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Rinsho Shinkeigaku 2022 Jun 28;62(6):464-468. Epub 2022 May 28.

Department of Neurology, School of Medicine, Sapporo Medical University.

A 42-year-old woman presented at our hospital with acute paraphasia and word finding difficulty. She was not paralyzed or ataxic. Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) was diagnosed based on brain MRI finding of edematous lesions in bilateral temporal lobe cortexes that did not match the vascular territory, elevated lactate and pyruvate levels in blood and cerebrospinal fluid, and the presence of a mtDNA 3243A>G mutation. Read More

Ann Med Surg (Lond) 2022 May 22;77:103665. Epub 2022 Apr 22.

Department of General Surgery A, Hospital La Rabta, Tunis, Tunisia.

Background: Idiopathic megabowel is a rare condition. Its physiopathology is still unclear. We report a case of a patient presenting with acute bowel obstruction due to idiopathic megacolon and megarectum that was successfully treated with proctocolectomy. Read More

Clin Toxicol (Phila) 2022 06 5;60(6):672-680. Epub 2022 May 5.

Pharmacology, Toxicology & Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.

Introduction: Enemas containing phosphate are widely prescribed and may cause important adverse effects. A systemic review published in 2007 reported the literature on the adverse effects of phosphate enemas from January 1957 to March 2007 and identified 12 deaths. These were thought due to electrolyte disturbances, heart failure and kidney injury. Read More

Indian J Gastroenterol 2022 Apr 26. Epub 2022 Apr 26.

Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India.

Background: Optimal outcomes in acute severe ulcerative colitis (ASUC) are related to time-bound management based upon early prediction of response to intravenous (IV) steroids. In an earlier study, we described the All India Institute of Medical Sciences (AIIMS) index (baseline Ulcerative Colitis Endoscopic Index of Severity [UCEIS] ≥ 7 and day 3 fecal calprotectin [FCP] > 1000 μg/g) for predicting failure of IV steroids. The current study is designed to validate this index in a prospective cohort. Read More

Pan Afr Med J 2022 5;41:11. Epub 2022 Jan 5.

Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.

Most cases of Hirschsprung disease (HD) cases are known in newborns or infants. Nevertheless, some cases with mild symptoms are not identified until acute presentations, such as bowel obstruction present in adolescence or adulthood. We reported a 25-year-old male with a history of chronic constipation from childhood presenting with bowel obstruction due to HD. Read More

AACN Adv Crit Care 2022 Mar;33(1):85-98

Eleanor R. Fitzpatrick is Clinical Nurse Specialist, Surgical Intensive Care Unit, Thomas Jefferson University Hospital, 111 S 11th Street, 4141 Gibbon Building, Philadelphia, PA 19107

Infectious and inflammatory disorders of the gastrointestinal system are life-threatening and occur frequently in hospitalized adults. Inflammatory and inflammation-related diseases of the gastrointestinal tract seen in the acutely and critically ill have numerous causes. In acute pancreatitis and toxic infections caused by the bacterium Clostridium difficile, where severe infections can develop, inflammation plays a causative and crucial role. Read More

JAMA Netw Open 2021 12 1;4(12):e2141089. Epub 2021 Dec 1.

ICES, Ontario, Canada.

Importance: Little is known about the incidence and outcomes of Clostridioides difficile infection (CDI) in solid organ transplant (SOT) recipients.

Objective: To estimate the CDI incidence and outcomes in SOT recipients.

Design, Setting, And Participants: A population-based cohort study was conducted using administrative health care data for all Ontario, Canada, residents who received organ allografts from April 1, 2003, to December 31, 2017; March 31, 2020, was the end of the study period. Read More

Zhonghua Wei Chang Wai Ke Za Zhi 2021 Dec;24(12):1054-1057

Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai 200433, China.

Adult megacolon is a rare disease with heterogeneneous etiology. The treatment schemes of megacolon caused by different causes are also different, but surgery is the final and the most effective method. Due to the lack of early understanding of the disease, many patients have not been clearly diagnosed as adult megacolon and have not been properly treated. Read More

Int J Surg Case Rep 2021 Dec 18;89:106608. Epub 2021 Nov 18.

Faculty of medicine, Alexandria university, Egypy.

Introduction: Sigmoid volvulus (SV) is a rare complication of Hirschsprung's disease (HD) with only 31 cases have been reported in the English literature. Although its diagnosis is challenging, unrecognized SV is a life-threatening condition requiring early recognition to decrease morbidity and mortality.

Presentation Of Case: A 14-year-old male presented to our emergency department with massive abdominal distention. Read More

J Int Med Res 2021 Sep;49(9):3000605211043412

Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.

Hirschsprung-associated enterocolitis (HAEC) is a serious and life-threatening condition, and atypical tuberculosis (TB) associated with HAEC is even more serious. A male newborn aged 4 days was diagnosed with Hirschsprung disease and transanal Soave pull-through was performed at 4 months old. Six months later, he suffered from enterocolitis. Read More

Autops Case Rep 2021 3;11:e2021319. Epub 2021 Sep 3.

Mount Sinai Medical Center, Department of General Surgery, Miami Beach, FL, USA.

Background: The bowel is the most common site of extragenital endometriosis, with involvement of the locoregional sigmoid colon and anterior rectum seen most often. The clinical presentation varies depending on how soon patients seek medical care, thus requiring changes in management strategies. Endometriosis can cause a life-threatening surgical emergency with progressive obliteration of the bowel lumen leading to obstruction and late complications including toxic megacolon and transmural necrosis. Read More

Int J Clin Pract 2021 Oct 28;75(10):e14626. Epub 2021 Jul 28.

Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

Background: Inflammatory bowel diseases are gaining more interest in the past few years. Ulcerative colitis (UC) is a chronic disease that requires accurate follow-up for a good treatment plan. Colonoscopy alone cannot be efficient to detect disease extent and has a high risk of perforation in acute severe UC and toxic megacolon. Read More

World J Emerg Surg 2021 05 11;16(1):23. Epub 2021 May 11.

Department of Surgical Sciences, Policlinico Sant'Orsola Malpighi, Bologna, Italy.

Background: Despite the current therapeutic options for the treatment of inflammatory bowel disease, surgery is still frequently required in the emergency setting, although the number of cases performed seems to have decreased in recent years. The World Society of Emergency Surgery decided to debate in a consensus conference of experts, the main pertinent issues around the management of inflammatory bowel disease in the emergent situation, with the need to provide focused guidelines for acute care and emergency surgeons.

Method: A group of experienced surgeons and gastroenterologists were nominated to develop the topics assigned and answer the questions addressed by the Steering Committee of the project. Read More

World J Clin Cases 2021 May;9(13):3219-3226

Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu 18618687, São Paulo, Brazil.

Background: Acute severe ulcerative colitis (ASUC) is a complication of ulcerative colitis associated with high levels of circulating tumor necrosis factor alpha, due to the intense inflammation and faster stool clearance of anti-tumor necrosis factor drugs. Dose-intensified infliximab treatment can be beneficial and is associated with lower rates of colectomy. The aim of the study was to present a case of a patient with ASUC and megacolon, treated with hydrocortisone and accelerated scheme of infliximab that was monitored by drug trough level. Read More

Medicine (Baltimore) 2021 May;100(18):e25772

Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Rationale: Gastrointestinal tract duplication is a rare congenial anomaly which can be found anywhere along the gastrointestinal tract. While many patients are incidentally diagnosed during operation, in some cases it can present with severe gastrointestinal symptoms. In this case report, the patient presented with signs of toxic megacolon leading to rapid aggravation of inflammatory shock. Read More

BMC Surg 2021 Mar 3;21(1):109. Epub 2021 Mar 3.

Department of Surgery, Tikur Anbessa Specialized Hospital, Addis Ababa University, Zambia St., Addis Ababa, Ethiopia.

Background: Sigmoid volvulus is an uncommon problem in children and adolescents, and is rarely considered a diagnosis in this group. A high index of suspicion is necessary to reach a diagnosis and avoid morbidity and mortality. Sigmoid volvulus is a rare complication of Hirschsprung's disease, which has been reported in neonates, children, and adults. Read More

Chirurg 2021 Jun 25;92(6):551-558. Epub 2021 Feb 25.

Abteilung für Allgemein und Viszeralchirurgie, BG Klinikum Hamburg, Hamburg, Deutschland.

Background: Patients with paraplegia develop syndrome-specific complications relevant to visceral surgery, which occur in the context of the acute spinal shock or as a consequence of the progressive neurogenic bowel dysfunction (NBD) with the formation of an elongated colon and/or megacolon. Moreover, acute abdominal emergencies, such as acute appendicitis, cholecystitis, diverticulitis and ileus images, pose particular challenges for the clinician when the clinical signs are atypical or even absent. The expansion of indications for obesity surgery to include patients with a paraplegic syndrome, whose independence and quality of life can be impaired due to the restricted mobility, especially by obesity, is becoming increasingly more important. Read More

ANZ J Surg 2021 01;91(1-2):214

Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.

PLoS One 2021 9;16(2):e0246692. Epub 2021 Feb 9.

Department of Bioscience and Technology, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiania, GO, Brazil.

Megacolon is one of the main late complications of Chagas disease, affecting approximately 10% of symptomatic patients. However, studies are needed to understand the mechanisms involved in the progression of this condition. During infection by Trypanosoma cruzi (T. Read More

BMJ Case Rep 2020 Dec 22;13(12). Epub 2020 Dec 22.

General Surgery, Dudley Group NHS Foundation Trust, Dudley, UK

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. Read More

Front Cell Infect Microbiol 2020 15;10:583899. Epub 2020 Oct 15.

Departament of Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil.

There is a growing consensus that the balance between the persistence of infection and the host immune response is crucial for chronification of Chagas heart disease. Extrapolation for chagasic megacolon is hampered because research in humans and animal models that reproduce intestinal pathology is lacking. The parasite-host relationship and its consequence to the disease are not well-known. Read More

Curr Opin Gastroenterol 2021 01;37(1):66-75

University of Texas School of Public Health.

Purpose Of Review: To provide the definition, causes, and current recommendations for workup and treatment of acute infectious colitis in adults, a common medical problem of diverse cause.

Recent Findings: The management of acute colitis in adults depend upon establishment of cause. Most forms of infectious colitis are treatable with antimicrobials. Read More

Curr Opin Crit Care 2020 12;26(6):648-657

Department of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia.

Purpose Of Review: The aim of this study was to describe important features of clinical examination for the surgical abdomen, relevant investigations, and acute management of common surgical problems in the critically ill.

Recent Findings: Lactate remains a relatively nonspecific marker of gut ischemia. Dual energy computed tomography (DECT) scan can improve diagnosis of bowel ischemia. Read More

Anesth Prog 2020 09;67(3):158-163

Department of Anesthesiology, Kanagawa Dental University Hospital, Yokosuka, Kanagawa, Japan.

Inflammatory bowel disease (IBD) is a group of chronic inflammatory disorders of the gastrointestinal tract including ulcerative colitis (UC) and Crohn's disease. Pain management can be challenging in patients with IBD because there are limitations on the use of analgesics. Use of nonsteroidal anti-inflammatory drugs is not recommended in patients with IBD because there is risk of relapse of IBD and an overall increase in disease activity. Read More

Ann R Coll Surg Engl 2020 Sep 17;102(7):e176-e179. Epub 2020 Aug 17.

Department of General and Digestive Surgery, University Hospital of Móstoles, Madrid, Spain.

Spain has been one of the most affected countries by the COVID-19 outbreak. After the high impact of the pandemic, a wide clinical spectrum of late complications associated with COVID-19 are being observed. We report a case of a severe colitis in a post-treatment and recovered COVID-19 patient. Read More

Sci Adv 2020 07 22;6(30):eaaz2015. Epub 2020 Jul 22.

Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK 73019, USA.

Chagas disease (CD) is a parasitic disease caused by protozoa, presenting with cardiomyopathy, megaesophagus, and/or megacolon. To determine the mechanisms of gastrointestinal (GI) CD tissue tropism, we systematically characterized the spatial localization of infection-induced metabolic and microbiome alterations, in a mouse model of CD. Notably, the impact of the transition between acute and persistent infection differed between tissue sites, with sustained large-scale effects of infection in the esophagus and large intestine, providing a potential mechanism for the tropism of CD within the GI tract. Read More

Surg Today 2021 Feb 23;51(2):181-186. Epub 2020 Jun 23.

Department of Pediatric Surgery, Graduate School of Medical Sciences, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.

Hirschsprung's disease (HD) is a congenital disease manifesting various degrees of functional bowel obstruction caused by the absence of enteric ganglion cells, which are usually absent in the colonic segment of the HD patient. Because the aganglionic segment of HD always includes the rectum, pathological diagnosis can be made using a rectal sample. HD should be diagnosed as early as possible because serious complications, such as acute enterocolitis or toxic megacolon, can develop without a definitive diagnosis and appropriate treatment. Read More

Toxins (Basel) 2020 06 8;12(6). Epub 2020 Jun 8.

Department of Medicine, The University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA.

Harmful algal blooms (HAB) have become a major health concern worldwide, not just to humans that consume and recreate on contaminated waters, but also to the fauna that inhabit the environments surrounding affected areas. HABs contain heterotrophic bacteria, cyanobacterial lipopolysaccharide, and cyanobacterial toxins such as microcystins, that can cause severe toxicity in many aquatic species as well as bioaccumulation within various organs. Thus, the possibility of trophic transference of this toxin through the food chain has potentially important health implications for other organisms in the related food web. Read More

J Nephrol 2021 02 8;34(1):241-245. Epub 2020 Jun 8.

Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Neonatal thrombotic microangiopathy (TMA) is a rare and severe disease characterized by a triad of non-immune hemolytic anemia, thrombocytopenia, and organ dysfunction in neonates. We describe herein an early-term infant who underwent hemicolectomy at 4 days of age due to intestinal perforation. Following surgery, the patient had recurrent bouts of vomiting and abdominal distention, together with acute kidney injury, non-immune hemolytic anemia, and severe thrombocytopenia. Read More