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BACKGROUND Small bowel obstructions (SBO) are common and can be caused by various pathologies including intra-abdominal adhesions and hernias. Less frequently, these obstructions are caused by malignancy. The following article will review the etiology and treatment of SBOs, discuss complications of hernia repair with mesh, and examine if there is an association between mesh and cancer. CASE REPORT We present the case of a man who was over 89 years old who presented with an SBO that failed non-operative management. He previously had bilateral inguinal hernia repairs with mesh and pelvic radiation for prostate cancer. Imaging obtained during the workup was concerning for malignancy. Exploratory laparotomy revealed an ascending colon adenocarcinoma and small bowel obstruction secondary to jejunal adenocarcinoma. The jejunal adenocarcinoma was adhered to and invaded into the mesh from a previous hernia repair. He underwent successful resection and anastomosis, had an uneventful postoperative course, and was discharged. Given his advanced age, he refused further workup or treatment. CONCLUSIONS The etiology and management of small bowel obstructions is multifactorial. Small bowel obstructions affect a large portion of the population worldwide and the subsequent management accounts for significant health care spending. This case shows an exceedingly rare and possibly novel case of jejunal adenocarcinoma that invaded into the hernia mesh, leading to a malignant small bowel obstruction. While there is not a clear explanation behind this patients' pathology, we hypothesize that his prior hernia surgery led to an intra-abdominal adhesion, and subsequent pelvic radiation may have facilitated the malignancy invading the mesh and causing a high-grade small bowel obstruction.

Objective: This study aims to explore the appropriate surgical treatment method for acute intestinal obstruction caused by gastrointestinal foreign bodies in children through a comparison of clinical characteristics in patients treated via laparoscopically assisted approach and open surgery., Methods: This study retrospectively analyzed 12 children with acute intestinal obstruction caused by gastrointestinal foreign bodies treated at Shanghai Children's Hospital and Huzhou Maternity and Child Care Hospital from June 2019 to June 2024. Basic information, treatment methods, and prognoses of the patients were collected. General data, operation time, postoperative fasting time, postoperative hospital stay, and intraoperative and postoperative complications were compared between the two groups. Categorical data were compared using Fisher's exact test. Normally distributed continuous data were expressed as mean ± standard deviation and analyzed using an independent samples t-test; non-normally distributed data were expressed as M (P25, P75) and analyzed using the non-parametric Mann-Whitney U test., Results: Six cases underwent laparoscopic transumbilical extended incision, successfully extracting the intestines and removing the foreign bodies without converting to open surgery. Compared to Six cases undergoing traditional open surgery during the same period, the postoperative fasting time and postoperative hospital stay in the laparoscopic group were 4 (5 ± 3.65) days and 5.5 (5 ± 7.5) days, respectively, while in the traditional open surgery group, they were 5 (4.25 ± 6) days and 6 (5 ± 8.6) days, respectively; the differences were statistically significant (P < 0.05). The laparoscopic group had significantly shorter operation time and faster postoperative recovery. The acceptance of the laparoscopically assisted approach by the families was significantly higher than that of the open surgery treatment., Conclusion: The method of extracting obstructed intestines and removing foreign bodies via laparoscopic-assisted transumbilical extended incision has advantages over open surgery for treating acute intestinal obstruction caused by gastrointestinal foreign bodies, such as shortening hospital stay and operation time. However, for children with secondary gastrointestinal perforation caused by magnetic foreign bodies, open surgery, due to its broader exploration scope, is more advantageous for detecting occult perforations., Competing Interests: Declarations. Ethics approval and consent to participate: All therapeutic methods were carried out in accordance with relevant guidelines and regulations. This study was approved by Ethical Committee of Shanghai Children’s Hospital and the study methodology conformed to Helsinki Declaration standards as revised in 2000. The Ethical Committee of Shanghai Children’s Hospital granted permission to access and use the medical records of participants of the study. All data remained confidential, and the legal guardians of all participants signed the informed contents. Appropriate measures were applied to ensure the confidentiality of the data. Human ethics and consent to participate: This study was approved by the Ethics Committee of Huzhou Maternity & Child Health Care Hospital, approval number 2024-J-096. All participants provided written informed consent prior to their participation in the study. Consent for publication: Written parental consents for the publication have been obtained. Conflicts of interest: The authors have no financial and non-financial conflicts of interest., (© 2024. The Author(s).)

BACKGROUND Gallstone ileus is an uncommon cause of intestinal obstruction. Rigler's classic triad for a gallstone ileus includes the following: small bowel obstruction, air in the biliary tract, and an obstructing gallstone. This triad, however, is not always observed. We present an unusual case of a gallstone present in the small bowel for several years prior to presenting with an acute obstruction. CASE REPORT A 71-year-old man presented with 3 days of lower abdominal pain, constipation, and abdominal distension, with his last reported bowel movement 3 days prior. The patient's vitals were stable, with a white blood cell count of 11.47×10⁹/L and no lactic acidosis. Abdominal exam was significant for bilateral lower-quadrant tenderness and mild distension. Findings on abdominal computed tomography revealed a large foreign body in the distal small bowel, with evidence of proximal small bowel obstruction. Review of imaging from 4 years prior incidentally revealed the foreign body more proximally in the jejunum. Laparoscopy and enterotomy were performed with removal of a 4×4 cm gallstone encased in fecal material. The patient recovered well from surgery and had no complications. CONCLUSIONS A 71-year-old man presented with lower abdominal pain and distension. Work-up revealed a small bowel obstruction secondary to a presumed foreign body, later found to be a gallstone. We present a highly unusual presentation of a gallstone ileus, with radiographic evidence of an enteric gallstone present 4 years prior, with no evidence of pneumobilia or biliary-enteric fistula in current or previous computed tomography scans.

Background: In the last decade, therapy using multipotent mesenchymal stromal cells (MSCs) has offered hope for regenerating the lungs of preterm babies with chronic lung disease. Due to similar disease mechanisms, it is logical to explore the potential impact of MSC therapy on pulmonary hypoplasia in congenital diaphragmatic hernia. Furthermore, MSCs may also contribute to the regeneration of the intestines affected by adhesive small bowel obstruction in patients with congenital diaphragmatic hernia., Case Presentation: A female newborn, delivered at 32 weeks and six days gestational age, was diagnosed with a left congenital diaphragmatic hernia. After surgical repair and respiratory/nutritional support for 39 days, she was still dependent on a ventilator and total parenteral nutrition. Two MSC treatments were given a week apart: 10 million cells/kg intratracheally and 5 million cells/kg intravenously. She was extubated, and her enteral nutrition improved after the treatment. No side effects were detected. We present the first documented case using MSCs derived from the umbilical cord to simultaneously treat pulmonary hypoplasia and adhesive small bowel obstruction of congenital diaphragmatic hernia., Conclusion: Although MSC treatment is very promising for pulmonary hypoplasia and adhesive small bowel disease of congenital diaphragmatic hernia, much more needs to be learned about potential side effects, appropriate dosage, and the optimal method of administration., Competing Interests: The authors declare that there is no conflict of interest.

Colonic melanoma is a rarely detected aetiology of small bowel obstruction. This is a case of a male in his 80s with a history of treated stage IIIA melanoma on his trunk 7 years prior who presented with small bowel obstruction. He underwent urgent surgical intervention, where a partial colectomy was performed. Pathology revealed a 4.6 cm melanoma causing intussusception. This case highlights the insidious nature of metastatic melanomas and discusses an uncommon location of melanoma metastasis that evaded detection until a late stage., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Neonatal adrenal haemorrhage affects approximately 0.17%-0.21% of babies, although, usually, it remains asymptomatic, and therefore, the exact incidence is probably greater. The increased vascularity and relatively large size of the adrenal glands in neonates increases their vulnerability to haemorrhage during labour. There have been few cases that have presented with bowel obstruction.A term neonate was admitted with bilious vomiting, dehydration and mottled skin. He was afebrile but hypoglycaemic. Dark green aspirations were present on placement of a nasogastric tube, and emergent upper gastrointestinal contrast study demonstrated failure of contrast to pass and deviation of the duodenum. Together these features raised concern of malrotation with volvulus promoting surgical exploration. Intraoperatively, a left suprarenal mass was discovered, causing bowel obstruction. An ileostomy was created, and a biopsy was taken. Adrenal haemorrhage was diagnosed, which is an extremely rare cause of bowel obstruction. Serial ultrasound scans have been done since, showing reduction of the haemorrhage and his ileostomy has been reversed.Adrenal haemorrhage is rarely reported to cause bowel obstruction. A neonate with bilious vomiting and an abnormal contrast may represent malrotation; however, adrenal haemorrhage is an uncommon, but important, differential to consider in these scenarios., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Anaplastic large-cell lymphoma primarily involving the omentum is an extremely rare entity with variable clinical presentation. Owing to its rarity and nonspecific clinical manifestation, omental T-cell lymphoma is often diagnosed at a later stage, riddled with complications. While imaging modalities such as computed tomography scan can help a physician reach a diagnosis, cases that present with complications may require a multidisciplinary approach that combines surgical exploration along with consultation from Oncology., Case Presentation: We hereby report a rare case of a 66-year-old African American male patient who presented to the emergency department with complaints of acute gastrointestinal obstruction. A computed tomography scan of the abdomen and pelvis revealed evidence of an internal hernia and surgical exploration revealed a hemorrhagic and infarcted omentum. Biopsies along with immunophenotypic studies confirmed the diagnosis of anaplastic T-cell lymphoma of the omentum complicated by Massilia timonae infection., Conclusion: The case highlights the significance of considering lymphoma, although rare, as a differential in a patient who presents with small bowel obstruction and the importance of investigating for malignancy for early diagnosis and treatment of primary omental lymphomas, before complications develop., (© 2024. The Author(s).)

This case report describes a pregnant woman who underwent a laparoscopic MiniMizer Gastric Ring procedure for clinically severe obesity only one month before conception. At 31 weeks of gestation, the patient as admitted to the hospital with postprandial vomiting and persistent left-sided colicky abdominal pain. Maternal abdominal MRI revealed an intestinal obstruction and elective surgery was recommended. Due to the considerable risk to the fetus, antenatal corticosteroids were immediately administered to promote lung maturation and magnesium sulfate was started for fetal neuroprotection. During an exploratory laparoscopy, significantly enlarged and ischemic intestinal loops were found, leading to the decision to perform an atraumatic "en caul" cesarean delivery. After a successful "en caul" delivery, the MiniMizer ring, which had dislodged downwards and led to mesenteric ischemia, was visualized. Intraoperative esophagogastroduodenoscopy revealed a 1cm defect in the stomach wall related to gastric ring, covered with purulent exudate. Further exploration, showed a herniation of the distal alimentary loop through the Petersen foramen. Successful management included ring removal and intestinal loop reduction from the Petersen's space, without evidence of strangulation, as confirmed with indocyanine green (ICG) angiography. The postoperative course was uneventful. Women with obesity who have undergone bariatric surgery should to be informed of the increased likelihood of becoming pregnant after treatment. It is advised to notify the patient of the importance of maintaining a sufficient interval between bariatric surgery and conception. Additionally reports from the literature on various complications during pregnancy after bariatric surgery are presented., (© 2024. The Author(s).)

Background: Serial transverse enteroplasty is used to treat patients with chronic intestinal failure owing to short bowel syndrome. Current literature lacks discussion of its role for other etiologies of intestinal failure and its impact on adult patients' nutrition support needs and quality of life., Methods: We performed a case series on adults with parenteral nutrition (PN) dependence who underwent serial transverse enteroplasty at Emory University Hospital, a quaternary referral center between 2011 and 2022. Data collected included demographics, operative technique, and preoperative and postoperative PN requirements. A phone survey was administered to evaluate the impact of PN and the operation on quality of life., Results: Ten patients underwent the procedure of interest during the study period. Indications included short bowel syndrome following multiple abdominal operations or intra-abdominal catastrophe and chronic partial bowel obstruction with dysmotility. Bowel length increased by a median of 83%. All patients were discharged home after a median hospital stay of 21 days. At 1-year follow-up, survival was 100%, two (20%) patients fully weaned from PN, three others (30%) reduced PN frequency, and six (60%) decreased their daily parenteral energy requirement. Two additional patients fully weaned from PN by 18 months postoperatively., Conclusion: This represents one of the largest case series of serial transverse enteroplasty in adults. Small intestinal length nearly doubled, and PN dependence was reduced in most patients. Given the low morbidity and good quality of life observed in this series, this procedure should be more widely investigated for patients with chronic intestinal failure., (© 2024 American Society for Parenteral and Enteral Nutrition.)

Background and Aim: Luminal strictures, common in inflammatory bowel disease (IBD), especially Crohn's disease (CD), are typically treated with endoscopic balloon dilatation (EBD). The newer endoscopic stricturotomy (ESt) approach shows promise, but data is limited. This systematic review and meta-analysis assess the effectiveness and safety of ESt in IBD-related strictures., Methods: A comprehensive literature search was conducted until November 2023 for studies assessing ESt efficacy and safety in IBD. Primary outcomes were clinical and technical success, with secondary endpoints covering adverse events, subsequent stricture surgery, additional endoscopic treatments (ESt or EBD), medication escalation, disease-related emergency department visits, and hospitalization post-ESt. Technical success was defined as passing the scope through the stricture, and clinical success was defined as symptom improvement. Single-arm meta-analysis (CMA version 3) calculated the event rate per patient with a 95% confidence interval (CI). Heterogeneity was evaluated using I 2 ., Results: Nine studies were included, involving 640 ESt procedures on 287 IBD patients (169 CD, 118 ulcerative colitis). Of these, 53.3% were men, with a mean age of 43.3 ± 14.3 years and a mean stricture length of 1.68 ± 0.84 cm. The technical success rate was 96.4% (95% CI 92.5-98.3, p-value < 0.0001), and the clinical success rate was 62% (95% CI 52.2-70.9, p-value = 0.017, I 2  = 34.670). The bleeding rate was 10.5% per patient, and the perforation rate was 3.5%. After an average follow-up of 0.95 ± 1.1 years, 16.4% required surgery for strictures post-ESt, while 44.2% needed additional endoscopic treatment. The medication escalation rate after ESt was 14.7%. The disease-related emergency department visit rate was 14.7%, and the disease-related hospitalization rate post-procedure was 21.3%., Conclusion: Our analysis shows that ESt is safe and effective for managing IBD-related strictures, making it a valuable addition to the armamentarium of endoscopists. Formal training efforts should focus on ensuring its widespread adoption., Competing Interests: Declarations Conflicts of interest The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest. The authors declare that they have no conflicts of interest. Ethical approval Not applicable. Consent to participate Not applicable. Consent for publication Not applicable., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Malignant bowel obstruction (MBO) due to peritoneal carcinomatosis (PC) is associated with poor outcomes. Optimal management for palliation remains unclear. This study aims to characterize nonoperative, procedural, and operative management strategies for MBO and evaluate its association with mortality and cost. Materials and Methods: ICD-10 coding identified patient admissions from the 2018 to 2019 National Inpatient Sample (NIS) for MBO with PC from gastrointestinal or ovarian primary cancers. Management was categorized as nonoperative, procedural, or surgical. Multivariate analysis was used to associate treatment with mortality and cost. Results: 356,316 patient admissions were identified, with a mean age of 63 years. Gender, race, and insurance status were similar among groups. Length of stay (LOS) was longest in the surgical group (surgical: 17 days; procedural: 14 days; nonoperative: 7 days; P = .001). In comparison to nonoperative, procedural and surgical patients had statistically higher hospital charges, post-discharge medical needs, palliative care consults, and admission to rehab centers. Mortality was 7% in nonoperative, 9% in procedural, and 8% in surgical ( P = .007) groups. In adjusted analyses, older age, palliative care consult, and non-Medicare payer status were associated with higher mortality. Compared to nonoperative, procedural and surgical groups resulted in increased costs (procedural: $17K more; surgical: $30K more). Conclusions: Admissions for procedural and surgical treatment of MBO are associated with increased LOS, hospital costs, and discharge needs. Optimal management remains challenging. Clinicians must examine all options prior to recommending palliative interventions given a trend towards higher resource utilization and mortality., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Peritoneal adhesion is a common cause of small bowel obstruction (SBO). In this study, we included 40 adult patients who had SBO, or partial obstructive symptoms. In the abdominal instillation of crystalloid fluid (AICF) cohort, 16 patients underwent lysis of adhesions and abdominal crystalloid fluid instillation at the end of the procedure. In the control (CO) group, 24 patients received lysis of adhesions without fluid instillation. AICF was achieved by the abdominal instillation of 1864 ± 97.5 mL of crystalloid fluid. We analyzed the recurrence of peritoneal adhesions resulting in reoperation for SBO within the 64.3 ± 9.15 months of follow-up time for the CO and the 70.5 ± 13.16-month follow-up for the AICF group. The AICF group had a lower SBO recurrence rate of 12.5% compared to the CO group's 41.6% rate ( P = .049). Taken together, AICF decreased the recurrence of SBO requiring reoperation secondary to adhesion formation compared to the lysis of adhesions alone, as seen in the CO group., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Small bowel obstruction (SBO) is a significant cause of surgery in adult horses presenting with colic pain. SBOs often require resection and anastomosis. While various techniques for intestinal anastomoses have been developed, it remains uncertain if any fully meet our clinical needs., Objective: To conduct a scoping review of publications on anastomosis techniques and outcomes for the treatment of SBO., Study Design: Scoping review., Methods: A literature review was conducted using the CAB, Web of Science, Scopus, and PubMed databases. Peer-reviewed scientific articles in English, published between 1992 and 2023, were included. A quality assessment was performed for potentially eligible articles. Experimental studies, case reports, and case series with less than five cases were excluded and relevant data on study methods and sample size were extracted and charted from remaining articles. Anastomosis type and outcome were reported for articles considered potentially eligible for meta-analysis. Articles in which only overall outcome was reported or details on type of anastomosis were not reported were excluded for the final charting., Results: Of 3024 articles, 210 underwent a quality assessment. The most common study designs were case reports and case series (64.3%), followed by experimental studies (17.1%). After further exclusions, 104 articles met the inclusion criteria. In only 42 articles detailed data on type of anastomosis and relative outcome were reported. A total of 23 anastomosis types were reported for the treatment of SBO, with 6 different outcomes evaluated. Both short- and long-term survival rates consistently exceed 70% for all types of anastomosis (jejuno-jejunal, jejuno-ileal, and jejunocaecal)., Main Limitation: Non-English language studies and conference proceedings were excluded., Conclusion: The body of literature focused on surgical treatment for SBO exhibits low-quality evidence. Several techniques of anastomosis were described for different pathologies. However, there is a lack of homogeneity in reporting outcome for each surgical technique. Furthermore, outcomes considered varied significantly among studies and were sometimes poorly reported, although success rates are generally high. Overall, there is a need for better-structured studies on existing and commonly used techniques before comparing techniques and exploring other innovative approaches., (© 2024 EVJ Ltd.)

Large bowel obstruction is most commonly due to colorectal carcinoma, diverticular disease or volvulus. Rare causes of large bowel obstruction like endometriosis may occur in premenopausal women and diagnosis of large bowel endometriosis can be challenging to confirm preoperatively. Hence, clinicians should maintain a high index of suspicion for rare causes of large bowel obstruction like endometriosis. This may require complete surgical resection of the involved bowel to eliminate the risk of local recurrence.

Introduction and Importance: Large bowel obstruction caused by volvulus poses a life-threatening risk without immediate intervention. Sigmoid colon volvulus is predominant (43-75%), followed by cecal volvulus 10-52%). Synchronous double colonic volvulus is extremely rare, with limited documented cases in academic literature., Case Presentation: We report a case of synchronous volvulus involving the sigmoid colon and cecum in a 45-year-old male of the Toro tribe from Fort Portal city in western Uganda who presented with acute abdominal pain, distension, and complete constipation for 2 days, accompanied by five episodes of non-bloody feculent vomiting and anorexia., Clinical Discussion: Upon admission, the patient presented with stable vital signs and a mildly tender, tympanic, distended abdomen with absent bowel sounds. Plain radiographs revealed the characteristic "coffee bean" sign, indicative of sigmoid volvulus. Following optimization, laparotomy confirmed synchronous volvulus involving both the sigmoid and cecum. Subsequently, a total colectomy with end ileostomy was performed, after which the patient experienced an uneventful recovery., Conclusion: Synchronous double colonic volvulus, a rare condition, is frequently overlooked clinically. Timely recognition and intervention are crucial to address diagnostic challenges and prevent potentially fatal outcomes., (© 2024. The Author(s).)

Rationale: Extraosseous Ewing sarcoma (EES) is a rare manifestation within the Ewing sarcoma tumor family (ESFT). Its clinical manifestations lack specificity, intestinal obstruction is the main symptom but can also present with abdominal pain, gastrointestinal bleeding, and other discomforts, making it prone to misdiagnosis as intestinal mesenchymal tumor., Patient Concerns: A 29-year-old male was admitted to the hospital with intestinal obstruction symptoms and abdominal CT suggesting "left abdominal occupation.", Diagnosis: The patient was initially misdiagnosed as intestinal mesenchymal tumor, and was later definitively diagnosed as abdominal Ewing sarcoma by postoperative pathology and genetic testing., Interventions: Due to the patient's surgical indication, surgical resection with exploratory laparotomy was performed and then the patient underwent systemic chemotherapy., Outcomes: Intraoperatively, we found a 15-cm tumor originating from the proximal jejunum, with invasion into the peritoneum, duodenum, jejunum, and colon. Finally, the pathological report revealed Ewing sarcoma., Lessons: Giant abdominal Ewing sarcoma with a diameter of 15 cm is rare. Considering postoperative pathology and genetic testing, abdominal Ewing sarcoma was suspected. The patient was successfully treated using surgery., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

An 80-year-old woman presented to our hospital complaining of nausea and abdominal distention. An abdominal computed tomography scan revealed wall thickening of the small intestine, a dilated oral intestinal tract, swollen intra-abdominal lymph nodes, and splenomegaly. Moreover, the soluble interleukin-2 receptor level was increased at 2,120 U/mL. Accordingly, we diagnosed the patient with a small bowel obstruction due to malignant lymphoma of the small intestine, for which we performed a laparoscopy-assisted partial resection of the small intestine after decompression. The resected specimen was pathologically diagnosed as diffuse large B-cell lymphoma. The patient's general condition recovered rapidly after laparoscopic surgery, and her clinical course proceeded smoothly to the initiation of chemotherapy(R-CHOP)at the Department of Hematology. The tumor remains in remission now. Here, we report a case of laparoscopic surgery for malignant lymphoma of the small intestine that caused bowel obstruction due to luminal narrowing along with a relevant literature review.

Summary: Small bowel volvulus (SBV) is a rare cause of bowel obstruction, specifically in adults, accounting for approximately 1% of bowel obstruction in the adult population in North America. It is more common in the neonatal and paediatric population, mostly due to congenital abnormalities such as malrotation, atresia and congenital bands. We present two cases of SBV managed at a level 2 provincial hospital within a 2-month period. In the first case no primary cause could be found and in the second case adhesions following midline laparotomy resulted in SBV., (Copyright© Authors.)

Background: We aimed to present our experience with children with symptomatic omphalomesenteric duct (OMD) anomalies and evaluate the patients' characteristics, treatment, and outcomes., Methods: Records of children who were operated for symptomatic OMD anomalies in Şanlıurfa Training and Research Hospital between October 2018 and November 2022 were retrospectively analysed., Results: There were 35 patients with a median age of 31.7 (1 day-17 years) weeks, 29 (82.8%) males and six (17.2%) females. The presenting signs were gastrointestinal tract (GIT) obstruction in 17 (48.6%) patients, acute abdomen in 11 (31.4%), umbilical abnormalities in four (11.4%) and rectal bleeding in three (8.6%). All patients presenting with umbilical abnormalities were newborn. These were OMD fistula to skin ( n = 1), OMD fistula to umbilical cord hernia sac ( n = 1), OMD cyst in umbilical cord hernia ( n = 1) and OMD band adherence to umbilical cord hernia sac ( n = 1). Meckel's scan was positive in all three patients with rectal bleeding. Surgical findings in patients other than umbilical abnormalities were diverticulitis (with/without perforation) ( n = 14), intussusception due to diverticulum ( n = 9) and Meckel's band obstruction ( n = 8). At surgery, an ileal resection was performed in 19 cases, wedge resection in 10 cases, resection with stapler in five cases and ileocolonic resection in one patient. On histopathological examination, ectopic gastric mucosa was detected in 11 specimens and both gastric and pancreatic tissue in two. There were only two cases of postoperative complications (incisional hernia, n = 1, postoperative colon perforation due to forced manual reduction of intussusception, n = 1) and all patients survived in good condition., Conclusion: In the present study, GIT obstruction is the primary symptom in patients with symptomatic OMD anomalies, with umbilical anomalies exclusively found in newborns. Surgery is confirmed as the definitive treatment, with wedge resection and simple diverticulectomy being safe but sometimes insufficient. A significant portion of patients might need more complex segmental bowel resections due to severe complications. With ectopic tissue found in about one-third of cases, managing OMD anomalies presents distinct challenges., (Copyright© Authors.)

Background: Anastomotic strictures following colectomy and proctectomy are a significant cause of benign lower gastrointestinal tract (LGIT) obstruction, with a reported incidence of up to 30%. Endoscopic interventions such as balloon dilation, stricturotomy, mechanical dilation, electrocautery incision, and stent placement are utilized for management. This meta-analysis aimed to evaluate the efficacy and safety of endoscopic interventions for the management of benign LGIT anastomotic strictures., Methods: Literature search was performed for published full-text articles using the Embase, Pubmed, Web of Sciences, and Cochrane databases for endoscopic management of anastomosis strictures and related terms including endoscopic balloon dilation (EBD), stricturotomy (EST), mechanical dilation, electrocautery incision (ECI), and stent placement., Results: A total of 1363 patients from 33 studies were included. The most common indication for anastomosis was colorectal cancer (92%). Overall technical success (ability to pass the endoscope) was achieved in 93% of cases, with immediate clinical success in 85% and sustained success in 81% at follow-up. ECI demonstrated the highest clinical success rates (98% immediate, 91% at the end of follow-up). Adverse events occurred in 6% of patients, most commonly perforation, which was most frequent with EBD. Stent placement showed high initial success but had issues with stent migration and adverse events., Conclusion: Overall, EBD and ECI were the most effective, with ECI showing the highest success rates. Despite its technical challenges, EST was both effective and safe. This study underscores the need for further prospective research comparing various endoscopic interventions to improve management strategies for LGIT anastomotic strictures., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: A bridge to surgery (BTS) after self-expandable metallic stent (SEMS) placement is a widely recognized treatment strategy for obstructive colorectal cancer. However, there is still a lack of evidence for the efficacy and safety of laparoscopic surgery following SEMS placement. The aim of this systematic review and meta-analysis was to compare the short-term and long-term outcomes of laparoscopic surgery with those of open surgery following SEMS placement in patients with obstructive colorectal cancer., Methods: An electronic literature search through to December 2022 was performed to identify studies comparing short-term and long-term outcomes between laparoscopic and open surgery following SEMS placement for obstructive colorectal cancer. The main outcome measures were postoperative complication rates and mortality. Secondary outcome measures were the 3-year recurrence-free survival (RFS) and 3-year overall survival (OS) rates. The meta-analysis was performed using fixed-effect or random-effects methods to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs)., Results: The meta-analysis included 15 studies and 883 patients, of whom 467 (52.9%) underwent laparoscopic surgery and 416 (47.1%) underwent open surgery following SEMS placement. The postoperative complication rate was significantly lower in the laparoscopic surgery group than in the open surgery group (OR 0.47, 95% CI 0.32-0.67, P < 0.001). There was no significant difference in the 3-year RFS rate or 3-year OS rate between the laparoscopic and open surgery groups (3-year RFS, OR 0.78, 95% CI 0.50-1.24, P = 0.30; 3-year OS, OR 0.68, 95% CI 0.41-1.12, P = 0.13)., Conclusion: This meta-analysis found that the short-term outcome was better in patients who underwent laparoscopic surgery following SEMS placement than in those who underwent open surgery. Furthermore, there was no significant difference in long-term outcomes between the two groups. Laparoscopic surgery following SEMS placement may be a safe and effective treatment option for obstructive colorectal cancer., (© 2024. The Author(s).)

Background: Acute incarcerated paraesophageal hernias (PEH) have historically been considered a surgical emergency. Emergent operations have a higher rate of morbidity and mortality compared to elective surgery. Our institution has adopted a strategy of initial conservative management in patients presenting with acute obstruction from an incarcerated PEH who are clinically stable. Patients are given at least 24 h for their symptoms to improve (selective nasogastric decompression). If symptoms resolve, contrast on an upper GI study passes to the small bowel, and liquids are tolerated, patients are discharged with planned interval repair. We sought to characterize the outcomes of this interval surgical strategy for incarcerated PEH., Methods: A retrospective chart review was performed to identify patients admitted to a single institution between October 2019 and September 2023 with an incarcerated PEH. Patients taken directly to surgery within 24 h were excluded., Results: A total of 45 patients admitted with obstruction from an incarcerated PEH were identified. Ten patients (22%) were taken urgently to surgery due to clinical instability and were excluded. Of the remaining 35 patients, 23 (66%) resolved their obstruction with conservative non-operative management and were offered planned interval PEH repair (successful conservative management). In the successful conservative management cohort, there was one unplanned readmission before interval PEH repair. Average time between discharge and repair was 25 days. Complication rates did not differ in those who failed and in those who had a successful conservative management result. The cumulative length of stay for those who succeeded in conservative management (including days for the interval surgery) was equivalent with those who underwent PEH repair during the index admission., Conclusion: A trial of conservative management in clinically stable patients with symptomatic incarcerated PEH appears to be safe and often avoids emergent repair without increasing perioperative complications or total days in the hospital., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Small bowel obstruction (SBO) frequently necessitates emergency surgical intervention. The impact of frailty and age on operative outcomes is uncertain. This study evaluated postoperative outcomes of SBO surgery based on patient's age and frailty and explore the optimal timing to operation in elderly and/or frail patients., Methods: Patients who underwent SBO surgery were identified in American College of Surgeons National Surgical Quality Improvement Program database 2005 to 2021. Patients aged ≥65 years were defined as elderly. Patients with 5-Factor Modified Frailty Index≥2 were defined as frail. Multivariable logistic regression was used to compare 30-day postoperative outcomes between elderly frail versus nonfrail patients, as well as between nonfrail young versus elderly patients., Results: There were 49,344 patients who had SBO surgery, with 7,089 (14.37%) patients classified as elderly frail, 17,821 (36.12%) as elderly nonfrail, and 21,849 (44.28%) as young nonfrail. Elderly frail patients had higher mortality (adjusted odds ratio, 1.541; p < 0.01) and postoperative complications compared with their elderly nonfrail counterparts; these patients also had longer wait until definitive operation ( p < 0.01). Among nonfrail patients, when compared with young patients, the elderly had higher mortality (adjusted odds ratio, 2.388; p < 0.01) and complications, and longer time to operation ( p < 0.01). In elderly nonfrail patients, a higher mortality was observed when surgery was postponed after 2 days. Mortality risk for frail elderly patients is heightened from their already higher baseline when surgery is delayed after 4 days., Conclusion: When SBO surgery is postponed for more than 2 days, elderly nonfrail patients have an increased mortality risk. Consequently, upon admission, these patients should be placed under a nasogastric tube and undergo an initial gastrograffin challenge. If there is no contrast in colon, they should be operated on within 2 days. Conversely, elderly frail patients with SBO have a higher mortality risk when surgery is delayed beyond 4 days. Thus, following the same scheme, they should be operated on before 4 days if gastrograffin challenge fails., Level of Evidence: Therapeutic/Care Management; Level III., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Hiatal hernia may development after esophagectomy or Gastrectomy. Post- esophago-gastric hiatal hernia is a rare but challenging condition. Nearly half of reported cases involve emergent situations, underscoring the urgency of addressing this condition. However, there is currently no consensus on the optimal treatment approach for this type of hernia., Methods: All consecutive patients who underwent repair for Post- esophago-gastric hiatal hernia over the past five years were retrospectively reviewed. Patient characteristics and perioperative data were collected. The primary outcomes, repair methods, and surgical results following post-esophago-gastric hiatal repair were analyzed., Results: A total of eight patients with post-esophago-gastric hiatal hernia were included in this study. All patients presented with emergent conditions, specifically bowel obstruction. Laparoscopic repair was successful in four cases, with a conversion rate to open surgery of 50% (4 out of 8). Primary suture was performed in three cases, while biological mesh repair was carried out in four cases, and one case was left unrepaired. Bowel gangrene and perforation occurred in one case. The most notable postoperative complications included wound infection and pleural fluid collection. Importantly, there were no instances of hernia recurrence during the follow-up period, which ranged from 2 to 55 months, with a 100% follow-up rate observed., Conclusion: Post-esophago-gastric hiatal hernia is a rare yet significant condition, often presenting emergently and linked to higher morbidity and mortality rates. Therefore, symptomatic patients warrant surgical repair, and immediate intervention should be provided to those with acute-onset symptoms and clinical signs of bowel obstruction. Primary suture repair, with or without biological mesh, appears to be a durable method of repair., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background and Aim: Endoscopic ultrasound-guided gastroenterostomy is a procedure used to connect the stomach and dilated afferent loop using a stent under endoscopic ultrasound for afferent loop syndrome. However, the actual efficacy and safety of this procedure remain unclear. Therefore, this retrospective study aimed to evaluate the efficacy and safety of endoscopic ultrasound-guided gastroenterostomy using a laser-cut-type fully covered self-expandable metallic stent and an anchoring plastic stent for afferent loop syndrome., Methods: Technical and clinical success rates, adverse events, recurrent intestinal obstruction rates, time to recurrent intestinal obstruction, and technical and clinical success rates of re-intervention were evaluated in intended patients who underwent endoscopic ultrasound-guided gastroenterostomy for afferent loop syndrome from October 2018 to August 2022., Results: In 25 intended patients with afferent loop syndrome who intended endoscopic ultrasound-guided gastroenterostomy, the technical success rate was 100% (25/25), whereas the clinical success rate was 96% (24/25). Two patients experienced grade ≥ 3 early adverse events, including one with intra-abdominal abscess and one with hypotension. Both events were attributed to intestinal fluid leakage. No late adverse events were observed. The recurrent intestinal obstruction rate was 32% (8/25), and the median time to recurrent intestinal obstruction was 6.5 months (95% confidence interval: 2.8-not available). The technical and clinical success rates of re-intervention were both 100% (8/8)., Conclusions: Endoscopic ultrasound-guided gastroenterostomy using a fully covered self-expandable metallic stent and an anchoring plastic stent is effective and safe as a treatment procedure for afferent loop syndrome., (© 2024 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Introduction: Colon cancer obstruction is one of the most serious conditions in colorectal surgery. However, the use of self-expanding metallic stent (SEMS) has made it possible to avoid emergency surgery and stoma creation, therefore enabling minimally invasive surgery and one-stage operation. In this study, we aimed to investigate whether there is an optimal interval from SEMS to surgery for the best long-term oncologic outcomes., Methods: Obstructive colon cancer patients treated with SEMS insertion and received surgery were included in the study. Patient data were retrospectively reviewed in prospectively collected data. Using the ROC curve, the optimal interval to surgery after SEMS insertion was 10 days; the patients were divided into the early surgery group (≤10 days, ES) and the late surgery group (>10 days, LS). Factors contributing to the 5-year disease-free survival (DFS) and overall survival (OS) were analyzed., Results: 83 patients were included in this study. Eight patients (9.6 %) had SEMS insertion failure, with 3 perforations and 5 failed expansions. There were no differences between the ES group and the LS group in terms of pathologic characteristics, incidence of stoma creation, and adjuvant chemotherapy. Twenty-six patients (31.3 %) had recurrences; local (Arnarson et al., 2023) [6], peritoneal seeding (Lee et al., 2013) [8], liver (Ho et al., 2017) [11], lung [7], bone (van Hooft et al., 2020) [2], and abdominal wall metastasis (Chen and Sheen-Chen, 2000) [1]. The 5-year DFS rate was significantly better in the ES group than the LS group (74.3 % vs. 55.01 %; p = 0.0394). The 5-year OS was slightly better in the ES group than the LS group (76.11 % vs. 58.75 %; p = 0.0901). In univariable analysis, the ES group showed a lower risk of recurrence than the LS group (OR: 0.447 [0.204-0.984], p = 0.0455), but this was not reproduced in the multivariable analysis., Conclusion: This study has shown that the long-term oncologic outcomes were better in patients who received surgery after SEMS within 10 days. Hence, we propose with caution that elective surgery might be suggested to take place within 10 days from SEMS insertion for better oncologic outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Transmesenteric internal hernia is an uncommon cause of small bowel obstruction that occurs when small bowel loops protrude through a mesenteric defect into the abdominal cavity. Herein, we present an unexpected case of colonoscopy-induced transmesenteric internal hernia. An 81-year-old male patient presenting with intermittent hematochezia and constipation had undergone a laparoscopic left nephrectomy for ureteral cancer. A colonoscopy was performed to identify the etiology of his symptoms. He complained of severe abdominal pain 2 h after the examination despite uneventful endoscopic procedures, including cold snare polypectomy. Contrast-enhanced computed tomography revealed a strangulated small bowel obstruction with a closed-loop formation outside the descending colon. The small bowel loop was incarcerated into the left retroperitoneal space. Emergency laparotomy detected small bowel loops that prolapsed into the nephrectomy pedicle via a descending mesenteric defect, developed during the laparoscopic left nephrectomy. The incarcerated small bowel was detached from the hernia and returned to its normal position, and the mesenteric defect was closed. He demonstrated an uneventful postoperative course, with no internal hernia recurrence after discharge. This case indicates the risk of transmesenteric internal hernia through inadvertently created mesenteric defects should be borne in mind, especially when performing colonoscopies in patients who underwent laparoscopic nephrectomies., (© 2024. Japanese Society of Gastroenterology.)

We report the case of a patient who comes to the emergency department with abdominal pain, oral intolerance and bloody stools, being diagnosed with intestinal obstruction secondary to a jejunal tumor with contained perforation. A laparotomy was performed with resection of the jejunal tumor and taking biopsies from lesions with similar characteristics in the rest of the small bowel compatible with monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL). The monomorphic epitheliotropic intestinal T-cell lymphoma is a rare intestinal tumor with a poor prognosis that is characterized by the proliferation of intraepithelial lymphocytes. The abdominal symptoms are nonspecific and the known major complications are intestinal perforation and obstruction. There is no standard therapeutic approach, being a combination of surgical resection, chemotherapy and autologous stem cell transplant.

Study Objective: To estimate the risk of bowel obstruction (BO) after hysterectomy for benign indications depending on the surgical method (abdominal, vaginal, or laparoscopic) and identify risk factors for adhesive BO., Design: A national registry-based cohort., Setting: Danish hospitals during the period 1984-2013., Patients: Danish women who underwent hysterectomy for benign indications (N = 125 568)., Interventions: Abdominal hysterectomies were compared with vaginal hysterectomies, laparoscopic hysterectomies, and minimally invasive (vaginal and laparoscopic) hysterectomies., Measurements and Main Results: The incidence of BO according to the surgical method was compared using Cox proportional hazard regression. The covariates included were the time period, age, concomitant operations, previous abdominal surgery or disease, and socioeconomic factors. In a subanalysis (n = 35 712 women) of the period 2004-2013, detailed information from the Danish Hysterectomy Database enabled the inclusion of patient-, surgery-, and complication-related covariates. The overall crude incidence of BO was 17.4 of 1000 hysterectomies (2196 incident cases). The 10-year cumulative incidence of BO differed among the surgical routes (abdominal, 1.7%; laparoscopic, 1.4%; and vaginal, 0.9%). In multiple-adjusted analyses, the risk of BO was higher after abdominal hysterectomy than after vaginal (hazard ratio 1.64 [95% confidence interval, 1.39-1.93]) and minimally invasive (vaginal or laparoscopic) hysterectomy (hazard ratio 1.54 [1.33-1.79]). Additional pre-existing risk factors for BO at the time of hysterectomy were increased age, low education, low income, smoking, high American Society of Anesthesiologists comorbidity score, history of infertility, abdominal infection, and previous abdominal surgery (apart from cesarean section), penetrating lesions in abdominal organs, or operative adhesiolysis. Perioperative risk factors at the time of hysterectomy included concomitant removal of the ovaries, adhesiolysis, blood transfusion, readmission, and overall presence of perioperative complications., Conclusion: Abdominal hysterectomy is associated with a 54% higher risk of BO than minimally invasive (laparoscopic or vaginal) hysterectomy., (Copyright © 2024 AAGL. Published by Elsevier Inc. All rights reserved.)

Objective: To compare survival and report perioperative complications in cats undergoing surgery for small intestinal (SI) linear (LFBO) and discrete (DFBO) foreign body obstructions (FBO). To report success of a red rubber catheter technique (RRCT) to remove LFBOs., Study Design: Retrospective study., Animals: Client-owned cats (n = 169)., Methods: Medical records of cats undergoing surgery for SI FBO from a veterinary teaching hospital between February 2012 and January 2023 were classified as LFBO, DFBO, or both linear and discrete FBO (BFBO). Signalment and perioperative data were collected., Results: Preoperative hypoalbuminemia (LFBO: n = 1/6; DFBO: n = 5/6) and septic peritonitis (LFBO: n = 2/4; DFBO: n = 0/4; BFBO: n = 2/4) were rare. Intraoperative hypotension did not differ between LFBOs and DFBOs (p = .4756). RRCT was successful in 20/24 attempts of LFBO removal. Three cats were euthanized intraoperatively (LFBO: 1; DFBO: 1; BFBO: 1). Postoperatively, two cats (DFBO) experienced intestinal dehiscence and two cats (DFBO) died or were euthanized. Survival to discharge (p = 1.0000) and postoperative complications (p = .1386) did not differ between LFBOs and DFBOs., Conclusions: Postoperative complications and survival did not differ between cats with LFBOs and DFBOs. Intestinal dehiscence secondary to FBO in cats is rare. A RRCT can be successful in many cats with LFBOs., Clinical Significance: Cats with LFBOs and DFBOs have similar postoperative complication rates and survival to discharge when preoperative septic peritonitis is not present. Intestinal dehiscence is rare, which is important when discussing surgical prognosis with owners. A RRCT can be considered to remove LFBOs when there is concern for multiple enterotomies., (© 2024 American College of Veterinary Surgeons.)

Objectives: A bowel diameter threshold of ≥2.5 cm, originally derived from the research using computed tomography, is frequently used for diagnosing small bowel obstruction (SBO) with point-of-care ultrasound (POCUS). We sought to determine the optimal bowel diameter threshold for diagnosing SBO using POCUS and its accuracy in predicting surgical intervention., Methods: We conducted a secondary analysis using individual patient-level data from a previous systematic review on POCUS for SBO diagnosis across five academic EDs. Patient data were collected, including imaging results, surgical findings, and final diagnosis. The measured diameter of the small bowel using POCUS was recorded. ROC area under the receiver operating characteristic curves (AUC) were constructed to determine the optimal threshold for bowel diameter in predicting SBO diagnosis and surgical intervention. Subgroup analyses were performed based on sex and age., Results: A total of 403 patients had individual patient-level data available, with 367 patients included in the final analysis. The most accurate bowel diameter overall for predicting SBO was 2.75 cm (AUC = 0.76, 95% CI 0.71-0.81). A bowel diameter of ≤1.7 cm had 100% sensitivity with no miss rate, while a bowel diameter of ≥4 cm had 90.7% specificity in confirming SBO. Patients under 65 had an optimal threshold of 2.75 cm versus 2.95 cm in patients over 65. Females had an optimal threshold of 2.75 cm, while males had a value of 2.95 cm. There was no significant correlation between bowel diameter thresholds and surgical intervention., Conclusion: A bowel diameter threshold of 2.75 cm on POCUS is more discriminative diagnostic accuracy for diagnosing SBO. Patients' age and sex may impact diagnostic accuracy, suggesting that tailored approaches may be needed., Competing Interests: Declaration of competing interest HS, NAJ, GDP, KMD, BB, KB, SL, MS, MC, TJ, and MG report no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Small bowel obstruction (SBO) is one of the most frequent causes of general emergency surgery. The 30-day mortality rate post-surgery ranges widely from 2 to 30%, contingent upon the patient population, which renders risk assessment tools helpful. this study aimed to develop a 30-day point-scoring risk calculator designed for patients undergoing SBO surgery. Patients who underwent SBO surgery were identified in the ACS-NSQIP database from 2005 to 2021. Patients were randomly sampled into an experimental (2/3) and a validation (1/3) group. A weighted point scoring system was developed for the risk of 30-day mortality, utilizing multivariable regression on preoperative risk variables based on Sullivan's method. The risk scores underwent both internal and external validation. Furthermore, the efficacy of the risk score was evaluated in 30-day major surgical complications. A total of 93,517 patients were identified, with 63,521 and 29,996 assigned to the experimental and validation groups, respectively. The risk calculator is structured to assign points based on age (> 85 years, 4 points; 75-85 years, 3 points; 65-75 years, 2 points; 55-65 years, 1 point), disseminated cancer (2 points), American Society of Anesthesiology (ASA) score of 4 or 5 (1 point), preoperative sepsis (1 point), hypoalbuminemia (1 point), and fully dependent functional status (1 point). The risk calculator showed strong discrimination (c-statistic = 0.825, 95% CI 0.818-0.831) and good calibration (Brier score = 0.043) in the experimental group. The point scoring system was successfully translated from individual preoperative variables (c-statistic = 0.840, 95% CI 0.834-0.847) and was externally validated in ACS-NSQIP (c-statistic = 0.827, 95% = CI 0.834-0.847, Brier score = 0.043). The SBO risk score can effectively discriminate major surgical complications including major adverse cardiovascular events (c-statistic = 0.734), cardiac complications (c-statistic = 0.732), stroke (c-statistic = 0.725), pulmonary complications (c-statistic = 0.727), renal complications (c-statistic = 0.692), bleeding (c-statistic 0.674), sepsis (c-statistic = 0.670), with high predictive accuracy (all Brier scores < 0.1). This study developed and validated a concise yet robust 10-point risk scoring system for patients undergoing SBO surgery. It can be informative to determine treatment plans and to prepare for potential perioperative complications in patients undergoing SBO surgery., (© 2024. Italian Society of Surgery (SIC).)

Sclerosing mesenteritis (SM) is a rare disorder that involves the mesenteric adipose tissue with chronic fibrosing inflammation. Few reports mention the natural history of severe SM cases. Here, we report a severe and relapsing SM case in which a long-term natural history could be followed. The patient had undergone surgery for small bowel stenosis of unknown cause 10 years earlier. He had stopped visiting the hospital at his discretion. He was admitted to the hospital 10 years later due to recurrent symptoms, and a close examination revealed multiple small intestinal strictures; thus, surgery was performed again. The pathological results revealed that the patient had SM, corticosteroid administration dramatically improved his symptoms, and he has maintained remission for a long time., (© 2024. Japanese Society of Gastroenterology.)

An 83-year-old man was admitted to the emergency room with abdominal pain and bloating. Abdominal computed tomography (CT) revealed a sigmoid colon obstruction caused by colonic carcinoma involving a short segment with circumferential luminal narrowing. The patient underwent endoscopy with colonic self-expanding metallic stent (SEMS) placement as a bridge to surgery. Six days after SEMS placement, the patient was prepared for esophagogastroduodenoscopy for screening. Although screening revealed no complications, 8 h later, the patient complained of sudden abdominal pain. Emergency abdominal CT revealed that the SEMS was about to burst out of the colon. An emergency operation with sigmoidectomy and colostomy was performed, and operative findings revealed a colonic perforation by the SEMS at the proximal side of the tumor. The patient was discharged from the hospital without major problems. This case is a very rare complication of colonic SEMS insertion. It is possible that increased intraluminal bowel movement and/or CO2 pressure during the esophagogastroduodenoscopy caused colonic perforation. Endoscopic placement of a SEMS is an effective alternative to surgical decompression for treating colon obstruction. To avoid unexpected and unnecessary perforations, tests that could increase the intraluminal pressure within the intestine after SEMS insertion should be avoided.

The intragastric balloon (IGB) is recognised as a minimally invasive intervention for the treatment of obesity. Here, we detail a rare and life-threatening complication stemming from this procedure. A female patient in her 40s, who had an IGB in situ for 14 months, presented at the emergency department with septic shock characterised by abdominal guarding and emesis. These symptoms were a direct result of IGB-induced bowel obstruction. We emphasise that the patient missed the recommended 6-month removal window, which in our opinion is the decisive cause leading to deflated balloon migration and subsequent complications. In the course of managing multiple critical events, the patient required multiple operations related to the bowel obstruction, numerous nutritional and psychological challenges. Currently, the patient is living with short bowel syndrome, secondary to the chronic intestinal failure, necessitating the administration of parenteral nutrition 6 days per week., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Advanced obstructive colorectal cancer (AOCC) presents surgical challenges. Consideration must be given to alleviating symptoms and also quality of life and survival time. This study compared prognostic efficacies of palliative self-expanding metal stents (SEMSs) and surgery to provide insights into AOCC treatment., Methods: PubMed, Web of Science, MEDLINE, and Cochrane Library were searched for studies that met inclusion criteria. Using a meta-analysis approach, postoperative complications, survival rates, and other prognostic indicators were compared between patients treated with SEMSs and those treated surgically. Network meta-analysis was performed to compare prognoses between SEMS, primary tumor resection (PTR), and stoma/bypass (S/B)., Results: Twenty-one studies were selected (1754 patients). The odds ratio (OR) of SEMS for clinical success compared with surgery was 0.32 (95% confidence interval [CI] 0.15, 0.65). The ORs for early and late complications were 0.34 (95% CI 0.19, 0.59) and 2.30 (95% CI 1.22, 4.36), respectively. The ORs for 30-day mortality and stoma formation were 0.65 (95% CI 0.42, 1.01) and 0.11 (95% CI 0.05, 0.22), respectively. Standardized mean difference in hospital stay was - 2.08 (95% CI - 3.56, 0.59). The hazard ratio for overall survival was 1.24 (95% CI 1.08, 1.42). Network meta-analysis revealed that SEMS had the lowest incidence of early complications and rate of stoma formation and the shortest hospital stay. PTR ranked first in clinical success rate and had the lowest late-complication rate. The S/B group exhibited the lowest 30-day mortality rate., Conclusion: Among palliative treatments for AOCC, SEMSs had lower early complication, stoma formation, and 30-day mortality rates and shorter hospital stays. Surgery had higher clinical success and overall survival rates and lower incidence of late complications. Patient condition/preferences should be considered when selecting AOCC treatment., (© 2024. The Author(s).)

Lung cancer is one of the most lethal solid organ malignancies. Metastasis commonly spreads to the liver, adrenal glands and bone. We report a case of a male patient who presented with an 8 week history of cramping abdominal pain and vomiting. Subsequent investigation revealed evidence of an obstructing small bowel lesion. He underwent a small bowel resection. Histopathology revealed evidence of lung adenocarcinoma as the likely primary disease. Although metastasis of lung adenocarcinoma to the small bowel is rare, early recognition may prevent potentially life-threatening sequelae including bowel perforation and peritonitis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

A man in his late 30s presented with a history of recurrent colicky abdominal pain, bilious vomiting and intermittent mass formation in the lower abdomen. The mass was mobile, non-tender and fluctuant, and appeared in the right iliac fossa during episodes of pain and disappeared once the pain subsided. Contrast-enhanced CT (CECT) scan revealed a thick membrane-like structure covering the clumped small bowel loops, suggestive of an abdominal cocoon. A midline laparotomy was carried out with extensive adhesiolysis, and a membrane incision was performed. The final histopathological diagnosis was primary encapsulating peritoneal sclerosis. Encapsulating peritoneal sclerosis of idiopathic origin is rare and typically presents as an acute or subacute intestinal obstruction. A CECT scan is the diagnostic modality of choice, with a thick peritoneal membrane covering the small bowel loops being the hallmark sign. Surgical intervention is the preferred treatment for idiopathic cases, while medical management may address secondary causes., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

The incidence of colorectal cancer is relatively high in our country, with the majority of patients being diagnosed at an advanced stage. For individuals with advanced-stage colorectal cancer, conversion or neoadjuvant therapy is frequently necessitated to facilitate surgical intervention and achieve a curative effect. And about 10% to 30% of colon cancer patients are complicated with intestinal obstruction. Surgical intervention remains the primary treatment for managing intestinal obstructions, albeit with a considerable risk of perioperative mortality and an increased likelihood of postoperative complications. PDT, as a neoadjuvant treatment for colon cancer, can shrink the local tumor and relieve obstruction, and is effective in colon cancer combined with obstruction. Robotic surgery has the advantages of high stability and low trauma, and compared with laparoscopic colon cancer surgery, robotic surgery can achieve better results. Fluorescent laparoscopic clarifies the location and size of the tumor lesion, allowing for greater precision when removing colon cancer lesions in robotic surgery. Therefore, in the treatment of colon cancer, PDT can offer an opportunity for surgery after relieving obstruction in patients with obstructive colon cancer. Additionally, when combined with fluorescent laparoscopic robotic colon cancer surgery, it provides a novel treatment approach for patients with obstructive colon cancer. Preoperative photodynamic neoadjuvant therapy combined with robotic colon cancer surgery has not yet been reported. Here, we report a case of colon cancer with obstruction, preoperative TNM stage was T4N1, and the lesion had caused intestinal stenosis. After four sessions of PDT, the patient's intestinal lumen was unobstructed and the lesion had regressed. After evaluation, fluorescent laparoscopic localization and visualization of lymph nodes combined with robotic colon cancer resection were performed. Postoperative pathology showed that the patient's tumor regression grade was grade 1. The patient's tumor was completely resected with good resection effect. No tumor invasion was found on both sides of the resection margin, and the patient did not relapse after surgery., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Huang, Han, Li, Zhang, Ma, Wang, Yin, Gao, Shi, Maswikiti and Chen.)

Background: Inoperable malignant bowel obstruction, which results in chronic nausea, vomiting and abdominal pain, often requires nasogastric tube decompression. However, these tubes are often uncomfortable for patients and require hospitalization during the end-of-life care. Cervical esophago-gastric (CEG) decompression tubes are a potential palliative solution. The objective of this study is to present the outcomes of CEG tubes in 11 patients with malignant bowel obstruction., Methods: We performed a retrospective review of patients requiring nasogastric tube decompression who received CEG decompression tubes for inoperable malignant bowel obstructions between 2016-2022. CEG tube placement was performed percutaneously through the left neck using a guidewire and an endoscopic technique., Results: The average age of patients was 58 years (31-72 years), with metastatic colorectal cancer (36.4%) and ovarian cancer (27.3%) being the most common causes of malignant bowel obstruction. All procedures were completed percutaneously, without requiring conversion to open procedures. The morbidity of the procedure was 27%, which included tube dislodgement, local cellulitis, or bleeding at the insertion site. None of the patients required reoperation, with most of the patients successfully treated conservatively. Most patients were discharged home after the procedure (82%); however, 45% were readmitted (mostly due to abdominal pain). Most patients (73%) were able to continue additional chemotherapy after tube placement. The average survival from cancer diagnosis was approximately six months, whereas the average survival after the procedure was about four months. No mortalities occurred due to CEG tube placement., Conclusions: A CEG decompression tube is safe for patients with malignant bowel obstruction. The procedure allows patients to undergo additional chemotherapy and be discharged home with a more comfortable tube.

Objectives: Malignant large bowel obstruction (LBO) is a frequent complication affecting women with gynecologic cancers and is an indication for emergent surgery. However, the life expectancy and subsequent medical care utilization are unknown. We sought to estimate overall survival (OS) following colostomy and describe subsequent healthcare utilization among patients with advanced gynecologic malignancies., Methods: We conducted a retrospective analysis of patients with advanced gynecologic cancers who underwent colostomy with palliative intent due to LBO at our institution between March 2014 and January 2023. Summary statistics were used to describe the clinical and demographic characteristics of the study population. OS was estimated using the Kaplan-Meier method, and we defined healthcare utilization at the end-of-life using criteria published by the National Quality Forum., Results: A total of 78 patients were included. The median age at the time of surgery was 61 (range: 34-83), and most patients had recurrent ovarian, fallopian tube, or primary peritoneal cancer (n = 51, 65.4%), followed by cervical cancer (n = 16, 20.5%), and uterine cancer (n = 10, 12.8%). The median Charlson comorbidity index was 3 and median postoperative length of stay was five days (range: 1-26). The median follow-up for all patients was 4.5 months (range: 0.07-46.2), and the median OS was 4.5 months (95% CI: 2.9-6.0), including 12 patients (15.4%) with <30-day OS and 21 (26.9%) with <60-day OS. In the last 30 days of life, 62.7% of patients were re-admitted to the hospital, 53.0% were seen in the emergency department, and 18.5% were admitted to an intensive care unit., Conclusions: A significant proportion of patients died within 60 days of surgery, and many had high healthcare utilization at the end of life., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Self-expandable metallic stent (SEMS) placement is widely used as a bridge to surgery (BTS) procedure for obstructive colorectal cancer. However, evidence regarding the optimal interval between SEMS placement and elective surgery is lacking., Methods: We retrospectively collected data from patients with BTS between January 2013 and October 2021. Inverse probability treatment-weighted propensity score analyses were used to compare short- and long-term outcomes between the short-interval (SI) and long-interval (LI) groups, using a cutoff of 20 days., Results: In total, 138 patients were enrolled in this study (SI group, n = 63; LI group, n = 75). In the matched cohort, the patients' backgrounds were well balanced. The incidence of Clavien-Dindo grade ≥ II postoperative complications was not significantly different between the SI and LI groups (19.0% vs. 14.0%, P = 0.47). There were no significant differences between the SI and LI groups in the 3-year recurrence-free survival (68.0% vs. 76.4%, P = 0.73) or 3-year overall survival rates (86.0% vs. 90.6%, P = 0.72)., Conclusions: A longer interval did not deteriorate the oncological outcomes. Individual perioperative management with an appropriate interval to improve the patient's condition is required to ensure safe surgery., (© 2024. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)

Procalcitonin has been investigated as a marker for bowel ischemia. This study examined the role of procalcitonin in predicting failure of non-operative management (NOM) in bowel obstructions. Patients with bowel obstructions at a single center from August 2022 to January 2023 were prospectively enrolled (n = 79). Lactic acid (LA) and procalcitonin were collected after surgical consultation. The primary outcome was success or failure of NOM. Univariate analysis, multivariable logistic regression, and performance measures of procalcitonin and LA in predicting bowel ischemia was performed. Of 79 patients included, 48 (61%) required operative intervention during index admission. There were no significant differences in demographics, comorbidities, procalcitonin, nor LA between groups. Time from last bowel movement was associated with failure of NOM (OR 1.03 [95% CI 1.01-1.06]; P = .008), though initial procalcitonin or LA was not. Procalcitonin >.3 ng/mL had acceptable sensitivity in screening for bowel ischemia., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.