosis.Despite surgical management,the patient succumbed to septic shock.CONCLUSION High clinical suspicion,expedited cross-sectional imaging(computed tomogra-phy/Magnetic resonance imaging),and emergent surgery are critical to reduce mortality.展开更多
基金Supported by The Bio&Medical Technology Development Program of the National Research Foundation(NRF)funded by the Korean government(MSIT),No.RS-2023-00220408.
文摘BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.
文摘Resume of the study & Background: Radial forearm free flap with all its present day modifications is the workhorse of soft tissue reconstruction. Although there are several advantages, it requires sacrifice of a major artery of forearm. Several modifications are described in harvesting a forearm flap. In order to achieve a reliable, safe flap harvest & design one must have a very clear understanding of radial artery perforators, relative to its distribution, territory & flow. The purpose of this study is to determine the location, size & vascular territory of the radial artery cutaneous perforators & to demonstrate application of shape modification of radial forearm free flap based on its distal & proximal perforators in various head & neck defects. Materials & Methods: Anatomical Study: 12 fresh human cadavers & 24 cadaveric forearms were dissected to determine the number, location, size & vascular territory of radial artery perforator. The cutaneous territory of distally dominant perforators was analyzed using methylene blue injections & three-dimensional computed tomographic angiogram to determine the vascular network. Clinical Study: 15 patients with various head neck defects following oncological resections were reconstructed with shape modified adipo-fascio cutaneous free forearm flap. All these patients were prospectively followed for donor site healing, motor & sensory nerve deficit, function & quality of life questioner for donor site assessment. Results: 12 fresh human cadavers & 24 cadaveric forearms were dissected, and a total of 222 perforators were dissected for an average of 18.5 perforators per forearm. 118 were smaller than 0.5 mm in diameter (53.15%) & were not clinically significant. 104 perforators were greater than 0.5 mm in diameter (46.84%) & were clinically significant. 127 perforators (57.20%) were radially distributed & 95 perforators (42.79%) had ulnar distribution. 90 perforators (40.54%) were identified on distal side (Radial styloid) & 132 perforators (59.45%) were identified on proximal side (Lateral epicondyle). Mean number of perforators, on radial side was 10.6 & 7.9 on ulnar side;comparison of both using student t paired test gives a P value of 0.006, which is significant. Comparison of mean number of perforators on the distal side was 7.5 & proximal side was 11.0;Student Paired t test gives a P value of 0.003, which was statistically significant. Comparison of mean diameter of perforators on Distal side (1.11) & Proximal side (0.86), side using Student Paired t test gives a P value of 0.01 which was statistically significant. A chi square test was done to compare mean diameter of perforators on distal side, which was more than 1 mm (80%) & less than 1 mm (20%) & on proximal side more than 1 mm (35.6%) & less than 1 mm (64.4%). Chi square value of 42.406 was obtained, degree of freedom value was 1 & P value of Conclusion: Increase in knowledge of vascular territory of radial artery perforators with regards to numbers, size, location, & cutaneous territory can lead to expanded use of radial forearm flap based on either distal or proximal perforator alone. Shape modified technique for harvesting radial forearm flap allows primary closure of donor site. Donor site is better healed and shows a predicted pattern, which is functionally and aesthetically good.
文摘Utilizing finite element analysis,the ballistic protection provided by a combination of perforated D-shaped and base armor plates,collectively referred to as radiator armor,is evaluated.ANSYS Explicit Dynamics is employed to simulate the ballistic impact of 7.62 mm armor-piercing projectiles on Aluminum AA5083-H116 and Steel Secure 500 armors,focusing on the evaluation of material deformation and penetration resistance at varying impact points.While the D-shaped armor plate is penetrated by the armor-piercing projectiles,the combination of the perforated D-shaped and base armor plates successfully halts penetration.A numerical model based on the finite element method is developed using software such as SolidWorks and ANSYS to analyze the interaction between radiator armor and bullet.The perforated design of radiator armor is to maintain airflow for radiator function,with hole sizes smaller than the bullet core diameter to protect radiator assemblies.Predictions are made regarding the brittle fracture resulting from the projectile core′s bending due to asymmetric impact,and the resulting fragments failed to penetrate the perforated base armor plate.Craters are formed on the surface of the perforated D-shaped armor plate due to the impact of projectile fragments.The numerical model accurately predicts hole growth and projectile penetration upon impact with the armor,demonstrating effective protection of the radiator assemblies by the radiator armor.
基金Open access funding provided by FCT|FCCN(b-on)the Strategic Research Plan of the Centre for Marine Technology and Ocean Engineering(CENTEC),which is financed by the Portuguese Foundation for Science and Technology(Fundação para a Ciência e Tecnologia-FCT)under contract UIDB/UIDP/00134/2020.
文摘An analytical model of a floating heaving box integrated with a vertical flexible porous membrane placed right next to the box applications to wave energy extraction and breakwater systems is developed under the reduced wave equation.The theoretical solutions for the heave radiating potential to the assigned physical model in the corresponding zones are attained by using the separation of variables approach along with the Fourier expansion.Applying the matching eigenfunction expansion technique and orthogonal conditions,the unknown coefficients that are involved in the radiated potentials are determined.The attained radiation potential allows the computation of hydrodynamic coefficients of the heaving buoy,Power Take-Off damping,and wave quantities.The accuracy of the analytical solution for the hydrodynamic coefficients is demonstrated for different oblique angles with varying numbers of terms in the series solution.The current analytical analysis findings are confirmed by existing published numerical boundary element method simulations.Several numerical results of the hydrodynamic coefficients,power capture,power take-off optimal damping,and transmission coefficients for numerous structural and physical aspects are conducted.It has been noted that the ideal power take-off damping increases as the angle of incidence rises,and the analysis suggests that the ability to capture waves is more effective in shallower waters compared to deeper ones.
文摘Aim:Anterolateral thigh(ALT)flap is widely used in reconstruction of various defects.Preoperative imaging facilitates perforator mapping,overcoming intraoperative uncertainty.The purpose of this study was to investigate the utility of multi-detector row computed tomography angiography(MDCTA)and a handheld Doppler in locating ALT perforators.Methods:Twenty patients were randomized into two groups.Group 1 patients received MDCTA and Doppler studies whereas Group 2 received only a Doppler study.The number,location,course,and source of all cutaneous and sizable perforators were compared with intraoperative findings.Surgeons’stress levels during flap harvest and flap harvest time were compared.Results:MDCTA findings correlated well with intraoperative findings for perforator type and segmental distribution with 100%concordance.Doppler alone had a 52%rate of concordance.The sensitivity and specificity for MDCTA in demonstrating the presence of perforators were 85.71%and 97.22%,respectively;whereas for Doppler alone the sensitivity and specificity were 80%and 87.91%,respectively.In demonstrating perforator source,MDCTA showed a sensitivity of 100%and specificity of 91.66%,with 100%accuracy.Sensitivity and specificity for sizable perforators were 90%each,with 88.88%accuracy.Doppler studies were unable to provide this information.Comparison of surgeon stress levels showed no differences between the two groups,although the time for flap harvest was significantly shorter in Group 1.Conclusion:MDCTA compared to Doppler is more sensitive,specific,and accurate with respect to location,course,and source of perforators.
文摘Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases.During the last few years,the incidence rate of perforations in colonoscopic procedures has increased,especially in therapeutic colonoscopies.The recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection,endoscopic full-thickness resection,and endoscopic submucosal dissection(ESD)could be a risk factor for this increased risk.The incidence rate of mortality of serious colonoscopic perforations is 7.1%.The management plan for these perforations starts with conservative treatment in mild cases,endoscopic closure,and surgical management in severe cases.Recently,endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case reports.This editorial provides an overview of the current guidelines for the management of iatrogenic colorectal perforations.These insights are from the perspectives of endoscopists and gastroenterologists.We also present a management algorithm based on the guidelines of the European Society of Gastrointestinal Endoscopy,the American Gastroenterological Association,and the World Society of Emergency Surgery.We also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.
基金supported by the Postdoctoral Fellowship Program of CPSF(Grant No.GZC20233326)the Chongqing Science Fund for Distinguished Young Scholars(Grant No.CSTB2022NSCQJQX0028)the National Natural Science Foundation of China(Grant Nos.U23A20597,52274112).
文摘An abrasive water jet(AWJ)is commonly used to develop deep geothermal resources,such as drilling in hot dry rock(HDR).The influence of rock mineral properties,such as mineral types,mineral contents,and grain size,on the formation of perforation by AWJ is unclear yet.In this study,we investigate AWJ impacts on three types of granite samples with different mineral fractions using a polarizing microscope and scanning electron microscope(SEM).The results show that when the grain size is doubled,the perforation depth increases by 16.22%under the same type of structure and properties.In general,fractures are more likely to be created at the position of rough surfaces caused by abrasive impact,and the form of fractures is determined by the mineral type.In addition,microstructure analysis shows that transgranular fractures typically pass through large feldspar particles and quartz removal occurs along mineral boundaries.The longitudinal extension of perforation depends mainly on the strong kinetic energy of the jet,while the lateral extension is controlled by the backflow.The results contribute to a better understanding of the process involved in the breaking of hard rock by abrasive jets during deep geothermal drilling.
文摘A theoretical analysis on the perforation of Weldox 460E steel plates struck by flat-nosed projectiles is presented using a previously developed model within a unified framework.This model contains a dimensionless empirical equation to describe the variation of energy absorbed through global deformation as a function of impact velocity.The study further investigates the energy absorption mechanisms of Weldox 460E steel plates,with particular focus on the“plateau”phenomenon,i.e.,limited increase in ballistic limit with increasing plate thickness.This phenomenon is explained and compared with results from previously studied 2024-T351 aluminium plates.The model predictions agree well with experimental data for Weldox 460E steel plates impacted by flat-nosed projectiles,including:relationship between global deformation and impact velocity,ballistic limit,residual velocity,and critical conditions for the transition of failure modes.Moreover,the model effectively predicts the“plateau”phenomenon observed in intermediate plate thickness range.It is also found that the indentation absorption energy contributes a significantly larger fraction of the total absorption energy in Weldox 460E steel plates perforated by flat-nosed projectiles than in 2024-T351 aluminium plates,due to the differences in material properties.
文摘BACKGROUND Perforated gastric cancer(GC)is a rare but life-threatening surgical emergency.Optimal surgical management remains controversial,and evidence from highvolume centers,especially in Western countries,is limited.AIM To evaluate surgical and survival outcomes of patients with perforated GC(PGC)according to the initial treatment strategy.METHODS A retrospective cohort study was conducted including all patients with pathologically confirmed perforated gastric adenocarcinoma treated at a single tertiary cancer center between January 2009 and March 2024.Surgical strategies were categorized as gastrectomy or primary perforation repair.Outcomes analyzed included 30-and 90-day mortality,postoperative major complications,and overall survival(OS).RESULTS Among 1586 GC patients undergoing surgical treatment,36(2.3%)presented with PGC.The mean age was 62.5 years,and 55%were male.American Society of Anesthesiologists(ASA)class III/IV was present in 58.3%,and 83%had stage IV disease,with distant metastasis in 50%.Perforation repair was performed in 26 patients(72.2%),while 10(27.8%)underwent one-stage gastrectomy.ASA III/IV status(57.7%vs 30%,P=0.260)and metastatic disease(57.7%vs 30%,P=0.137)were more frequent in the Perforation Repair Group,though not statistically significant.This group also had a higher rate of diffuse-type and poorly differentiated tumors(P=0.024 and P=0.014,respectively).Thirty-and 90-day mortality were higher in the Perforation Repair Group(61.5%vs 30%,P=0.139;and 65.4%vs 30%,P=0.073),without significance.Three patients initially repaired were later referred for gastrectomy.OS was significantly better in the Gastrectomy Group(P=0.002),with median survival of 8.8 months vs 0.5 months.On multivariable analysis,gastrectomy was independently associated with improved survival(P=0.026).CONCLUSION When clinically feasible,gastrectomy—either immediate or delayed—provides superior survival compared to local perforation repair alone in patients with PGC.
文摘BACKGROUND Motorcycle accidents often result in abdominal trauma in patients seeking emergency care.Injuries to the hollow viscera,including the duodenum,jejunum,urinary bladder,and colorectum,are relatively common.In contrast,owing to the protective function of the anterior rib cage,gastric rupture is exceptionally rare,with an incidence of<1.7%.Gastric rupture typically occurs in the anterior wall and rarely presents as multiple ruptures.This report describes an unusual case of multiple gastric ruptures resulting from blunt trauma.CASE SUMMARY A 21-year-old man,who was involved in a motorcycle collision at 70 km/hour after consuming a large meal,presented with hypotension.Physical examination revealed abdominal tenderness.Laboratory test results indicated elevated amylase,lipase,and liver enzyme levels.Computed tomography showed pneumoperitoneum,hemoperitoneum,and gastric wall discontinuation,suggesting gastric perforation alongside pancreatic,splenic,and hepatic injuries.Angiographic embolization was performed because of active contrast leakage in the left gastric and right gastroepiploic arteries.Emergency laparotomy revealed substantial blood loss,hematoma,and gastric contents scattered throughout the abdominal cavity.Two 10 cm gastric perforations in the anterior and posterior walls were identified,as well as severe liver damage,splenic injury,and pancreatic contusion.Surgical interventions included primary closure of the gastric wall,splenectomy,and partial hepatectomy.After temporary abdominal closure,the patient underwent a second surgery without further bleeding.The gastric repair site was resected and reinforced for optimal tissue healing.CONCLUSION Gastric rupture following blunt trauma is fatal.However,patients without severe complications can recover through surgical interventions and postoperative care.
文摘Diverticular disease(DD)represents a prevalent clinical challenge,especially in the aging population.The sigmoid colon is the most frequently affected area.However,the presence of DD in the upper gastrointestinal tract,including the duodenum and jejunum,underscores the need for comprehensive understanding and management.In this minireview we analyzed the epidemiology,pathogenesis,clinical presentation,diagnosis,and management of DD with a specific focus on jejunal diverticulosis.Although the incidence of gastrointestinal DD increases with age,the male and female prevalence is the same.Clinical presentation is either asymptomatic or with unclear abdominal symptoms.However,complications such as perforation and bleeding can occur in a subset of patients and demand urgent diagnosis and surgical treatment.Imaging alternatives,including CT and enteroscopy,play key roles in diagnosis.Surgical management is warranted in cases with persistent bleeding or more complicated acute abdomen.Jejunal diverticulosis(JD)is a less common condition and poses a unique diagnostic and therapeutic challenge.Bleeding has been reported as the most important complication in JD.Therefore,early diagnosis and management are critical to improve patient outcomes and reduce morbidity and mortality.This article highlighted the importance of considering JD in the differential diagnosis of gastrointestinal bleeding,especially in patients with concurrent colon diverticulosis in which the bleeding source remains unidentified.Therefore,current challenges in JD are better understanding the etiopathology and optimal management strategies.
文摘BACKGROUND Complications occur in approximately 12%of cases of diverticulitis,with perforation occurring in up to 10%of complications.Typically,patient with perforated diverticulitis present intraperitoneally with abdominal pain and peritoneal signs.By contrast,pneumoretroperitoneum and pneumomediastinum are rare complications and lack typical symptoms,making their diagnosis difficult and often delayed,leading to increased morbidity and mortality.CASE SUMMARY A 66-year-old man presented with lower abdominal pain for 3 days.On examination,his vital signs were stable,and the abdomen was soft with mild distension and left lower quadrant tenderness,but no peritoneal signs were noted.Laboratory tests indicated leukocytosis and a markedly elevated C-reactive protein level.Abdominal computed tomography(CT)revealed focal wall thickening and fat stranding near the rectosigmoid junction as well as pneumoretroperitoneum,pneumomediastinum,and minor pneumoperitoneum.Suspecting hollow organ perforation,an emergent exploratory laparotomy was performed which revealed a retroperitoneal abscess with mesocolonic necrosis,likely due to perforated sigmoid diverticulitis.The patient underwent sigmoid resection with Hartmann’s procedure and retroperitoneal drainage.Follow-up CT on postoperative day 14 confirmed resolution of the free air,and the patient was discharged on postoperative day 40 with an uneventful recovery.CONCLUSION Pneumoretroperitoneum and pneumomediastinum are rare complications of perforated diverticulitis,often with delayed diagnosis due to the absence of peritoneal signs.CT aids detection,and timely surgical intervention is crucial.
基金Supported by Beijing Municipal Natural Science Foundation,No.7234387Chinese PLA General Hospital Young Independent Innovation Science Foundation,No.22QNFC004.
文摘This letter discusses the findings of Pang et al retrospective study on omental patch repair as a balanced treatment for gastric ulcer perforation.We acknowledge its clinical value while highlighting a critical limitation:Conventional mechanical closure often results in fibrotic scarring and functional impairment across the mucosal,muscular,and neurovascular layers.To address this,we propose the innovative concept of“multi-layer repair”and present a proof-ofconcept three-dimensional bioprinted functional biopatch.This patch features a multilayer structure:An inner layer laden with gastric mucosal organoids and an outer layer containing primary gastric muscle cells,both integrated onto a wetadhesive electrospun membrane.Preliminary animal studies have yielded encouraging results,supporting its potential to promote functional restoration beyond mechanical sealing.
基金Supported by Jiaxing Science and Technology Plan Project,No.2024AD30035.
文摘BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and an ideal postoperative antiinfective approach for PPA management has yet to be established.AIM To examine the spectrum of pathogenic bacteria in pediatric PPA and to summarize the postoperative experience with carbapenem(CBP)and cephalosporin(CPS)antibiotics.METHODS We retrospectively analyzed medical records of 65 children(43 boys,22 girls;mean age 6.92±3.41 years)with PPA who underwent surgery at our hospital between December 2019 and August 2022.Data were collected in September 2023.Based on postoperative antibiotic selection,patients were divided into CBP(32 cases)and CPS(33 cases)groups.Chi-square and T-tests compared recovery outcomes,while univariate and multivariate regression models identified independent factors affecting postoperative recovery.RESULTS There were no significant differences between the two groups in gender,age,weight,height,body mass index,baseline ear temperature,or heart rate(P>0.05).Escherichia coli(40.00%)and Pseudomonas aeruginosa(24.62%)were the most common pathogens in PPA.Postoperative analysis showed significantly shorter C-reactive protein(CRP)recovery times in the CPS group than in the CBP group[(6.18±1.84)vs(8.12±3.48)days,P=0.009].Univariate logistic regression indicated CPS selection(OR=0.32,95%CI:0.10-0.97,P=0.044)was significantly associated with a higher CRP recovery rate within 7 days.Multivariate analysis confirmed CPS selection(OR=3.49,95%CI:1.19-10.24,P=0.023)as an independent factor affecting CRP recovery within 7 days postoperatively.CONCLUSION The choice of CBP or CPS independently affects CRP recovery within 7 days.CBP offers no advantage over CPS in treating PPA,with CPS also demonstrating favorable clinical outcomes.
文摘BACKGROUND Post-polypectomy syndrome(PPS)is a rare but relevant complication of endo-scopic colorectal polyp removal.Although its course is usually benign,it may conceal more severe conditions.This case report presents several complications resulting from a colorectal polypectomy.CASE SUMMARY We report the case of a 67-year-old man who presented with asthenia and abdo-minal discomfort after a scheduled polypectomy.The patient was initially diagnosed with PPS and managed conservatively.However,progressive clinical deterioration led to hospital admission.Imaging revealed a right-sided intra-abdominal abscess secondary to colonic perforation.The initial polyp was iden-tified as a subepithelial lipoma.The patient underwent successful percutaneous drainage,antibiotic therapy,and recovered without the need for surgical inter-vention.CONCLUSION This case highlights the importance of accurate endoscopic diagnosis and te-chnique selection.PPS should not preclude the consideration of concurrent comp-lications.Early identification and a tailored therapeutic approach can prevent Core Tip:Although therapeutic colonoscopy is generally safe,it may be associated with significant complications.This case illustrates how post-polypectomy syndrome can mask a colonic perforation with subsequent abscess formation.It em-phasizes the importance of an accurate initial endoscopic assessment,the use of advanced resection and closure techniques,and close clinical follow-up.Recognizing this spectrum of complications and intervening early can help prevent major surgical procedures and improve patient outcomes.
文摘BACKGROUND Single-balloon enteroscopy(SBE)is an established procedure for evaluating small bowel lesions.While its efficacy is well recognized,the incidence of major complications and their associated risk factors in a large population remain unclear.AIM To investigate the complications and risk factors associated with diagnostic SBE.METHODS This multicenter retrospective study included consecutive patients who underwent diagnostic SBE at three tertiary care hospitals between January 2016 and September 2024.Data on baseline characteristics,procedural parameters,indications,findings,and major complications were collected and analyzed.RESULTS A total of 2865 SBE procedures were performed in 1840 patients.The mean age was 51±18 years,and 64.5%were male.The most common indication was obscure gastrointestinal bleeding(57.1%),followed by abdominal pain(30.5%).The major complication rate was 0.4%(7/1840),all of which involved acute intestinal perforation identified during the procedure.Among the perforation cases,6 occurred in patients undergoing SBE for abdominal pain and 1 for obscure gastrointestinal bleeding.The perforation sites included the ileum(6/7)and duodenum(1/7).All cases were successfully managed surgically.Previous abdominal surgery and the use of abdominal compression were significantly associated with an increased risk of perforation(P value<0.001 for both).In subgroup analysis,perforation rates were 2.1%(6/288)in patients with prior abdominal surgery and 1.6%(7/428)with abdominal compression.CONCLUSION Acute intestinal perforation is a rare but serious complication.Prior abdominal surgery and abdominal compression are important risk factors,and careful patient selection is recommended to minimize complications.
文摘Several issues should be considered before the surgical treatment of gastric ulcer perforations,including morbidity,mortality,and recurrence.However,an oftenoverlooked issue is determining the cause of the perforation.When the perforation is secondary to an underlying and undiagnosed malignancy,stomach resection inadequately treats the oncological disease and may increase postoperative morbidity and require re-surgery.
文摘This pictorial review discusses the imaging approach to evaluate for proper placement or complications of pediatric gastrostomy tube(G-tube)placement and long-term use.G-tubes are crucial for long-term nutritional support in patients facing challenges with oral intake.The article depicts the role of imaging such as contrast radiography,fluoroscopy,ultrasound,and computed tomography scans for confirming G-tube position and evaluating complications,in addition to basic anatomical considerations and placement techniques.Complications discussed include malposition,intraperitoneal placement,buried bumper syndrome,and tube malfunction.Specific imaging techniques and checklists are provided to guide clinicians in assessing G-tube placement accurately.The latter half of the review is a comprehensive exploration of pearls and pitfalls of imaging when employed to detect complications to avoid false positives and negatives.
文摘Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reconstruction techniques and outcomes in patients with myelomeningocele at our center.Methods: A retrospective study was conducted on reconstruction methods and outcomes in patients with myelomeningocele referred to the Plastic and Reconstructive Unit,Hospital Universiti Sains Malaysia(HUSM),Kelantan,for wound coverage from to 1997–2023.Data on patient demographics,defect size,reconstruction methods,operation duration,flap-related complications,and secondary repairs were collected and analyzed.Results: Thirteen patients were identified in this retrospective study,comprising 5 female patients,7 male patients,and 1 ambiguous gender patient.Wound closures were performed using primary closure method,local flaps,or regional flap closure.Nine(69.2%) of the thirteen patients underwent soft tissue reconstruction using the local flap,three(23.1%) underwent primary closure,and only one(7.7%) patient underwent wound closure with a regional flap.Flap-related complications were observed in four of the thirteen patients,including wound breakdown in two cases and partial flap necrosis in two cases.Of these four patients,secondary repair was required in three: split-thickness skin grafting was performed in two,and primary closure in one.The remaining patient was managed conservatively with dressings.Patients were followed up for a mean duration of56.6(±62.4) months,and complete healing was achieved in all cases.Conclusion: Myelomeningocele repair remains challenging,and a multidisciplinary approach is recommended.We demonstrated various local and regional flap closure methods with good outcomes.Reconstruction techniques should be tailored for individual cases based to the surgeon expertise.
文摘BACKGROUND Intestinal obstruction(IO)in pregnancy,though rare(1:1500-1:66000),carries high maternal(6%-10%)and fetal mortality(26%).Adhesions from prior surgery are the leading cause.Diagnosis is often delayed due to symptom overlap with nor-mal pregnancy,increasing risks of perforation and sepsis.CASE SUMMARY A 25-year-old gravida 2 para 1 woman at 28 weeks of gestation presented with 1-week constipation,feculent vomiting,and abdominal distension.She had a history of exploratory laparotomy in 2015 for blunt abdominal trauma.The diagnosis of IO in pregnancy was confirmed via abdominopelvic ultrasound and clinical findings.Interventions included conservative measures(nasogastric tube decompression,enemas)followed by emergency laparotomy with bowel resec-tion/anastomosis.Despite surgical management,the patient succumbed to septic shock.CONCLUSION High clinical suspicion,expedited cross-sectional imaging(computed tomogra-phy/Magnetic resonance imaging),and emergent surgery are critical to reduce mortality.
