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Obstructive sleep apnea (OSA) can lead to intestinal injury, endotoxemia, and disturbance of intestinal flora. Additionally, as a crucial component of the endocannabinoid system, some studies have demonstrated that cannabinoid 1 (CB1) receptors are closely linked to the multiple organ dysfunction triggered by OSA. However, the role of the CB1 receptor in alleviating OSA-induced colon injury remains unclear. Here, through the construction of the OSA classic model, we found that the colon tissue of chronic intermittent hypoxia (CIH)–induced mice exhibited an overexpression of the CB1 receptor. The results of hematoxylin-eosin staining and transmission electron microscopy revealed that inhibition of the CB1 receptor could decrease the gap between the mucosa and muscularis mucosae, alleviate mitochondrial swelling, reduce microvilli shedding, and promote the recovery of tight junctions of CIH-induced mice. Furthermore, CB1 receptor inhibition reduced the levels of metabolic endotoxemia and inflammatory responses, exhibiting significant protective effects on the colon injury caused by CIH. At the molecular level, through western blotting and real-time polymerase chain reaction techniques, we found that inhibiting the CB1 receptor can significantly increase the expression of ZO-1 and Occludin proteins, which are closely related to the maintenance of intestinal mucosal barrier function. Through 16S rRNA high-throughput sequencing and short-chain fatty acid (SCFA) determination, we found that inhibition of the CB1 receptor increased the diversity of the microbial flora and controlled the makeup of intestinal flora. Moreover, butyric acid concentration and the amount of SCFA-producing bacteria, such as Ruminococcaceae and Lachnospiraceae, were both markedly elevated by CB1 receptor inhibition. The results of the spearman correlation study indicated that Lachnospiraceae showed a positive association with both ZO-1 and Occludin but was negatively correlated with the colon CB1 receptor, IL-1β, and TNF-α. According to this study, we found that inhibiting CB1 receptor can improve CIH-induced colon injury by regulating gut microbiota, reducing mucosal damage and promoting tight junction recovery. Key points: •CIH leads to overexpression of CB1 receptor in colon tissue. •CIH causes intestinal flora disorder, intestinal mucosal damage, and disruption of tight junctions. •Inhibition of CB1 receptor can alleviate the colon injury caused by CIH through regulating the gut microbiota, reducing mucosal injury, and promoting tight junction recovery. [ABSTRACT FROM AUTHOR]

Background: Banxia Xiexin decoction (BXD) can control irinotecan (CPT‐11)‐caused delayed diarrhea, but the corresponding mechanism remains undefined. Aims: This paper aimed to uncover the mechanism of BXD in regulating CPT‐11‐caused delayed diarrhea. Materials & Methods: Sprague‐Dawley (SD) rats were assigned into the control, model, BXD low‐dose (BXD‐L, 5 g/kg), BXD medium‐dose (BXD‐M, 10 g/kg), BXD high‐dose (BXD‐H, 15 g/kg), 5‐aminosalicylic acid (5‐ASA, 10 mL/kg), and BXD‐M + 5‐ASA groups. Rats were injected intraperitoneally with 150 mg/kg CPT‐11 at Day 4 and Day 5 to induce delayed diarrhea, and later treated with various doses (low, medium, and high) of BXD and 5‐ASA for 9 days, except for rats in control group. The body weight of rats was measured. The rat colon tissue injury, inflammatory cytokine levels, and the activation of toll‐like receptor 4/nuclear factor‐κB (TLR4/NF‐κB) signaling pathway were detected. Results: BXD (5, 10, or 15 g/kg) or 5‐ASA (10 mL/kg) alleviated body weight loss and colon tissue injury, decreased levels of inflammatory cytokines, and inactivated TLR4/NF‐κB signaling pathway in CPT‐11‐induced model rats. BXD at 10 g/kg (the optimal concentration) could better treat CPT‐11‐induced intestinal dysfunction, as evidenced by the resulting approximately 50% reduction on injury score of model rats. Moreover, BXD‐M (10 g/kg) synergistic with 5‐ASA (10 mL/kg) further strengthened the inhibition on rat body weight loss, colon tissue injury, inflammatory cytokine levels, and TLR4/NF‐κB signaling pathway. Conclusion: To sum up, BXD has a protective effect against CPT‐11‐induced intestinal dysfunction by inhibiting inflammation through inactivation TLR4/NF‐κB signaling pathway. In particular, the combined use of BXD and 5‐ASA holds great promise for treating CPT‐11‐induced delayed diarrhea. [ABSTRACT FROM AUTHOR]

The management of traumatic colon injuries has evolved over the past two decades. Recent evidence suggests that primary repair or resection over colostomy may decrease morbidity and mortality. Data comparing patients undergoing primary repair versus resection are lacking. We sought to compare the outcomes of patients undergoing primary repair versus resection for low-grade colon injuries. A retrospective review of all patients who presented with American Association for the Surgery of Trauma grade I and II traumatic colon injuries to our Level I trauma center between 2011 and 2021 was performed. Patients were further dichotomized based on whether they underwent primary repair or resection with anastomosis. Outcome measures included length of stay data, infectious complications, and mortality. A total of 120 patients met inclusion criteria. The majority of patients (76.7%) were male, and the average age was 35.6 ± 13.1 y. Most patients also underwent primary repair (80.8%). There were no statistically significant differences between the groups in arrival physiology or in injury severity score. Length of stay data including hospital length of stay, intensive care unit length of stay, and ventilator days were similar between groups. Postoperative complications including pneumonia, surgical site infections, fascial dehiscence, the development of enterocutaneous fistulas, and unplanned returns to the operating room were also all found to be similar between groups. The group who underwent resection with anastomosis did demonstrate a higher rate of intra-abdominal abscess development (3.1% versus 26.1%, P < 0001). Mortality between both groups was not found to be statistically significant (7.2% versus 4.3%, P = 0.4) For low-grade (American Association for the Surgery of Trauma I and II) traumatic colon injuries, patients undergoing primary repair demonstrated a decreased rate of intra-abdominal abscess development when compared to patients who underwent resection with anastomosis. [ABSTRACT FROM AUTHOR]

Concurrent colonic injury among patients with gunshot-related fractures presents a potential risk for infectious complications. We hypothesized that colon injuries are associated with more infectious orthopedic complications among gunshot victims with concurrent fractures. We reviewed trauma patients arriving at our level 1 trauma center from January 1, 2019 to May 31, 2022 who suffered any gunshot-related fracture and also underwent an exploratory laparotomy. Of these patients, those with colon injuries were compared to those without colon injuries. Baseline characteristics, including antibiotic regimens, were collected in addition to outcomes of length of stay, intensive care unit admission, ventilator requirement, and development of infectious orthopedic complications. Overall, 56 of the 107 included patients had colon injuries. Age, sex, race/ethnicity, and Injury Severity Score were similar between groups. Of patients with colonic injuries, 16.1% received early, repeat dosing of broad-spectrum antibiotics, while only 3.9% of patients without colonic injuries received this antibiotic dosing (P = 0.04). Interestingly, only patients with colon injuries developed infectious orthopedic complications and none of the patients without colon injuries developed such complications (10.7% versus 0.0%, P = 0.03). All patients with orthopedic infections had infected pelvic fractures. Length of stay was 3 d longer in the colon injury group (P = 0.04). There was no difference in intensive care unit admission, ventilator requirement, or death. Concurrent colon injuries among patients with gunshot-related fractures are associated with higher risk of infectious orthopedic complications, likely from direct spread of fecal contaminant. Early, broad-spectrum antibiotics may be associated with reduced infectious orthopedic complications. [ABSTRACT FROM AUTHOR]

This article discusses the occurrence and management of anal sphincter injuries caused by bullfighting trauma. While these injuries are not common, they can have severe consequences, including faecal incontinence. Diagnostic tools such as endoanal ultrasound and anorectal manometry are used to assess the extent of the injury and guide surgical repair. The article emphasizes the importance of follow-up examinations and precise diagnostic modalities for better outcomes. Additionally, it highlights the need for broad-spectrum antibiotic coverage due to the high risk of infectious complications. Treatment options depend on various factors, and the article concludes by emphasizing the long-term morbidity associated with these injuries. [Extracted from the article]

Chronic kidney disease (CKD) can cause gut microbiota dysbiosis and thus impair intestinal barrier function. Disruption of intestinal homeostasis facilitates the production of enterogenic toxins, which exacerbate CKD-induced uremic toxicity and inflammation. Dietary fiber, by targeting the gut–kidney axis, could be used for CKD treatment. Psyllium seed husk (PSH) extracted from the seeds of Plantago ovata contains highly branched, gel-forming arabinoxylan. Positive effects of PSH on host physiology have been demonstrated but whether it also acts on the microbial ecosystem in CKD patients is unknown. In this study, the effects of dietary PSH on the gut microbiota, intestinal barrier function, systemic inflammation, uremic toxins, and renal injury were investigated in 5/6 nephrectomy (5/6Nx) CKD rats. Blood, feces, and kidney and colon tissues were collected from PSH-treated and control rats and subjected to biochemical and histological analyses, enzyme-linked immunosorbent assays, and 16SrRNA sequencing. PSH supplementation reduced serum creatinine and blood urea nitrogen levels, and attenuated renal tubular interstitial injury, in 5/6Nx rats. 16SrRNA sequencing showed that PSH improved the gut microbiota and intestinal barrier function in addition to down-regulating serum interleukin (IL)-1, IL-6, and indoxyl sulfate levels. Together, these results demonstrate the potential of PSH supplementation for treating CKD, including by improving intestinal microecology, reducing uremic toxin levels and systemic inflammation, and delaying disease progression. [ABSTRACT FROM AUTHOR]

Traumatic colon injury (TCI) is a typical injury with high mortality. Prolongation of the intervention time window is a potentially useful approach to improving the outcomes of TCI casualties. This study aimed to identify the pathological mechanisms of TCI and to develop effective strategies to extend the survival time. A semicircular incision was made to prepare a TCI model using C57BL/6 mice. An overview of microbiota dysregulation was achieved by metagenome sequencing. Protein expression reprogramming in the intestinal epithelium was investigated using proteomics profiling. The mice that were subjected to TCI died within a short period of time when not treated. Gut symbiosis showed abrupt turbulence, and specific pathogenic bacteria rapidly proliferated. The protein expression in the intestinal epithelium was also reprogrammed. Among the differentially expressed proteins, SERPINA3N was overexpressed after TCI modeling. Deletion of Serpina3n prolonged the posttraumatic survival time of mice with TCI by improving gut homeostasis in vivo. To promote the translational application of this research, the effects of melatonin (MLT), an oral inhibitor of the SERPINA3N protein, were further investigated. MLT effectively downregulated SERPINA3N expression and mitigated TCI‐induced death by suppressing the NF‐κB signaling pathway. Our findings prove that preventive administration of MLT serves as an effective regimen to prolong the posttraumatic survival time by restoring gut homeostasis perturbed by TCI. It may become a novel strategy for improving the prognosis of patients suffering from TCI. Highlights: SERPINA3N expression is significantly upregulated in the intestinal epithelium of traumatic colon injury (TCI) mice.Restoration of ectopic SERPINA3N expression prolongs the survival time by attenuating the dysregulation of gut homeostasis in TCI mice.Preventive administration of melatonin, as an oral inhibitor of SERPINA3N expression, is a potentially useful approach to treat patients with TCI. [ABSTRACT FROM AUTHOR]

Iatrogenic colonic perforation (ICP) is a rare but serious complication of colonoscopy, with an incidence ranging from 0.016% to 8% depending on the type and purpose of the procedure. Several patient-related, endoscopist-related, and procedure-related factors increase the risk of ICP, which most commonly occurs in the sigmoid colon. Following specific guidelines for colonoscopy performance and quality can help prevent ICP. Early diagnosis is essential, and imaging modalities such as radiography or CT scan may be needed to evaluate the extent of damage. The management of ICP depends on the size and location of the perforation, the presence of peritonitis or sepsis, the underlying colon pathology, and the patient's general condition. Endoscopic, surgical, or conservative methods may be used, but surgical consultation should always be sought urgently. Surgery is usually indicated for large perforations, signs of peritonitis, inadequate bowel preparation, severe comorbidity, failure of conservative treatment, underlying colon disease requiring surgery, transplant recipients, or immunocompromised patients. Laparoscopic-assisted exploration is the preferred surgical technique for ICP. The timing of a follow-up colonoscopy depends on the indication for the initial colonoscopy that led to ICP. [ABSTRACT FROM AUTHOR]

Purpose: Factors predicting morbidity and mortality in patients with colon-related gunshot injuries and the management of these injuries are not always straightforward. This aimed to assess the impact of abdominal gunshot wounds with colonic injuries on patients' overall outcomes. Methods: This cross-sectional prospective observational study compared patients with colon injuries and without colon injuries. Data was collected from admission, theatre and postoperative care. Patients were recruited between 1 January 2020 and 20 October 2021. Results: Of 132 patients with abdominal gunshot injuries, 71 (54.0%) had colon injuries. The colon injury group had a higher incidence of laparotomy wound sepsis (p<0.0001), bullet exit wound infection (p<0.0001), tract necrotizing fasciitis (p<0.0001), relook laparotomies (p<0.0001) and a longer hospital stay (p<0.0001). Septicaemia (p=0.002) or anastomotic leak (p=0.041) was associated with a penetrating abdominal trauma index (PATI) ≥25. Most patients who developed tract necrotizing fasciitis did not have their tract debrided/ lavaged (p=0.004). The type of colon repair did not influence the length of hospital stay (p=0.688) or the development of a colon-related complication (p=0.578). Between 18 and 25 years (p<0.0001) and >2 organs injured (p=0.018) were associated with colon-related complications. Patients between 18 and 25 years were 4.748 times more likely to develop a colon-related complication (p=0.046). Conclusion: Gunshot wounds to the abdomen with associated colonic injuries had a worse outcome with an increased risk of developing wound infections. There is no difference in the operative management of colonic injury. Patients between the ages of 18 and 25 years or >2 organs injured are more likely to develop a complication. [ABSTRACT FROM AUTHOR]

Industrial advancement has led to an increase in the production and usage of bisphenol A (BPA), thereby resulting in serious environmental pollution problems. BPA ingestion causes multiorgan toxicity. However, the exact mechanism underlying BPA-induced colon damage remains elusive. Moreover, no safe treatment is available to alleviate BPA-induced colon injury. Therefore, the in vivo and in vitro approaches were employed to detect the protective effects of melatonin (MT) on BPA-induced colon injury and to determine the underpinning molecular mechanisms. MT treatment of mice and the colonic epithelial cells NCM460 alleviated BPA-induced colon damage by inhibiting the mitochondrial dynamic imbalance, enhancing mitochondrial respiratory chain (MRC) complexes expression, reducing reactive oxygen species (ROS) production, and suppressing apoptosis and necroptosis. MT upregulated the proteins level of silent information regulator 1 (SIRT1) and peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α), which further increased the expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and the downstream antioxidant target genes heme oxygenase-1 (HO-1) and NAD(P)H quinone redox enzyme-1 (NQO1). Treatment with the SIRT1 inhibitor EX527 effectively reversed the MT-induced upregulation of the aforementioned protein levels. Thus, the MT-activated Sirt1/PGC-1α signaling pathway restored the mitochondrial dynamic balance and activated the Nrf2 antioxidant axis to attenuate BPA-induced colon injury. These results demonstrate that MT supplementation may potentially mitigate BPA toxicity. [Display omitted] • MT ameliorates BPA-induced mitochondrial dynamics disorder and dysfunction. • MT ameliorates BPA-induced mitochondrial ROS accumulation and ATP depletion. • MT ameliorates BPA-induced colonic apoptosis and necroptosis. • MT ameliorates BPA-induced colon injury by activating SIRT1/PGC-1α/Nrf2 axis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the complications of laparoscopic cholecystectomy in the symptomatic cholelithiasis and other benign gall bladder diseases. Methods: This descriptive observational study was carried out at CMH Dhaka and CMH Jashore from March 2016 to Jun 2022, to evaluate the frequency and outcome of management of all the complications in laparoscopic cholecystectomy. A total of 1425 patients of laparoscopic cholecystectomy were included in this study. Patients were followed up for a period of three months after operation. The complications in laparoscopic cholecystectomy observed in this study were divided into (i) Access related (ii) Intraoperative (biliary and extrabiliary) and (iii) Postoperative. Results: The incidence of access-related, intraoperative or procedure-related biliary, extrabiliary and postoperative complications were 3.64%, 2.95%, 4.98% and 1.96% respectively. Access related complications were extraperitoneal insufflations 1.40%, port site bleeding 1.19%, small bowel laceration 0.21% and transverse colon injury 0.07%.Procedural biliary complications included common bile duct (CBD) injury 0.14%, common hepatic duct (CHD) injury 0.07% and iatrogenic gall bladder perforation with bile leakage 2.74%. Procedural extrabiliary complications were Liver injury 0.56%, duodenal perforation 0.07%, colon perforation 0.07%, bleeding through cystic artery 0.49% and bleeding from gall bladder fossa 1.12%. Two colonic perforations and one duodenal perforation were the major complications encountered in this series. Two colonic perforations required conversion to open procedure but duodenal perforation was managed laparoscopically by intracorporeal suturing. Total nine (0.63%) patients required conversion to open procedure. Postoperative complications included port site infection (PSI) 1.05%, port site hernia 0.56%, major sepsis 0.14% and ischemic stroke 0.07%. There was no retained stone, biliary stricture and mortality reported in this series. Conclusion: Complications in laparoscopic cholecystectomy are mainly due to access related and intraoperative and have their own characteristics. CBD transaction, CHD injury, Colonic perforations and duodenal perforations were the major complications requiring conversion to open procedure except duodenal perforation which was dealt laparoscopically. Conversion to open procedure should not be considered as a complication. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic colectomy following traumatic injury has been increasingly utilized, but open resection remains the standard of care. Therefore, identifying appropriate candidates for laparoscopy is critically important. This study's purpose was to identify predictors of clinical outcomes in patients undergoing laparoscopic colectomy following traumatic injury.Methods: The National Trauma Databank was queried for patients undergoing laparoscopic colectomy within 48 hours of admission between 2007 and 2015. Patient, injury, and management characteristics were abstracted. Multivariable regression analyses adjusted for baseline characteristics and identified significant predictors of clinical outcomes.Results: A total of 581 patients satisfied inclusion criteria. The median age was 31 years, 465 (80%) were male, and 321 (55%) sustained penetrating injuries. An ostomy was created in 143 (25%) cases. Multivariable logistic regression showed that significant predictors of mortality included a falling mechanism (odds ratio [OR] 104.917, P = .002), admission tachycardia (OR 5.823, P = .001), admission hypotension (OR 26.089, P < .001), and multi-system injuries like head (OR 1.587, P = .008) and thoracic (OR 1.627, P = .001) injuries. Significant predictors of unplanned reoperation included transverse (OR 7.657, P = .033) and left (OR 17.155, P = .014) colon resections, obesity (OR 24.407, P = .016), and chronic respiratory disease (OR 32.963, P = .018). Ostomy creation was significantly associated with neither mortality nor unplanned reoperation.Conclusion: These data suggest that readily identifiable preoperative characteristics are significantly associated with differences in clinical outcomes. Additional research is required to determine if varying treatment based on these qualities can improve outcomes. [ABSTRACT FROM AUTHOR]

Background: Penetrating diaphragmatic injuries are associated with a high incidence of posttraumatic empyema. We analyzed the contribution of trauma severity, specific organ injury, contamination severity, and surgical management to the risk of posttraumatic empyema in patients who underwent surgical repair of diaphragmatic injuries at a level 1 trauma center. Methods: This is a retrospective review of the patients who survived more than 48 h. Univariate OR calculations were performed to identify potential risk factors. Multiple logistic regression was used to calculate adjusted ORs and identify independent risk factors. Results: We included 192 patients treated from 2011 to 2020. There were 169 (88.0) males. The mean interquartile range, (IQR) of age, was 27 (22–35) years. Gunshot injuries occurred in 155 subjects (80.7%). Mean (IQR) NISS and ATI were 29 (18–44) and 17 (10–27), respectively. Thoracic AIS was > 3 in 38 patients (19.8%). Hollow viscus was injured in 105 cases (54.7%): stomach in 65 (33.9%), colon in 52 (27.1%), small bowel in 42 (21.9%), and duodenum in 10 (5.2%). Visible contamination was found in 76 patients (39.6%). Potential thoracic contamination was managed with a chest tube in 128 cases (66.7%), with transdiaphragmatic pleural lavage in 42 (21.9%), and with video-assisted thoracoscopy surgery or thoracotomy in 22 (11.5%). Empyema occurred in 11 patients (5.7%). Multiple logistic regression identified thoracic AIS > 3 (OR 6.4, 95% CI 1.77–23. 43), and visible contamination (OR 5.13, 95% IC 1.26–20.90) as independent risk factors. The individual organ injured, or the method used to manage the thoracic contamination did not affect the risk of posttraumatic empyema. Conclusion: The severity of the thoracic injury and the presence of visible abdominal contamination were identified as independent risk factors for empyema after penetrating diaphragmatic trauma. [ABSTRACT FROM AUTHOR]

We have previously found that enhancer of zeste homolog 2 (EZH2) is correlated with inflammatory infiltration and mucosal cell injury in ulcerative colitis (UC). This study aims to analyze the role of X-inactive specific transcript (XIST), a possible interactive long non-coding RNA of EZH2, in UC and to explore the mechanisms. C57BL/6N mice were treated with dextran sulfate sodium (DSS), and mouse colonic mucosal epithelial cells were treated with DSS and lipopolysaccharide (LPS) for UC modeling. The UC-related symptoms in mice, and the viability and apoptosis of mucosal epithelial cells were determined. Inflammatory injury in animal and cellular models were assessed through the levels of ACS, occludin, IL-1β, IL-18, TNF-α, caspase-1, and caspase-11. Molecular interactions between XIST, EZH2, and GABA type A receptor-associated protein (GABARAP) were verified by immunoprecipitation assays, and their functions in inflammatory injury were determined by gain- or loss-of-function assays. XIST was highly expressed in DSS-treated mice and in DSS + LPS-treated mucosal epithelial cells. It recruited EZH2, which mediated gene silencing of GABARAP through H3K27me3 modification. Silencing of XIST alleviated body weight loss, colon shortening, and disease active index of mice and reduced inflammatory injuries in their colon tissues. Meanwhile, it reduced apoptosis and inflammation in mucosal epithelial cells. However, these alleviating effects were blocked by either EZH2 overexpression or GABARAP knockdown. Rescue experiments identified caspase-11 as a key effector mediating the inflammatory injury following GABARAP loss. This study suggests that the XIST-EZH2 interaction-mediated GABARAP inhibition activates caspase-11-dependent inflammatory injury in UC. [ABSTRACT FROM AUTHOR]

Background: Although the treatment strategy for colorectal trauma has advanced during the last part of the 20th century and the result has improved and compared to other injuries and problems, such as high septic complication rates and mortality rates, still exist, so standard management for colorectal trauma is still a controversial issue. Aims and Objectives: This study aims to determine the factors that affect morbidity and mortality in colon and rectum injuries. Materials and Methods: This study was prospective cohort study. The study was conducted at Burdwan Medical College and Hospital, West Bengal from May 2019 to October 2020 including 80 patient of trauma over abdomen. Thorough history taking and clinical examination were done. Template was generated in MS Excel sheet and analysis was done on statistical package for the social sciences software. Results: Among 80 patients, the majority of the patients were in the age group of 21–30 years (45%). Majority 69 patients (86.25%) were males and 11 patients (13.75%) were females. Gunshot wounds were found in maximum 41 (51.3%) and stab wounds in 27 (33.7%). Colon was injured in 68 (85%) patients and the rectum in 12 (15%) patients. CIS Grade 1, 2, and 3 was observed in 69 (86.3%) patients. Primary repair was performed in 45.0% (36) patients. Resection and anastomosis management was given to 32 (40.0%) patients. Conclusions: If colorectal injuries are not treated appropriately, severe complications leading to death may be induced; nonetheless, controversy still exists concerning the standard treatment. In this regard, unnecessary proximal diversions should be avoided. [ABSTRACT FROM AUTHOR]

Introduction: There is limited evidence to suggest that patients with penetrating colon injury have higher complication rates when there is concomitant small bowel (SB) injury.Aim: We performed a retrospective study looking at outcomes of penetrating colonic trauma in patients with- and without concomitant SB injury.Methods: We interrogated our electronic registry over an eight-year period (2012-2020) for all patients over 18 years who had sustained penetrating colon injury and who had survived beyond 72 h. Demographic data, admission physiology, and Injury Severity Score (ISS) were recorded. Two groups of patients were observed: those with colonic injury (no SB injury) and those with combined colon and SB injury. Outcomes observed included leak rates, length of Intensive Care Unit (ICU) stay, length of hospital stay (LOS), morbidity and mortality.Results: A total of 450 patients were eligible for analysis, of which 257 had colon injury without SB injury and 193 had a combination of colon and SB injury. There was no difference in mechanism of injury between groups. Admission physiology was similar between groups but arterial blood gas values were worse in the combined group. Rates of damage control surgery and ICU admission were higher in the combined group. Primary repair was done in equal proportions between groups but anastomosis was more frequently performed in the combined group. There was no difference in complication rates, including gastro-intestinal complications and suture line leaks. Length of ICU stay, LOS, and mortality were similar between groups. Univariable analysis demonstrated that the presence of concomitant small bowel injury was not an independent risk factor for colonic suture line failure or death.Conclusion: There is no evidence from this data that the presence of a combined penetrating colon and SB injury should change management priorities. Each injury should be treated on its own merit, in the context of the patient's physiology. [ABSTRACT FROM AUTHOR]

Citrus reticulata pericarpium (CRP), the peel of Citrus reticulata 'Dahongpao' (DHP) is a medicinal herb with significant therapeutic value for treating ulcerative colitis (UC). However, the active therapeutic components of CRP are unclear. This study aims to reveal the metabolites potentially associated with the pharmacological properties of CRP. We performed flavonoid-targeting metabolomics to characterize the components of CRP (anti-UC part), tangerine pith and Citrus reticulata semen (no anti-UC effects parts) of DHP and further screened active components of CRP using network pharmacology and molecular docking. Lipopolysaccharide (LPS)-stimulated RAW 264.7 cells were used to study the anti-inflammatory effect of the selected biologically active components. The therapeutic effects of the selected components were further investigated in a mouse model of UC induced by DSS. Three compounds, namely nobiletin, sinensetin, and hispidulin had the lowest docking scores among all screened ingredients. IL-6 and NO concentrations were significantly decreased in the LPS-stimulated RAW264.7 cells compared with control cells treated with these compounds. Moreover, UC mice treated with these compounds showed a reversal in weight loss, inhibition of shortening of colon length, and amelioration of colon injury. Our results indicated that sinensetin, nobiletin, and hispidulin can be potentially used for the treatment of UC. [Display omitted] • Screened the active ingredient with anti-UC effects in the peel of Citrus reticulata 'Dahongpao'. • Our results indicated that sinensetin, nobiletin, and hispidulin may have potential in the treatment of UC. • This work provided a powerful method for identifying herbal medicine ingredients with anti-UC properties. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence to suggest that the more distal a penetrating colonic injury, the poorer its expected outcome, prompting consideration of diversion rather than anastomosis when faced with left colonic injury. The clinical outcomes of penetrating colonic trauma in relation to their anatomical location within the colon were reviewed. Methods: A review was performed over eight years (2012—2020) of all patients over 18 years who had sustained penetrating colon injury and presented to our trauma centre in South Africa. Direct comparison was made between right colon vs left colon injuries. Results: A total of 450 patients were included; right colon: 260, left colon: 190. Gunshots predominated in the right colon, and the PATI was higher in this group. There were minimal differences in admission physiology and blood gas parameters between groups, but higher damage control surgery and ICU admission rates for the right colon group. There were similar rates of primary repair, anastomosis, and stoma between groups. Leak rates were no different between the two groups, and although overall complication rates were higher for the right colon, there was no difference with regard to gastro-intestinal and other complications, nor for mortality. While regression analysis did identify PATI to be a risk factor for overall complications and mortality, it failed to do so for anastomotic leak. Conclusion: Our study did not demonstrate any difference in anastomotic leak rates or mortality between right vs left colonic injury. We recommend that all colonic injuries should be treated on their own merit, balanced against the patient's condition, regardless of anatomical location within the colon. [ABSTRACT FROM AUTHOR]

Background: Endoscopic submucosal dissection (ESD) is a challenging procedure for the removal of colorectal tumors, especially tumors located in the right colon. The use of traction could make this procedure technically easier and reduce procedure times and complication rates. In this study, we demonstrated the feasibility and utility of a traction technique utilizing an endoscopic snare through an overtube, a double-balloon endolumenal interventional platform (DEIP) in a porcine colorectal model. Methods: A total of 120 procedures were performed using three different techniques: standard ESD technique (STD), ESD with DEIP (DEIP alone), and ESD with DEIP and a snare (DEIP + Snare). The snare was passed inside the overtube and used as a grasper on the tissue to provide traction. Lesions 3 or 4 cm in diameter were removed with a 5 mm margin from the anterior and posterior walls of the proximal Transverse Colon, the Hepatic Flexure, and the posterior wall of the Cecum. The outcomes measured included procedure times and the number of muscularis propria injuries. Results: The DEIP + Snare group showed significantly shorter total procedure and submucosal dissection times for lesions in all locations (median 28.1 min (DEIP + Snare, n = 32) vs 39.8 (STD, n = 32) vs 39.7 (DEIP alone, n = 32); 7.5 min vs 25.3 vs 25.1) and had fewer muscularis propria injuries (median 0 [range 0–2] vs 2 [0–7] vs 1 [0–6]) than the two other groups. Larger lesions (4 cm) were successfully removed by regrasping the tissue in DEIP + Snare group, which showed significantly shorter total procedure time [31.4 min (DEIP + Snare, n = 8) vs 40.1 (STD, n = 8) vs 45.6 (DEIP alone, n = 8)] and submucosal dissection time (12.3 min vs 27.6 vs 29.1) than the two other groups. Conclusions: ESD traction technique with an endolumenal platform and snare enables faster removal of large polyps in the right colon with fewer injuries than standard methods of ESD. [ABSTRACT FROM AUTHOR]

In this paper we report the trauma suffered by a green turtle (Chelonia mydas), caused by a collision with a motorboat, and describe the case ante and post-mortem. An adult female green turtle was rescued alive on December 2, 2016 at Ponta Negra beach, municipality of Natal, Rio Grande do Norte, Brazil. The rescued animal was sent to the Marine Fauna Rehabilitation Center (PCCB-UERN), municipality of Areia Branca (RN), in Brazil. Physical examination revealed an excellent body score, noisy breathing, moderate dehydration, absence of hind limb and cloacal reflexes when stimulated by pressure, and two traumatic injuries characteristic of a collision with a motorboat. After three days of supportive treatment, the animal died and was immediately sent for necropsy. The animal had a complete fracture of the vertebral bodies (dorsal elements D9 and D10) and spinal cord section. The entire gastrointestinal tract had food content, in addition to sharp injuries in the colon caused by the bone fragments of the fractured carapace. The lungs were congested, hemorrhagic with frothy and bloody secretion, and interstitial bronchiole fibrosis. There was also present some fibrin and a large number of leukocyte cells, consisting mainly of macrophages. The liver was enlarged, with rounded edges and thickening of the capsule, multifocal areas of hepatocellular necrosis, and dissociation of the hepatocyte cords. The collision resulted in the exposure of the coelomic cavity and spinal cord, causing the animal intense pain, paralysis of the hind limbs and cloaca, speticemia, and consequently, death. [ABSTRACT FROM AUTHOR]

Background: The management of colon injuries in damage control surgery (DCS) remains controversial. Methods: A retrospective study investigating outcomes of penetrating colonic trauma in patients who survived beyond the initial repeat laparotomy (IRL) after DCS was performed. Patients over 18 years with penetrating colon injury and who underwent DCS from 2012 to 2020 were included from our electronic trauma registry. Demographic data, admission physiology and Injury Severity Score (ISS) were reviewed. Patients were classified into three groups: primary repair of non‐destructive injuries at DCL, delayed anastomosis of destructive injuries at IRL and diversion of destructive injuries at IRL. Outcomes observed included leak rates, length of intensive care unit stay, length of hospital stay, morbidities, mortality and colon‐related mortality. Results: Out of 584 patients with penetrating colonic trauma, 89 (15%) underwent DCS. After exclusions, 74 patients were analysed. Mean age was 32.8 years (SD 12.5); 67 (91%) were male. Mechanism of injury was gunshot in 63 (85%) and stab 11 (15%) patients. Seventeen patients underwent primary repair at DCS, of which one leaked. Twenty patients underwent delayed anastomosis at IRL. Of these, five (25%) developed leaks. Mortality was significantly higher for those with an anastomotic leak compared to those without (p < 0.001). Thirty‐seven patients were diverted at IRL. Overall mortality (p = 0.622) and colon‐related mortality (p = 0.592) were not significantly different across groups. Conclusion: Delayed anastomosis at IRL following DCL was associated with a leak rate of 25% in this study. When anastomotic leak did occur, it was associated with significant mortality. Delayed anastomosis should only be undertaken in highly selected patients. [ABSTRACT FROM AUTHOR]

Background: Abdominal pregnancy accounts for 0.6 to 4% of all ectopic pregnancies. Due to delays in diagnosis and difficulties in the management of abdominal pregnancy, the risk of mortality is significantly higher than for uncomplicated ectopic pregnancies. A 23 years-old gravida-II, ectopic-I Ethiopian woman was initially managed as a case of missed second trimester abortion. Later on, abdominal ectopic pregnancy was diagnosed with ultrasound and she underwent a laparotomy. Though fetus and placenta was removed successfully without significant hemorrhage, there was inadvertent sigmoid colon injury.Conclusion: In the management of abdominal ectopic pregnancy, the possibility of bowel injury during entry to the abdominal cavity at laparotomy should always be considered and an experienced general surgeon should always be in attendance before opening the abdomen, to prevent it from happening. [ABSTRACT FROM AUTHOR]

Background: Management of colon injuries has significantly evolved in the recent decades resulting in considerably decreased morbidity and mortality. We set out to investigate penetrating colon injuries in a high-volume urban academic trauma center in South Africa.Methods: All patients with penetrating colon injuries admitted between 1/2015 and 1/2018 were prospectively enrolled. Data collection included demographics, injury profile and outcomes. Primary outcome was in-hospital mortality. Secondary outcome was morbidity.Results: Two-hundred and five patients were included in the analysis. Stab and gunshot wounds constituted 18% and 82% of the cases, respectively. Mean age was 28.9 (10.2) years and 96.1% were male. Median injury severity score (ISS) and penetrating abdominal trauma index (PATI) were 16 (9-25) and 19 (10-26), respectively. A total of 47.8% of the patients had a complication per Clavien-Dindo classification. Colon leak rate was 2.4%. Wound and abdominal organ/space infection rate was 15.1 and 6.3%, respectively. Overall in-hospital mortality was 9.3%. Risk factors for mortality were higher ISS and PATI, shock on admission, need for blood transfusion, intra-abdominal vascular injury, damage control surgery, and extra-abdominal severe injuries.Conclusions: Contemporary overall complication rate remains high in penetrating colon injuries, however, anastomotic leak rate is decreasing. Colon injury associated mortality is related to overall injury burden and hemorrhage rather than to colon injuries. [ABSTRACT FROM AUTHOR]

BACKGROUND: Protecting the intestinal mucosa from being destroyed helps reduce the inflammation caused by acute pancreatitis (AP). In this study, whether okra pectin (OP) could attenuate the inflammation of AP through protecting the intestinal barrier was investigated. RESULTS: OP was obtained from crude okra pectin (COP) through the purification by DEAE cellulose 52 column. Supplementation with OP or COP in advance reduced the severity of AP, as revealed by lower serum amylase and lipase levels, abated pancreatic edema, attenuated myeloperoxidase activity and pancreas histology. OP or COP inhibited the production of pancreatic proinflammatory cytokines, including tumor necrosis factor‐α and interleukin‐6. In addition, the upregulation of AP‐related proteins including ZO‐1, occludin, the antibacterial peptide‐defensin‐1 (DEFB1) and cathelicidin‐related antimicrobial peptide (CRAMP), as well as the histological examination of colon injuries, demonstrated that OP or COP provision could effectively maintain intestinal barrier function. Ultimately, dietary OP or COP supplementation could inhibit AP‐induced intestinal inflammation. For the above, the effect of OP was better than COP. CONCLUSION: Dietary OP supplementation could be considered as a preventive method that effectively interferes with intestinal damage and attenuates inflammatory responses trigged by AP. © 2020 Society of Chemical Industry [ABSTRACT FROM AUTHOR]

Ulcerative colitis is an inflammatory bowel disease with increasing prevalence and incidence. Current treatments for ulcerative colitis are not generally applicative and are often accompanied by side effects. IGF2 is an endogenous protein that plays roles in anti-inflammation and stemness maintenance, but little is known about its mechanism and function in the progression of ulcerative colitis. In this study, mouse recombinant IGF2 was used in a mouse model of ulcerative colitis established by DSS. IGF2 expression was reduced in colon tissues but not plasma of DSS-induced colitis mice. IGF2R expression was also decreased in colitis colons, which was then elevated by recombinant IGF2. Recombinant IGF2 alleviated colon injury in colitis, which was evaluated by colon shortening, body weight loss and DAI score. IGF2 treatment also relieved the inflammatory response in colitis, which was assessed by the spleen weight index, MPO activity and proinflammatory cytokine expression and was also detected in LPS-stimulated RAW264.7 cells in vitro. Moreover, IGF2R was predicted and further verified to interact with the Sting protein, and the cGAS-Sting pathway as a key pathway for stemness regulation, was upregulated in colonic colons, which was blocked by IGF2 treatment. Additionally, IGF2 treatment can maintain colonic stemness and further repair colonic tight junction function in DSS-induced colitis. In conclusion, IGF2/IGF2R downregulated the cGAS-Sting pathway to sustain colonic stemness and barrier integrity to protect against ulcerative colitis induced by DSS. [ABSTRACT FROM AUTHOR]

Background: Ulcerative colitis (UC) is a chronic and recurrent disease without satisfactory treatment strategies. Dental pulp stem cell (DPSC) transplantation has been proposed as a potential therapy for UC. This study aimed to investigate the therapeutic effects of the rat hepatocyte growth factor (HGF) gene transduced into DPSCs for UC. Methods: The therapeutic effects of HGF-DPSCs transplanted intravenously into a rat model of UC induced by 5% dextran sulphate sodium (DSS) were compared with the other treatment groups (LV-HGF group, DPSCs group and GFP-DPSCs group). Immunofluorescence and immunohistochemistry were used to observe the localization and proliferation of HGF-DPSCs at the site of colon injury. The expression levels of inflammatory factors were detected by real-time quantitative PCR (RT-PCR) and western blotting. The oxidative stress markers were detected by ELISA. DAI scores and body weight changes were used to macroscopically evaluate the treatment of rats in each group. Results: Immunofluorescence and immunohistochemistry assays showed that HGF-DPSCs homed to colon injury sites and colocalized with intestinal stem cell (ISC) markers (Bmi1, Musashi1 and Sox9) and significantly promoted protein expression (Bmi1, Musashi1, Sox9 and PCNA). Anti-inflammatory cytokine (TGF-β and IL-10) expression was the highest in the HGF-DPSCs group compared with the other treatment groups, while the expression of pro-inflammatory cytokines (TNF-α and INF-γ) was the lowest. Additionally, the oxidative stress response results showed that malondialdehyde (MDA) and myeloperoxidase (MPO) expression decreased while superoxide dismutase (SOD) expression increased, especially in the HGF-DPSCs group. The DAI scores showed a downward trend with time in the five treatment groups, whereas body weight increased, and the changes were most prominent in the HGF-DPSCs group. Conclusions: The study indicated that HGF-DPSCs can alleviate injuries to the intestinal mucosa by transdifferentiating into ISC-like cells, promoting ISC-like cell proliferation, suppressing inflammatory responses and reducing oxidative stress damage, which provides new ideas for the clinical treatment of UC. [ABSTRACT FROM AUTHOR]

Background: percutaneous nephrolithotomy (PCNL) is regarded as the treatment of choice for most renal stones larger than 2cm. Colon injury is one of the rare and preventable complications during PCNL. The rare and unusual location of the colon behind the kidney (retrorenal colon) is an anatomical predisposing factor and other factors that can result in colon perforation during PCNL. Aim: To evaluate the prevalence of retrorenal and posterolateral colon and among CT scanned patients. Patients and methods: one thousand CT scanned patients of all ages and both sexes were included and their CT images were evaluated prospectively at the CT scan center at Azadi Teaching Hospital for the presence of retrorenal colon and the relation of the colon to different parts of the kidney. Results: In this study, 1000 CT scanned patients of different ages and both sexes were included. There were 522 males and 478 females; their ages ranged from 6 to 85 years. The overall prevalence of retrorenal colon was 7.5% (6.3% in males and 8.7% in females). The prevalence of retro renal colon according to different ages was: at below 10 y was 16%, 11- 20 years 8.3%, 21-30 y 5.9 %, 31-40 y 7.2 %, 41-50y 7.2%, 51-60y 11.2%, 61-70y 5.8% 71- 80y 7.2% and at 81-90 y was 9%, and the differences regarding the ages and sexes were statistically not significant. The lower pole of the left kidney is the most common part involved by the retrorenal colon in 70.6%, while the right lowers pole by 12%, the left middle part by 10.6%, and bilateral lower poles by 6.6%. Conclusion: Locally, the prevalence of retrorenal colon is within the usual range with no sex or age predominance, and a pre-operative abdominal CT scan (native one) is a diagnostic one and is essential if left lower renal calyx is planned to be targeted to avoid colonic injury. [ABSTRACT FROM AUTHOR]

Background. Emerging evidence reveals that long noncoding RNAs (lncRNAs) play important roles in the pathogenesis of sepsis. However, the detailed regulatory mechanisms of lncRNAs or whether certain lncRNA could serve as a biomarker in the septic colon remains unclear. The aim of this study was to investigate the profiles of lncRNAs and mRNAs in the septic colon through whole-transcriptome RNA sequencing and to reveal the associated regulatory mechanism. Method and Result. We established a mouse model of sepsis by cecal ligation and puncture (CLP). Colon samples were collected upon CLP or sham surgery after 24 h. Whole-transcriptome RNA sequencing was performed to profile the relative expressions of lncRNAs and mRNAs. 808 lncRNAs and 1509 mRNAs were differentially found in the septic group compared with the sham group. Bioinformatics analysis including Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes pathway analysis (KEGG) was performed to predict the potential functions of these RNAs. GO analysis showed that the altered lncRNAs were enriched and involved in multiple immune responses, which may be a response to sepsis stress. KEGG analysis indicated that upregulated lncRNAs were significantly enriched in the p53 signaling pathway, NF-κB signaling pathway, and HIF-1 signaling pathway. Downregulated lncRNAs were mostly found to be involved in tight junction, leukocyte transendothelial migration, and HIF-1 signaling pathway. Conclusion. Our results indicate that these altered lncRNAs and mRNAs may have crucial roles in the pathogenesis of sepsis. This study could contribute to extending the understanding of the function of lncRNAs in sepsis, which may help in searching for new diagnostic biomarkers and therapeutic targets to treat sepsis. [ABSTRACT FROM AUTHOR]

Iatrogenic injury to an internal organ such as the stomach, colon, small bowel, or liver after percutaneous endoscopic gastrostomy (PEG) tube insertion is a rare complication. We present a case of rectal bleeding due to colon injury during PEG tube placement. This required urgent exploratory laparoscopic surgery with segmental resection of the transverse colon and replacement of the PEG tube. Postoperatively, the patient significantly improved with time and tolerated PEG tube feeding. [ABSTRACT FROM AUTHOR]

Background: In our study, we have defined and evaluated risk factors for the development of post‐operative complications in patients with gunshot wounds to the colon. The purpose of the study is to identify the most influential risk factors. Methods: A retrospective study of 172 patients admitted with gunshot wounds to the colon from 17 February 2011 to 31 December 2014. Age, gender, shock upon admission defined by vital signs and haemoglobin level, blood transfusion, injured site of the colon, the colon injury score, faecal contamination, surgical procedure, colon diversion, multiple organ injuries, delay time pre‐operation and duration of the operation were considered as risk factors. All patients were observed for any postoperative complications. Results: One hundred and sixty‐six patients (96.5%) were males, and six (3.5%) were female. The mean age was 28.5 years. On admission 104 (60.5%) patients were in shock, 89 (51.7%) required blood transfusion. Forty‐four (25.5%) patients had an injury to the ascending colon, while 53 (30.8%), 13 (7.6%), 23 (13.4%), 21 (12.2%) and 18 (10.5%) patients had an injury in transverse, descending, sigmoid, rectum and multiple colon injuries respectively. A colon diversion was used in 64 patients (37.2%). Post‐operative complications documented in 67 (38.9%) patients, 35 (20.3%) required re‐exploratory laparotomy, while the disability occurred in 18 (10.4%)) cases, and post‐operative mortality was 12 (6.9%). Conclusion: Surgeons should be aware that shock state upon admission and blood transfusion are risk factors for postoperative complications in a patient with a gunshot penetrating injury to the colon. [ABSTRACT FROM AUTHOR]

Background: One of the most common surgical procedures, cesarean section, can cause adhesion bands in the abdomen. Intestinal injury is a complication of repeat cesarean sections, particularly in the presence of adhesion bands. Occurrence of extensive cervical, subcutaneous, and mediastinal emphysema following colon perforation is a rare condition. This report presents a very rare case of cervical and mediastinal emphysema as the primary sign following colon perforation caused by a cesarean section. Case: A 27-year-old woman undergoing cesarean section was referred to an emergency room due to crepitus palpation. A physical examination revealed that she had "snowball" crepitation in her neck and upper chest. A chest-X ray revealed that she had mediastinal emphysema. In an abdominal exploration, her sigmoid colon was found sticking to her abdominal wall in the left corner of a Pfannenstiel incision while that colon had a small laceration and fistula to the abdominal wall. The sigmoid colon was released from the fascia and repaired with some Gambee stitches. Then, the pneumomediastinum space was drained from her neck by a collar incision. Results: The patient's granulation tissue gradually appeared at the incision line over the intestine and lateral wound. The skin in the upper and lower parts of the midline incision were approximated, and the lateral wound was left open for spontaneous closure. A few days after the surgery, the subcutaneous and mediastinal emphysema disappeared. She was discharged with instructions on taking a daily bath and dressing the lateral surgical wound. After 4 weeks, the lateral surgical wound had closed. Conclusions: Adhesion bands occur in repeat cesarean sections due to intestinal injuries, even though an optimal technique is used. A sufficient pressure gradient between the intestinal duct and the subcutaneous space following perforation and the presence of dead spaces in fascia resulting in surgical wounds are important factors in development of subcutaneous emphysema due to intestinal perforation. [ABSTRACT FROM AUTHOR]

After traumatic injury, primary anastomosis after colon resection has overtaken ostomy diversion. Improved technology facilitating primary anastomosis speed and integrity may have driven this change. Trends in ostomy versus anastomosis have yet to be quantified, and recent literature comparing outcomes is incomplete. The National Trauma Databank (2007-2014) was queried for all blunt colon injuries requiring resection. Patients were dichotomized into study groups based on whether they underwent ostomy creation. Ostomy creation frequency was compared over time. After subgrouping patients by colon injury location, multivariate regression adjusted for baseline characteristics and evaluated the impact of ostomy on clinical outcomes. A total of 13,949 colon injuries requiring colectomy were identified. Ostomy frequency did not vary by study year (P = 0.536). Univariate analysis showed that patients undergoing ostomy were older (median, 40 versus 32; P < 0.001) and more often had comorbidities (65% versus 56%; P < 0.001). Multivariate analysis showed that ostomy creation was significantly associated with lower mortality after sigmoid colon injury (odds ratio, 0.512; P = 0.011) and higher rates of unplanned reoperation after transverse colon injury (odds ratio, 3.135; P = 0.048). Across all colon injuries, ostomies were significantly associated with longer hospital length of stay, intensive care unit length of stay, and ventilator days. Ostomy creation for colonic injury has reached an equilibrium trough. The impact of ostomy creation varies by not only clinical outcome but also injury location. Further study is needed to define the optimal surgical management for blunt colon injuries requiring resection. [ABSTRACT FROM AUTHOR]

This paper evaluates possible relations between the clinical activity and the histopathological findings of the entire intestine in dogs with inflammatory bowel disease (IBD). To perform this study, hospital records of 64 dogs of different sex and breed diagnosed with IBD were evaluated. The results of this study did not show a statistically significant correlation between clinical activity and the histopathological assessment of dogs with IBD. Certain connections were found between diarrhea and lacteal dilation in duodenum, and hematochezia and villous epithelial injury in colon but no other associations were found between the rest of the lesions and symptoms. [ABSTRACT FROM AUTHOR]

In the majority of patients undergoing transcatheter aortic valve implantation, the transfemoral access is the suggested approach due to its less invasive nature and feasibility in patients with suitable vascular anatomy. The complications of the transfemoral access site are generally vascular; however, we herein present a rare case of colon perforation following the transfemoral procedure owing to prior abdominal surgery. A transfemoral aortic valve was inserted on account of severe aortic stenosis and a high probability of surgical mortality. The patient developed acute abdomen following the procedure. Hemicolectomy was performed because of colonic perforation caused by femoral catheterization. The patient was well at 3 months' follow-up. [ABSTRACT FROM AUTHOR]

Impalement injuries are uncommon and are infrequently reported in the literature. Impalement injury in children is extremely rare. But fall from height are not uncommon in children and it is occasionally associated with major impalement injuries. These are complex surgical problems and the extent of injury depends on the tract traversed by the impaling object. The aim of this study is to focus on the extent of damage caused by impalement injury in children due to fall from height. Five cases of visceral impalement injuries in children were treated. Age of the patients ranged from 7 to 11 years. There were one female and four male patients. Modes of injury in all the cases were due to fall on projecting object: two cases due to fall from a tree and in three cases due to jumping into a pond. After initial resuscitation, all the cases were subjected to surgery. The tract of impalement, organs injured, treatment done, and outcome are analyzed. Route of entry of the impaling object was the anus in four cases and the umbilicus in one case. Impaling objects were extruded at the site of trauma in three cases and the objects were lying inside victim in two cases. The abdominal cavity was involved in two cases, and both abdomen and thorax were involved in three cases. The rectum or sigmoid colon were involved in four cases, small intestine in three cases, liver and diaphragm in three cases, and the right lung in three cases. A chest tube was inserted in three cases and colostomy was done in four cases. Hospital stay ranged from 11 to 27 days (mean 16.2 days). There was no mortality but morbidities were related to sepsis, tube thoracostomy, and colostomy. Impalement injuries are not uncommon in children. Injuries are usually complex and bizarre. Timely surgical intervention can save life but these are associated with significant morbidities. [ABSTRACT FROM AUTHOR]

[Display omitted] Ulcerative Colitis (UC) is a chronic idiopathic inflammatory bowel disease in which the colon's lining becomes inflamed. Exploring herbal remedies that can recover mucosal damage is becoming popular in UC. The study aims to investigate the probable colo-protective effect of a natural isoflavone, genistein (GEN), and/or a drug, sulfasalazine (SZ), against acetic acid (AA)-induced UC in rats, in addition to exploring the possible underlying mechanisms. UC was induced by the intrarectal installation of 1–2 ml of 5% diluted AA for 24 h. Ulcerated rats were allocated into the disease group and three treated groups, with SZ (100 mg/kg), GEN (100 mg/kg), and their combination for 14 days, besides the control groups. The anti-colitic efficacy of GEN and/or SZ was evidenced by hindering the AA-induced weight loss, colon edema, and macroscopic scores, besides reduced disease activity index and colon weight/length ratio. Furthermore, treatments attenuated the colon histopathological injury scores, increased the number of goblet cells, and lessened fibrosis. Both treatments reduced the up-regulation of INF-γ/JAK1/STAT1 and INF-γ /TLR-4/ NF-κB signaling pathways and modulated the IRF-1/iNOS/NO and IL-6/JAK2/STAT3/COX-2 pathways and consequently, reduced the levels of TNF-α and IL-1β. Moreover, both treatments diminished oxidative stress, which appeared by reducing the MPO level and elevating the SOD activity, and hindered apoptosis; proved by the decreased immunohistochemical expression of caspase-3. The current findings offer novel insights into the protective effects of GEN and suggest a superior benefit of combining GEN with SZ, over either drug alone, in the UC management. [ABSTRACT FROM AUTHOR]

Although radiation therapy (RT) is a feasible treatment approach for early colorectal cancer, RT is considerably toxic to normal tissues due to the increased reactive oxygen species production, which can induce tissue damage. Ginseng, a natural antioxidant agent, exhibits the protective effects against ionizing radiation (IR)-induced damage in in vitro and in vivo models. The explosive puffing of ginseng has been investigated as a process to improve the efficacy of ginseng due to the resulting physicochemical changes in its functional components. In this study, we provided the evidence for promotion in the beneficial role of puffed ginseng extract (PGE) and associated mechanisms of action, in comparison with white ginseng extract (WGE), against IR-induced colorectal injury, using in vivo study on a mouse model. To study the role of PGE in preventing IR-induced damage, we examined colorectal injury and apoptotic changes in mice exposed to 137Cs at 8 Gy. High-performance liquid chromatography analysis showed that PGE had an increased total ginsenoside concentration with new generation of Rg3, Rg5, and Rk1, compared with the concentrations in WGE. Administering PGE, but not WGE, significantly ameliorated IR-induced colorectal cell death through negative regulation of apoptotic signaling pathways. These antiapoptotic effects of PGE were linked to the capacity to suppress the p53-mediated DNA damage response and NF-κB-mediated apoptotic signaling. Moreover, IR-induced oxidative stress in the colorectal epithelium was markedly reduced by PGE administration. Collectively, this study establishes a mechanism of action by which PGE counteracts IR-induced colorectal injury as a novel radioprotective agent. [ABSTRACT FROM AUTHOR]

BACKGROUND: The main purpose behind conducting this study was to assess the effect of various factors in the management of colonic injuries and their outcome; and to propose a safe and valid protocol for the management of such injuries. METHODS: 66 patients presenting with colonic injuries through emergency in General Surgical Unit of Allied Hospital Faisalabad were included in our study. RESULTS: The patients had an average age of 28 years, 73% being male. Forty-one patients underwent primary repair of the colon while 25 patients underwent fecal diversion. The time interval between injury and repair was less than 6 hours in 71% of patients. 67% of the patients sustained a gunshot wound to the abdomen, 15% were stab wounds and 18% were blunt injury. The associated abdominal organ injury was presented in most of the patients. Primary repair done in 62% patients and colostomies performed in 38% patients. The mortality rate was 14%. CONCLUSIONS: Several Factors contribute to the colon related post operative morbidity of patients and hence the treatment option such as: units of blood transfusion, multiorgan injuries, colon injury score, Injury Severity Score and degree of contamination. (p value <0.05 significant). [ABSTRACT FROM AUTHOR]

Two main procedures are performed on patients suffering from colonic perforation, diverting colostomy and primary tissue repair. We investigated patient race, ethnicity, and socioeconomic status (SES) that predicted surgical outcomes after blunt or penetrating trauma. A retrospective analysis was performed using data from the National Trauma Data Bank for three years (2013-2015). We identified patients who presented with primary colonic injury and subsequent colon operation (n = 5431). Operations were grouped into three classes: colostomy, ileostomy, and nonostomy. Multiple linear and logistic regressions were performed to assess how race and insurance status are associated with the primary outcome of interest (ostomy formation) and secondary outcomes such as length of stay, time spent in ICU, and surgical site infection. Neither race/ethnicity nor insurance status proved to be reliable predictors for the formation of an ostomy. Patients who received either a colostomy or ileostomy were likely to have longer stays (OR [odds ratio]: 5.28; 95% CI [confidence interval]: 3.88-6.69) (OR: 11.24; 95% CI: 8.53-13.95), more time spent in ICU (2.73; 1.70-3.76) (7.98; 6.10-9.87), and increased risk for surgical site infection (1.32; 1.03-1.68) (2.54; 1.71-3.78). Race/ethnicity and SES were not reliable predictors for surgical decision-making on the formation of an ostomy after blunt and penetrating colonic injury. However, the severity of the injury as calculated by Injury Severity Score and the number of abdominal injuries were both associated with higher rates of colostomy and ileostomy. These data suggest that surgical decision-making is dependent on perioperative patient presentation and, not on race, ethnicity, or SES. [ABSTRACT FROM AUTHOR]

Introduction: Racial disparities have been both published and disputed in trauma patient mortality, outcomes, and rehabilitation. In this study, the objective was to assess racial disparities in patients with penetrating colon trauma.Methods: The National Trauma Data Bank was searched for males aged ≥14years from 2010 through 2014 who underwent operative intervention for penetrating colon trauma. The primary outcomes for this study were stoma formation and transfer to rehabilitation; secondary outcomes were postoperative morbidity and mortality. Analyses were performed in 2016-2018.Results: There were 7,324 patients identified (4,916 black, 2,408 white). Black and white patients underwent fecal diversion with stoma formation at a similar rate (19.6% vs 18.5%, p=0.28). Black patients were more likely than white patients to be uninsured (self-pay; 37.1% vs 29.9%) and more likely to be injured by firearms (88.3% vs 70.2%, p<0.001), but had a lower overall postoperative morbidity rate (52.6% vs 55.3%, p=0.04). The odds of stoma formation (OR=0.92, 95% CI=0.78, 1.09, p=0.35) and the odds of transfer to rehabilitation (OR=1.03, 95% CI=0.82, 1.30, p=0.78) were similar for black versus white patients.Conclusions: Black patients experienced similar rates of stoma formation and transfer to rehabilitation as white patients with penetrating colon trauma. Multivariate analysis confirmed expected findings that trauma severity increased the odds of receiving an ostomy and rehabilitation placement. The protocol-based management approach to emergency trauma care potentially decreases the risk for the racial biases that could lead to healthcare disparities.Supplement Information: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health. [ABSTRACT FROM AUTHOR]

Background: Analysis of safe laparoscopic grasping thresholds for the colon has not been performed. This study aimed to analyse tissue damage thresholds when the colon is grasped laparoscopically, correlating histological changes to mechanical compressive forces.Methods: An instrumented laparoscopic grasper was used to measure the forces applied to porcine colon, with data captured and plotted as a force-time (f-t) curve. Haematoxylin and eosin histochemistry of tissue subjected to 10, 20, 40, 50 and 70 N for 5, 30 and 60 s was performed, and the area of colonic circular and longitudinal muscle was compared in grasped and un-grasped regions. The area under the f-t curve was calculated as a measure of the accumulated force applied, known as the force-time product (FTP).Results: FTP ranged from 55.7 to 3793 N.s. Significant differences were observed between the muscle area of the grasped and un-grasped regions in both longitudinal and circular muscle at 50 N and above for all grasping times. For the longitudinal muscle, significant differences were observed between grasped and un-grasped areas at 20 N force for 30 s (mean difference = 59 mm2, 95% CI 41-77 mm2, P = 0.04), 20 N force for 60 s (mean difference = 31 mm2, 95% CI 21.5-40.5 mm2, P = 0.006) and 40 N force for 30 s (mean difference 37 mm2, 95% CI 27-47 mm2, P = 0.006). Changes in histology correlated with mechanical forces applied to the longitudinal muscle at a FTP over 300 N s.Conclusions: This study characterizes the grasping forces that result in histological changes to the colon and correlates these with a mechanical measurement of the applied force. The findings will contribute to the development of smart laparoscopic graspers with active constraints to prevent excessive grasping and tissue injury. [ABSTRACT FROM AUTHOR]

Hippocrates stated in 460-C.370 BC that, "All diseases begin in the Gut." This statement may be beginning to have meanings in the advent of new diseases such as Nodding Syndrome (NS) and Autism Spectrum Disorder (ASD). Interestingly, a recent publication from China in the journal of microbiology in 2017 suggests that high grain diet had dynamically shifted the composition of mucosa-associated microbiota and induced mucosal Injuries in the colon of Sheep. NS is a devastating childhood neurological disorder characterized by atonic seizure, cognitive impairment, head nodding, wasting and stunted growth. In addition, NS in Northern Uganda is clustered in time (those who were in IDPs), in space (discretely observed on either sides of the two rivers of Aswa and Pager) and in person (onset mainly between the ages of 5-15 years) and therefore exhibits spatial temporality. The first case of NS was noticed in Kitgum district in 1997, one year after the reported displacement of that community into IDP. Prior to that internal displacement, there were no reported cases of NS. The same scenario occurred in the IDPs of Odek, Gulu district where the population was displaced into IDPs in 2001 and approximately a year later in 2002, cases of NS began to appear. In the IDPs, children that eventually developed NS fed nearly exclusively on food ration provided by relief agencies and roughly a year later, cases of NS began to appear. In the other East African countries, there were no reported cases of NS prior to internal displacement and dependence on food ration. The observed common factors in the three East African regions where NS occurs at endemic proportion are perhaps: Internal displacement and feeding on relief food. These researchers suggest that NS may have perhaps resulted from dietary and environmental factors during IDPs which may have been foreign to their GIT and links this observation to the concept of microbiota-gut-brain axis. [ABSTRACT FROM AUTHOR]

Background: In emergency surgery, management of an enterotomy, either spontaneous or following resection of a bowel segment can be by approximation of cut edges, referred to as primary repair or by exteriorization of the involved segment, referred to as ostomy. Indication of this operation can be a perforated bowel segment (produced as a result of trauma or secondary to an inflammatory process of gut) or a devitalized/redundant segment of bowel requiring resection. Penetrating colon injury or blunt abdominal trauma carries a high risk of a high-risk rate of infectious morbidity. The development of infectious complications is related to the injury severity and haemodynamic status of the patient, not the type of operation performed. Aim of the Work: Comparing the outcome of primary repair versus colon diversion in emergency cases regarding efficacy, safety and usefulness. Patients and Methods: A prospective study on 40 patient undergoing either primary repair of bowel or intestinal stoma formation following emergency laparotomies in the Department of Surgery in El-Hussien and El-Haram Hospitals, which is a big emergency and trauma center and cover large geographic area. All persons will give their informed consent. The people who have the decision in performing and choosing the type of the operation are specialists and consultants (they have the license as decision makers). All patients presented in ER department with colorectal emergencies, included trauma (penetrating, gunshot & blunt), obstruction (malignant & non-malignant) and acute abdomen due to perforation, and need emergent laparotomy confirmed by history, clinical examination and investigations. Results: It included 40 patients divided into three age groups with main age of 31.2 ± 20.1 years old. There were 26 males and 14 females. Etiological causes were trauma 30 patients (75%), benign obstruction 2 patients (5%), malignant obstruction 4 patients (10%) and the acute abdomen 4 patients (10%). Time between injury and admission was less than 8 hours in 28 patients and it was between 9 to 24 hours in 12 patients (30%) and more than 24 hours in 4 patients (10%). Shock defined by systolic blood pressure less than 90 mmHg was present in 7 (17.5 %) patients and non-shocked patients were 33 patients (82.5%). Conclusion: After reviewing many literatures and studies, after this work. We recommend primary repair of the colon in colorectal emergent conditions. Especially injuries and benign obstruction and care must be taken when performing primary repair in cases of malignant obstruction and peritonitis due to non-traumatic colonic perforation (PNTCP). First of all the main indicator for the primary repair is the patient's general condition. Over all the main determine to do primarily repair or to divert is the general condition of the patient. [ABSTRACT FROM AUTHOR]

Background Colostomy was used for treatment of colorectal injuries since the 2nd World War, and it is a lifesaving procedure. There is a trend towards primary closure of colorectal injuries without colostomy in hemodynamically stable patients. Objective To evaluate the safety of primary closure of colorectal injuries without colostomy in hemodynamically stable patients. Methods A cross sectional study was performed at Al-Imamein Al-Kadhimein Medical City for patients with colorectal injuries over the period from July 2011 to July 2017. Management was started with active resuscitation of the patient, explorative laparotomy (securing hemorrhage) and assessment of the colorectal injuries. When the patients were stable hemodynamically without associated injuries to other parts of the body; debridement of the wound edges of the colon and primary repair by suturing in two layers using 2/0 absorbable suture (polyglactin) on a round needle with or without colostomy. But if the patients were in a shock state with multiple associated injuries to other parts of the body, with severely devascularized lacerated colon; proximal colostomy was done as a part of damage control surgery with resection of the devascularized segment and suturing of the distal end of the colon. Results A total of 231 patients sustained colorectal injuries; 143 (61.90%) males and 88 (38.09%) females. The age of the patients ranged from 6-76 years, mean age was 32.16±76 year. Colostomy was done for 134 (58.01%) patients. Primary repair without colostomy were done for 97 (41.99%) patients. Postoperative follow up of the patients treated with primary repair of colorectal injuries without colostomy were detected collection and leaking repaired segment of colon in 5 (5.15%) patients. Re-exploration of the abdomen and colostomy were done for them. There was no mortality in patients treated without colostomy. The mortality rate was 9 (6.71%) for patients treated by colostomy due to associated multiple traumas to other parts of the body. Conclusion Primary repair of colorectal injuries without colostomy are safe in a hemodynamically stable patient without associated injuries to other parts of the body. [ABSTRACT FROM AUTHOR]

Riboflavin (RF) has been found to be a promising antioxidant and/or anti-inflammatory agent in several studies. However, the effect of RF against acetic acid (AA)-induced colonic injury is currently unknown. This study aimed to investigate the potential antioxidant and protective effects of RF in a rat model of ulcerative colitis. Starting immediately after the colitis induction (AA+RF group) or 1 week before the colitis induction (RF+AA+RF group), the rats were treated with RF (25 mg/kg per day; p.o.) for 3 days. The control and AA groups received saline (1 mL; p.o.) whereas AA+SS group (positive control) received sulfasalazine (100 mg/kg per day; p.o.) for 3 days. Colonic samples were taken for the biochemical and histological assessments on the third day. High damage scores, elevated tissue wet weight index (WI), tissue myeloperoxidase (MPO) activity, 8-hydroxy-2'-deoxyguanosine levels and chemiluminescence values, and a pronounced decrease in antioxidant glutathione (GSH) levels of the AA group were all reversed by RF pretreatment (RF+AA+RF group) and SS treatment (AA+SS group) (P < .05-. 001). Tissue WI, MPO activity and GSH levels were not statistically changed in the AA+RF group. Western blot analysis revealed that the decreased protein expressions of tissue collagen (COL) 1A1, COL3A1 and transforming growth factor-ß1 in the AA group were elevated in all the treatment groups (P < .05-.001). In conclusion, RF exerts both the antioxidant and anti-inflammatory effects against AA-induced colonic inflammation by suppressing neutrophil accumulation, inhibiting reactive oxidant generation, preserving endogenous glutathione, improving oxidative DNA damage and regulating inflammatory mediators, suggesting a future potential role in the treatment and prevention of ulcerative colitis. [ABSTRACT FROM AUTHOR]

Foreign bodies are commonly ingested and usually pass through the gastrointestinal tract, but in less than 1% complications can be seen. We aimed to report a very rare case of multiple hepatic abscesses caused by perforation of the sigmoid colon due to a chicken bone. An 82-year-old man presented with a 5-day history of abdominal pain, fever, and coffee ground vomiting. He was febrile and tachycardic and had a mild localized abdominal tenderness in the left lower quadrant. Laboratory findings revealed a lymphocyte dominant leukocytosis with an elevated erythrocyte sedimentation rate. Multiple abscesses were shown in the right lobe of the liver in abdominal computed tomography. Colonoscopy showed a chicken bone perforating both walls of the sigmoid colon. He received broad-spectrum antibiotics and underwent surgery for a complete recovery. Chronic lymphocytic leukemia was diagnosed by flow cytometry phenotyping. Mortality and morbidity of hepatic sepsis caused by foreign body-induced colon perforation depend on a rapid diagnosis. We presented a very rare condition that should always be kept in mind when dealing with a case of liver abscess and even while confronting septic shock with an unknown origin. [ABSTRACT FROM AUTHOR]

Introduction. Surgery for cardiac trauma is considered fatal and for wounds of the colon by associated sepsis is normally considered; however, conservative management of many traumatic lesions of different injured organs has progressed over the years. Presentation of the Case. A 65-year-old male patient presented with multiple shotgun wounds on the left upper limb, thorax, and abdomen. On evaluation, he was hemodynamically stable with normal sinus rhythm and normal blood pressure, no dyspnea, or abdominal pain. Computed tomography (CT) scan of the chest shows hematoma around the aorta without injury to the blood vessel wall with an intramyocardial projectile without pericardial effusion. CT scan of the abdomen showed pellets in the transverse colon and descending colon endoluminal without extravasation of contrast medium or intra-abdominal fluid. The patient remains hemodynamically stable, and nonsurgical procedure was established. Discussion. Patients with asymptomatic intramyocardial projectiles can be safely managed without surgery. Nonsurgical management is only possible in asymptomatic patients with trauma of the colon through close surveillance and with very selective patients since standard management is surgery. Conclusion. Nonsurgical management of cardiac trauma, as well as colon penetrating trauma, can be performed in carefully selected patients with proper clinical follow-up, imaging, and laboratory studies. [ABSTRACT FROM AUTHOR]