Risk of Gastrointestinal Complications in Post Laparoscopic Cholecystectomy

Background: Post-cholecystectomy is related with a significant risk of developing gastrointestinal symptoms which affect the quality of life of patients. Objective: To assess the gastrointestinal complications risks in post-cholecystectomy patients (laparoscopic). Study Design: Retrospective study Place and Duration of Study: Department of Surgery, Services Hospital, Lahore from 1st April 2020 to 31st March 2021. Methodology: One hundred and fifty patients were enrolled. All patients under went laparoscopy for their acute or chronic cholelithiasis treatment. Patients demographic, body mass index, clinical assessment was documented. Patients were followed up for a period of six months and their gastrointestinal complains were recorded. Results: There were 86 females and 64 males with a mean age 49.8±6.3 years and mean body mass index were 24.8±3.6 kg/m2. Diarrhoea and fat intolerance were main complains within 56% and 57.3% patients within three months respectively. Flatulence, fat intolerance and right upper quadrant pain was also main complains of patients. Conclusion: Risk of diarrhoea, right upper quadrant pain, flatulence, and fat intolerance are noticeable as gastrointestinal complication in laparoscopic post-cholecystectomy patients. Keywords: Post-cholecystectomy, Gastrointestinal complications, Diarrhoea

CD16+CD163+ monocytes traffic to sites of inflammation during necrotizing enterocolitis in premature infants

Necrotizing enterocolitis (NEC) is a severe gastrointestinal complication of prematurity. Using suspension and imaging mass cytometry coupled with single-cell RNA sequencing, we demonstrate severe inflammation in patients with NEC. NEC mucosa could be subtyped by an influx of three distinct neutrophil phenotypes (immature, newly emigrated, and aged). Furthermore, CD16+CD163+ monocytes/Mϕ, correlated with newly emigrated neutrophils, were specifically enriched in NEC mucosa, found adjacent to the blood vessels, and increased in circulation of infants with surgical NEC, suggesting trafficking from the periphery to areas of inflammation. NEC-specific monocytes/Mϕ transcribed inflammatory genes, including TREM1, IL1A, IL1B, and calprotectin, and neutrophil recruitment genes IL8, CXCL1, CXCL2, CXCL5 and had enrichment of gene sets in pathways involved in chemotaxis, migration, phagocytosis, and reactive oxygen species generation. In summary, we identify a novel subtype of inflammatory monocytes/Mϕ associated with NEC that should be further evaluated as a potential biomarker of surgical NEC and a target for the development of NEC-specific therapeutics.

Diagnosis and management of acute appendicitis in 21 pediatric hematology and oncology patients at a tertiary care cancer center

Acute appendicitis is a rare gastrointestinal complication of anti-cancer chemotherapy and hematopoietic stem cell transplantation. Among a cohort of 2341 hemato-oncologic patients at a pediatric tertiary care cancer center, we identified 21 patients (0.9%) with 23 episodes of acute appendicitis, based on pathological imaging of the appendix and clinical findings. Median age at diagnosis was 10.21 years. Types of underlying disease included acute leukemias (n = 15), solid tumors (n = 4), and aplastic anemia (n = 2). Clinical symptoms seen in > 1 case were recorded for all 23 episodes as follows: abdominal pain, n = 22; abdominal tenderness, n = 4; fever, n = 7; nausea, n = 2; emesis; n = 2; diarrhea, n = 5; and constipation, n = 2. Median leukocyte count at diagnosis was 0.5 × 109/L, with a median of 0.1 × 109/L for the absolute neutrophil count (ANC). All patients received broad-spectrum antibiotics and 18/23 (78%) patients underwent uneventful appendectomy after a median of 5 days and with a median ANC of 0.7 × 109/L. Median duration until continuation of chemotherapy was 17 days for the 20 cases of appendicitis occurring during the patients’ disease course. Overall, 5/21 (19%) patients died including one related to the appendicitis itself which progressed to a typhlitis and was due to a fungal infection. The other fatalities were transplant- (n = 2) and leukemia-related (n = 2). Acute appendicitis is a rare and usually not life-threatening event in pediatric hemato-oncologic patients, which, if managed by prompt administration of broad-spectrum antibiotics (and antimycotics), can be safely followed by an elective (delayed) appendectomy, even before complete recovery of the neutrophils is achieved.

Accidental Magnet Ingestion in A Toddler: A Diagnostic Dilemma

Foreign body ingestion is common in children. Ingestion of foreign bodies with magnetic properties are less common, but can be associated with more severe complication, especially involving multiple magnets. We present a 16-month-old boy with developmental delay who developed small bowel perforation following multiple magnet ingestion. He had three days history of vomiting and abdominal distension associated with pain, suggestive of an acute intestinal obstruction. Abdominal imaging confirmed foreign body ingestion, and an exploratory laparotomy revealed two magnets attracted across the intestinal lining with resultant intestinal obstruction and perforation. Surgical removal of the magnets and the necrotic bowel tissue was complicated by post-operative wound dehiscence. After secondary suturing, the child subsequently made a complete recovery. We discuss the diagnostic dilemma in multiple magnet ingestion along with the importance of early recognition and prompt management due to the risk of more severe gastrointestinal complication associated with delayed intervention.

AB0856 CHRONIC INTESTINAL PSEUDO-OBSTRUCTION WITH HYDRONEPHROSIS: A CASE REPORT ON SUCH DISABLING AND RARE COMPLICATION OF LUPUS

Background:Chronic intestinal pseudo-obstruction can be a rare complication of systemic lupus erythematosus. It is often late to be identified in contrast to other commoner organs involvement in systemic lupus erythematosus such as nervous system, joint and kidney.Objectives:To report a case of uncommon gastrointestinal complication of lupus, with associated hydronephrosis at the ureter, with treatment delay.Methods:We report a case of chronic intestinal pseudo-obstruction.Results:A 34 year old, with ten-year history of lupus nephritis, presented with recurrent abdominal pain and diarrhoea past nine months. The patient had just been diagnosed as end-stage renal failure a year ago, on regular haemodialysis. For the past ten years, the patient was not able to tolerate immunosuppressant due to the multiple episodes of infections, including shin carbuncle, herpes zoster, breast abscess and catheter-related candida/bacterial infections. However, the patient did not have any other major organs manifestations of lupus for the past ten years. The patient was apyretic. Multiple stool cultures were negative including Clostridium difficile. The abdominal radiography showed dilated small bowel with diffuse thickening of large and small bowels on computed tomography. Bilateral uretero-hydronephrosis was also noted without any evidence of obstructive uropathy on imaging. Ileocolic resection was done for presumed intestinal obstruction and the ileocolic biopsy did not reveal any granuloma, malignancy or vasculitis except for non-specific inflammation of cecum. Cytomegalovirus inclusion body was absent as well. Tuberculosis culture was negative. Oesophagoduodenoscopy and colonoscopy were offered in view of persistent unexplained loose stool and abdominal pain. But unremarkable findings were noted from multiple biopsy specimens of the small and large bowels. Second relook of the initial hemicolectomy specimen with special actin immunostain on the smooth muscle revealed degenerative changes of the muscularis propria. These were evidenced by cytoplasmic vacuolation, atrophy and pyknotic nucleus of the smooth muscle cells with surrounding oedema. Smooth muscle dysmotility could be the underlying pathology of this patient presentation. The patient responded well to intravenous immunoglobulin followed by azathioprine in addition to prednisolone and prokinetic agent.Conclusion:Prompt recognition is pivotal in this case could have prevented the unnecessary surgical intervention earlier. It is potentially reversible. Long term prognosis of this rare entity is, however, varying.Disclosure of Interests:None declared

GASTROINTESTINAL COMPLICATIONS OF CORONAVIRUS DISEASE (COVID-19)

ABSTRACT Background: It is currently understood that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) directly enters target cells by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. Accordingly, tissues with high expression levels of ACE2 are more susceptible to infection, including pulmonary alveolar epithelial cells, small intestine enterocytes, cholangiocytes, and vascular endothelial cells. Considering the atypical manifestations of COVID-19 and the challenges of early diagnosis, this review addresses the possible gastrointestinal complications of the disease. Method: The phrase “Gastrointestinal complication of COVID” was searched in the PubMed, Medline, and SciELO databases. Due to the heterogeneity of the studies included in the present review, a narrative synthesis of the available qualitative data was performed. Result: The literature search retrieved 28 articles, primarily case reports and case series, for the qualitative analysis of gastrointestinal complications of COVID-19, in addition to two retrospective cohort and one case-control. The studies focused on hemorrhagic, thrombotic, ischemic, and perforation complications, in addition to acute pancreatitis and pneumatosis intestinalis. Conclusion: There is a straight relationship between high expression levels of ACE2 in the gastrointestinal tract and its greater susceptibility to direct infection by SARS-CoV-2. So, it is important to consider the gastrointestinal infection manifestations for early diagnosis and treatment trying to avoid more serious complications and death.